Musculoskeletal and medication

A client receives a prescription for methocarbamol, and the nurse reinforces instructions to the client regarding the medication. Which client statement should indicate a need for further teaching?

"If my vision becomes blurred, I don't need to be concerned about it."

A client with acute muscle spasms has been taking baclofen. The client calls the clinic nurse because of continuous feelings of weakness and fatigue and asks the nurse about discontinuing the medication. The nurse should make which appropriate response to the client?

"Weakness and fatigue commonly occur and will diminish with continued medication use."

The nurse is caring for a client with Paget's disease. The nurse knows that when serum calcium levels are lowered, what hormone secretion increases to release calcium to the blood?

Antidiuretic hormone (ADH)

The nurse is giving the client with a left leg cast crutch-walking instructions using the three-point gait. The client is allowed to touch down the affected leg. How should the nurse teach the client to use the crutches?

Crutches and the left leg, then advance the right leg

The nurse is monitoring a client receiving baclofen for side effects related to the medication. Which should indicate that the client is experiencing a side effect?

Drowsiness

A client has sustained a closed fracture and has just had a cast applied to the affected arm. The client is complaining of intense pain. The nurse has elevated the limb, applied an ice bag, and administered an analgesic, which was ineffective in relieving the pain. The nurse interprets that this pain may be caused by which condition?

Impaired tissue perfusion

A client with multiple sclerosis is receiving baclofen. The nurse monitoring this client should look for which outcome to indicate a primary therapeutic response from the medication?

Decreased muscle spasms

The nurse is teaching a client with osteoporosis who is being discharged with a prescription for a bisphosphonate. What comment by the client shows a need for further teaching?

"I'll take it before supper with 8 ounces of water and stay in an upright position for 30 to 60 minutes."

The clinic nurse is teaching a client who has just been diagnosed with osteoporosis about nutritional therapy. Which comment by the client indicates a need for further teaching?

"I'm glad I can still drink as much coffee as I want."

A film-coated form of diflunisal has been prescribed for a client for the treatment of chronic rheumatoid arthritis. The client calls the clinic nurse because of difficulty swallowing the tablets. Which initial instruction should the nurse reinforce to the client?

"Swallow the tablets with large amounts of water or milk."

The nurse is providing care to a client with this type of cast. (Refer to figure.) The nurse documents that the client has which type of cast?

A hip spica cast

The nurse is reviewing the record of a client who has been prescribed baclofen. Which disorder should alert the nurse to contact the primary health care provider (PHCP)?

A seizure disorder

A client is experiencing an acute exacerbation of bursitis. The nurse encourages the client to avoid which least likely helpful measure until the current episode is resolved?

Active intermittent range of motion

The nurse notes that meloxicam is prescribed for a client. The nurse knows that what are the specific actions of this medication? Select all that apply.

Analgesic Antipyretic Anti-inflammatory

The nurse in the emergency department is caring for a client with a fractured arm. The nurse understands that which item is least likely needed before reduction of the fracture in the casting room?

Anesthesia consent

A primary health care provider is planning to administer a skeletal muscle relaxant to a client with a spinal cord injury. The medication is going to be administered intrathecally. Which medication would the nurse expect to be prescribed and administered by this route?

Baclofen

The nurse is administering an intravenous dose of methocarbamol to a client with multiple sclerosis. For which adverse effect should the nurse monitor?

Bradycardia

The nurse is caring for a client who just been prescribed alendronate. Which conditions contraindicate this medication being given to the client? Select all that apply.

Hypocalcemia Poor renal function Gastroesophageal reflux disease (GERD)

A client has Buck's extension traction applied to the right leg. The nurse should plan which intervention to prevent complications of the device?

Inspecting the skin on the right leg at least once every 8 hours

A client diagnosed with rheumatoid arthritis (RA) has been started on medication therapy with hydroxychloroquine. The nurse reinforces teaching with this client regarding the most serious adverse effect of this medication?

Retinal damage

The nurse is teaching a client how to walk with a cane. Which information should the nurse include? Select all that apply.

The cane should create no more than 30 degrees of flexion of the elbow. The top of the cane should be parallel to the greater trochanter of the femur. A straight leg cane is used if the client only needs minimal support for an affected leg.

A licensed practical nurse (LPN) is reviewing the medical record of a newly assigned client and notes that the client is receiving cyclobenzaprine hydrochloride for the treatment of muscle spasms. The LPN questions the prescription if which disorder is noted in the admission history?

Angle-closure glaucoma

The nurse is caring for a client with muscle spasticity characterized by heightened muscle tone, spasm, and loss of dexterity caused by multiple sclerosis. Which centrally acting skeletal muscle relaxants might be prescribed for this client? Select all that apply.

Baclofen Diazepam Dantrolene

The nurse is reviewing the laboratory studies on a client receiving dantrolene sodium. Which laboratory test(s) would identify an adverse effect associated with the administration of this medication?

Liver function tests

The nurse is caring for a client with gout who is taking colchicine. The client has been instructed to restrict the diet to low-purine foods. Which food would the nurse instruct the client to avoid while taking this medication?

Scallops

Carisoprodol is been prescribed for a client to relieve muscle spasms. The client is being discharged and the nurse is instructing the client and family about the medication. What comment by the client indicates a need for further teaching?

"I'm glad there are no withdrawal problems when I stop taking this medication.

The nurse is planning to teach a client with a left arm cast about measures to keep the left shoulder from becoming stiff. Which suggestion should the nurse include in the teaching plan?

"Lift the left arm up over the head."

The nurse is preparing discharge instructions for a client receiving baclofen. Which instruction should be included in the teaching plan?

Avoid the use of alcohol.

The nurse prepares to reinforce instructions to a client who is taking allopurinol. The nurse should include which instruction in the plan?

Instruct the client to drink 3000 mL of fluid per day.

A licensed practical nurse (LPN) is reviewing laboratory results for a client taking dantrolene sodium. The LPN should suggest that the registered nurse notify the primary health care provider if which finding is noted on the laboratory report sheet?

Lactate dehydrogenase (LDH) 600 units/L

The nurse is caring for a client recently diagnosed with Parkinson disease (PD). The nurse is assessing the client and knows that PD is characterized by what cardinal signs/symptoms? Select all that apply.

Tremor Muscle rigidity Postural instability Bradykinesia or akinesia (slow movement/no movement)

A client with osteoarthritis is receiving diclofenac sodium. The licensed practical nurse (LPN) reviewing the client's medication prescription sheet should verify the prescription with the registered nurse (RN) if which other medication is listed?

Warfarin

A client is receiving a maintenance dose of oral dantrolene sodium for the treatment of spasticity. The nurse reviews the medication record, expecting which dose to be prescribed?

100 mg twice daily

A client with multiple sclerosis is receiving dantrolene for relief of muscle spasticity. When would this medication be discontinued if there is no relief of spasticity?

2 months

A client with rheumatoid arthritis is taking acetylsalicylic acid on a daily basis. Which medication dose should the nurse expect the client to be taking?

4 g daily

A primary health care provider instructs a client with rheumatoid arthritis to take ibuprofen. The nurse reinforces the instructions, knowing that the normal adult dose for this client is which?

400 mg orally 3 times a day

The nurse is discharging a client with a diagnosis of gout. Which best practice guidelines should the nurse teach the client? Select all that apply.

Drink plenty of fluids. Avoid taking diuretics. Avoid excessive physical or emotional stress.

A client with a history of spinal cord injury is receiving baclofen for muscle spasms. The nurse determines that the client is experiencing a side effect of this medication if the client experiences which sign/symptom?

Drowsiness

A client with a left arm fracture complains of severe, diffuse pain that is unrelieved with pain medication. Based on these findings the nurse should take which action?

Notify the registered nurse.

Auranofin has been prescribed for a client with rheumatoid arthritis. The nurse who is collecting data 2 weeks later interprets that the client may be experiencing the signs of medication toxicity based on what data collection findings? Select all that apply.

Observes several mouth lesions Notes a rash on trunk and neck Reports a metallic taste in the mouth Notes purplish blotches on the skin

The nurse is reviewing medications with the client receiving colchicine for the treatment of gout. The nurse determines that the medication is effective if the client reports a decrease in which?

Joint inflammation

An older client with rheumatoid arthritis has been instructed by the primary health care provider to take acetaminophen 3000 mg to 4000 mg daily. Which laboratory test needs to be monitored on this client?

Liver function test (LFTs)

The nurse has given medication instructions to a client beginning therapy with carisoprodol. The nurse determines that the client understands the effects of the medication if the client makes which statement?

"I need to avoid alcohol while taking this medication."

The nurse has reinforced discharge instructions to a client with multiple sclerosis who is receiving baclofen. Which statement by the client indicates an understanding of the medication?

"I need to watch for urinary retention."

Allopurinol has been prescribed for a client with chronic tophaceous gout. The nurse explains to the client that what condition can occur during the first few months of treatment?

Acute gouty arthritis

The nurse is caring for a client who has had a spinal fusion with insertion of hardware. The nurse should be especially concerned with which finding?

An oral temperature of 101° F orally

A client has been taking indomethacin for gout and experiencing side/adverse effects. Which assessment should the nurse expect the primary health care provider to prescribe?

Checking for occult blood

The nurse is caring for a client being treated for fat embolus after multiple fractures. Which data indicate to the nurse a favorable resolution of the fat embolus?

Clear chest x-ray

A primary health care provider prescribes auranofin for a client with rheumatoid arthritis. Which data would indicate to the nurse that the client is experiencing toxicity related to the medication?

Complaints of a metallic taste in the mouth

The nurse is caring for a client who has had an open reduction with internal fixation (ORIF) with a posterior approach. The client has been prescribed hip precautions. The nurse plans to implement which activities in the care of the client? Select all that apply.

Ensure the client doesn't sit or stand for long periods of time. Ensure the client doesn't cross the legs past the midline of the body. Ensure the client uses assistive/adaptive devices with activities of daily living.

Cyclobenzaprine is prescribed for a client to treat muscle spasms, and the nurse is reviewing the client's record. Which disorder would indicate a need to contact the primary health care provider (PHCP) regarding the administration of this medication?

Glaucoma

A client is receiving diazepam for its skeletal muscle relaxant effects. The nurse would monitor this client for which side effect of this medication?

Incoordination

A client with multiple sclerosis is receiving diazepam, and the home care nurse reinforces instructions to the client regarding the side effects of the medication. The nurse tells the client that which is a side effect of this medication?

Incoordination

The nurse is caring for a comatose client at risk for fat embolism because of a fractured femur and pelvis sustained in a fall. Which finding does the nurse identify as early signs/symptoms of possible fat embolism?

Increased heart rate and adventitious breath sounds

A client is complaining of skin irritation from the edges of a cast applied the previous day. The nurse should plan for which intervention?

Petaling the cast edges with adhesive tape

The nurse is checking the casted extremity of a client. The nurse should check for which sign indicative of infection?

Presence of a "hot spot" on the cast

A client is receiving baclofen for muscle spasms caused by a spinal cord injury. The nurse monitors the client, knowing that which is a side effect of this medication?

Slurred speech

During the monitoring of a client's response to disease-modifying antirheumatic drugs (DMARDs), which findings should the nurse interpret as acceptable responses? Select all that apply.

Symptom control during periods of emotional stress Normal white blood cell, platelet, and neutrophil counts Radiological findings that show nonprogression of joint degeneration An increased range of motion in the affected joints 3 months into therapy

Alendronate is prescribed for a client with osteoporosis and the nurse is providing instructions for the administration of the medication. Which instruction should the nurse reinforce?

Take the medication with a full glass of water after rising in the morning.

The nurse is caring for a client with a long bone fracture who is at risk for fat embolism. The nurse specifically monitors for the early signs of this complication by checking which criteria? Select all that apply.

The client's mental status The client's respiratory function

The client has been taking medication for rheumatoid arthritis for 3 weeks. During the administration of etanercept, it is most important for the nurse to collect which data?

The white blood cell and platelet counts

A client is admitted to the hospital with complaints of back spasms. The client states, "I have been taking 2 or 3 aspirin every 4 hours for the past week, and it hasn't helped my back." Aspirin intoxication is suspected. Which complaint would indicate aspirin intoxication?

Tinnitus

A client is being given a transcutaneous electrical nerve stimulation (TENS) unit to use for relief of chronic pain. Which instructions should the nurse reinforce to the client about the TENS unit? Select all that apply.

Using this unit will help relieve the pain. he unit works after attaching electrodes to the skin. The unit needs to be prescribed by the primary health care provider. The unit will decrease the amount of pain medication needed. The electrodes attached to the unit are placed on the skin around the area of pain.

The nurse is caring for a recently admitted client with painful muscle spasms due to a traumatic injury. Besides drug therapy, what are some of the physical measures the nurse expects will be prescribed for this client? Select all that apply.

Whirlpool baths Physical therapy Immobilization of the affected muscle

An adult client with severe muscle spasticity is receiving intrathecal baclofen (ITB). The nurse knows that what adverse effects may occur if the medication is suddenly withdrawn. Select all that apply.

seizures hallucinations

The nurse is one of several people who witness a vehicle hit a pedestrian at a fairly low speed on a small street. The individual is dazed and tries to get up, and the leg appears fractured. The nurse should plan to perform which action?

Stay with the person and encourage the person to remain still.

The nurse is providing instructions to a client with a diagnosis of rheumatoid arthritis (RA) who is receiving acetylsalicylic acid 5 g orally daily. Which statement by the client would indicate an understanding of the instructions?

"I should notify the primary health care provider if I get any ringing in my ears."

The nurse reviews the medication history of a client admitted to the hospital and notes that the client is taking leflunomide. During data collection, the nurse asks which question to determine if the medication is effective?

"Do you have any joint pain?"

Dantrolene sodium is prescribed for a client experiencing flexor spasms, and the client asks the nurse about the action of the medication. The nurse responds knowing that which is the therapeutic action of this medication?

Acts directly on the skeletal muscle to relieve spasticity

The nurse is reinforcing discharge instructions to a client receiving baclofen. Which should the nurse include in the instructions?

Avoid the use of alcohol.

A client is complaining of low back pain with radiation down the left posterior thigh. The nurse continues to collect data from the client to see if the pain is worsened or aggravated with which action?

Bending or lifting

The nurse is caring for a client who has developed compartment syndrome from a severely fractured arm. The client asks the nurse how this can happen. How should the nurse explain compartment syndrome?

Bleeding and swelling cause increased pressure in an area that cannot expand.

A client with multiple sclerosis is receiving diazepam, a centrally acting skeletal muscle relaxant. Which data would indicate that the client is experiencing a side effect related to this medication?

Drowsiness

The nurse is preparing to reinforce instructions to a client regarding how to safely use crutches. Before initiating the teaching, the nurse collects data on the client. Which priority data should be included?

The client's vital signs, muscle strength, and previous activity level

The client has been on treatment for rheumatoid arthritis for 3 weeks. Which is most important for the nurse to check during the administration of etanercept?

The white blood cell counts and platelet counts

Cyclobenzaprine is prescribed for a client for muscle spasms and the nurse is reviewing the client's record. Which disorder, if noted in the record, should indicate a need to contact the health care provider about the administration of this medication?

Glaucoma

A client with right-sided weakness needs to learn how to use a cane. How should the nurse teach the client to position the cane?

Left hand, and 6 inches lateral to the left foot

Baclofen is prescribed for a client with a spinal cord injury who is experiencing muscle spasms, and the nurse prepares a list of the associated side effects of the medication and reviews the list with the client. Which side effect identified by the client indicates a need for further teaching?

Photosensitivity

Colchicine is prescribed for a client with a diagnosis of gout. The nurse reviews the client's medical history in the health record, knowing that the medication would be contraindicated in which disorder?

Renal failure

A client has been started on cyclobenzaprine for the management of muscle spasms in the cervical spine. The client is experiencing drowsiness, dizziness, and dry mouth. The nurse interprets these signs/symptoms as which response?

These are the common side effects of this medication.

A client is taking large doses of acetylsalicylic acid for rheumatoid arthritis. The nurse tells the client to report which signs/symptoms of ototoxicity?

Tinnitus, hearing loss, dizziness, ataxia

A client has been prescribed cyclobenzaprine in the treatment of painful muscle spasms accompanying a herniated intervertebral disk. The nurse should withhold the medication and question the prescription if the client had which concurrent prescriptions to take?

Tranylcypromine

The home care nurse is caring for a client who had a below-the-knee amputation of the right leg. What are some teaching points the nurse gives to the client and family? Select all that apply.

Use a shrinker stocking or sock to cover the wrapped stump. Begin residual limb care when sutures or staples are removed. After the limb is healed, it is cleaned each day with the rest of the body during bathing with soap and water. When the staples or sutures are removed, inspect the end of the residual limb every day for signs of inflammation or skin breakdown.

A client is admitted to the nursing unit after a left below-knee amputation following a crush injury to the foot and lower leg. The client tells the nurse, "I think I'm going crazy. I can feel my left foot itching." How does the nurse correctly interpret the client's statement?

"It is a normal response and indicates the presence of phantom limb sensation."

The nurse is assessing a client recently diagnosed with rheumatoid arthritis. Besides joint inflammation, what are some early systemic sign/symptoms of this disease that the nurse expects to assess? Select all that apply.

fatigue weakness paresthesias low grade fever