Musculoskeletal Alternations Study Guide Questions
Which precaution is most appropriate for the nurse to teach a client with osteoarthritis (OA) who is prescribed to take acetaminophen for mild to moderate pain? A. "Avoid alcoholic beverages while taking this drug." B. "Avoid coffee and other caffeinated drinks while taking this drug." C. "Do not drive or operate dangerous machinery until you know how this drug affects you." D. "If any decrease in vision occurs, stop the drug and notify your primary health care provider immediately."
A. "Avoid alcoholic beverages while taking this drug." Acetaminophen can cause severe liver damage and even liver failure when taken at high doses or too often. This adverse reaction is much more likely to occur in clients who drink alcoholic beverages while on acetaminophen therapy.
Which statement by a client who has arthritis indicates to the nurse the possibility of Sjogren syndrome? Select all that apply. A. "Lately, my eyes have felt gritty by the end of the day." B. "Ice sometimes helps my joint pain better than heat does." C. "If I don't use a vaginal lubricant, intercourse is painful." D. "Some little bumps have appeared on my arm, but they don't hurt." E. "When my arthritis gets worse in one joint, the pain seems worse in all my joints." F. "It's kind of crazy but I have had more cavities in the past 2 years than in all the rest of my life."
A. "Lately, my eyes have felt gritty by the end of the day." C. "If I don't use a vaginal lubricant, intercourse is painful." F. "It's kind of crazy but I have had more cavities in the past 2 years than in all the rest of my life." The three hallmarks of Sjogren syndrome are dry eyes, dry mouth, and (in women) vaginal dryness. Dry mouth greatly increases the risk for and incidence of dental cavities.
What is the nurse's best response when a client who had a long-leg plaster cast applied an hour ago reports that the casts feels "hot"? A. "Plaster gives off heat as it dries, and the heat does not mean anything is wrong." B. "It is likely that you have an infection and will need to be started on antibiotics immediately." C. "This means you are having an allergic reaction and this cast will have to be removed immediately." D. "Don't worry. This heat is normal and I will apply a cooling blanket over it for your comfort."
A. "Plaster gives off heat as it dries, and the heat does not mean anything is wrong." Plaster is applied as a wet and easily deformed substance. As plaster dries, it gives off heat as part of this normal chemical reaction. The client is reassured that the heat is normal. Because plaster is easily deformed until it dries completely, it cannot be covered with a cooling blanket.
Which clients will the nurse collaborate with a registered dietitian nutritionist to assist in modifying their nutritional risk for osteoporosis? Select all that apply. A. 25-year-old female who drinks six cups of coffee daily B. 30-year-old female who is overweight for height C. 35-year-old male who is on the high-protein Atkins diet D. 45-year-old female who drinks unfortified almond milk E. 55-year-old male who drinks one carbonated beverage every day F. 65-year-old male with chronic alcoholism
A. 25-year-old female who drinks six cups of coffee daily C. 35-year-old male who is on the high-protein Atkins diet D. 45-year-old female who drinks unfortified almond milk F. 65-year-old male with chronic alcoholism
Which client will the nurse assess most frequently for indications of venous thromboembolism (VTE)? A. 25-year-old weightlifter with a fracture of the right femur B. 45-year-old with metastatic cancer and a spinal compression fracture C. 55-year-old car crash victim with multiple facial fractures D. 65-year-old with a broken elbow and hypertension
A. 25-year-old weightlifter with a fracture of the right femur VTE is the most common complication of lower extremity fracture resulting from trauma. Immobilization of the limb also contributes to the risk.
Which client will the nurse determine has the highest risk for osteoporosis? A. 30-year-old female who drinks 48 oz(~1250 mL) of diet cola daily and uses high-protection sunscreen В. 40-year-old male who is 72 inches (1.8 m) tall, eats a vegan diet, and participates in competitive martial arts C. 50-year-old male with type 1 diabetes mellitus who lifts weights for exercise D. 60-year-old female who is 15 lb (6.8 kg) overweight and walks 2 miles daily
A. 30-year-old female who drinks 48 oz(~1250 mL) of diet cola daily and uses high-protection sunscreen Risk factors for osteoporosis include being female, consuming excessive amounts of phosphorus (which is a major component of carbonated soft drinks), and being deficient in vitamin D. Not only does the amount of soft drinks consumed daily increase the blood levels of phosphorus, it may well be consumed in place of calcium and vitamin D containing dairy products. The use of high-protection sunscreen limits the amount of vitamin D activated in the skin by exposure to sunlight.
Which client will the nurse assess for the possibility of regional osteoporosis? A. 40-year-old who has been in a long leg cast for 10 weeks B. 45-year-old on long-term corticosteroid therapy for a chronic inflammation C. 55-year-old who is being managed for hyperparathyroidism D. 60-year-old who is postmenopausal with a history of falls
A. 40-year-old who has been in a long leg cast for 10 weeks Regional osteoporosis results from conditions that affect only one body region or area. Having a leg in a long leg cast for 10 weeks can result in bone density loss from reduced mobility and disuse. The other conditions can cause generalized osteoporosis rather than regional problems.
Which new-onset symptoms in a client who is 2 days postoperative after total hip arthroplasty(THA) suggests to the nurse that hip dislocation may have occurred? Select all that apply. A. Agitation B. Loss of appetite C. Increased pain intensity D. Clear drainage on dressing E. Inability to dorsiflex the foot F. Leg shortening on the operative side
A. Agitation C. Increased pain intensity F. Leg shortening on the operative side Signs and symptoms specific to hip dislocation include report of sudden intense pain, sudden agitation for the patient who is unable to communicate, and affected leg rotation, and/or leg shortening.
Which assessments are a priority for the nurse to perform to prevent harm on a client who was hit by a motorcycle and has a suspected pelvic fracture? Select all that apply. A. Checking vital signs B. Asking about opioid use C. Examining urine for presence of blood D. Asking the client to rate his or her pain E. Determining the level of consciousness F. Performing neurovascular checks of the lower limbs
A. Checking vital signs C. Examining urine for presence of blood E. Determining the level of consciousness Injuries that cause pelvic fractures often also cause significant damage to the abdomen and can cause internal hemorrhage, as well as damage to the bladder. Assessing vital signs and level of consciousness have the highest priority to rule out whether hemorrhage and shock are present. Assessing for bladder injury is also a priority. Although the other assessments are important, they are not the immediate priority.
How will the nurse document the assessment finding of a grating sound and grating feeling when moving the knee joint through range of motion on a client who reports pain in that knee? A. Crepitus B. Osteophytosis C. Secondary synovitis D. Subcutaneous emphysema
A. Crepitus Crepitus is a grating sensation heard or felt on palpation when moving through range of motion. It is caused by loosened bone and cartilage present in a synovial joint.
Which precautions are most important for the nurse to stress to prevent harm when teaching about drug therapy to a 32-year-old female client who is prescribed to take oral methotrexate? Select all that apply. A. Do not drink alcohol while taking this medication. B. Be sure to use a reliable form of contraception. C. If the drug causes you nausea, take it at bedtime." D. Avoid crowds of people and those who are ill. E. If you miss a dose, call your rheumatology health care provider immediately. F. This drug may require weeks to months before a full effect is present.
A. Do not drink alcohol while taking this medication. B. Be sure to use a reliable form of contraception. D. Avoid crowds of people and those who are ill. This drug induces liver toxicity and clients are taught not to drink alcohol while on this drug. The drug is known to increase the risk for birth defects and is contraindicated during pregnancy. Methotrexate lowers immunity and increases the risk for infection. The client is taught to avoid crowds and people who are ill. Although the drug may require an extensive period of time before symptoms are reduced, this information does not prevent harm and neither does the suggestion to take it at bedtime. The drug is only taken once per week. If the client misses a dose on the regularly schedule day, he or she is taught to take it as soon as it is remembered. The health care provider does not need to be notified.
Which actions are appropriate for the nurse to perform when caring for a client who is placed in Buck's traction after a hip fracture? Select all that apply. A. Ensuring that the weight never rest on the floor. B. Removing the boot or belt every 8 hours to assess skin integrity. C. Comparing the amount of weights applied with the amount prescribed. D. Removing the weights every 8 hours for 30 minutes to prevent muscle spasms. E. Assessing circulation distal to the traction device every hour for the first 24 hours. F. Instructing all personnel and visitors to not touch or change the position of the weights.
A. Ensuring that the weight never rest on the floor. B. Removing the boot or belt every 8 hours to assess skin integrity. C. Comparing the amount of weights applied with the amount prescribed. E. Assessing circulation distal to the traction device every hour for the first 24 hours. F. Instructing all personnel and visitors to not touch or change the position of the weights. Traction weights are prescribed at a specific weight and are not removed without an order. They are not to be lifted manually, allowed to rest on the floor, and must hang freely at all times. The belt or boot used for skin traction is removed every 8 hours to inspect the skin under the device. The client's circulation is monitored every hour for the first 24 hours after traction is applied and at least every 4 hours thereafter.
Which activity will the nurse recommend that a client with regional osteoporosis of the vertebrae avoid to prevent harm? Select all that apply. A. Jogging B. Jumping rope C. Riding horses D. Participating in yoga E. Riding a stationary bicycle F. Performing water aerobics
A. Jogging B. Jumping rope C. Riding horses Clients with regional osteoporosis of the spine (vertebrae) are at risk for harm from vertebral compression fractures. To reduce this risk, clients are advised to avoid activities that jar the spine. Riding a stationary bicycle, performing water aerobics, and participating in yoga are not "jarring" activities.
Clients with which problems or factors will the nurse assess most frequently for development of acute compartment syndrome? Select all that apply. A. Lower legs caught between the bumpers of two cars B. Massive infiltration of IV fluid into the forearm C. Bivalve cast on the lower leg D. Multiple insect bites to lower legs E. Daily use of oral corticosteroids F. Severe burns to the upper extremities
A. Lower legs caught between the bumpers of two cars B. Massive infiltration of IV fluid into the forearm D. Multiple insect bites to lower legs F. Severe burns to the upper extremities Acute compartment syndrome is a serious limb-threatening condition in which increased pressure within one or more compartments (that contain muscle, blood vessels, and nerves) reduces circulation to a lower leg or forearm. Common health problems leading to this condition include crush injuries to the extremities, extravasation and infiltration of IV fluids, and severe inflammatory response with excessive swelling in an extremity, such as with burn injuries or release of toxins from multiple insect stings or bites.
Which assessment findings in a client with osteoarthritis scheduled to have a total joint replacement (TJR) will the nurse report to the surgeon immediately? Select all that apply. A. Reports having an abscessed tooth B. Has asthma symptoms with seasonal allergies C. Had a dental implant placed about 3 years ago D. Repeat blood pressure readings are consistently higher than 160/90 E. Pain rating in affected joint is 9 on a 0 to 10 pain rating scale F. Has type 2 diabetes and today's fasting blood glucose level is 102 mg/dL (5.7 mmol/L)
A. Reports having an abscessed tooth D. Repeat blood pressure readings are consistently higher than 160/90 Before TJR can proceed, the client needs to be infection free and have other chronic health problems well controlled. The client has a current infection and hypertension is not controlled. The diabetes is controlled. None of the other client issues are contraindications for TJR surgery.
Which assessment findings will the nurse expect in a client who is admitted with acute osteomyelitis of the left lower leg? A. Temperature greater than 101°F, swelling, tenderness, erythema, and warmth in the area B. Ulceration resulting with sinus tract formation, localized pain, and drainage C. Aching pain, poorly described, deep, and worsened by pressure and weight bearing D. Shortening of the extremity with pain during weight bearing or palpation
A. Temperature greater than 101°F, swelling, tenderness, erythema, and warmth in the area The most common symptom of acute osteomyelitis is pain. Fever, usually with temperature greater than 101° F (38.3° C) also is present. As the area around the infected bone swells, tenderness on palpation occurs. Erythema (red-ness) and heat may also be present.
Which points and actions will the nurse include when teaching a client and family after a below-the-knee amputation about care of the residual limb? Select all that apply. A. Demonstrating how to apply a figure-eight elastic wrap B. Reviewing the signs and symptoms of wound infection C. Reminding the client and family to rewrap the limb several times each day D. Obtaining a return demonstration of the elastic wrap application E. Reviewing positioning and exercises for prevention of flexion contractures F. Informing the client that after the incision is healed, it can be cleaned during bathing or showering with soap and water
All of them. All of the listed points and actions are appropriate for the nurse to include when teaching a client and family about care of the residual limb at home.
How will the nurse instruct a client to prepare for a dual x-ray absorptiometry (DA) scan? A. "Blood and urine specimens will be taken immediately before the test." B. "Leave metallic objects such as jewelry, coins, and belt buckles at home." C. "Be sure to have someone come with you to drive you home after the test." D. "Bring a comfortable loose nightgown without buttons or snaps, and a pair of slippers."
B. "Leave metallic objects such as jewelry, coins, and belt buckles at home." DA scans are painless and do not require medications or blood and urine specimens. The client remains dressed, but is required to have no metallic objects on them. Metal can interfere with the test.
Which statement by a client with osteoarthritis(OA) indicates to the nurse the need for more education about health promotion to prevent harm? Select all that apply. A. "My children gave me a gift certificate for parathin dips for my feet." B. "When my joints are really stiff, I try to stay in bed most of the day." C. "I find that my knees hurt less when I wear shoes with firm soles rather than slippers." D. "Keeping my knees bent on a large pillow while sleeping at night helps reduce my pain." E. "Even on days when I have more severe symptoms, I try to walk short distances outside." F. "I read that avoiding eating tomatoes, potatoes, and eggplant can help reduce arthritis pain."
B. "When my joints are really stiff, I try to stay in bed most of the day." D. "Keeping my knees bent on a large pillow while sleeping at night helps reduce my pain." Staying in bed can lead to muscle atrophy and other problems that worsen mobility. Keeping the knees bent on a large pillow while sleeping can lead to flexion contractures that reduce mobility.Options A, C, and E are good health promotion actions for client with OA. Although there is no evidence that avoiding certain foods can help reduce pain and other problems with OA, the avoidance of the listed foods does not cause harm to the client.
What is the nurse's best response to a client with lower limb amputation who says "I think I am going crazy. I know my foot is gone but I still feel my big toe burning and itching."? A. "Are you sure you were awake? Sometimes people dream this pain was part of hoping that the missing body part will grow back." B. "You are not crazy; many people continue to feel pain and other sensations in a limb that was amputated. How severe is this pain?" C. "This complication is usually seen in a person who has not accepted the fact that the limb is gone. A psychologist can help you cope with this." D. "This problem is very common and although nothing can be done about it, we can give you pain medication for the pain you feel at the surgical site."
B. "You are not crazy; many people continue to feel pain and other sensations in a limb that was amputated. How severe is this pain?" Phantom limb pain (PLP) is a real physiologic problem for many people after amputation. The pain is real and requires appropriate management. Telling the client that the limb cannot be hurting because it is missing is not therapeutic and will not reduce the client's expressed concern that he may be "crazy". Drug therapy for PLP varies with the type of sensation felt as well as the intensity. Although some clients may need a mental health care professional to assist with coping, immediate pain management is the priority for this client, along with allaying his anxiety.
Which clients with fractures will the nurse recognize as being at increased risk for delayed or slow bone healing? Select all that apply. A. 28-year-old male with multiple long-bone fractures B. 35-year-old female with diet-induced osteopenia C. 45-year-old female semiprofessional tennis player D. 58-year-old female taking corticosteroids daily for an autoimmune disorder E. 65-year-old male with arteriosclerosis F. 75-year-old male chronic obstructive pulmonary disease
B. 35-year-old female with diet-induced osteopenia D. 58-year-old female taking corticosteroids daily for an autoimmune disorder E. 65-year-old male with arteriosclerosis F. 75-year-old male chronic obstructive pulmonary disease Risk factors for delayed or slow bone healing after a fracture include age older than 70 years, presence of bone density loss, such as with osteopenia or chronic use of corticosteroids, and poor circulation, such as would be present with arteriosclerosis. Unless there are complications, multiple fractures do not increase delayed healing risk.
Which client will the nurse determine requires the most assistance with performance of ADLs? A. 28-year-old with bilateral below-the-knee amputations B. 40-year-old with amputation of the dominant hand C. 50-year-old with an above-the-knee amputation of the dominant leg D. 70-year-old with amputation of all the toes on the left foot
B. 40-year-old with amputation of the dominant hand Clients who have any part of an upper extremity amputated, especially of the dominant hand are much more likely to become less independent in ADLs. A 70-year-old client who has been independent in ADLs is likely to remain independent after amputation of all toes on the left foot although balance and mobility may be changed.
For which client with osteoporosis will the nurse question the primary health care provider's prescription for calcium and vitamin D supplementation? A. 40-year-old with diabetes mellitus B. 50-year-old with urinary stones C. 55-year-old with esophageal ulcers D. 65-year-old with venous thromboembolism
B. 50-year-old with urinary stones Increasing serum calcium levels can exacerbate the development of urinary stones in a client who has a history of stone formation.
Which associated problem will the nurse assess for in a client with osteoarthritis who has a large effusion of the left knee? A. Corresponding symptoms in the right knee B. Atrophy of the muscles above the left knee C. Presence of Heberden nodules on the right knee D. Joint hardness on palpation of the left knee
B. Atrophy of the muscles above the left knee Decreased mobility is common when clients have pain from joint effusions, which results in muscle atrophy about the affected joint. With OA, the disorder is usually unilateral. Heberden nodules appear on the fingers (distal joints), not on the knees. Joint effusions fill the joint with fluid, making them soft on palpation.
Which health problems or assessment findings in a client with osteoarthritis who reports that he has been taking glucosamine for joint pain causes the nurse to have concern about this complementary therapy? Select all that apply. A. Client is 20 lb (9.9 kg) overweight B. Blood pressure is 150/90 C. Resting pulse is 90 beats/min D.A light red rash is present D. Client has type 2 diabetes E. Morning stiffness lasts 2 hours
B. Blood pressure is 150/90 E. Morning stiffness lasts 2 hours Glucosamine can increase blood glucose levels and raise blood pressure. It is contraindicated for clients who are hypertensive or have diabetes mellitus. The other problems or findings have no significance with glucosamine therapy.
Which assessment finding in a client who has a fracture of the right wrist alerts the nurse to a possible early indication of a complication? A. Wiggling fingers causes pain. B. Client reports numbness and tingling. C. Fingers are cold and pale; pulses are impalpable. D. Pain is severe and seems out of proportion to injury.
B. Client reports numbness and tingling. Numbness and tingling are early indications of nerve entrapment or impingement. Moving the fingers below a wrist injury is expected to cause some pain. Cold, pale fingers in which pulses cannot be palpated is a late indication of a complication, as is pain that grows worse out of proportion to the injury.
Which exercise will the nurse suggest for the client with kyphosis to improve lung capacity? A. Swimming and yoga B. Deep breathing and pectoral stretching C. Range of shoulder and hip movements D. Walking or jogging 30 minutes three times weekly
B. Deep breathing and pectoral stretching Kyphosis reduces chest expansion and lung ca-pacity. Exercises that can specifically improve lung capacity include abdominal tightening, deep breathing, and pectoral stretching.
What lifestyle changes does the nurse suggest to help slow joint degeneration for a client who has been newly diagnosed with osteoarthritis(OA)? Select all that apply. A. Avoiding direct sunlight and other sources of ultraviolet light B. Keeping body weight appropriate for height and body type C. Quitting smoking, vaping, or using nicotine in any form D. Avoiding any participation in outdoor activities E. Avoiding activities that may result in trauma F. Engaging in low-impact exercises daily
B. Keeping body weight appropriate for height and body type C. Quitting smoking, vaping, or using nicotine in any form E. Avoiding activities that may result in trauma F. Engaging in low-impact exercises daily Increased weight both causes OA and worsens damage to existing OA. Nicotine causes vasoconstriction and reduces blood flow to joints, which may result in ischemia and necrosis of already damaged joints. Activities that may result in trauma put stress on uninjured joints and intensity the damage to joints already affected by OA. Engaging in daily, low-impact exercises helps prevent muscle atrophy around affected joints, taking some stress off those joints. Avoiding sunlight or any ultraviolet light does not prevent problems with OA and, because exposure to sunlight activates vitamin D in the skin and contributes to bone density maintenance, limited sun exposure may increase the risk for osteopenia. There is no orthopedic benefit to avoiding the outdoors.
Which dietary changes will the nurse in collaboration with the registered dietitian nutritionist reinforce to the client who has osteoporosis to treat the disorder? Select all that apply. A. Increasing fiber B. Limiting caffeinated beverages C. Increasing leafy green vegetables D. Increasing low-fat dairy products E. Reducing high carbohydrate-containing fruit F. Eliminating eggs and other animal-sourced proteins
B. Limiting caffeinated beverages D. Increasing low-fat dairy products The specific dietary treatment for osteoporosis is the same as prevention. This focuses on increasing intake of calcium and vitamin D (dairy products) and reducing dietary intake of substances that can reduce blood levels of the mineral and vitamin (i.e., caffeine). Eggs and other proteins are needed to maintain good bone health, as are fruits and vegetables.
Which client assessment findings or factors indicate to the nurse the possible presence of carpal tunnel syndrome (CTS)? Select all that apply. A. Client has been taking calcium and vitamin D supplements for osteopenia. B. Numbness and pain are reported on performance of the Phalen maneuver. C. Muscle pad below the thumb is flat and atrophied. D. Client's favorite hobby is knitting and crocheting. E. Wrist and hand pain awaken the client at night. F. Lifestyle is very sedentary.
B. Numbness and pain are reported on performance of the Phalen maneuver. C. Muscle pad below the thumb is flat and atrophied. D. Client's favorite hobby is knitting and crocheting. E. Wrist and hand pain awaken the client at night. CTS is most commonly caused by repetitive motions of the hand and wrist, such as would occur with knitting and crocheting. Muscle atrophy of hand muscles often results from CTS. Pain and numbers with the Phalen maneuver are strong indicators of CTS as is the increased presence of these symptoms at night. Neither osteopenia nor a sedentary lifestyle predispose a person to CTS.
How will the nurse interpret the risk for osteoporosis in a client whose T-score is -3? A. Osteopenia is present. B. Osteoporosis is present. C. Risk for osteopenia is increased. D. Score is normal and does not indicate a risk for osteoporosis.
B. Osteoporosis is present. The T-score represents the standard deviations above or below the average bone marrow density (BDM) for young healthy adults. A T-score of -1 to -2.5 indicates osteopenia. A T-score lower than -2.5 (-3) indicates osteoporosis.
Which assessment finding on a client who has a closed fracture of the lower femur with extensive swelling and bruising best indicates to the nurse that perfusion in the affected limb is adequate? A. Pulse oximetry on the right forefinger is 98%. B. Pedal pulse of the affected limb is easily palpated and strong. C. Femoral pulse of the affected limb is easily palpated and strong. D. Capillary refill on great toe of the affected limb is about 4 seconds.
B. Pedal pulse of the affected limb is easily palpated and strong. Measures of perfusion adequacy in the affected limb must be made on the affected limb, distal to the injury. Although capillary refill can provide an indication of perfusion adequacy, it is not as reliable as a pedal pulse.
Which assessment findings in a client with a complete and displaced fracture of the femur indicates to the nurse possible fat embolism syndrome (FES)? Select all that apply. A. Increased swelling over the fracture site B. Petechiae on the neck and chest C. Decreased platelet count D. Dry mucous membranes E. Sudden-onset confusion F. PaO2=72 mm Hg
B. Petechiae on the neck and chest C. Decreased platelet count E. Sudden-onset confusion F. PaO2=72 mm Hg Decreased arterial oxygen level, acute confusion, and a decreased platelet count are common indicators of FES. Although the presence of a petechial rash is a late manifestation, it is a classic finding of FES. Swelling over the fracture site and dry mucous membranes are not symptoms associated with FES.
Which client condition will the nurse recognize as increasing the risk for osteomyelitis of facial bones? A. Chronic sinusitis as a result of persistent allergies B. Poor dental hygiene and periodontal infection C. Untreated pharyngeal streptococcal infection D. Presence of chronic diabetic foot ulcers
B. Poor dental hygiene and periodontal infection Often, osteomyelitis develops as a result of in-fection in adjacent tissues that spreads directly to nearby bone. These are known as contiguous osteomyelitis infections. Poor dental hygiene and periodontal (gum) infection can be causative factors in contiguous osteomyelitis in facial bones.
Which client risk factors or health problems will the nurse associate with osteoporosis? Select all that apply. A. Muscle cramps B. Sedentary lifestyle C. Back pain relieved by rest D. Fracture E. Urinary or renal stones F. High-cholesterol diet
B. Sedentary lifestyle C. Back pain relieved by rest D. Fracture A sedentary lifestyle with little weight-bearing activity contributes to the development of osteoporosis. Health problems that can result from osteoporosis include back pain relieved by rest and fragile fractures. Muscle cramps and urinary stones do not result in or from osteoporosis. Although poor nutrition is associated with osteoporosis, no evidence suggests that a high-cholesterol diet increases the risk for osteoporosis.
A client expresses concern over the presence of external pins and external devices used to manage her fracture and says she wishes it all could have been placed internally so it wound't be visible. What advantages will the nurse tell the client that external fixation has over internal fixation of fractures? Select all that apply. A. The risk for infection is reduced. B. You lost less blood than you would have with an internal fixation. C. This device allows you to move and walk earlier than an internal device. D. You will not need surgery to remove these devices after healing is complete. E. Most people have less pain with the external devices than with internal devices. F. This device replaces the need for the use of any other device such as a cast or a boot, later.
B. You lost less blood than you would have with an internal fixation. C. This device allows you to move and walk earlier than an internal device. D. You will not need surgery to remove these devices after healing is complete. E. Most people have less pain with the external devices than with internal devices. The use of external fixation devices results in less blood loss and less pain than internal fixation devices. Moving, walking, and exercising can occur much earlier. The infection risk for external fixation devices is greater than with internal devices because there is a continuing disruption of skin integrity with the presence of pins. Other devices may still be needed after fractures are stabilized with external fixation devices.
What is the nurses best response when a client who has been treated for 4 weeks for osteomyelitis asks why the disease is so difficult to cure? A. "Bones have a poor blood supply and are located so deep in the body that it is hard for antibiotics to reach them." B. "There are no early symptoms of osteomyelitis, so by the time it is detected the infection is widespread." C. "After a bone abscess forms, it gets covered with a new layer of bone that is difficult for drugs to penetrate." D. "The most common organisms that cause osteomyelitis are usually drug-resistant."
C. "After a bone abscess forms, it gets covered with a new layer of bone that is difficult for drugs to penetrate." Bone infections can easily damage bone tissue leading to tissue necrosis and abscess formation.Because bone is a dynamic tissue and attempts to heal itself, osteoblasts often lay new bone tissue over the infected tissue making it difficult for drug therapy to penetrate into the infected bone. Although some organisms may be drug-resistant, even when the organism is sensitive to the antibiotic, the real problem is drug pen-etration. Higher doses and longer duration of drug therapy are needed to eradicate the infection and prevent complications such as chronic osteomyelitis and sepsis.
Which client statement indicates to the nurse the possibility of osteoarthritis (OA)? A."When I stand too long in one place, my back hurts although walking doesn't bother it." B."I noticed that my third finger joint seems to be tilting inward toward my other fingers." C. "My knees hurt so much that I end up taking a lot of acetaminophen or aspirin." D. "There is a lot of osteoarthritis in my family. What can I do to prevent it?"
C. "My knees hurt so much that I end up taking a lot of acetaminophen or aspirin." Persistent and specific joint pain is the most common reason that clients with OA seek health care.
Which instruction is most appropriate for the nurse to teach a client prescribed to take alendronate 10 mg daily? A. "Be sure to rotate injection sites every week." B. "Be sure to take the drug 1 hour before or at least 2 hours after a meal." C. "Remain in the upright position for at least 30 minutes after taking the drug." D. "Report any headaches you experience to your primary health care provider immediately?
C. "Remain in the upright position for at least 30 minutes after taking the drug." This drug, along with all others in the bisphosphonate class, greatly increases the risk for esophagitis, esophageal ulcers, and gastric ul-cers. The drug should be taken without food and on an empty stomach. Having the client remain in the upright position after taking the drug helps prevent stomach contents from refluxing back into the esophagus and irritating it.
When interviewing a client who is suspected to have osteoarthritis (OA), which question is most important for the nurse to ask? A. "Can you tell if your pain and mobility are worse after eating certain foods?" B. "In looking at your family, who has more arthritis, the men or the women?" C. "What activities would you like to do but don't because of your joint pain?" D. "When pain is present, is it usually accompanied by a headache?"
C. "What activities would you like to do but don't because of your joint pain?" Assessing how much the pain affects the client's quality of life and ability to participate in ADLs, as well as home care, work, and pleasurable activities, is important in planning interventions and client education materials for management of the disorder.
Which clients will the nurse be sure to assess as having an increased risk for developing osteoarthritis (OA)? Select all that apply. A. 30-year-old woman with a family history of rheumatoid arthritis B. 35-year-old man who is 10 lb (4.5) underweight and has never smoked C. 40-year-old woman with multiple knee injuries from playing soccer in high school D. 45-year-old man who worked construction for 25 years E. 50-year-old man who is 10 lb (4.5 kg) overweight and plays golf twice weekly F. 65-year-old obese woman who lives alone after working as a hairdresser for 40 years
C. 40-year-old woman with multiple knee injuries from playing soccer in high school D. 45-year-old man who worked construction for 25 years F. 65-year-old obese woman who lives alone after working as a hairdresser for 40 years Obesity is an independent risk factor for OA in men and women. Although more men than women usually have OA as a result of sports injuries, women who sustained significant joint injuries when younger also have an increased risk for OA in those previously injured joints. Working at jobs that require heavy manual labor or remaining in one position for long periods of time increase the risk. A family history of rheumatoid arthritis does not increase the risk the OA and neither does participating in lower impact activities such as golf.
For which client with osteoarthritis (OA) will the nurse question a prescription for celecoxib? A. 40-year-old with asthma B. 45-year-old with type 2 diabetes C. 50-year-old with cardiovascular disease D. 55-year-old with irritable bowel syndrome
C. 50-year-old with cardiovascular disease All COX-2 NSAIDs, including celecoxib, increase the risk for cardiovascular events, especially myocardial infarctions. These drugs are either not recommended or are used with extreme caution in clients with cardiovascular disease.
For which side effect will the nurse most closely monitor an older client receiving an opioid drug for pain control after total hip replacement surgery? A. Sudden-onset hypertension B. Urinary retention C. Acute confusion D. Dark, tarry stools
C. Acute confusion Although any client can become confused as a result of opioid drugs, older clients are much more likely to have this side effect.
What is the most appropriate action for the nurse to take when assessment on a client with external fixation reveals crusts have formed around the pin sites? A. Assessing the client's temperature B. Notifying the surgeon immediately C. Documenting the finding as the only action D. Removing the crusts and culturing the drainage
C. Documenting the finding as the only action Drainage of clear fluid (weeping) is expected in the first 72 hours around pin sites. The drainage forms crusts that are believed to protect the site from infection and are not removed.
Which foods will the nurse suggest to increase calcium and vitamin D intake for a client who is lactose intolerant? A. Fresh apples and pears B. Whole-grain bread and pasta C. Fortified soy or rice products D. Skim milk and fat-free yogurt
C. Fortified soy or rice products Fortified soy and rice products are good sources of calcium and vitamin D. A client who is lactose intolerant would not be able to use dairy products as a calcium source. The other items listed do not contain significant amounts of calcium and vitamin D.
Which assessment finding on an older client who fell while getting out of bed indicates to the nurse a possible fracture? A. The client is extremely confused and trying to get up. B. The client cries out when the nurse attempts to examine him. C. One leg is shorter than the other and has a protruding bump on the side. D. The skin of both legs is cooler and darker than that of the upper extremities.
C. One leg is shorter than the other and has a protruding bump on the side. Strong indicators of lower limb fracture or joint dislocation is a change in the length (usually shorter) of the affected limb and abnormal protrusions or obvious deformities. In an older client, the skin of the legs is cooler and darker than that of the arms. Confusion may be a cause or a consequence of the fall but does not indicate a fracture of bone injury. Pain is nonspecific.
Which assessment is the priority for the nurse to perform on a client admitted to the emergency department with multiple rib fractures? A. Pulses in all 4 extremities B. Pulse rate and rhythm C. Oxygen saturation D. Pain intensity
C. Oxygen saturation Rib fractures are painful and the client may be breathing too shallowly to maintain gas exchange. In addition, if there are shard edges on the ribs, the lungs can be punctured. After respiratory assessment, cardiac assessment would be the next priority.
Which instruction will the nurse give to the client with plantar fasciitis about self-management to reduce pain? A. Use rest, elevation, and warm packs. B. Perform gentle jogging exercises. C. Strap the foot to maintain the arch. D. Wear loose or open shoes, such as sandals.
C. Strap the foot to maintain the arch. Plantar fasciitis is an inflammation of the fascia that holds foot bones in place to form the foot's arch. Supporting the arch by wearing shoes with a good arch support or an orthotic insert can help prevent the fascia from pulling and irritation. Strapping the center of the sole of the foot, which can be performed by the client, also helps maintain the arch and reduce the pain.
Which suggestion will the nurse make to help a client who has complex regional pain syndrome (CRPS) in the right arm weeks after an open reduction was required to repair a broken elbow and fractured radius to reduce the discomfort? A. Take pain medications around the clock even when the pain is not present. B. When the sensations occur, immobilize and ice the limb until they pass. C. Use a dry wash cloth and rub the skin on the arm several times daily. D. Wrap the arm in warm, wet compresses as soon as the pain starts
C. Use a dry wash cloth and rub the skin on the arm several times daily. CRPS is a dysfunction of the central and peripheral nervous systems in areas of bone fractures with soft-tissue damage that leads to severe, persistent burning pain, muscle spasms, and changes in skin color, temperature, and sensitivity among other symptoms. To facilitate soft-tissue healing and prevent CRPS, clients are told to frequently apply a variety of objects with varying surface types directly to the skin to desensitize it. These objects can be rough, smooth, hard, soft, sharp (but not enough to damage the skin), or dull.
Which drugs belong to the estrogen agonist/ antagonist class? Select all that apply. A. Alendronate B. denosumab C. estrogen/bazedoxifene D. ibandronate E. raloxifene F. risedronate G. zoledronic acid
C. estrogen/bazedoxifene E. raloxifene Alendronate, ibandronate, risedronate, and zole-dronic acid all belong to the bisphosphonate class of drugs. Denosumab is a monoclonal antibody.Estrogen/bazedoxifene and raloxifene are from the estrogen agonist/antagonist class of drugs.
Which responses, from a client with advanced osteoarthritis, alert the nurse that the client may be having a problem coping with the image and role changes related to disease progression? Select all that apply. A. "It seems that I am getting younger.I used to tie my shoes; now I am using Velero closures just like my grandkids." B. "Washing dishes in very warm water makes my hands feel so good that I don't use the dishwasher much." C. "I used to be a playground assistant; now I contribute by working with children who need help with reading" D. "Because my joints hurt so much, I just look out the window instead of working in my garden. E. "I no longer wear my rings so I don't draw attention to how awful my hands look." F. "Although I can no longer play the piano, I really enjoy going to concerts."
D. "Because my joints hurt so much, I just look out the window instead of working in my garden. E. "I no longer wear my rings so I don't draw attention to how awful my hands look." The responses about missing an activity without replacing it and the one about how awful the hands look shows a negative body image. All of the other responses demonstrate positive changes or adaptations that the client uses in adapting to disease progression.
Which question is most important for the nurse to ask a client who is about to receive a prescribed preoperative dose of IV cefazolin before total joint replacement surgery to prevent harm? A. "Did you shower with chlorhexidine gluconate this morning?" B. "When did you last take aspirin or any other NSAID?" C. "Do you have a sulfa drug allergy?" D. "Do you have a penicillin allergy?"
D. "Do you have a penicillin allergy?" The most commonly used antibiotic prescribed to be administered within an hour of initiation of surgery is cefazolin. This drug is structurally similar to penicillin and if the client is allergic to penicillin, he or she will also be allergic to cefazolin.
Which question is most appropriate for the nurse to ask a client who has been receiving scheduled and PRN opioids for severe pain with multiple fractures who now has a distended abdomen and hypoactive bowel sounds? A. "Did you use opioids or other recreational drugs before your injury?" B. "What specific foods have you eaten in the past 2 days?" C. "How would you rate your pain on a 0 to 10 scale?" D. "When was your last bowel movement?"
D. "When was your last bowel movement?" Severe fractures are very painful and usually require opioid pain medications for some time regardless of whether the client has ever used opioids in the past. A major side effect of opioids is decreased peristalsis and constipation (opioid-induced constipation [OIC]). The first question to ask is when did the client last have a bowel movement. The client usually requires a bowel regimen to relieve constipation and prevent a possible paralytic ileus.
Which client will the nurse consider to be at highest risk for nonunion after a fracture? A. 40-year-old who is 20 lb overweight and has a Colles fracture of the wrist B. 50-year-old female with comminuted fracture of the humerus C. 60-year-old male with multiple fractured ribs D. 70-year-old female with a "sib-fib" fracture
D. 70-year-old female with a "sib-fib" fracture This client has three major risk factors for nonunion: older age, female, and lower limb fracture.
With which client will the nurse remain most alert for indications of acute hematogenous osteomyelitis? A. 30-year-old male with a leg fracture and external skeletal pins B. 50-year-old female in an ICU with pneumonia C. 65-year-old female with MRSA infection D. 72-year-old male with a catheter-related urinary tract infection
D. 72-year-old male with a catheter-related urinary tract infection Acute hematogenous infection results from bacteremia, underlying disease, or non-penetrating trauma. Urinary tract infections, particularly in older men, tend to spread to the lower vertebrae.
After ensuring airway, breathing, and circulation along with a head-to-toe assessment, which action will the nurse take next in the emergency care of a client with an extremity fracture? A. Checking the neuromuscular status of the area distal to the injury: temperature, color, sensation, movement, and distal pulses by comparing the affected and unaffected limbs B. Elevating the affected area on pillows, applying an ice pack that is wrapped to protect the skin, and obtaining a prescription for pain medication C. Immobilizing the extremity by splinting; including joints above and below the fracture site, followed by rechecking the circulation D. Removing or cutting the client's clothing to inspect the affected area while supporting the injured area above and below the injury
D. Removing or cutting the client's clothing to inspect the affected area while supporting the injured area above and below the injury Before any appropriate intervention action can be taken, the nurse must first visually inspect the area to adequately assess the trauma. This entails removing or cutting away clothing in the affected area without causing more harm.
