Musculoskeletal Disease- ATI and Nclex questions

A patient asks the nurse the difference between Rheumatoid arthritis and osteoarthritis. The nurse responds, " Osteoarthritis is.... a. autoimmune b. localized c. systemic d. bilateral

b. localized localized process associated with aging and can affect any joint

The nurse is discharging a patient who underwent LKA. The patient understands the discharge instructions if the patient states the need to: a.maintain bedrest for 1 day b. notify physical if site inflammation or fever develops c. restrict food intake for 1st day d. resume normal activity the following day

CORRECT: b. notify physical if site inflammation or fever develops

A client is discharged after having an open reduction and internal fixation of a fractured tibia with application of a plaster caste. The nurse teaches the client to evaluate for early signs of decreased circulation r/t post surgical edema. The teaching was understood when the client identifies a manifestation of decreased circulation as... A. Coldness of the toes B. Capillary refill of 3 seconds C. Blanching of the nail beds with pressure D. Pain at the surgical site

A. Coldness of the toes Decreased venous return from the constriction caused by a cast may lead to impaired circulation of the foot. Manifestations of impaired circualation include toes that are cold, numb, tingling, or swollen.

A client with a radial fracture reports itching under the casted area. The appropriate nursing action to relieve itching is to... A. Use a hair dryer on a cool setting to blow air into the cast B.elevate the affected extremity C. Provide a cotton swab to scratch the area D. Explain to the client that itching is an indication the fracture is healing

A. Use a hair dryer on a cool setting to blow air into the cast The cool air will cause vasoconstriction and decrease neural transmission of sensation to the affected area

The nurse is providing discharge instructions to a patient who had a THA. Which patient statement indicates a need for additional instruction? a/" I should avoid driving for at least 6 weeks" b. "I should avoid low squatting exercises" c. "I should change my position at least every 2 hours" d. "I should keep a pillow between my legs when I life down"

CORRECT: c. "I should change my position at least every 2 hours" --> frequent standing, stretching, and movement 1. pillow in-between legs= promote abduction of hips

A Nurse is assessing a patient suspected of having carpal tunnel syndrome. Which assessment is indicative of carpal tunnel syndrome? a. negative tine's sign b. negative Trousseau's sign c. Positive Phalen's sign d. Positive Trousseau's sign

CORRECT: c. Positive Phalen's sign - tingling in hand with wrist flexion, median nerve compression INCORRECT: a. negative tine's sign --- correct: POSITIVE TINEL's sign ---- characterized by tingling in hand after tapping the median nerve of wrist b and d. Trousseau's sign ---- correct: associated with hypocalcemia

A pt with osteoporosis is post-op day two in the hospital for a hip fracture. Which of the following would improve her outcomes? Select all that apply a. encourage ambulation b. involving and educating the patient's significant other in care c. leaving foley in place to prevent incontinence until better motility is regained d. recommending that visitors come in the afternoon to avoid conflict with morning nursing cares e. working with pt to develop a care plan that will meet her discharge goals

CORRECT: a. encourage ambulation b. involving and educating the patient's significant other in care e. working with pt to develop a care plan that will meet her discharge goals

The goal for nursing care management in a client with osteoarthritis is promotion of a healthy, positive adaptation. Education is a key to successful treatment of the disease. Which of the following are accurate client teachings about the disease and strategies to minimize its impact? SELECT ALL THAT APPLY a. encourage use of long-handled combs b. exercise the weakest joints to avoid misuse c. perform activities that require a firm grip d. suggest relaxation techniques and guided imagery e. teach client that pain during exercise means that they are working out properly f. tell doctor if you have abdominal pain, tarry stools, or hematemesis when taking NSAIDS

CORRECT: a. encourage use of long-handled combs d. suggest relaxation techniques and guided imagery f. tell doctor if you have abdominal pain, tarry stools, or hematemesis when taking NSAIDS

The nurse is caring for a patient with a left arm cast. Nurse should alert which of the following when assessing for signs of infection: Select all that apply a. foul odor b. hot spot on the cast c. absent radial pulse d. delayed cspillary refill e. edema

CORRECT: a. foul odor b. hot spot on the cast INCORRECT: c. absent radial pulse d. delayed cspillary refill e. edema SIGNS OF COMAPRTMENT SYNDROME

The nurse is discharging a patient who recently underwent AKA of the left lower extremity. The patient requires more education if he states: a. "I should call my prosthetist if my prosthesis is not fitting correctly" b. "I should elevate the affected limb to reduces swelling" c. I will change my limb stock every day" d. "I will clean wound daily with rubbing alcohol" e. "I will inspect the amputation site daily"

CORRECT: b. "I should elevate the affected limb to reduces swelling" ---- can cause flexion contractures of hip promote hip extension--> lie prone d. "I will clean wound daily with rubbing alcohol" ----will dry skin and lead to cracking

The nurse is educating a patient with scoliosis about the potential complications associated with this disease. Which complications should the nurse discuss with the patient? Select all that apply a. adrenal dysfunction b. kidney stone formation c. low back pain d. shortness of breath or dyspnea e. spinal hemorrhage

CORRECT: c. low back pain (extra strain) d. shortness of breath or dyspnea (due to impairment of pulmonary function)

The nurse is caring for a patient who requires skeletal traction after a back injury. Which of the following is appropriate nursing interventions? SELECT ALL THAT APPLY a. asses pin site for signs of infection b. maintain traction at all times c. perform a skin assessment of bony provinces every time patient is repositioned d. support the weights to prevent injury e. withhold stool softeners to prevent perineal skin breakdown

CORRECT: a. asses pin site for signs of infection b. maintain traction at all times c. perform a skin assessment of bony provinces every time patient is repositioned INCORRECT: d. support the weights to prevent injury ----correct: never should be supported e. withhold stool softeners to prevent perineal skin breakdown ----correct: stool softeners= prevent post-op constipation and obstruction

The nurse is teaching an oriented RN about fractures. Which of the following statements made by the new graduate nurse indicates that teaching has been effective. SELECT ALL THE APPLY a. compartment syndrome can cause irreversible damage only after 4 hrs b. early ambulation is important for patients after surgery for hip fractures c. fat emboli are the most common in patients with rib fractures d. Low dose heparin therapy should be avoided because of the risk of internal bleeding e. patients do not need a continuous passive motion device if they receive physical therapy

CORRECT: a. compartment syndrome can cause irreversible damage only after 4 hrs b. early ambulation is important for patients after surgery for hip fractures INCORRECT: c. fat emboli are the most common in patients with rib fractures --Correct: most common in long bone fractures *femurs* d. Low dose heparin therapy should be avoided because of the risk of internal bleeding ---correct: important in the prevention of thromboembolism, especially after surgical repairs of fractures

The nurse is caring for a patient after a closed reduction of a fractured humorous. While monitoring for a fat embolism, the nurse should be alert for which symptoms? SELECT ALL THE APPLY a. chest pain that radiates to left arm b. confusion and drowsiness c. diminished pulse and pallor of affected arm d. hypoxemia and dyspnea e. petechiae on the chest and in the conductive

CORRECT: b. confusion and drowsiness d. hypoxemia and dyspnea e. petechiae on the chest and in the conductive respiratory changes, neurological changes, and petechiae

The nurse is assessing a patient in thomas splint traction, a device used to immobilize a hip fracture. The nurse should assess for complications as indicated by: a. pain at the site of fracture b. redness on the skin that does not blanch c. tight bandages overlapping the length of the length d.warm toes e. weak posterior tibial pulse

CORRECT: b. redness on the skin that does not blanch e. weak posterior tibial pulse

A patient with acute bak pain is admitted to the hospital. Physician orders an MRI of the spine and a physical therapy consult for back strengthening. In what sequence should the nurse schedule the orders? a. MRI prior to PT b. Schedule around the department's schedule c. MRI the following day so Patient can be NPO d. PT prior to MRI

CORRECT: a. MRI prior to PT

A patient who is one day post Knee replacement has a nursing diagnosis of acute pain. Which short-term goal is appropriate for patient? a. Pt. will report pain level of less than 6/10 by end of shift. b. Pt will be pain free by the end of the shift c. the pt will limit his activity to minimize pain d. the pt will not use narcotic pain medication this shift

CORRECT: a. Pt. will report pain level of less than 6/10 by end of shift.

The nurse is preparing to ambulate a patient to a chair after a TKA. To protect the knee, the nurse should a. apply knee immobilizer b. apply an oath boot c. apply ice d. use crutches to minimize weight on knee

CORRECT: a. apply knee immobilizer

The nurse is assessing a 66 yr old patient with osteoarthritis. The patient also has a history of emphysema and paynaud's phenomenon. The nurse would expect to observe which of the following symptoms? SELECT ALL THAT APPLY a. chronic cough b. cold fingers c. joint pain and crepitus with the presence of Heberden's nodes d. Joint stiffness and pain after sitting or laying too long e. tender joints that feel warm, morning stiffness lasting for hours and the presence of Bouchard's nodes

CORRECT: a. chronic cough (emphysema) b. cold fingers (raynaud) c. joint pain and crepitus with the presence of Heberden's nodes (OA) d. Joint stiffness and pain after sitting or laying too long (OA) INCORRECT: e. tender joints that feel warm, morning stiffness lasting for hours and the presence of Bouchard's nodes ---correct: bouchard nodes (OA); tender joints with warmth in morning (RA)

Nurse is educating a patient before a scheduled lumbar fashion. What position is best for bed rest? a. flat b. high fowlers c. lateral recumbent d. semi fowlers

CORRECT: a. flat repositioned evry 2 hours using the logrolling method

The nurse is caring for a patient with severe pain and swelling in the joints of the feet that occurs at night. The nurse notes that the joints in feet are red and hot. What joint disease is most likely present? a. gouty arthritis b. osteoarthritis c. RA Septic Arthritis

CORRECT: a. gouty arthritis -increased acid levels, swollen, red, hot, or painful joints -generally occurs at night INCORRECT: Osteoarthritis: joint stiffness, pain creptius, heberden's nodes, and bouchard;s nodes 1. occurs with prolonged or excessive use and relieved by rest RA: swollen and tender joints, stiffness, nodules, anemia, and joint pain; occurs in the morning or inactivity septic arthritis: invasion of the joint by microbes

A patient who sustained a fractured fibula has developed compartment syndrome. The nurse explains compartment syndrome to the patient knowing that: a. is the buildup of pressure from swelling in an enclosed space b. swelling causes blood vessels to hemorrhage c. swelling causes nerve damage, resulting in numbness d. swelling causes the fractured bone to shrink, resulting in atrophy

CORRECT: a. is the buildup of pressure from swelling in an enclosed space Compartment syndrome is when increasing edema or bleeding causes pressure to buildup in an enclosed space--> reduced blood flow and ischemia

When caring for a patient after a muscle biopsy, the nurse should keep the site elevated for: a. 12 hrs b. 24 hrs c. 6 hrs d. 8 hrs

CORRECT: b. 24 hrs -will reduce edema and discomfort elevating for less than 24 hrs may cause additional edema

A patient has been diagnoses with osteoarthritis and is instructed to take an NSAID to manage pain and inflammation. Which of the following health care professionals should be consulted to help manage the patient's condition? a. pain management nurse b. PT c. respiratory therapist d. social worker

CORRECT: b. PT

The nurse is assessing a patient with a fractured ulna, The nurse notes the bone is protruding throught the skin. What type of fracture is this? a. complete fracture b. compound fracture c. impacted fracture d. simple fracture

CORRECT: b. compound fracture

The nurse is reviewing the x-ray of a patient with a fractured humerus. The x ray shows one side of the bone broken while the other side is bent. What type of fracture is this? a. compression b. greenstick c. impacted d. Oblique

CORRECT: b. greenstick

The nurse is caring for a patient with osteoporosis. The patient is most likely to be an: a. diabetic, elederly mn b. middle- aged, menstruating women c. Postmenopausal, elderly women d. Women with more than 4 kids

CORRECT: c. Postmenopausal, elderly women Osteoporoisis- due to estrogen deficiency and sedentary lifestyle

An elderly women with RA informs the nurse that most of her friends have osteoarthritis and asks what difference is between the two diseases. The nurse should understand that: a. OA pain occurs after periods of inactivity, while RA occurs with activity' b. RA affects the larger joints, while OA affects smaller joints c. RA causes joints to be inflamed, red, and swollen, while OA does not generally swell d. RA is most common in men

CORRECT: c. RA causes joints to be inflamed, red, and swollen, while OA does not generally swell OA 1. degenerative disease 2. pain with activity 3. affects larger joints RA 1. pain and inflammation after inactivity 2. affects small joint 3. more common in women

a 78 year old patient has osteoarthritis of the right hip and requires a cane in order to ambulate. While instructing the patient on how to use a cane, the nurse should tell the patient to: a. hold cane away from body to prevent swaying b. hold cane on affected side c. hold cane on unaffected side d. place the base of the cane a few inches away from feet

CORRECT: c. hold cane on unaffected side take step with affected leg and bring cane forward at the same time -should be held close to body to prevent leaning -base 2 feet from the patient's little toe

The nurse is reviewing the X-ray of a patient with a fractured tibia. The Xray shows a fracture diagonal to the bone's long axis. What type of fracture is this? a. comminuted b. linear c. oblique d. transverse

CORRECT: c. oblique

The nurse is caring for a patient with Paget disease of the bone. The patient complains of difficulty urinating. The nurse should suspect the presence of: a. dehydration b. enlarged prostate c. renal calculi d. urinary tract infection

CORRECT: c. renal calculi hypercalcemia resulting in crystals that form in the kidneys--> kidney stones Biophosphonate medications ( decrease bone resorption) used to treat Piget's disease

A nurse is caring for a patient who underwent a fasciotomy for treatment of compartment syndrome. Which type of dressing should the nurse prepare to cover the site? a. betadine soaked dressing b. silver-based, hydrocolloid dressing c. sterile saline soaked dressing d. vaseline gauze with bacitracin

CORRECT: c. sterile saline soaked dressing after 24-48 hrs, negative pressure wound therapy can be used

The nurse is assessing the crutches of a 27 yr old with a fractured ankle. The crutches are fitted properly if: a. the axillae are resting on the pad b. the elbows are at a 15 degree angle when the patient;s hands grasp the handgrips c. the elbows are at a 30 degree angle when the patient;s hands grasp the handgrips d. the elbows are straight when the patient's hands grasp the handgrips

CORRECT: c. the elbows are at a 30 degree angle when the patient;s hands grasp the handgrips

The nurse is caring for a patient with a skeletal muscle disorder. The nurse expects which creatine phosphokinase isoenzyme to be elevated? a. BB b. MB c. MK d. MM

CORRECT: d. CK-MM

The nurse is caring for a patient who has sustained multiple fractures and a spinal injury from a motor accident. Which nursing intervention is MOST IMPORTANT when caring for this patient on bedrest? a. elevate head to promote lung expansion b. help with activities of daily living to conserve patient's energy c. limit fluid intake to reduce edema d. Reposition every 2 hours

CORRECT: d. Reposition every 2 hours INCORRECT: a. elevate head to promote lung expansion ---Correct: elevating= shear and friction c. limit fluid intake to reduce edema --- Correct: INCREASE fluid intake--> reduce risk of renal calculi formation

A nurse is caring for a 16 yr old boy with multiple fractures. Around this age, ppl often experience closure of epiphyses. After that occurs, which of the following are true? a. bone lengthening continues, but thickness remains same b. bone lengthening increases c. bone thickness increases d. no additional bone lengthening occurs

CORRECT: d. no additional bone lengthening occurs

The nurse is caring for a patient who has undergone AKA. The nurse encourages the patient to begin exercising the affected limb: a. after 5 days to allow healing b. after discharge c. immediately after surgery d. the day after surgery

CORRECT: d. the day after surgery

A curvature of 65 degrees or more in one region can lead to some serious complications. The nurse should assess which region of the spine for this risk? a. cervical b. lumbar c. sacral d. thoracic

CORRECT: d. thoracic

A nurse is caring for a client who sustained a traumatic injury to the leg in a farming accident resulting in amputation. Following an above the knee amputation, which of the following is the highest priority in the client's immediate post-op care... a. risk for hemorrhage b. complications of immobility c. inability to perform self-care d. altered body image

a. risk for hemorrhage physiological needs must be met first; amputation will likely involve severing and repairing major blood vessels-- **high risk for hemorrhaging ***

A client involved in a motor vehicle crash sustained maxillofacial trauma from striking the windshield. The client receives inter maxillary fixation with interdental wiring. Postoperativiley, the client vomits clear liquids. Which of the following actions is appropriate for the nurse to take a. suction the emesis form the client's mouth using a tonsil tip suction b. insert a NG tube to suction out any remaining stomach contents c. cut the wires to allow the client to expectorate the emesis d. instruct client to vomit in an emesis basin

a. suction the emesis form the client's mouth using a tonsil tip suction Intermaxillary fixation= wiring of the teeth which are left in lace for around 6 weeks until fracture is healed. Clear vomit can be easily removed from oral cavity by suctioning in the buccal space (b/w gums and teeth) ** attend to client's risk of aspiration first**** INCORRECT: c. wire cutters at hand in case of choking or emesis d. action does not address the client's risk of aspiration

A nurse is caring for a client who has a full arm cast and reports pain of 8/10 that is unrelieved by pain medication. Which of the following actions should the nurse plant to take first? a. administer additional pain meds b. check for circulation of the affected extremity c. document the findings d. reposition the affected extremity

b. check for circulation of the affected extremity greatest risk to client is neuromuscular injury resulting from compartment syndrome

2 days after fracturing his tibia playing lacrosse, a college student is brought to the hospital with roommate who reports that client is not acting like himself and seems confused. The nurse notes that the client has a long leg cast on his right leg and that the client is disoriented to time and place. Vital signs reveal that the client is tachycardia and tachypneic, the nurse should assess the client for other signs of a. hypovolemic shock b. fat embolism c. thrombophlebitis d. bone malalignment

b. fat embolism Fat embolism syndrome follows long bone fractures. Young men with fractures are at increased riskk of fat embolism, Classic presentation consists of a asymptomatic interval followed by pulmonary and neurological manifestations, such as fever and cutaneous petechiae of the neck, chest, and abdomen.

A client sustains an open fracture of the left femur. An intramedullary pin is inserted, and the client is placed in skeletal traction. While performing the initial assessment, the nurse finds the client has slipped down toward the foot of the bed and the traction weight is resting on the floor. The appropriate nursing action is to... A. Remove the weight and move the client to the correct alignment in bed B. check for movement of the toes in the left foot C. notify the attending orthopedic physician D. help the client use the trapeze to pull himself up in bed

D. help the client use the trapeze to pull himself up in bed The traction is no longer effective when it is resting on the floor. The nurse should help the client resume his normal position in bed to reestablish traction

A nurse is caring for a client who had BKA for gangrene of the foot. The client knows that the foot has been amputated, but reports to the nurse severe pain in the toes of the injured foot. The nurse should recognize this as a. an actual pain sensation b. delusional belief c. a referred postoperative incisional pain d. a defense mechanism of denial

a. an actual pain sensation phantom limp pain- severed peripheral nerve pathways

A nurse is assessing a client who has a new diagnosis of osteoarthritis. Which of the following findings should the nurse expect? (Select all that apply) a. crepitus with joint movement b. decreased range of motion of the affected side c. involvement of smaller joints of the body d. spongy tissue over the joints e. joint pain that resolves with rest

a. crepitus with joint movement b. decreased range of motion of the affected side e. joint pain that resolves with rest crepitus- grating sound common in osteoarthritis INCORRECT C. Osteoarthritis affects larger joints, such as the hips and knees d. Spongy joint tissue is an expected finding of rheumatoid arthritis, which is an inflammatory disease

A nurse in the ER is caring for a client after suddenly losing consciousness and falling in her home. The provider determines the client had an embolic stroke. Which of the following medications should the nurse administer? a. recombinant tissue plasminogen activator b. recombinant factor VIII c. Nitrolglycerin d. Lidocaine

a. recombinant tissue plasminogen activator thrombolytic administered to dissolve the blood clot that caused the stroke INCORRECT b. recombinant factor VIII- manage symptoms of hemophilia c. Nitroglycerin- vasodilator that treats angina d. Lidocaine- antidysrythmic agent used to treat ventricular dysrhythmias

During report, a nurse is told to assess a client who was recently casted for a radial fracture for compartment syndrome. For which of the following findings should the nurse assess? a. decreased ROM of the fingers distal to case b. numbness and tingling c. cyanosis of the fingers distal to the cast d. elevated client temperature

b. numbness and tingling Compartment syndrome involves the compression of nerves and blood vessels within an enclosed space, leading to impaired blood flow and nerve damage. Increase pressure which will compress the muscles, blood vessels and nerves. Hallmark symptom of CS: 1. severe pain that does not respond to elevation or pain medication. In more advances cases, numbness and tingling, weakness, and paleness of skin (5 P's)

A client is on bed rest following a pelvic fracture when he suddenly becomes dyspneic and reports feeling short of breath, The nurse assesses the client and finds that tachycardia,hypotension, and tachypnea are occurring. The client's oxygen saturation is dropping rapidly. The nurse should identify that the client is exhibiting signs consistent with... a. pneumonia b. pulmonary emolus c. tension pneumothorax d. flail chest

b. pulmonary emolus patient who has a fracture and maintained on bed rest is at high risk for pulmonary embolism DUE TO venous status and hyper-coagulation. Typical presentation of a client with a a blood clot in the arterial structure of the lung includes: 1. difficulty breathing 2. low blood pressure (hypotension) 3. confusion and hypoxia 4. high pulse (tachycardia). INCORRECT: a. pneumonia can be a complication of immobility following pelvic fracture BUT does not cause a sudden onset of difficult breathing or a rapid drop in oxygen saturation rate.

A nurse is providing teaching for a client who is prescribed alendronate for osteoporosis. Which of the following info should the nurse include in the teaching? a. take medication with milk b. remain upright for 30 min after taking this medication c. Expect medication to increase serum calcium levels d. Increase vitamin D intake to promote medication absoprtion

b. remain upright for 30 min after taking this medication Bisphosphonates (alendronate) combine to bone tissue to prevent bone resorption. decrease serum calcium level

A client is 3 days postoperative following a RHA. The client cries out in pain when transferred to a chair. Which of the following nursing observations should lead to the suspicion of a dislocated hip prosthesis a. bulging in the right hip area b. shortening of the right leg c. adduction of the left leg d. external rotation of the right leg

b. shortening of the right leg classic indicators of prosthetic dislocation: 1. shortening of the leg 2. abnormal rotation 3. increased discomfort INCORECT a. cause of pain will not result in any bulging c. The cause of clients pain will not result in changes to the unaffected leg d. The cause of the clients pain will cause internal rotation of the right leg

A nurse is assessing a client who has rheumatoid arthritis. Which of the following assessment findings should the nurse expect? a. unilateral joint involvement b. ulnar deviation c. fractures of the spine d. decreased sedimentation rate

b. ulnar deviation Inflammation in hand joints can make client with RA susceptible to deformity from daily use ulnar deviation, or lateral deviation of fingers, can occur from opening jars and other similar motions. INCORRECT: a. RA occurs bilaterally and symmetrical- (Osteoarthritis occurs unilaterally) c. compression fractures of spine are more common in Osteoporosis d.Pt. with RA will exhibit INCREASED sedimentation rate R/T body's response to this inflammatory CT disorder

On a health history form, a client being admitted to an outpatient surgery center for KA indicates taking celecoxib (celebrex) daily. Based on the medication, the nurse should suspect that the client has a history of... a. infection b. depression c. Rheumatoid arthritis d. seizures

c. Rheumatoid arthritis Celecoxib (celebrex)= nosteroidal anti-inflammatory cyclooxygenase-2 (COX02) inhibitor Used to relieve some manifestations caused by rheumatoid arthritis in adults

A nurse is admitting a client with a history of GOUT. Which of the following manifestations should the nurse expect to find on the client's admission physical assessment... a. fluctuant subcutaneous nodules b. Herberden's nodes c. Tophi d. Boutonniere deformity

c. Tophi Acute gouty arthritis is a metabolic disease marked by uric acid deposits in the joints. the disorder causes painful gouty arthritis, especially in the joints of the feet and legs. Top are deposits of rate crystal deposits that occur on the hands, knees, feet, forearms, and the chilled tendons in a client with chronic gout INCORRECT: a. fluctuant subcutaneous nodules: swelling under the skin that contain fluid b. Heberden's nodules and enlarged joints: manifestations of osteoarthritis . Hard nodules or bony swellings, which develop around the distal interphalangeal joints d. Boutonniere deformity: inflammation of the finger tendons seen in RA which results in a permanent deformity of the phalanges

A nurse is caring for a client who is 72 hr post op AKA and reports phantom limb pain. Which of the following actions should the nurse take? a. remind the client that the limb has been removed b. change dressing on the client's residual limb c. administer an oral dose of gabapentin to the client d. elevate the client's residual limb above the heart

c. administer an oral dose of gabapentin to the client Nurse should administer a nonopioid medication. Gabapentin is an anti epileptic medication and is effective for treatment of phantom limb pain. INCORRECT d. elevating limb above heart after 48hrs can cause a hip or knee flexion contracture

Following shoulder surgery, a client is instructed to keep the arm adducted at all times. The nurse explains to the client that this means he must keep the arm... a. bent at the elbow b. positioned on two pillows c. close to the body d. with the shoulder at a 90 degree angle

c. close to the body adducted means arm toward midline INCORRECT a. bent- flexion b. two pillows- elevation d. 90 degree- abduction (away from midline)

A night shift nurse is assigned to care for a client who is 12 hr postoperative following a total knee arthroplasty. The nurse finds the clients leg in a continuous passive motion machine, drain attached to an evacuator unit is in place, and the client has a PCA device. The client reports to the nurse, "I am in so much pain". The nurse's first action at this time is to... a. suggest the client push the button for the PCA decide b. Reposition the client for increased comfort per the client's instruction c. complete the assessment of the client including the client's pain d. turn off the continuous passive motion machine until the pain improves

c. complete the assessment of the client including the client's pain RKA is a surgery to replace a painful, damaged, or disease knee with a prosthetic joint. The nurse should complete assessment before selecting a course of action regarding pain. Should determine the characteristics of the client's pain and the frequency with which the client is using the PCA device Assessment ALWAYS comes first, followed by analysis, planning, intervening, and finally evaluating

A client has been admitted to the orthopedic floor to have a RKA performed. Which of the following statements demonstrates to the nurse that the client understands the preoperative teaching? "I will... a. have my knee placed in a continuous passive motion machine for 24 hours a day b.ask for pain medicine whenever the pain gets bad c. wear elastic stockings on both legs until i am discharged have to stay in bed for a week after my surgery

c. wear elastic stockings on both legs until i am discharged purpose of elastic stockings is to prevent thrombophlebitis, a common complication after orthopedic surgery INCORRECT a. passive motion machine is usually for a few hours at a time and of a total of 8-12 hrs a day. b. client should ask for pain meds BEFORE the pain becomes severe d. Ambulation usually begins 48 hr following a TKA

A nurse is planning care for a patient following a lumbar puncture. Which of the following actions should the nurse plan include? a. apply a pressure dressing to the site for 12 hrs b. restrict the client's fluid intake for 24 hrs c.ensure the client lies flat for 4 to 8 hrs d. administer pain medication every 3-4 hrs

c.ensure the client lies flat for 4 to 8 hrs This prevents cerebrospinal fluid leakage from the puncture site ALSO INCREASE FLUID- reduce the risk of a headache following procedure

A client with an ankle sprain is being discharged from the ER. To promote tissue healing and relieve discomfort, the nurse instructs the client to... a.continue typical activities with the ankle immobilized b.keep the extremity in a dependent position c. keep a loose dressing on the affected area d. apply cold compresses to the affected area

d. apply cold compresses to the affected area cold minimizes swelling and erythema to the affected area. However, cold compresses should not be applied continuously for more than 30 min

A nurse is caring for a client in balanced suspension skeletal traction who reports intermittent muscle spasms. Which of the following actions should the nurse take first? a. reposition patient b. provide distraction c. administer a muscle relaxant d. check the position of the weights and ropes

d. check the position of the weights and ropes 1st action- assess the patient check position of the weights and ropes to determine cause of muscle spasms

A nurse in a rehabilitation facility is caring for a client with multiple fractures of both lower extremities following a motor vehicle crash. The nurse realizes that the factor which is most critical for the client's successful rehabilitation is the a. nursing care plan reflects realistic nursing goals for client b. heath care team must weekly discuss the client's progress c. client's family must be involved in decision making d. client must be an active participant in the program

d. client must be an active participant in the program

A nurse is assessing a client who is quadriplegic secondary to a cervical fracture at vertebral level C5. the client reports a throbbing headache and nausea. The nurse notes a facial fishing and a blood pressure of 220/110 mm Hg. Which of the following actions should the nurse take first? a. administer hydralazine via IV bolus b. loosen client's clothing c. empty client's bladder d. elevate the head of the client's bed

d. elevate the head of the client's bed ** MAIN PRIORITY*** risk for autonomic dyreflexia or increased intracranial pressure - results in rapid postural hypotension Correct BUT NOT PRIORITY a. administer hydralazine- potent vasodilator to lower the clients BP (BUT NOT PRIORITY) b. loosen clothes- body temp and tactile stimulation are triggers of autonomic dysreflexia c. fecal impaction is a trigger of autonomic dysreflexia

A diabetic client with a non-healing wound of the heel is diagnosed with osteomyelitis. The nurse anticipates the client's treatment regimen will include a. ice to the site to decrease edema b. application of a short leg cast to limit movement of the involved ankle joint c. administration of glucocorticoids to decrease inflammatory process d. insertion of a peripherally inserted catheter line for long term IV antibiotics

d. insertion of a peripherally inserted catheter line for long term IV antibiotics Osteomyelitis is an acute or chronic bone infection Patient may eventually require amputation.

A nurse notes on a client's MAR that the client is to receive alendronate sodium (Fosamax). The nurse should know that for the proper absorption of the medication the client must.. a. schedule medication between meals b. take medication with calcium supplement c. take the medication with food d. sit up for 30 min after administration

d. sit up for 30 min after administration (prevent esophageal irritation!!!* ) alendronate sodium (Fosamax) is a BISPHOPHONATE- which is a classiffication of medications that prevent the development of osteoporosis. INSTRUCTIONS: 1. full glass of water 2. First thing in the morning 3. EMPTY STOMACH at least 30 min prior to consuming any other food, beverage, or medication 4. SITS UP RIGHT FOR 30 MIN-- prevent esophageal irritation!!!*

Spiral fracture

fracture twists around the shaft of the bone

Open fracture

fracture where there is damage involving the skin or mucous membranes

Comminuted fracture

fracture- bone fragment into several pieces

greenstick

fracture- bone to fracture on one side and bend on the other side