Musculoskeletal

The nurse is caring for a client who underwent a total hip replacement. What should the nurse and other caregivers do to prevent dislocation of the new prosthesis?

Avoid internal rotation of the affected leg.

After a physician describes the surgical procedure for lumbar spinal fusion and its associated risks, the nurse provides a consent form for the client to sign. The client asks the nurse what the term "fusion" means and whether he'll lose a lot of blood during the procedure. Which action should the nurse take?

Notify the physician of the client's questions about the procedure before having the client sign the informed consent form.

A client is admitted to the orthopedic unit for treatment of a fractured right femur caused by a motor vehicle crash. He is scheduled to undergo an open reduction internal-fixation of his right femur. The night before surgery, the nurse administers 250 mg of glutethimide (Doriden) as prescribed. Which statement regarding usage of glutethimide is correct?

The nurse should store the drug in a tight, light-resistant container.

osteoporosis The nurse is teaching a female client about preventing osteoporosis. Which of the following teaching points is correct?

The recommended daily allowance of calcium may be found in a wide variety of foods.

Which laboratory study is most relevant to treating a client who has sustained a pelvic fracture?

Type and crossmatch

The nurse is caring for a client who recently underwent a total hip replacement. The nurse should:

instruct the client to limit hip flexion while sitting.

After a traumatic spinal cord injury, a client requires skeletal traction. When caring for this client, the nurse must:

maintain traction continuously to ensure its effectiveness.

A diagnostic test that involves radiographs of the vertebral column and spinal cord after injection of a contrast medium or air is called a (an) A. Arthroscopy B. Arthrocentesis C. Nerve Conduction Studies D. Myelogram

Myelogram

osteoporosis For a client with osteoporosis, the nurse should provide which dietary instruction?

"Eat more dairy products to increase your calcium intake."

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 include which measure?

Administering large doses of I.V. antibiotics as prescribed

osteoporosis A client is diagnosed with osteoporosis. Which electrolytes are involved in the development of osteoporosis?

Calcium and phosphorous

A client is admitted to an acute care facility with osteomyelitis. Which organism usually causes this infection?

Staphylococcus aureus

Cervical fractures, especially C-1 to C-4, can be life-threatening. If you suspect an injury, immobilize the client and call for help immediately. Select one: True False

True

When assessing a patient for signs and symptoms of early respiratory depression immediately after leaving the postoperative area, the nurse will be alert for signs of what? SATA a. Cyanosis # later b. Lethargy c. Restlessness d. Anxiety e. Increased mental alertness # decrease

b. Lethargy c. Restlessness d. Anxiety

(SELECT ALL THAT APPLY) A client who was involved in a motor vehicle accident has a fractured femur. The nurse caring for the client documents Acute pain as one of the nursing diagnoses in his care plan. Which nursing interventions are appropriate?

(5) Assess the client's perception of pain., (6) Ask the client about methods he has used previously to alleviate pain.

osteoporosis At a health fair, a woman, age 43, with a family history of osteoporosis asks the nurse how much calcium she should consume. The nurse tells her that the recommended daily calcium intake for premenopausal women is: 250 to 500 mg. 600 to 800 mg. 1,000 to 1,200 mg. 1,500 to 2,000 mg.

1,000 to 1,200 mg.

The nurse is assisting the health care provider in applying a cast. Which intervention should be provided during immediate cast care? a. Rest the cast on the bedside table. b. Dispose of the plaster water in the sink. c. Support the cast with the palms of her hand. d. Wait until the cast dries before cleaning surrounding skin.

1st Support the cast with the palms of her hand. 2nd dispose of the plaster water in a sink with a plaster trap or in a garbage bag. 3th Wait until the cast dries before cleaning surrounding skin.

The health care provider has ordered sulfasalazine for a child with juvenile rheumatoid arthritis. The nurse questions the order when reading that the client has an allergy to what medication? 1 alprazolam 2naproxen 3 sulfamethoxazole-trimethoprim 4 penicillin

3 sulfamethoxazole-trimethoprim

A 3-year-old girl with a diagnosis of spasticity caused by cerebral palsy has been admitted to the unit. The physician has ordered dantrolene to see if it relieves the spasticity in the child's arms and hands. The nurse would schedule this child for what routine screenings? A) Central nervous system and gastrointestinal (GI) function B) Respiratory and cardiovascular (CV) function C) Growth and development D) Renal and hepatic function

A

A nurse is providing discharge teaching for a patient who will be going home on cyclobenzaprine (Flexeril) prescribed for his acute musculoskeletal pain. The nurse will stress that the patient should avoid what? A) Drinking alcohol B) Taking antiemetics C) Taking antihistamines D) Taking antibiotics

A

A patient comes to the clinic to receive a Botox injection in her forehead. The patient has adult acne across her forehead. What is the nurse's priority action? A) Hold the injection and consult the health care provider. B) Cleanse the area well with an antibacterial soap. C) Apply a topical antibiotic after administering the Botox. D) Provide patient information about post-Botox injection care.

A

A patient has been diagnosed with multiple sclerosis and experiences spasticity in several muscle groups. What drug would the nurse anticipate will be ordered as the drug of choice to manage spasticity associated with neuromuscular diseases? A) Dantrolene (Dantrium) B) Baclofen (Lioresal) C) Carisoprodol (Soma) D) Botulinum toxin type B (Myobloc)

A

A patient is admitted to the unit with central spasticity after a terrible motor vehicle accident. The doctor places an intrathecal delivery pump. What medication can be administered via this route to treat the central spasticity? A) Baclofen (Lioresal) B) Cyclobenzaprine (Flexeril) C) Dantrolene (Dantrium) D) Carisoprodol (Soma)

A

A patient with severe spasticity sees his physician. The physician orders dantrolene. In what circumstances is the drug dantrolene contraindicated? A) Spasticity that contributes to upright position B) Spasticity that involves both legs C) Spasticity that involves the arm and the leg on the same side D) Spasticity that contributes to mobility

A

After administering a centrally acting skeletal muscle relaxant, what other independent nursing measures might the nurse implement to relieve pain and reduce spasm? A) Rest of the affected muscle B) Application of cold C) Physical therapy D) Order of a nonsteroidal anti-inflammatory drug

A

The nurse admits a child diagnosed with tetanus. What medication will the nurse expect to administer? A) Methocarbamol (Robaxin) B) Baclofen (Lioresal) C) Dantrolene (Dantrium) D) Diphenhydramine (Benadryl)

A

The nurse is teaching a class on muscular coordination and explains it is the movement of what electrolyte that contributes to the process of muscle contraction and relaxation? A) Calcium B) Chloride C) Magnesium D) Hydrogen

A

What part of the brain does the nurse recognize the patient is using when making precise, intentional movements? A) Pyramidal tract B) Substantia nigra C) Broca's area D) Extrapyramidal tract

A

When spinal reflexes involve synapses with interneurons within the spinal cord, what physiological adjustments are made? A) Coordinate movement and position B) Adjust response and recovery C) Adjust to upright position D) Coordinate balance

A

The nurse is aware that amputation is the absence or removal of all or part of a limb or body organ. Which of the following candidates is most at risk for amputation? A) A homeless person with diabetes mellitus B) An elderly client who is on bed rest following a hip replacement C) A client who has advanced Parkinson's disease D) A client who runs marathons on the weekends

A) A homeless person with diabetes mellitus

The nurse is caring for a client who has bursitis related to gout. What is an appropriate nursing intervention for this client? A) Applying heat to the affected part B) Applying cold compresses to the affected part C) Providing AROM for the affected part D) Administering antibiotics as prescribed

A) Applying heat to the affected part Bursitis is inflammation of a bursa related to mechanical irritation, bacterial infection, trauma, or gout. In response to inflammation, fluid increases, causing distention. Usual treatment includes heating and resting the affected part. Anti-inflammatory medications may be indicated.

The nurse is preparing a client with joint pain for an arthrogram. Which of the following is a nursing condition related to this test? A) Ask the client about sensitivities to food, iodine, latex, or medications. B) Ask the client if he or she has metallic implants, such as orthopedic screws. # for MRI scanning C) Ask the client to drink extra fluids to increase excretion of isotope. # Following a bone scan D) Following the test, elevate the client's joint and apply ice to control edema. # After arthroscopy

A) Ask the client about sensitivities to food, iodine, latex, or medications

A 3-year old client is diagnosed with a fracture of the ulnar bone after a fall from the stairs. The fracture appears to be on one side of the bone, whereas the other side is bent. What type of fracture does the client have? A) Greenstick B) Depressed C) Compression D) Oblique

A) Greenstick A greenstick fracture is one in which one side of the bone breaks, while the other side bends. A depressed fracture is one in which bone splinters are driven into underlying tissue. A compression fracture is one in which the bone collapses in on itself. An oblique fracture is a fracture of the bone in which the direction of the fracture line is in an oblique direction.

The nurse is caring for a client who has severe joint pain. Which of the following treatments might the nurse use to cause vasodilation and promote healing? A) Hot OR WARM compresses B) Cold compresses # to prevent edema. C) AROM # physical therapy D) Immobilization # immobilization devices to alleviate pain and discomfort, prevent further injury, and promote healing.

A) Hot OR WARM compresses Hot compresses cause vasodilation, thereby drawing oxygen, leukocytes, and nutrients to an injured or diseased area to promote healing and prevent infection.

The nurse is performing a focused assessment of a client to check for musculoskeletal disorders. Which of the following data would be collected using nursing assessment techniques? SATA A) Palpate skin temperature for warmth. B) Percuss soft tissues, joints, and muscles. C) Perform range-of-motion exercises. D) Observe emotional response to the disorder. E) Check vital signs. # initial physical assess=ment F) Observe posture, coordination, and body build.

A) Palpate skin temperature for warmth C) Perform range-of-motion exercises D) Observe emotional response to the disorder F) Observe posture, coordination, and body build

The nurse is giving discharge instructions to a patient who just had Botox A injections around her eyes. What adverse effects would the nurse include in her discharge instructions? (Select all that apply.) A) Respiratory infections B) Flu-like syndrome C) Droopy eyelids D) Cough E) Diarrhea

A,B,C

A client has a Fiberglas cast on the right arm. Which action should the nurse include in the plan of care?

Assessing movement and sensation in the fingers of the right hand

For a client who has had a stroke, which nursing intervention can help prevent contractures in the lower legs?

Attaching braces or splints to each foot and leg

Which instruction by the nurse would be considered primary prevention of injury from osteoarthritis? SATA Stay on bed rest. # would contribute to many other systemic complications. Avoid physical activity. Avoid repetitive tasks. Warm up before exercise. Perform only repetitive tasks.

Avoid repetitive tasks. Warm up before exercise.

A young woman attends a "Botox Party" and is injected with botulinum toxin type A to decrease "frown lines" between her eyebrows. Later that evening the patient is admitted to the emergency department and is hysterical, because she cannot move her eyebrows. The nurse explains that that toxin causes what? A) "The toxin causes muscle death, which smoothes wrinkles in the area." B) "The toxin causes muscle paralysis, preventing movement and relieving wrinkles." C) "The drug is a toxin to nerves in the area." D) "The drug is a permanent muscle relaxant and the muscles will never move again."

B

The nurse is caring for a patient taking dantrolene. How would the nurse assess the therapeutic effects of this drug? A) Observe the patient when emotionally stressed to assess for exacerbation of spasticity. B) Discontinue the drug for 2 to 4 days and assess for exacerbation of spasticity. C) Measure the amount of spasticity before and after administration of medication. D) Collect a thorough history to ask the patient any improvement has been noticed.

B

The nurse provides patient teaching about chlorzoxazone (Paraflex) in preparation for the patient's discharge to home. The nurse evaluates the patient understands potential adverse effects when the patient makes what statement? A) "This drug can cause diarrhea." B) "My urine may turn orange to purple red while taking this drug." C) "My skin may turn yellow but that will go away when I stop taking the drug." D) "After I take a pill it will take 2 to 3 hours before I feel the effects."

B

What are the simplest nerve pathways in the body? A) Arc reflexes B) Spinal reflexes C) Afferent nerve reflexes D) Spindle gamma loop

B

What is the drug of choice for an older adult or a patient with hepatic or renal impairment? A) Baclofen B) Carisoprodol C) Chlorzoxazone D) Cyclobenzaprine

B

The nurse is caring for a client who has severe back pain related to lordosis. Which of the following accurately describes this condition? A) Narrowing of the intervertebral space # Spinal stenosis B) Abnormal curvature of lumbar vertebrae C) Abnormal curvature of thoracic spine # Kyphosis or "humpback" or "hunchback" D) Lateral angulation of the spinal column # Scoliosishigh in purine

B) Abnormal curvature of lumbar vertebrae Back pain may be caused by abnormal or exaggerated curvature of the vertebral column. Lordosis ("swayback") is an abnormal curvature of lumbar vertebrae

Upper respiratory tractA client with Parkinson's disease is visiting a health clinic for a check-up. Which of the following tests might be ordered to determine whether the client's muscles respond appropriately to stimuli? A) Myelogram # x-ray examination of the spinal cord and vertebral canal. B) Electromyogram EMG C) Computed tomography CT # provides a three-dimensional radiographic view of a body par D) Magnetic resonance imaging # produce detailed images of internal organs.

B) Electromyelogram

A 30-year-old client who had an amputation of his left leg above the knee complains that he often feels the presence of the absent body part. He occasionally experiences pain and an itching sensation over the amputated portion of the leg. The client is diagnosed with phantom limb pain. What nursing measures and client teaching must the nurse employ when caring for this client? A) Explain that the condition is rare and occurs because of infections. # Phantom limb pain is a common condition and results from damage to the nerves in the stump B) Instruct the client to ask for pain medication, if needed. C) Explain that the condition does not interfere with prosthetic fitting. D) Encourage the client to place a pillow under the stump when sleeping. # NO to prevent hip contractures following amputation.

B) Instruct the client to ask for pain medication, if needed.

A nurse is caring for a 70-year-old client who has undergone hip replacement surgery. What measures must the nurse employ when caring for this client? A) Assist the client to cross the legs as often as possible. B) Restrict the client from bending more than 90 degrees. C) Assist the client to gently turn the affected leg inward. D) Provide back care twice a day when the client is on bed rest.

B) Restrict the client from bending more than 90 degrees.

A 30-year-old client with complaints of chronic wrist pain in his left arm along with numbness and tingling sensation in the fingers is diagnosed with carpal tunnel syndrome. Which of the following is true in a client with carpal tunnel syndrome? A) The client exhibits increased symptoms during the day. # nigh B) The client exhibits positive Tinel's signs. C) The client's grip is usually unaffected. # affected & weak D) The client has an inflamed wrist joint. # not caused by inflammation of the wrist joint; this condition occurs owing to compression of the median nerve in the wrist caused by repetitive movements, such as knitting or frequent use of the keyboard.

B) The client exhibits positive Tinel's signs.

Baclofen is a prototype drug for the centrally acting skeletal muscle relaxants. What adverse effects do drugs in this class have? (Select all that apply.) A) Coronary artery disease B) Hypotension C) Urinary frequency D) Dizziness E) Bone marrow suppression

B,C,D

When caring for a patient taking dantrolene, what adverse effects would the nurse monitor for? (Select all that apply.) A) Bradycardia B) Hepatitis C) Urinary retention D) Fatigue E) Rash

B,D,E

Baclofen (Lioresal) is prescribed for a client with chronic back pain and spastic muscles. The nurse monitors the client, knowing that the primary therapeutic effect of this medication is? Select one: A. Increased muscle tone B. Decreased muscle spasms C. Decreased muscle tone D. Increased range of motion

B. Decreased muscle spasms

The nurse is caring for four patients. Which patient would have the highest risk for hepatotoxicity from dantrolene (Dantrium)? A) An 87-year-old man who is taking a cardiac glycosideh B) A 32-year-old man who is taking an antipsychotic drug C) A 65-year-old woman who is on hormone replacement therapy D) A 48-year-old woman who is taking an antihypertensive agent

C

The nurse is caring for a client who has an amputated arm. How would the nurse classify the amputation? A) According to the severity of the amputation B) According to remaining function C) According to limb and level of amputation D) According to the type of prosthesis that is needed

C) According to limb and level of amputation Amputations are classified according to the affected limb and the level of the amputation. An amputation of the hand is called a below-the-elbow amputation (BEA); an amputation of the forearm and any part of the upper arm is called an above-the-elbow amputation (AEA). Amputation of the leg may be below-the-knee amputation (BKA) or above-the-knee amputation (AKA).

A client is in the recovery room following replantation of his severed arm. Which of the following is recommended postoperative management? A) Thrombin therapy B) Adding caffeine to the diet C) Administration of antibiotics D) Monitor for increased ROM

C) Administration of antibiotics the postoperative management of a client with a replanted limb includes anticoagulation therapy (the opposite of thrombin therapy), a caffeine-free diet to prevent vasospasm, wound care, administration of antibiotics, and continuous inspection of the replanted part. The nurse should perform frequent neurovascular checks of the replanted limb and monitor for complications such as bleeding, arterial or venous compromise, infection, or decreased ROM.

A client is undergoing a procedure to remove a bone spur from his shoulder. For which of the following procedures would the nurse prepare this client? A) Arthrogram # x-ray study of a join B) Arthrocentesis # aspiration of synovial fluid, blood, or pus from a joint cavity. C) Arthroscopy D) Bone scan # to detect primary bone tumors, metastatic bone disease, osteomyelitis, osteoporosis, inflammation, bone or joint infections, and stress fractures

C) Arthroscopy Arthroscopy is a minimally invasive procedure used in viewing joints for diagnostic and treatment purposes. Surgeons use arthroscopy to diagnose and treat joint disorders. For example, foreign or loose objects (e.g., a piece of cartilage, a bone spur) can be removed

The nurse is providing care for a client who is in skin traction temporarily to stabilize an upper arm fracture before surgery. Which of the following types of skin traction is being used? A) Buck's traction # used temporarily to manage a hip, lower spine, or simple fracture, often before surgical repair B) Cervical halter traction # is used for neck pain, neck strain, and whiplash. C) Dunlop's traction D) Russell's traction # skeletal

C) Dunlop's traction Generally used as temporary skin traction for stabilization of a fracture before surgery, Dunlop's skin traction is used for fractures of the upper arm and for shoulder dislocations.

The nurse is caring for a client who is in an immobilization device to prevent movement of the spinal cord following trauma related to a motor vehicle accident. Which of the following accurately describes a key finding related to complications of pressure, which may occur with an immobilization device in place? A) Elevated temperature # wound infection B) Elevated leukocyte count # wound infection C) Edema D) Hypotension # hemorrhage

C) Edema

A 50-year-old client diagnosed with intervertebral disk disease has to undergo a type of lumbar decompression that exposes the spinal canal and allows for relief of compression of the spinal cord and spinal nerve roots. What is the term used for this procedure? A) Diskectomy # procedure involves the removal of the herniated disk, thus relieving the pressure on the compressed nerves. B) Spinal fusion # is the surgical method of strengthening weakened vertebrae by the attachment of a steel rod or by grafting a piece of bone (from the tibia or iliac crest or a donated bone) onto several vertebrae or between a vertebra and the sacrum. C) Laminectomy D) Microdiskectomy # is a procedure similar to diskectomy that is done to remove a herniation, wherein the surgeon makes a smaller incision and uses a microscope to help visualize the disk.

C) Laminectomy # lumbar decompression that exposes the spinal canal and allows for relief of compression of the spinal cord and spinal nerve roots

A client is being treated for gout. Upon examination, which body part is usually affected by gout? Select one: A. sacrococcygeal vertebrae B. index finger C. great toe D. temporomandibular joint

C. great toe

GOUT A client who has been recently diagnosed with gout asks the nurse to explain why they need to take colchicine. What should the nurse base the response on? Colchicine increases estrogen levels in the bloodstream. Colchicine decreases the risk of infection. Colchicine decreases inflammation. Colchicine decreases bone demineralization.

Colchicine decreases inflammation.

A nurse on the orthopedic floor is caring for a group of clients who are in various stages of recovery after knee replacement surgery. One client is ready for discharge. How should the nurse proceed with discharge planning?

Complete the discharge instructions for the client who is being discharged, and allow time for him to ask questions.

Complications related to immobility:SATA A. Contractures B. Hypostatic pneumonia C. Skin breakdown D. Diabetes E. Anemia F. Thromboembolism

Complications related to immobility are thromboembolism, constipation, contractures, and skin breakdown, Hypostatic pneumonia

A patient has stepped on a rusty nail and is exhibiting signs of muscle rigidity and contractions. The patient's wife called the emergency department (ED) and the triage nurse told her to bring him in. The ED nurse will have which drug available for administration when the patient arrives? A) Carisoprodol (Soma) B) Cyclobenzaprine (Flexeril) C) Metaxalone (Skelaxin) D) Methocarbamol (Robaxin)

D

The nurse alerts the patient to what adverse effect of tizanidine (Zanaflex) that could cause injury? A) Constipation B) Dry mouth C) Fatigue D) Hypotension

D

The nurse assesses a newly admitted patient and finds the muscle tone in his left leg has sustained muscle contraction. How will the nurse document this finding? A) Tonus B) Flaccid C) Atonic D) Spastic

D

The nurse is caring for a patient receiving intrathecal baclofen via pump while participating in rigorous rehabilitation therapy. What is the nurse's priority to monitor related to adverse effects of this drug? A) Blood pressure B) Pulse pressure C) Spasticity D) Respiratory status

D

The nurse is caring for a patient with an infusing IV who is allowed noting by mouth due to a paralytic ileus. What centrally acting medication could the nurse administer to this patient? A) Chlorzoxazone (Paraflex) B) Carisoprodol (Soma) C) Cyclobenzaprine (Flexeril) D) Orphenadrine (Banflex)

D

The patient reports pain caused by muscle spasms in his back. The nurse assesses the patient as being very anxious and notes how the anxiety results in tensing of muscles. What medication would be most effective in treating this patient? A) Baclofen (Lioresal) B) Botulinum toxin type B (Myobloc) C) Dantrolene (Dantrium) D) Diazepam (Valium)

D

What drug would the nurse expect to administer to the patient experiencing malignant hyperthermia? A) Orphenadrine B) Metaxalone C) Chlorzoxazone D) Dantrolene

D

What is the maximum daily dose of cyclobenzaprine (Flexeril) the nurse can administer? A) 20 mg B) 30 mg C) 40 mg D) 60 mg

D

Which muscle relaxant was found to be embryotoxic in animal studies? A) Carisoprodol (Soma) B) Botulinum toxin A (Botox) C) Cyclobenzaprine (Flexeril) D) Dantrolene (Dantrium)

D

The nurse is teaching a client who is in a body cast how to perform exercises to reduce the effects of immobilization. Which of the following is a recommended teaching point for clients confined to bed? A) "Too much exercise is better than too little exercise." B) "Flex and extend the affected joints regularly." # unaffected C) "Do not use the trapeze bar for exercise." # trapeze helps lift their bodies for nursing care and use the trapeze for exercise. D) "Wiggle the fingers or toes of affected extremities."

D) "Wiggle the fingers or toes of affected extremities."

A nurse is caring for a 20-year-old athlete with a sprained left ankle. What nursing measures should the nurse employ when caring for this client? A) Apply a warm moist pack within 24 hours. # only after 24 to 48 hours B) Lower the ankle to relieve the pain. # elevating the injured part, C) Apply an ice pack over the ankle after 48 hours. # within 24 to 48 hour D) Apply an elastic bandage to immobilize the area.emotional

D) Apply an elastic bandage to immobilize area # sprained ankle

A nurse is caring for a 30-year-old client with a simple fracture in the right hand supported in a plaster cast. What measures must the nurse employ when caring for a client with a cast? A) Handle the wet cast with fingers only. B) Avoid washing the area around the cast. C) To move the arm, grasp on one side of the cast. D) Cover the edges of the cast with tape.

D) Cover the edges of the cast with tape. The nurse should cover the edges of the cast with tape if the cast's edges are rough. This procedure is called petaling. When handling a wet cast, the nurse has to hold the cast with the palm of the hand and not the fingers because the finger pressure can dent the cast and can also create pressure points over the cast. The nurse should ensure that the area around the cast is washed, dried, and massaged daily. Monitoring skin condition is a priority. When moving the client's injured arm, the nurse has to ensure that the cast is grasped on both sides, and not on one side only.

The nurse is caring for a client who is in balanced suspension traction. What type of fracture is being treated with this device? A) Arm B) Neck C) Back D) Femur

D) Femur Balanced suspension traction is a type of skeletal traction that is used to stabilize fractures of the femur. A wire (e.g., Kirschner's wire) and a pin (e.g., Steinmann pin) are inserted through the femur. The femur is then supported or balanced on a Thomas splint with a Pearson attachment. Skull tongs traction is used for cervical injuries or fractures.

Arthroscopy - A nurse is caring for a 45-year-old client who has undergone arthroscopy. What client teaching should the nurse provide when caring for this client after the procedure? A) Restrict the client from elevating the joint. # encourage elevating B) Encourage application of heat on the joint. # ice applied to it to control edema and pain C) Instruct the client to limit fluids. # After surgery, clients are NPO, Fluids are contraindicated. D) Instruct the client on monitoring the site for infections.

D) Instruct the client on monitoring the site for infections

A client presents at the ER with spinal cord pain. Which of the following tests would most likely be ordered to check for spinal cord abnormalities caused by tumors, herniated intervertebral disks, or other lesions? A) Arthrogram # x-ray study of a joint. B) Bone scan # detect primary bone tumors, metastatic bone disease, osteomyelitis, osteoporosis, inflammation, bone or joint infections, and stress fractures. C) Ultrasound # evaluate soft tissue masses, osteomyelitis, infection, congenital and acquired pediatric disorders, bone mineral density, sports injuries, and fracture healing. D) Myelogram # for evaluating spinal cord abnormalities caused by tumors, herniated intervertebral disks, or other lesions

D) Myelogram # x-ray examination of the spinal cord and vertebral canal after injection of a contrast medium or air into the spinal subarachnoid space.

During a visit to a client who underwent total hip replacement surgery, the home health care nurse notes small area rugs located throughout the house. How should the nurse intervene to ensure the client's safety?

Explain to the client that small area rugs pose a danger to clients after hip replacement surgery.

A nurse is reinforcing instruction for a client with a recent leg fracture and cast. Which statements by the client indicate that further education is needed? SATA a. "I need to report any numbness or tingling in my leg at once." b. "It's normal to have some numbness or tingling following a fracture." c. "It's normal to have severe pain even after the cast is on." d. "I need to keep my leg elevated as much as possible." e. "The color and temperature of my toes will be checked frequently." f. "It's normal to have swelling and for the cast to feel really tight."

Explanation: Paresthesia # numbness or tingling is the earliest sign, and severe pain is a later sign of compartment syndrome; they should be reported at once. Elevating the leg will help prevent venous stasis, edema, and impaired circulation. Circulation and limb sensation need to be monitored frequently.

After a physician describes the surgical procedure for lumbar spinal fusion and its associated risks, the nurse provides a consent form for the client to sign. The client asks the nurse what the term "fusion" means and whether he'll lose a lot of blood during the procedure. Which action should the nurse take? Explain the surgical procedure and the typical blood loss associated with it. Notify the physician of the client's questions about the procedure before having the client sign the informed consent form. Request that the charge nurse answer the client's questions about the procedure. Inform the client that the operating room nurse can clarify any questions before the procedure.

Notify the physician of the client's questions about the procedure before having the client sign the informed consent form. # only MD can explain

crutches Four clients on an orthopedic unit are scheduled to attend physical therapy at the same time. Facility policy dictates that each client be escorted to therapy in a wheelchair or on a stretcher. When it's time for therapy, only three wheelchairs are available. One of the four clients is learning crutch-walking and is scheduled for discharge in the morning. What should the nurse do to ensure the clients' safety and timely arrival to physical therapy?

Request that a physical therapist accompany the client to therapy while he uses the crutches.

A pt who has returned from abdominal surgery reports pain. The pt had received a neuromuscular blocking agents as part of the anesthesia for the surgery. What additional information is essential for the nurse to obtain before administering the precribed analgesic?

Respirations

A client is prescribed diazepam (Valium) to treat severe skeletal muscle spasms. During this therapy, the nurse monitors the client closely for adverse reactions. Which adverse reaction is most likely to occur?

Sedation

Which information should a nurse include when consulting with a home health care agency about the nursing care and physical therapy needs of a client who will be discharged after undergoing total hip replacement surgery?

The client lives alone and will be restricted from driving for at least 6 weeks.

2. The nurse is caring for a client who has had a lower extremity amputation. What intervention by the nurse will best prevent hip contractures? a. Change drains using aseptic technique. b. Elevate the foot of the bed. c. Inspect the limb for signs of infection. d. Do not place a pillow under the residual limb.

a. Do not place a pillow under the residual limb. Explanation: To prevent hip contractures, do not place pillows under the residual limb when the client is on the back. Changing drains will not having any bearing on the status of hip fractures. Elevating the foot of the bed will decrease edema but not prevent contractures. Inspecting the limb for signs of infection will not prevent contractures but will prevent sepsis.

1. A client is experiencing residual limb pain following a surgical amputation to the right lower extremity below the knee. What action by the nurse would help alleviate the pain? a. Have the client "move" the missing limb. b. Apply ice packs to the residual limb. c. Have the client discuss feelings of loss. d. Present reality and do not support the delusion of sensation.

a. Have the client "move" the missing limb. Explanation: Reassure clients that residual limb pain generally disappears in time. For pain relief, tell clients to "move" the missing limb. By activating the damaged nerves leading to the amputated limb, clients usually feel great relief. Ice packs to the limb may cause vasoconstriction and tissue damage. It is important to encourage clients who seem to be disturbed and uneasy following amputation to discuss their feelings; however, this will not alleviate physical pain. The client is not delusional or having hallucinations.

A client is 2 weeks post op from knee replacement surgery and has been on warfarin therapy. The client's most recent INR blood level was 5.6. What should the nurse prepare to administer to the client? a. vitamin K b. protamine sulfate # heparin c. acetylcysteine # acetaminophen d. sodium polystyrene sulfonate # potassium

a. vitamin K

A client has a left total hip replacement. In which of these positions should the nurse place the operative hip? Select one: A. adduction and flexion B. abduction and flexion C. adduction and extension D. abduction and extension

abduction and extension

crutches The nurse is teaching a client with a long leg cast how to use crutches properly while descending a staircase. The nurse should tell the client to:

advance both crutches first.

The nurse is assessing a client with possible osteoarthritis. The most significant risk factor for osteoarthritis is:

age

3. The nurse is caring for a client postoperatively who has had cervical decompression. What statements by the client should the nurse immediately report to the primary care provider? Select all that apply. a. Reports of discomfort when moving b. Reports of change in sensation of arms c. Difficulty breathing d. Difficulty moving arms e. No bowel movement for 2 days

b. Reports of change in sensation of arms c. Difficulty breathing d. Difficulty moving arms

A client is admitted with a possible diagnosis of osteomyelitis. Based on the documentation shown, which laboratory result is the priority for the nurse to report to the health care provider? a. rheumatoid factor negative b. blood culture positive for Staphylococcus c. alkaline phosphatase 60 units/L d. ESR 10mm/h

b. blood culture Osteomyelitis is a bacterial infection of the bone and soft tissue that occurs by extension of soft tissue infection, direct bone contamination following surgery, or spreading from other infection sites in the body

Which information is the priority to include in the discharge plan for a client leaving the hospital in a leg cast? cast care procedures and devices to relieve itching skin care, mouth care, and cast removal procedures cast care, neurovascular checks, and hygiene measures cast removal procedures, neurovascular checks, and devices to relieve itching

cast care, neurovascular checks, and hygiene measures Explanation: 1 Proper cast care procedures include 2 observing the skin nearest the cast edges for signs of pressure ulcers, 3 keeping the cast dry and intact, 4 avoiding the use of insertable devices such as wire hangers or sticks to relieve itching. 5 Frequent neurovascular checks can reveal evidence of pressure or impaired circulation to the leg under the cast. This includes checking the toes frequently for discoloration, swelling, or lack of movement or sensation. 6 Hygiene measures should focus on the client's normal elimination patterns and the importance of cleanliness after elimination, as well as on the need to maintain skin integrity by taking sponge baths and caring for dry skin.

The nurse is reinforcing education on cast care for a client with a cast on the arm. How should the nurse instruct the client to place the casted limb, if there is swelling? a. close to the body b. at the level of the heart c. below the level of the heart d. above the level of the heart

d. above the level of the heart

A client with long-standing rheumatoid arthritis has frequent reports of joint pain. The plan of care should be based on the understanding that chronic pain is most effectively relieved when analgesics are administered in which way? a. conservatively b. intramuscular c. on an as-needed basis d. at regularly scheduled intervals

d. at regularly scheduled intervals To control chronic pain and prevent cycled pain, regularly scheduled intervals of analgesia administration are most effective.

A client asks the reason for being placed in traction prior to surgery. Which response by the nurse is most appropriate? a.Traction will help prevent skin breakdown. b. Traction helps with repositioning while in bed. c. Traction allows for more activity. d.Traction helps to prevent trauma and overcome muscle spasms.

d.Traction helps to prevent trauma and overcome muscle spasms.

osteoporosis The physician diagnoses primary osteoporosis in a client who has lost bone mass. In this metabolic disorder, the rate of bone resorption accelerates while bone formation slows. Primary osteoporosis is most common in:

elderly postmenopausal women.

The nurse is caring for a child suspected of having muscular dystrophy. What clinical manifestations will correlate with this suspicion? a. hypertonia of extremities b. increased lumbar lordosis c. upper extremity spasticity d. hyperactive lower extremity reflexes

increased lumbar lordosis Explanation: An increased lumbar lordosis would be seen in a child suffering from muscular dystrophy secondary to paralysis of lower lumbar postural muscles. Increased lower extremity support may also be seen. Hypertonia isn't seen in muscular dystrophy. Upper extremity spasticity isn't seen because this disease isn't caused by upper motor neuron lesions. Hyperactive reflexes aren't indications of muscular dystrophy.

The nurse is reading the laboratory reports for a client who has severe rheumatoid arthritis. Which of the following tests may show inflammation related to an infection or inflammatory condition? SATA A) CBC B) ESR Erythrocyte sedimentation rate C) Uric acid levels D) Blood levels of calcium E) RF rheumatoid factor F) CK creatine kinase

infection or inflammatory condition. B) ESR E) RF F) CK

osteoArthritis The nurse is developing a teaching plan for a client diagnosed with osteoarthritis. To minimize the risk of injury to the osteoarthritic client, the nurse should instruct the client to:

install safety devices in the home.

A client with gouty arthritis is prescribed a low-purine diet. The nurse should instruct this client to avoid:

organ meats.

A client with possible osteoarthritis is having X-rays performed on both knees. X-rays of an osteoarthritic joint reveal:

osteophyte formation.

If the client is typical of others with a lower back herniated disk, the nurse would expect him to report which additional symptom? Select one: A. brief periods when his toes feel cold B. tenderness over one or both iliac crests C. pain radiating into the buttocks and leg D. diminished sensation in his fingers

pain radiating into the buttocks and leg

Elderly clients who fall are most at risk for:

pelvic fracture

osteoporosis An older adult client reports pain in the lower back and is diagnosed with osteoporosis. What education should the nurse reinforce to prevent complications? pain control safety precautions to prevent fractures The bones will harden and become stiff. an increase in the bone matrix and remineralization

safety precautions to prevent fractures

The nurse is developing a teaching plan for a client who must undergo an above-the-knee amputation of the left leg. After a leg amputation, exercise of the remaining limb:

should begin the day after surgery.

The nurse is caring for a female client with osteoarthritis who is being discharge to home. Which items would the nurse reinforce the use of in order to assist the client to dress independently at home? SATA tennis shoes that tie skirts with elastic waists blouse with rear buttons jackets with Velcro closures bras with front closure

skirts with elastic waists jackets with Velcro closures bras with front closure

Which activity in a child with muscular dystrophy should a nurse anticipate difficulty with first? breathing sitting standing swallowing

standing Explanation: Muscular dystrophy usually affects postural muscles of the hip and shoulder first. Swallowing and breathing are usually affected last. Sitting may be affected, but a child would have difficulty standing before having difficulty sitting.

A client presents with pain and warmth in his big toe and reduced urine output. The health care provider suspects gouty arthritis. The nurse can expect the health care provider to confirm this diagnosis by ordering which diagnostic tests? synovial fluid analysis and serum uric acid level great toe and chest x-rays blood gas analysis # respiratory disorders platelet count # clotting disorders serum protein and bilirubin levels

synovial fluid analysis and serum uric acid level

A client with a fractured femur is in Russell's traction and asks the nurse to help with back care. Which nursing action is most appropriate? telling the client that back care cannot be performed while he's in traction removing the weight to give the client more slack to move supporting the weight to give the client more slack to move telling the client to use the trapeze to lift his back off the bed

telling the client to use the trapeze to lift his back off the bed # TO MAITAIN CORRECT ALIGNMENT

which decription of pt receiving neuromuscular blocking agents is accurate

they are risk for developement of bronchospasm, edema, and urticaria

What is the mechanism of the centrally acting skeletal muscle relaxants? 1 they directly affect the muscle 2 they cause CNS depression 3 they affect nerve conduction 4 they cause the neuromuscular junctions to be desensitized to stimuli

they cause CNS depression

Why would pt with myasthenia gravis, spinal cord injuries, or multiple sclerosis need to be carefully identified prior to administration of neuromuscular blocking agents?

they need careful adjustments in dosages to assess their ability to tolerate the agent

The nurse is caring for a child with a Harrington rod placement. Which data gathered by the nurse would be of greatest concern 2 days postoperatively? fever of 99.5° F (37.5° C) reports of pain along the incision urine output less than 30 mL/hr hypoactive bowel sounds

urine output less than 30 mL/hr Explanation: Due to extensive blood loss during surgery and possible renal hypoperfusion, decreased urine output could indicate decreased renal function and this symptom is of greatest concern. A fever of 99.5° F is of concern but may be due to decreased chest expansion secondary to anesthesia, surgery, and pain. A paralytic ileus is common after Harrington rod placement surgery, and the child may have a nasogastric tube for the first 48 hours

Which of the following is the most appropriate nursing diagnosis for a client with a strained ankle?

Impaired physical mobility

The nurse is managing the care of a client with osteoarthritis. Appropriate treatment strategies for osteoarthritis include:

administration of nonsteroidal anti-inflammatory drugs (NSAIDs).

A client is treated in the emergency department for acute muscle strain in the left leg caused by trying a new exercise. During discharge preparation, the nurse should provide which instruction?

"Apply ice packs for the first 24 to 48 hours, and then apply heat packs."

A client with muscle weakness and an abnormal gait is being evaluated for muscular dystrophy. Which of the following confirms muscular dystrophy?

Muscle biopsy

Which nursing diagnosis takes highest priority for a client with a compound fracture?

Risk for infection related to effects of trauma

Which nursing diagnosis is most appropriate for an elderly client with osteoarthritis?

Risk for injury related to altered mobility

The nurse is reinforcing education for the parents of a child scheduled for a closed reduction of a fracture. Which statement should the nurse include? a. "All fractures can be reduced." b. "Fracture reduction restores alignment." c. "Undisplaced fractures may be reduced." d. "Fracture reduction is usually performed with minimal discomfort."

"Fracture reduction restores alignment."

A client has a long leg cast applied for a tibia fracture. Which statement made by the client would indicate to the nurse that compartment syndrome may be developing? a."I have some discomfort when I try and move my foot around." b. "My toenails are pink." c."My leg really itches." d."I am having a decrease in sensation of my toes."

"I am having a decrease in sensation of my toes." Explanation: Compartment syndrome can occur from internal # bleeding and external pressure # cast or dressing and can cause a feeling similar to the foot "falling asleep" # related to a lack of sensation. Blood flow is impaired. The toenails should be pink and capillary refill less than 3 seconds. The leg will itch underneath the cast and it is important to reinforce that no objects should be placed under the cast to scratch the skin. This can damage skin integrity and predispose the client to infection.

A client undergoes a total hip replacement. Which statement made by the client would indicate to the nurse that the client requires further teaching?

"I don't know if I'll be able to get off that low toilet seat at home by myself."

The nurse is reinforcing education for a client regarding back safety. Which response by the client indicates the education was effective? "I'll start carrying objects at arm's length from my body." # increase back strain. "I'll sleep on my back at night." # increase back strain. "I'll carry objects close to my body." # increase back strain. "I'll lift items by bending over at my waist."

"I'll carry objects close to my body."

A nurse has reinforced instruction for a client to accurately measure the circumference of both calves each morning and to report any increase in circumference. Which client statement indicates that education has been effective? "I'll use a measuring tape to check circumference." "I only have to call if one leg is significantly larger than the other." "I can measure my calves either near the knee or closer to the ankle." "I'll use the standardized chart for limb circumference."

"I'll use a measuring tape to check circumference. # place the tape at the level where the calf circumference is largest, and measure at this same place each time. The client was instructed to report any increase in circumference. A significant increase in calf circumference size might be unilateral or bilateral. There's no standardized chart for limb circumference.

A client asks a nurse to explain the difference between osteoarthritis (OA) and rheumatoid arthritis (RA). Which response is correct? "OA is a noninflammatory joint disease. RA is characterized by inflamed, swollen joints." "OA and RA are very similar. OA affects the smaller joints, and RA affects the larger, weight-bearing joints." "OA affects joints on both sides of the body. RA is usually unilateral." "OA is more common in women. RA is more common in men."

"OA is a noninflammatory joint disease. RA is characterized by inflamed, swollen joints."

A client with osteoarthritis tells the nurse she is concerned that the disease will prevent her from doing her chores. Which suggestion should the nurse offer?

"Pace yourself and rest frequently, especially after activities."

crutches The X-rays of a client who was brought to the emergency department after falling on ice reveal a leg fracture. After a cast is applied and allowed to dry, the nurse teaches the client how to use crutches. Which instruction should the nurse provide about climbing stairs?

"Place the unaffected leg on the first step, followed by the crutches and the injured leg, which should move together."

which are example of when it would be approriate to use neuromuscular blocking agent? SATA

1 when pt have tetanus 3 during the administration of general anesthesia 4 when intubating pts & preventing laryngospasm 5 during the administration of electroshock therapy to prevent

The nurse is caring for a client who complains of lower back pain. Which instructions should the nurse give the client to prevent back injury?

"Stand close to the object you're lifting."

A client who has just been diagnosed with mixed muscular dystrophy asks the nurse about the usual course of this disease. How should the nurse respond?

"You may experience progressive deterioration in all voluntary muscles."

An elderly client who is having difficulty using a walker tells the nurse, "I don't care what the doctor says; I'm not going to use that thing!" Which response by the nurse is best?

"You say that you don't like using the walker; is there any particular reason why?"

A middle-age client recovering from major back surgery must wear a back brace and walk with a cane after experiencing leg weakness. During routine care, the client tells a nurse, "I'm sorry I had this operation. Before surgery I didn't look like I had a problem, but now I do." Which response by the nurse is appropriate?

"You sound concerned about your appearance. In what way are you worse off than before?"

osteoporosis A nurse is teaching a class about osteoporosis. Which factors place a client at greater risk for developing this disease? SATA

(1) Being postmenopausal, (2) Long-term use of corticosteroids, (6) Sedentary lifestyle

which lab results to determine if the pt on chlorzoxazone Lorzone was exhibiting any hepatotoxicity? SATA 1 GGT 2 WBC 3RBC 4 AST 5 ALT

1 GGT 4 AST 5 ALT

The nurse knows that bone marrow depression can occur as an adverse effect with xanthine oxidase inhibitors & will monitor for which effects? SATA 1 Sore throat 2 restlessness 3 Jaundice 4 Progressive weakness 5 cardiac arrhythmias

1 Sore throat 3 Jaundice 4 Progressive weakness

The nurse needs to gather important assessment data on the pt w a skeletal muscle disorder including what factors? SATA 1 assessing the mental status 2 determining the degree of respiratory depression 3evaluating the capillary refill & any presence of paresthesias 4 noting any differences in circumference, symmetry, or length of limbs 5 assessing muscle strength by asking the pt to lift his head off the pillow

1 assessing the mental status 2 determining the degree of respiratory depression 4 noting any differences in circumference, symmetry, or length of limbs 5 assessing muscle strength by asking the pt to lift his head off the pillow

GOUT The nurse is preparing to administer colchicine for a pt with gout & needs to assess the pt for what? SATA 1 current bowel status 2 ability to cough & swallow adequately 3 laboratory values for uric acid, BUN, & AST 4 degree of spasticity involving the affected limb 5 Level & location of pain

1 current bowel status 2 ability to cough & swallow adequately 3 laboratory values for uric acid, BUN, & AST 5 Level & location of pain

For which adverse effects does the nurse need to evaluate the pt with a skeletal muscle disorder, related to the baclofen pump? 1 drowsiness 2 fatigue 3 headache 4 back pain 5 dizziness

1 drowsiness 2 fatigue 3 headache 5 dizziness

which statements about the effects of neuromuscular blocking agents ? SATA

1 have no effect on memory 2 have no effect on consciousness 3 have no effect on pain threshold

which medications are considered centrally acting skeletal muscle relaxants? SATA 1 metaxalone Skelaxin 2 dantrolene 3 cyclobenzaprine Amrix 4 allopurinol zyloprim 5 carisoprodol SOma

1 metaxalone Skelaxin 3 cyclobenzaprine Amrix 5 carisoprodol SOma

which statement about centrally acting skeletal muscle relaxants are true? SATA 1 they produce sedation 2 directly affect the neuromuscular fx, causing relaxation 3 the produce their therapeutic effect by depressing the CNS 4 directly relax the muscles by suppressing nerve conduction at the neuromuscular junction 5 they are agents of choice for the treatment of muscle spasticity associated with cerebral or spinal cord disease

1 they produce sedation 3 the produce their therapeutic effect by depressing th CNS

osteoporosis At a health fair, a woman, age 43, with a family history of osteoporosis asks the nurse how much calcium she should consume. The nurse tells her that the recommended daily calcium intake for premenopausal women is:

1,000 to 1,200 mg.

which drugs are Antidotes for neuromuscular blocking agents? SATA

2 pyridostigmine bromide 3 edrophonium chloride 4 neostigmine methylsulfate

A client undergoes a muscle biopsy. After the procedure, the nurse must keep the biopsy site elevated for:

24 hours.

A 22-year-old client with an external fixation device attached to his left thigh is unable to bear weight on his left leg. He asks a nurse if he can take a shower on his third postoperative day. After a review of the physician's orders, the nurse notes an order stating, "Client may shower ten (10) days after surgery." In order to meet the client needs, what appropriate action will the nurse take? 1 Assist the client into the shower while he supports himself with one crutch. 2 Suggest that the client wait until he's able to bear weight on his left leg. 3 Explain that he is not permitted to shower, but the nursing assistant can help him with a sponge bath. 4 Wrap the device with plastic and then assist the client into the shower using a wheelchair.

3 Explain that he is not permitted to shower, but the nursing assistant can help him with a sponge bath.

A 20-year-old female patient has been diagnosed with multiple sclerosis. What drug will most likely be prescribed? A) Baclofen (Lioresal) B) Cyclobenzaprine (Flexeril) C) Metaxalone (Skelaxin) D) Orphenadrine (Banflex)

A

A client who's being discharged with an arm cast wants to shower at home. The nurse demonstrates how to shower without getting the cast wet. For which reason is this important? 1 A wet cast can cause a foul odor. # infection 2 A wet cast will weaken or decompose. 3 A wet cast is heavy and difficult to maneuver. 4 It's all right to get the cast wet; just use a hair dryer to dry it off.

A wet cast will weaken or decompose

The patient presents to the emergency department with muscle spasms in the back. What types of injury would the nurse recognize can result in muscle spasm? (Select all that apply.) A) Overstretching a muscle B) Wrenching a joint C) Tearing a tendon or ligament D) Breaking a bone E) Exercising too vigorously.

A,B,C

The nurse is caring for a patient who is having a pump placed to deliver intrathecal baclofen and another patient who will receive dantrolene as a muscle relaxant. What nursing diagnosis would be appropriate for both care plans? (Select all that apply.) A) Acute pain related to GI effects of drug B) Risk for injury related to central nervous system (CNS) effects C) Disturbed body image related to muscle pain D) Disturbed thought processes related to CNS effects E) Deficient knowledge related to procedure

A,B,D

Which of the following would the nurse identify as a neurotransmitter? 1 Adenosine triphosphate (ATP) 2 Acetylcholine 3 Creatine phosphate # found in muscle that, when broken down, releases energy. 4 Cholinesterase

Acetylcholine # neurotransmitter

A nurse is providing care to a client with an acute attack of gout. Which action should the nurse provide first? a. Force fluids. b. Instruct the client on relaxation techniques. c. Encourage bed rest. d. Administer analgesics.

Administer analgesics.

crutches The nurse is teaching a client with a left fractured tibia how to walk with crutches. Which instruction is appropriate?

All weight should be on the hands.

The nurse is caring for an elderly female with osteoporosis. When teaching the client, the nurse should include information about which major complication of this condition?

Bone fracture

After total hip replacement, a client is receiving epidural analgesia to relieve pain. Which of the following is a nursing priority for this client? Assessing for sensation in the legs Changing the catheter site dressing every shift Assessing capillary refill time Keeping the client flat in bed

Assessing for sensation in the legs

The client with chronic back pain rated as an 8 on a scale of 1 to 10 asks for pain medication. Which medication order is appropriate for the client with severe chronic pain? a. Provide morphine sulfate 2mg IV stat. b. Administer oxycodone IR 10mg PO daily. c. Deliver hydromorphone 20 mg IM q 6 hrs PRN. d Apply fentanyl 30mg transdermal q 3 days.

Apply fentanyl 30mg transdermal q 3 days. # chronic back pain

The nurse is caring for a client with burns on his legs. Which nursing intervention will help prevent leg contractures?

Applying knee splints

A client has a Fiberglass cast on the right arm. Which action should the nurse include in the plan of care? Keeping the casted arm warm by covering it with a light blanket Avoiding handling the cast for 24 hours or until it is dry Evaluating pedal and posterior tibial pulses every 2 hours Assessing movement and sensation in the fingers of the right hand

Assessing movement and sensation in the fingers of the right hand

The nurse is planning care for a client who is on prolonged bed rest following a hip replacement. Which of the following is a nursing consideration for this client? A) Maintain prolonged bed rest to prevent contractures. B) Turn client frequently to prevent skin breakdown. C) Use abundant soap when bathing client. # minimize the use of soap. D) Plan a high-fat diet for the client. # high protein

B) Turn client frequently to prevent skin breakdown Prolonged bed rest is dangerous for clients with musculoskeletal disorders because of the increased risk for complications such as skin breakdown, contractures, constipation, and thromboembolism (also referred to as deep vein thrombosis)

The nurse monitors a client receiving enoxaparin (Lovenox), 30 mg subQ b.i.d after hip replacement surgery. Which adverse reaction is the client most likely to experience?

Bleeding

The anatomy and physiology instructor is discussing reflex systems with the prenursing class. What system would the instructor say causes a muscle fiber contraction that relieves the stretch? A) Arch reflex system B) Spinal reflex system C) Spindle gamma loop system D) Stretch receptor system

C

The nurse is caring for a patient who is being discharged home from the rehabilitation unit. Baclofen will be discontinued and the patient will begin taking carisoprodol as an outpatient. What is the nurse's primary consideration about discontinuing administration of baclofen? A) "Taper drug over 72 hours to reduce dependence on the drug." B) "Alternate doses of baclofen and soma over 10 days to prevent drug withdrawal." C) "Taper drug slowly over 1 to 2 weeks to prevent psychoses and hallucinations." D) "Start carisoprodol immediately while continuing baclofen at full dose to establish carisoprodol level."

C

A 35-year-old client with a cervical injury is provided with a halo device to stabilize the neck. What measures must the nurse employ when caring for a client with this type of device? A) Place the client in an antidecubitus bed, if possible. B) Tighten the halo device with a wrench if it loosens. C) Monitor the client for any difficulty in swallowing. D) Instruct the client to stay in bed until the injury heals.

C) Monitor the client for any difficulty swallowing. # because this indicates signs that the vertical bar of the device is too long.

A nurse is caring for a 12-year-old client diagnosed with muscular dystrophy. Which of the following complications is seen frequently in clients with muscular dystrophy? A) Pathologic bone fractures # osteoporosis B) Muscular spasms # common following a bone fracture C) Upper respiratory tract infection D) Necrosis of the tissue or gangrene # amputation of a limbThrombophlebitis

C) Upper respiratory tract infection # muscular dystrophy are wasted and weakened

A client with a casted left arm is elevated with pillows but still complains of increased pain at the site. The client was lasted medicated one hour ago with an analgesic, meperidine (Demerol) 100 mg IM. The nurse notes the client's fingers are swollen and pressing against the cast. The priority nursing action would be: A. Teach relaxation exercises to relieve the pain B. Call the physician and report findings C. Apply warm moist packs to the swollen fingers D. Administer another dose of meperidine (Demerol) 100 mg IM

Call the physician and report findings

A client with acute osteomyelitis is to receive parenteral penicillin for 4 to 6 weeks. Before administering the first dose, the nurse asks the client about known drug allergies. An allergy to which antibiotic or antibiotic class necessitates cautious use of penicillin?

Cephalosporins

To assess the joints, the nurse asks a client to perform various movements. As the client moves the arm away from the midline, the nurse evaluates the ability to perform:

abduction.

A client with skeletal fracture to the right leg reports severe right leg pain. Which action should the nurse take first? Call the health care provider. Check the client's alignment in bed. Remove the weights from the fracture. Perform pin care.

Check the client's alignment in bed. Explanation: A client who reports severe leg pain may need realignment to ease some pressure on the fracture site. If this is ineffective, the health care provider may need to be notified. The weights ordered may be too heavy, but the nurse can't remove them without a health care provider's order. Performing pin care isn't appropriate at this time.

The nurse is caring for a child with a hip spica cast which has become soiled. What is the appropriate action by the nurse? a. Clean with a damp cloth and dry cleanser. b. Clean with soap and water. c. Don't do anything. Change the cast.Demerol

Clean with damp cloth and dry cleanser.

When caring for a client experiencing an acute gout attack, the nurse anticipates administering which medication?

Colchicine

osteoporosis Teaching measures for a client with osteoporosis: SATA A. Consuming a diet high in calcium and vitamin D B. Seek medical advice for medications that help with osteoporosis C. Taking narcotic analgesics D. Implementing safety precautions E. Performing weight bearing exercises

Consuming a diet high in calcium and vitamin D, Performing weight bearing exercises, Seek medical advice for medications that help with osteoporosis, Implementing safety precautions

A mother brings her 9-year-old son to the clinic for a routine check up. The 9-year-old boy has cerebral palsy and is very spastic. The mother asks the nurse what causes the spasticity in her son. What is the nurse's best response? A) "Your son's spasticity is caused by injury to the muscle tissue." B) "Your son's spasticity is caused by deficiency of a neurotransmitter called serotonin." C) "Your son's spasticity is caused by damaged sensory neurons." D) "Your son's spasticity is caused by damaged motor neurons."

D

The nurse is caring for a 45-year-old male client following amputation of his right leg, which was crushed in a fall. Which of the following is a nursing consideration for this client? A) Change the compression bandage at least once a day. # at least twice per day, B) Wrap the stump so that it forms a rounded shape. #E a cone shape C) Change the dressing using clean technique. # aseptic technique. D) Encourage the client to lie in a prone position.

D) Encourage the client to lie in a prone position.

A client presents at a local clinic with a butterfly rash on her face. Which of the following diseases would the nurse suspect?' A) Gout # joint swelling, redness, and severe pain. B) Scleroderma # collagen disorder that involves chronic hardening and shrinking of connective tissues C) Rickets # bones remain soft and become distorted as the child grows. D) Systemic lupus erythematosus (SLE)

D) Systemic lupus erythematosus (SLE)

A client comes to the emergency department complaining of pain in the right leg. When obtaining his history, the nurse learns that the client was diagnosed with diabetes mellitus at age 12. The nurse knows that this disease predisposes the client to which musculoskeletal disorder?

Degenerative joint disease

A client with gangrene of the left foot is scheduled for below-knee amputation. When planning preoperative care, the nurse should assign highest priority to which nursing diagnosis?

Disturbed body image related to loss of body part

A client seeks medical attention for a ganglion. Which statement about this musculoskeletal disorder is true?

Dorsiflexion exacerbates signs and symptoms of a ganglion.

The nurse is explaining to a client whose cast is being removed what to expect under the cast. Which of the following is a normal finding? A) The skin may be covered with scales. B) The skin will be hot and edematous. C) The skin will appear red. D) The skin will be cyanotic.

Education Before a cast is removed 1 The skin may be covered with scales or crust of dead skin 2 muscle may appear atrophied and that the limb may be weak or stiff.

After sustaining injuries in a motor vehicle accident, a client spends 10 days recovering in the intensive care unit. His condition stabilizes and he's transferred to the orthopedic unit. Upon arrival at the unit, his vital signs are stable, his temperature is 100° F (37.8° C), and he has an indwelling urinary catheter in place. He is currently on bed rest and able to consume a regular diet. Which independent nursing action should the nurse include in this client's plan of care?

Encourage the client to increase his intake of fluids.

A client with osteoarthritis is refusing to perform independent daily care. Which approach would be most appropriate to use with this client? Perform the care for the client. Explain that complete independence should be maintained. Encourage the client to perform as much care as pain will allow. Inform the client that after care is completed, pain medication will be administered.

Encourage the client to perform as much care as pain will allow.

It is typically safe to move a limb by grasping the frame of an external fixation device when repositioning the client. Select one: True False

False

While a nurse on the orthopedic floor is administering medications to her group of clients, the physical therapy department calls to inform her that two of her clients are late for their scheduled session. What should the nurse do?

First, administer scheduled medications to the clients who require physical therapy, and then have them attend therapy.

A client is treated in the emergency department for a Colles' fracture sustained during a fall. What is a Colles' fracture?

Fracture of the distal radius

A client is admitted with severe pain in the knees. Which form of arthritis is characterized by urate deposits and joint pain, usually in the feet and legs, and occurs primarily in men older than age 30? a. Septic arthritis b. Traumatic arthritis c. Intermittent arthritis d. Gouty arthritis

Gouty arthritis

An X-ray of the left femur shows a fracture that extends through the midshaft of the bone and multiple splintering fragments. What is this type of fracture called?

Greenstick Fracture

A 32yo man came to the outpt clinic complaining about a recent injury sustaine while jogging & subsequent left knee pain. The nurse knows further education is needed after the pt makes which statement? 1 I can put ice on my knee to help with the swelling for 48h 2 I will have to elevate my leg initially to reduce swelling and pain 3 I can immobilize my knee w an elastic wrap to help w the pain 4 I can use hot packs on my knee initially to help with the pain

I can use hot packs on my knee initially to help with the pain

The nurse will need to provide further education when the pt makes which statement? 1 I need to take this to prevent an attack of gout 2 my joint swelling will subside within 12 hours 3 it will take from 48-72 h before I will get any pain relief 4 I know I can take a dose Q3 days to prevent an attack of gout

I know I can take a dose Q3 days to prevent attack of gout

Which statement by a client with gout indicates an appropriate understanding of patient instructions? A. "I need to limit the amount of water I drink each day." B. "I should avoid exercising my affected joint." C. "It's okay to drink alcohol." D. "I need to avoid foods high in purine

I need to avoid foods high in purine."

Which statement by a pt taking dantrolene Dantrium for treatment of muscle spasticity of stroke syndrome indicates that more pt education is needed? 1 I will avoid exposure to the sun, but I can still use tanning lamps. 2 I will notify MD if my skin turns yellow 3 I know that it might take up to a week for me to see any response to this drug 4 If I develop adverse effects from this medication, I will not discontinue treatment until I notify my healthcare provider

I will avoid exposure to the sun, but I can still use tanning lamps.

Which of the following is a priority nursing diagnosis for the client with an amputated extremity?

Ineffective tissue perfusion: peripheral related to injury and amputation

The nurse is caring for a client with a cast on his left arm. Which data collection finding is most significant for this client? Presence of a normal popliteal pulse Ability to move all toes Intact skin around the cast edges Normal capillary refill in the great toe

Intact skin around the cast edges

GOUT How does probenecid prevent acute attacks of gouty arthritis?

It enhance the excretion of uric acid by the kidneys

During a senior citizen health screening, the nurse observes a 75-year-old female with a severely increased thoracic curve, or "humpback". What is this condition called?

Kyphosis

A client is in Buck's skin traction after fracturing his right hip. The nurse should include which action in the plan of care?

Maintaining correct body alignment

A client is admitted to the orthopedic unit with septic arthritis of the knee. The case manager should be consulted if which of the following complications occurs during hospitalization?

Mobility decreases.

A client is undergoing an extensive diagnostic workup for suspected muscular dystrophy. The nurse knows that muscular dystrophy has many forms, but that one data collection finding is common to all forms. Which finding belongs in this category?

Muscle weakness

After a person experiences a closure of the epiphyses, which of the following is true? The bone grows in length but not thickness. The bone increases in thickness and is remodeled. Both bone length and thickness continues. No further increase in bone length occurs.

No further increase in bone length occurs.

During assessment, a licensed practical nurse (LPN) notes that a client who had a total hip replacement 5 days ago has a temperature of 100.4° F (38° C) and a red, edematous incision. The dressing that was covering the incision contains yellow-green, foul-smelling drainage, and the client complains of pain at the site. How should the nurse proceed?

Notify a registered nurse (RN) coassigned to the client, apply a sterile dressing to the incision, and administer pain medication as prescribed.

A client recovering from back surgery tells a nurse that she's concerned about going home. She explains that she has many stairs to navigate and household responsibilities she must perform. How can the nurse help ease this client's concerns?

Notify the charge nurse of the client's concerns, and request a team meeting to discuss the client's discharge planning.

A nurse is caring for a client who sustained a gunshot wound to the leg during a jewelry store robbery. The client is in police custody and receiving treatment in the emergency department. A member of the media asks the nurse about the client's condition. How should the nurse respond?

Notify the nursing supervisor so she can obtain a formal statement from the physician about the client's condition for the media.

A 69-year-old client asks the nurse what the difference is between osteoarthritis (OA) and rheumatoid arthritis (RA). Which response is correct?

OA is a noninflammatory joint disease. RA is characterized by inflamed, swollen joints.

A client is brought to the emergency department after injuring his right arm in a bicycle accident. The orthopedic surgeon tells the nurse that the client has a greenstick fracture of the arm. What does this mean?

One side of the bone is broken and the other side is bent.

A client is brought to the emergency department after injuring his right arm in a bicycle accident. The orthopedic surgeon tells the nurse that the client has a greenstick fracture of the arm. What does this mean? The fracture line extends through the entire bone substance. The fracture results from an underlying bone disorder. Bone fragments are separated at the fracture line. One side of the bone is broken and the other side is bent.

One side of the bone is broken and the other side is bent. Explanation: In a greenstick fracture, one side of the bone is broken and the other side is bent. A greenstick fracture also may refer to an incomplete fracture in which the fracture line extends only partially through the bone substance and doesn't disrupt bone continuity completely. (Other terms for greenstick fracture are willow fracture and hickory- stick fracture.) The fracture line extends through the entire bone substance in a complete fracture. A fracture that results from an underlying bone disorder, such as osteoporosis or a tumor, is a pathologic fracture, which typically occurs with minimal trauma. Bone fragments are separated at the fracture line in a displaced fractu

The elderly client fell in the bathroom and broke their left hip. Which treatment procedure would most likely be performed to correct this type of fracture? Select one: A. Full body cast B. Open reduction internal fixation (ORIF) C. Half cast D. Closed reduction

Open reduction internal fixation (ORIF) is the surgical treatment of choice for a fractured hip

Which cells are involved in bone resorption?

Osteoclasts

A client seeks care for low back pain of 2 weeks' duration. Which data collection finding suggests a herniated intervertebral disk?

Pain radiating down the posterior thigh or pain radiating into the buttocks and leg

The nurse educator is presenting an in-service on falls and notes that elderly clients are most at risk for a particular type of fracture. Which type of fracture, if identified by the nursing staff, would indicate to the educator that the in-service was effective? Wrist fractures # young men common Humerus fractures Pelvic fractures Cervical spine fractures

Pelvic fractures

A client comes to the outpatient department with suspected carpal tunnel syndrome. When assessing the affected area, the nurse expects to find which abnormality typically associated with this syndrome?

Positive Tinel's sign

A health care provider has prescribed oral prednisone for a client diagnosed with Duchenne muscular dystrophy. The parents ask the nurse what is the benefit of this medication. Which responses would be the best? SATA A. Prednisone can strengthen the bones. b. Prednisone can improve muscle strength. c. Prednisone can stop the progression of the disease. d. Prednisone can delay the progression of the disease. e. Prednisone can decrease depression.

Prednisone can improve muscle strength. Prednisone can delay the progression of the disease.

A client has a suspected sprain of the right ankle, immediate treatment involves: SAtA A. Provide rest B. Compression with elastic bandage C. Application of heat D. Apply an ice pack E. Elevation of affected extremity

Provide rest, Compression with elastic bandage, Elevation of affected extremity, Apply an ice pack

Why are neuromuscular-blocking agents used? SATA a. Easing endotracheal intubation and prevent laryngospasm b. Alleviation of pain c. Producing amnesia during painful procedures d. Reducing the use and adverse effects of general anesthetics C e. Decreasing muscular activity in electroshock therapy

Reducing the use and adverse effects of general anesthetics C Easing endotracheal intubation and prevent laryngospasm Decreasing muscular activity in electroshock therapy

Which nursing intervention is essential in caring for a client with compartment syndrome?

Removing all external sources of pressure, such as clothing and jewelry

A nurse is caring for a confused client with a fractured hip who is trying to get out of bed. Which action should the nurse take first? a. Obtain a prescription for wrist restraints. b. Review the facility's restraint policy. c. Move the client closer to the nurse's station. d. Reorient the client to the surroundings.

Reorient the client to the surroundings.

The nurse is giving instructions to a client who's going home with a cast on his leg. Which point is most critical?

Reporting signs of impaired circulation

An incarcerated client is admitted to the hospital after sustaining multiple contusions and a fractured femur in an assault. After surgical repair of the femur, the client develops paralytic ileus. A nasogastric (NG) tube and cleansing enemas are prescribed. The client has a prison guard assigned to his bedside. How should a nurse proceed to implement a physician's orders?

Request that the guard remain outside the client's door during the prescribed procedures.

Although the skeleton determines the size of the body's framework, muscle and fat determine body shape. The student nurse is preparing a chart on the various types of muscles. Based on this information, what should be included about skeletal muscles? A. Responsible for motion inside body organs and structures under involuntary control # Smooth muscle B. Responsible for locomotion under voluntary control C. Responsible for facial expression and posture under involuntary control # under voluntary control D. Responsible for propelling blood through blood vessels under voluntary control # involuntary Cardiac muscle

Responsible for locomotion under voluntary control

A school nurse is performing a scoliosis screening on a group of students. Which student would most commonly develop this condition? 7-year-old girl 7-year-old boy 13-year-old girl 13-year-old boy

Scoliosis is eight times more prevalent in adolescent girls than boys. Peak incidence is between ages 8 and 15. Therefore, a 13-year-old girl is at the highest risk. Seven-year-old boys and girls are at lower risk.

A child is brought to the school nurse with the index finger of the left hand partially amputated and hanging by a shred of skin. What is the appropriate action by the nurse? a. Place the finger under warm running water and wrap in a towel. b. Cut the skin holding the finger and wrap the detached finger in a clean wet towel. c. Tightly squeeze the finger 1 inch above the cut to stop bleeding. d. Securely wrap the hand and finger and place them in a cold water-filled baggie.

Securely wrap the hand and finger and place them in a cold water-filled baggie. Explanation: Leave the skin intact, wrap the entire hand and finger with a towel, and place it in a cool solution to preserve cell life and increase the chance of successful reattachment. The finger should not be detached, warm water should not be used and the circulation to the finger should not be decreased by tightly squeezing about the cut.

On a visit to the family physician, a client complains of painful swelling on the lateral side of the great toe, at the metatarsophalangeal joint. After determining that the swelling is a bunion, the physician injects an intra-articular corticosteroid. The client asks the nurse what causes bunions. Which answer is correct?

Some bunions are congenital; others are caused by wearing shoes that are too short or narrow.

The nurse is caring for a client with a long leg cast. Which nursing intervention can best prevent foot drop? a. Encourage bed rest. b. Support the foot with 45 degrees of flexion. c. Support the foot with 90 degrees of flexion. d. Place a stocking on the foot to provide warmth.

Support the foot with 90 degrees of flexion. lients who have undergone hip replacement surgery should be restricted from bending more than 90 degrees, such as bending forward to put on shoes, during postoperative care because it can alter the alignment of the affected hip and may lead to various other complications. The client should never be allowed to cross the legs during postoperative care because it can alter the alignment of the replaced hip. The client should never be allowed to turn the affected leg inward and should avoid bending or flexing the hip, which can affect the outcome of the surgery. The client must be given back care every 2 hours, not just twice daily, when on bed rest to avoid circulatory and pressure complications caused by prolonged immobility.

A client who sustained a right lower leg fracture in a motorcycle accident has an external fixation device in place. During visiting hours, a nurse sees a friend of the client using the device to lift the client's leg off of the bed. Which action should the nurse take?

Teach the client and his friend the proper technique for lifting the leg.

A client calls the clinic and informs the nurse that there is a foul odor coming from the cast. What is the best response by the nurse? 1 Tell the client to come to the clinic immediately since the foul odor may be a sign of infection. 2 Reinforce education for proper cast care, including hygiene measures. 3 Inform the client that odor is normal after the cast has been on for a while. 4 Inform the client that there may be some neurovascular compromise but it should resolve.

Tell the client to come to the clinic immediately since the foul odor may be a sign of infection.

The nurse is caring for a client recovering from left hip replacement surgery. Which findings should indicate to the nurse that the hip joint has dislocated? SATA a. The client is unable to move the left leg. b. The left leg is shorter than the right leg. c. The left knee cannot be straightened. d. The left leg is internally rotated. e. The client is experiencing increased pain. f. The pulse in the left foot is weak.

The client is unable to move the left leg. The left leg is shorter than the right leg. The left leg is internally rotated. The client is experiencing increased pain.

The nurse is teaching the client how to use a cane. Which statements is inaccurate?

The client should hold the cane on the involved side.

When observing a newly hired nurse change a wet-to-dry dressing, which action by the nurse would indicate to the nurse mentor that further teaching is needed? a. The nurse loosens the wet-to-dry dressing with normal saline. b. The nurse discards the drape that became wet when normal saline was poured. c. The nurse disposes of the used dressing in a red biohazard bag. d. The nurse keeps the hands between the waist and nipple level.

The nurse loosens the wet-to-dry dressing with normal saline. WRONG

GOUT What statement by the pt indicates that more teaching of probenecid therapy is needed? 1 I can expect that the incidence of gout attacks may increase for the first few months of therapy with this drug 2 I will tell my healthcare provider if I develop vomiting that looks like coffee ground 3 if I develop a rash, I will tell my healthcare provider because this most likely means that I have an allergy to this drug

This drug works on the tissues of my great toe, where I usually get the gout, to get rid of the problem

The client is on postoperative day 4 after total hip arthroplasty for a fractured left hip. Client reports right lower leg pain 9/10. Your assessment of the right lower leg reveals the following: dorsalis pedis pulse is present, pitting edema of the ankle, erythema and warm to touch. The client most likely has what postoperative complication? A. Osteomyelitis B. Thrombophlebitis (DVT) C. Arterial insufficiency D. Hip dislocationMyelogram

Thrombophlebitis (DVT) Homans' sign is positive with thrombophlebitis and Mrs. Kay, who is postoperative, is at risk for developing this because of her immobilized status.

A client is scheduled for a laminectomy to repair a herniated intervertebral disk. When developing the postoperative plan of care, the nurse should include which action? Maintaining bed rest for 72 hours after the laminectomy Turning the client from side to side, using the logroll technique Keeping a pillow under the client's knees at all times Placing the client in semi-Fowler's position

Turning the client from side to side, using the logroll technique

After surgery to treat a hip fracture, a client returns from the postanesthesia care unit to the medical-surgical unit. Postoperatively, how should the nurse position the client?

With the leg on the affected side abducted

A 22-year-old client with an external fixation device attached to his left thigh is unable to bear weight on his left leg. He asks a nurse if he can take a shower. How should the nurse respond to the client's request?

Wrap the device with plastic and then assist the client into the shower using a wheelchair.

4. A client is diagnosed with arthritis and wants to maintain an active lifestyle. What exercises should the nurse recommend to the client? Select all that apply. a. Swimming b. Jumping rope # high-impact activities that may cause pain and injury to joints c. Bicycling d. Running # high-impact activities that may cause pain and injury to joints e. Slow walking

a. Swimming c. Bicycling e. Slow walking

A client asks for information about osteoarthritis. Which statement should the nurse include when reinforcing education for the client on this condition? a. "Osteoarthritis is rarely debilitating." b. "Osteoarthritis is a rare form of arthritis." c. "Osteoarthritis is the most common form of arthritis." d. "Osteoarthritis afflicts people older than age 60."

c. "Osteoarthritis is the most common form of arthritis."

osteoporosis The nurse is reinforcing education for a client on preventing complications of primary osteoporosis. Which statement made by the client indicates an understanding of the education provided? a. "I will refrain from drinking alcohol." b. "I will be sure to take my potassium supplements." c. "I will be sure to take my calcium supplements." d. "I can't help it since I have rheumatoid arthritis."

c. "I will be sure to take my calcium supplements."

A client with osteoarthritis tells the nurse she is concerned that the disease will prevent her from doing her chores. Which suggestion should the nurse offer? a. "Do all your chores in the morning, when pain and stiffness are least pronounced." b. "Do all your chores after performing morning exercises to loosen up." c. "Pace yourself and rest frequently, especially after activities." d. "Do all your chores in the evening, when pain and stiffness are least pronounced."

c. "Pace yourself and rest frequently, especially after activities."

5. The nurse is preparing to administer allopurinol for a client with gout. What should the nurse include in the instructions? a. Use aspirin to additionally relieve pain. b. Eat foods high in purine. c. Drink at least 3 L of fluids each day. d. Alcohol may be used while taking this drug

c. Drink at least 3 L of fluids each day. Allopurinol inhibits uric acid formation. Instruct clients taking any of these medications to drink at least 3 L of a variety of fluids each day to promote excretion of a large urine volume. When taking these medications, clients should not take aspirin or any other salicylate because they counteract the effects of gout-relieving drugs. A diet low in purine helps prevent the accumulation of uric acid and should be encouraged. Alcohol should be avoided while taking this medication.

A nurse is providing nutritional information to a client with a diagnosis of gout. Which of the client's favorite foods should be limited? a. blackberries b. tofu c. liver d. tomatoes

c. liver

GOUT what is the primary therapeutic outcome of colchicine therapy?

eliminate joint pain secondary to acute gout attack

A child has just returned to the room with a cast on the leg after open reduction of a fractured femur. What is the most appropriate action for a nurse to take when a 6 cm by 10 cm area of blood is noted on the cast? a. Tape gauze pads over the bloody area. # after the child has been assessed b. Tell the client that this is normal. c. Lower the leg below heart level. d. Call the health care provider.

d. Call the health care provider.

Complications resulting from a fracture:SATA A. compartment syndrome B. infection C. fat embolism D. osteomyelitis E. atherosclerosis

fat embolism, compartment syndrome, osteomyelitis, infection

A nurse is gathering data to determine fall risk for a client. What information is most important for the nurse collect? Select all that apply. a. functional level b. muscular strength c. social history d. dietary preferences e. gait and balance f. visual acuity

functional level muscular strength gait and balance visual acuity

The nurse is teaching a client with a T4 spinal cord injury and paralysis of the lower extremities how to transfer from the bed to a wheelchair. The nurse should instruct the client to move:

his upper body to the wheelchair first.

A client is involved in a motor vehicle crash and is being transferred to a trauma center. For which classic fractures that typically occur from trauma should the nurse gather data from? brachial and clavicle brachial and humerus humerus and clavicle occipital and humerus

humerus and clavicle

During a scoliosis screening in a college heath center, a student asks the public health nurse about the consequences of untreated scoliosis. The nurse would be accurate by identifying one of the direct complications as:

impingement on pulmonary function.

The Milwaukee brace is commonly used in the treatment of scoliosis. Which position best describes the placement of the pressure rods? a. laterally on the convex portion of the curve b. laterally on the concave portion of the curve c. posteriorly on the convex portion of the curve d. posteriorly along the spinal column at the exact level of the curve

laterally on the convex portion of the curve

When assisting in discharge planning for a child with Duchenne muscular dystrophy, what should the nurse be sure to include regarding the diet? low calorie, high protein, and high fiber low calorie, high protein, and low fiber high calorie, high protein, and restricted fluids high calorie, high protein, and high fiber

low calorie, high protein, and high fiber explanation: A child with Duchenne muscular dystrophy is prone to constipation and obesity, so dietary intake should include a diet low in calories, high in protein, and high in fiber. Adequate fluid intake should also be encouraged.

After a traumatic spinal cord injury, a client requires skeletal traction. When caring for this client, the nurse must: a. change the client's position only if ordered by the physician. # Q2H unless other ordered to prevent skin break down b. maintain traction continuously to ensure its effectiveness. c. support the traction weights with a chair or table to prevent accidental slippage. # freely d. restrict the client's fluid and fiber intake to reduce the movement required for bedpan use. # increase

maintain traction continuously to ensure its effectiveness

The nurse is performing a focused assessment of a client to check for musculoskeletal disorders. What data would be collected using nursing assessment techniques? SATA A. Palpate skin temperature for warmth. B. Observe emotional response to the disorder. C. Palpate joints and muscles. D. Observe posture, coordination, and body build

observe posture, coordination, and body build, noting any asymmetry or deformity, palpate soft tissues, joints, and muscles, and measure muscle mass. palpate the skin temperature for warmth and document any swelling, crepitation, tenderness, skin discoloration, or other abnormality and perform range-of-motion exercises (ROM) to determine musculoskeletal function. Vital signs would be taken on an initial physical assessment.

A client in skeletal traction reports pain even though receiving an analgesic 1 hour ago. The nurse offers an alternative pain management measure. Which measure can be implemented within the nursing scope of practice? acupressure and shiatsu # required training or certification hypnosis and therapeutic touch # required training or certification relaxation and imagery Swedish massage and the Feldenkrais method # required training or certification

relaxation and imagery Relaxation and imagery are effective adjuncts to pharmacologic pain management that the nurse can implement without a health care provider's order

A child with muscular dystrophy has lost complete control of his lower extremities. There is some strength bilaterally in the upper extremities, but poor trunk control. Which mechanism would be the most important to have on the wheelchair? a. anti-tip device b. extended brakes c. headrest support d. wheelchair belt

wheelchair belt

1. a. The clinical features of arthritis include the following: • Persistent pain and stiffness on arising for 6 weeks or longer; stiffness aggravated by damp weather or strenuous activity • Pain or tenderness in the joints, often symmetrical

• Swelling in the joints • Recurrence of symptoms, particularly if more than one joint is involved • Obvious redness and warmth in a joint • Unexplained weight loss, fever, or weakness combined with joint pain • Bouchard nodes or Heberden nodes with degenerative joint disease

(SELECT ALL THAT APPLY) A client is preparing for discharge from the hospital after undergoing an above-the-knee amputation. Which instructions should the nurse include in the teaching plan for this client?

(4) Avoid exposing the skin around the stump to excessive perspiration.( 5) Be sure to perform the prescribed exercises., (6) Rub the stump with a dry washcloth for 4 minutes three times per day if the stump is sensitive to touch.

During data collection of a newly admitted client, the nurse observes a reddened area on the left heel. The nurse applies pressure to the reddened area and notes that it does not blanch when pressure is relieved. When documenting the findings, which appropriate stage would the nurse assign to this pressure sore? stage I stage II stage III stage IV

A stage I pressure sore is reddened and fails to resume its normal color or blanch when applied pressure is relieved. A stage II pressure sore is reddened with blistering or a break in the skin. A stage III pressure sore's skin impairment progresses to a shallow subcutaneous crater. A stage IV pressure sore is deeply ulcerated, exposing muscle and bone.

A client is hospitalized for open reduction of a fractured femur. After surgery, the nurse monitors for signs and symptoms of fat embolism, which include:

restlessness and petechiae.

The infection control team has identified a 25% infection rate on the orthopedic floor. The nursing staff members are asked to record their care activities by recording them in a log to help identify the cause of the high infection rate. Which of the following care activities should be recorded in the activity log?

Hand washing between client contacts

Arthroscopy - Before a client undergoes arthroscopy, the nurse reviews the data collection findings for contraindications for this procedure. Which finding is a contraindication?

Joint flexion of less than 50%

osteoArthritis A 78-year-old client has a history of osteoarthritis. Which signs and symptoms would the nurse expect to find on physical assessment?

Joint pain, crepitus, Heberden's nodes

Which of these findings best correlates with a diagnosis of osteoarthritis?

Joint stiffness that decreases with activity

A client has sustained a right tibial fracture and has just had a cast applied. Which instruction should the nurse provide regarding cast care?

Keep your right leg elevated above heart level.

A client undergoes hip-pinning surgery to treat an intertrochanteric fracture of the right hip. The nurse should include which intervention in the postoperative plan of care? 1 Performing passive range-of-motion (ROM) exercises on the client's legs once each shift 2 Keeping a pillow between the client's legs at all times 3 Turning the client from side to side every 2 hours # turned to the unaffected side 4 Maintaining the client in semi-Fowler's position # avoided

Keeping a pillow between the client's legs at all times

A client has a herniated disk in the region of the third and fourth lumbar vertebrae. When collecting data, the nurse expects to note:

severe low back pain.

The nurse is caring for a client placed in traction to treat a fractured femur. Which nursing intervention has the highest priority?

Assessing the extremity for neurovascular integrity

A client is admitted with severe pain in the knees. Which form of arthritis is characterized by urate deposits and joint pain, usually in the feet and legs, and occurs primarily in men older than age 30?

Gouty arthritis

(SELECT ALL THAT APPLY) A client is diagnosed with gout. Which foods should the nurse instruct the client to avoid?

(2) Liver, (3) Cod, (5) Sardines

(SELECT ALL THAT APPLY) A client with a suspected fracture of the right hip is in the emergency department. Which data collection findings would the nurse expect to see in the client's right leg?

(2)The right leg is shorter than the left leg., (4) The right leg is adducted., (5) The right leg is externally rotated.

(SELECT ALL THAT APPLY) A client is about to undergo total hip replacement surgery. Before the surgery, the nurse conducts a preoperative teaching session with him. The nurse can tell that her teaching has been effective when the client verbalizes the importance of avoiding which actions?

(3) Internally rotating the feet, (4) Bending to pick items up from the floor

A client with arterial insufficiency undergoes below-knee amputation of the right leg. Which action should the nurse include in the postoperative plan of care? Maintaining the client on complete bed rest Applying heat to the stump as the client desires Removing the pressure dressing after the first 8 hours Elevating the stump for the first 24 hours

Elevating the stump for the first 24 hours # helps reduce edema and pain by increasing venous return and decreasing venous pooling at the distal portion of the extremity.

The nurse is teaching a client with osteomalacia how to take prescribed vitamin D supplements. The nurse stresses the importance of taking only the prescribed amount because high doses of vitamin D can be toxic. Early signs and symptoms of vitamin D toxicity include:

GI upset and metallic taste.

crutches A client admitted to the hospital for internal fixation of a fractured left femur is attending physical therapy to learn how to use crutches. After the session, a nurse observes improper crutch use by the client. How should the nurse intervene?

Gently remind the client of the proper technique.