Musculoskeletal

A nurse cares for a frail, elderly client with osteoporosis in a nursing home. Which interventions are appropriate to include in the client's care plan to help prevent an hip fracture? Select all that apply 1. Calcium supplements 2. Encourage bed rest 3. Use of full bed rails during the night 4. Vitamin D supplements 5. Weight-bearing exercises

1, 4, 5 The primary treatment goal for elderly clients with osteoporosis is to prevent bone fracture, especially hip fracture. Teaching to increase bone mineral density and prevent bone loss includes: -Bisphosphonate medication (alendronate, risedronate, zoledronic) -Calcium and Vitamin D supplementation -Smoking cessation and alcohol avoidance -Weight bearing exercise (walking, dancing) and resistance training >3 times a week for 30 minutes, as increasing mechanical stress on bone increases bone density

A client arrives at the clinic for a follow-up after an ED visit the night before. The client sustained an ulnar fracture, and a fiberglass cast was applied. Which of the following teachings related to cast care should the nurse reinforce? Select all that apply 1. Contact the clinic if any hot areas or foul odors develop in the cast 2. Cover the cast with a plastic bag for bathing, and avoid getting the cast wet 3. Elevate the affected extremity above heart level for the first 48 hours 4. Expect some numbness and tingling of the fingers during the first week 5. Use only soft, padded objects to scratch the skin under the cast

1, 2, 3 Instructions for cast care include: -Report foul odors or hot areas in the cast, which may indicate infection -Avoid getting the cast wet, which may damage the cast and cause infection -Elevate the affected extremity above heart level for the first 48 hours to reduce edema -Regularly perform isometric and range of motion exercises to prevent muscle atrophy

The registered nurse on an orthopedic unit is orienting a new graduate nurse assigned to a client with a fractured hip and in Buck's traction. The RN intervenes when the GN performs with action? 1. Elevates the head of the bed 45 degrees 2. Hold the weight while the client is repositioned up in bed 3. Loosens the Velcro straps when the client reports that the boot is too tight 4. Provides the client with a fracture pan for elimination needs

1 Buck's skin traction maintains proper alignment of an injured body part by using weights to apply a continuous pulling force Appropriate actions for a client in Buck's skin traction include: -The client should be SUPINE or in semi-Fowlers position (MAXIMUM OF 20-30 DEGREES) Elevating the head of the bed more than 30 degrees would promote sliding -Regularly assess the neurovascular status and skin integrity of the limb in traction -Loosen Velcro straps if the boot is too tight as they can impair neurovascular status and skin integrity -Provide a fracture pan, which is smaller than a bedpan -Weights should be FREE-HANGING AT ALL TIMES and should never be placed onto the bed or touch the floor. A staff member should support the weight while the client is repositioned up in bed to prevent excessive pull on the extremity Skeletal traction is applied directly to the bone with a metal wire or pin and is used to immobilize position, or align a fracture when continuous traction is needed and skin traction is not possible. Removing the weights can cause injury to the client and should never be removed

The nurse working on an orthopedic unit is receiving report on 4 clients with recent fractures. Which client should the nurse assess first? 1. Client who has a femur fracture with a rash of pin-sized red spots on the chest and increased restlessness 2. Client who has purulent drainage and oozing from a skeletal traction pin insertion site and a temperature of 100.8 F 3. Client with a hip fracture receiving continuous IV saline with bilateral 2+ pitting leg edema and a blood pressure of 176/89 mmHg 4. Client with a rib fracture who is breathing at a rate of 23/min and is reporting 8/10 pain that is worse with inspiration

1 Clients with orthopedic injuries, particularly pelvic and long bone injuries (femoral fracture) may develop a FAT EMBOLUS. Fat emboli are thought to occur from the release of fat globules (lipids) from bone marrow or the systemic release of triglycerides into the bloodstream following a mechanical insult. The circulating lipids can OCCLUDE SMALL VESSELS in the lungs, brain, and skin, which impair circulation and oxygenation, leading to: -Respiratory distress syndrome (dyspnea, tachycardia, sudden and worsening chest pain, hypoxemia, restlessness, anxiety) -Altered mental status -Petechial hemorrhages in the arms, chest and/or neck Option 3: Pitting edema may occur in clients with impaired mobility (hip fracture) and often relates to fluid volume excess. HTN may also be related to the fluid volume excess in clients receiving IV fluids

A registered nurse is precepting a new graduate nurse on the orthopedic unit. Which action by the graduate nurse requires the registered nurse to intervene? 1. Elevating a client's residual limb on a pillow 1 day after above the knee amputation 2. Placing an abductor pill between a client's legs after total hip replacement 3. Positioning a client with Buck traction supine with the foot of the bed raised 4. Using pillows to raise a client's extremity following cast placement

1 To prevent hip flexion contractures in clients with above-the-knee amputation, the residual limb should not be elevated, especially after 24 hours. Instead, edema should be managed using a figure eight compression bandage. The bandage should be worn at all times until the residual limb is healed, and care should be taken not to wrap it too tightly. Hip flexion contractures can also be avoided by placing the client in PRONE POSITION with hip extension for 30 minutes 3 to 4 times a day Option 3: Buck traction immobilizes hip and femur fractures. A boot or traction tape is applied to the affected extremity and a prescribed weight pulls the limb into traction. The client is typically placed in supine position with the foot of the bed raised to maintain countertraction

The nurse provides discharge teaching to a client who had total hip replacement 4 days ago. Which client statement indicates that additional teaching is necessary? 1. "I will concentrate on leaning forward as I carefully sit down in a chair." 2. "I will do my leg raises and quadriceps and buttock isometric exercises 2-3 times a day." 3. "I will use the sock puller that the therapist gave me when I get dressed." 4. "My child got me a riser for the toilet seat at home. I hope my feet reach the floor!"

1 To prevent hip prosthesis dislocation following hip arthroplasty, a client must NOT FORCE THE HIP INTO >90 DEGREES OF FLEXION. Clients should use a chair with armrests and a high firm seat and proceed to place the hands on the armrests for support while lowering themselves onto the seat and when rising from it. Bending forward when getting into a chair creates excessive hip flexion and must be avoided Option 3: The client must not twist from the waist, reach across the affected extremity, or bend forward >90 degrees when dressing or putting on slippers, shoes, and socks Option 4: The client should use a toilet riser or a bedside commode chair with arms to prevent excessive hip flexion when getting on and off the toilet seat

The nurse is assessing a client in the outpatient clinic who has a cast on for a distal humerus fracture. Which statements made by the client would be the priority to assess further? 1. "I am having problems extending my fingers since this morning." 2. "I can't take any of the pain medicine because it makes me feel sick." 3. "I have to scratch under the cast with a nail file because of the itching." 4. "I noticed a warm spot on my cast, and a bad smell is coming from it."

1 Volkmann contracture occurs as a result of compartment syndrome associated with distal humerus fractures. Swelling of antecubital tissue causes pressure within the muscle compartment, restricting arterial blood flow (brachial artery). The resulting ischemia leads to tissue damage, wrist contractures, and an inability to extend the fingers. A Volkmann contracture is a medical emergency that can cause permanent damage to the extremity if left untreated. Any restrictive dressing should be removed immediately, and the HCP must be notified Option 3: The client must be instructed to never stick anything inside the cast; this can lead to altered skin integrity and infection Option 4: A warm spot on the cast with foul odor can indicate infection under the cast, especially if the client has been sticking objects inside to scratch the skin. This would be assessed second

The nurse reviews discharge teaching about residual limb care for a client who had a lower limb amputation. Which of the following instructions should the nurse include? Select all that apply 1. Assess the residual limb daily for redness or irritation 2. Keep limb socks and elastic wraps clean and dry 3. Lie on your stomach three times a day for 30 min 4. Massage the residual limb with lotion each day 5. Wash the residual limb daily with soap and water

1, 2, 3, 5 Residual limb care following an above-knee amputation (AKA) or below knee amputation (BKA) is an important component of rehabilitation and focuses on maintaining skin integrity, controlling pain, preventing infection, and restoring mobility. It is also important for the nurse to consider that the client may experience grief due to disturbed body image The nurse should include the following residual limb care instructions: -Clean the limb by washing it daily with soap and warm water. Thoroughly dry after washing to prevent skin maceration -Thoroughly inspect the limb for signs of infection -Keep limb socks, warps, and appliances/prostheses clean and dry -Perform daily range of motion exercises to improve muscle strength and mobility HIP FLEXION CONTRACTURES are a common complication during the recovery process. Nurses should teach clients to LIE PRONE several times each day and to AVOID SITTING in a chair for more than an hour Option 4: Clients should be taught to avoid applying potential irritants (alcohol, lotion, powder) to the residual limb

The ED nurse assesses an elderly client who was just admitted with a fractured hip after a fall. Which assessment findings would the nurse most likely expect? Select all that apply 1. Ecchymosis over the thigh and hip 2. Groin and hip pain with weight bearing 3. Internal rotation of the affected extremity 4. Muscle spasm around the affected area 5. Shortening of the affected extremity

1, 2, 4, 5 The most common clinical manifestations of hip fractures include: -Ecchymosis and tenderness over the thigh and hip- occur from bleeding into the surrounding tissue as the femur is very vascular and a fracture can result in significant blood loss (>1000mL) -Groin and hip pain with weight bearing -Muscle spasm in the injured area- occurs as the muscles surrounding the fracture contract to try to protect and stabilize the injured area -Shortening of the affected extremity- occurs because the fracture can reduce the length of the bone and the muscles above the fracture line pull the extremity upward -Abduction or adduction of the affected extremity depending on location and mechanism of injury Option 3: The affected extremity is usually externally rotated

A client with advanced osteoarthritis is admitted for right total knee arthroplasty. Which characteristic manifestations does the nurse expect to assess in this client? Select all that apply 1. Crepitus with joint movement 2. Low grade fever 3. Morning stiffness lasting 10 to 15 minutes 4. Pain exacerbated by weight-bearing activities 5. Positive serum rheumatoid factor

1, 3, 4 Osteoarthritis is a degenerative disorder of the synovial joints (knee, hip, fingers) that causes progressive erosion of the articular (joint) cartilage and bone beneath the cartilage. As the degenerative process continues, bone spurs (osteophytes), calcifications, and ulcerations develop within the joint space, and the "cushion" between the ends of the bones breaks down Clinical manifestations of OA of the knee include: -Pain exacerbated by weight-bearing activities. Results from synovial inflammation, muscle spasms, and nerve irritation -Crepitus, a grating noise or sensation with movement that can be heard or palpated; results from the presence of bone and cartilage fragments that float in the joint space -Morning stiffness that subsides within 30 minutes of arising -Decreased joint mobility and range of motion -Atrophy of the muscles that support the joint (quadriceps, hamstring) due to disuse

The new graduate nurse provides care for a client with a halo external fixation device. Which actions by the new nurse are appropriate? Select all that apply 1. Cleans around the pin sites using sterile water 2. Gently tightens the device screws if they become loose 3. Holds the frame of the device when logrolling the client 4. Places a small pillow under the head when client is supine 5. Uses a blow-dryer on the cool setting to dry the vest when wet

1, 4, 5 A halo external fixation device stabilizes a cervical or high thoracic fracture when there is insignificant damage to the ligaments or spinal cord. Sensory and muscle function should be monitored to determine any new deficits, and pin sites should be regularly assessed for loose pins or infection. Care for the client with a halo device includes: -Cleaning pin sites with sterile solution (chlorhexidine, water) to prevent infection -Keeping the vest liner clean and dry (changing weekly or when soiled, using a cool blow-dryer to dry) to protect the skin -Placing foam inserts under pressure points to prevent pressure injury -Placing a small pillow under the client's head when supine to reduce pressure on the device -Keeping the correct sized wrench available at all times in case of emergency Option 2: Only the HCP can adjust the pins Option 3: The nurse should avoid grabbing the device frame when moving or positioning the client, as this may cause the screws to loosen or alter device alignment

The HCP suspects a fat embolism syndrome in a client who has had multiple long bone fractures. Which finding does the nurse expect to assess to support this diagnosis? Select all that apply 1. Confusion and restlessness 2. Increasing pain despite the opioid analgesia 3. Paresthesia of the affected extremity 4. Petechiae over neck and chest 5. Pulse oximeter showing hypoxia

1, 4, 5 FES is a rare, but life-threatening complication that occurs in clients with long bone and pelvis fractures. It can also occur in nontrauma-related conditions, such as pancreatitis and liposuction. It usually develops 24-72 hours following the injury or surgical repair There are no specific diagnostic tests to identify FES. However, the initial characteristic signs and symptoms include: -Respiratory problems (dyspnea, tachypnea, hypoxemia) after a fat embolus travels through the pulmonary circulation and lodges in a pulmonary capillary, leading to impaired gas exchange and acute respiratory failure -Neuro changes (altered mental status, confusion, restlessness), which occur due to cerebral embolism and hypoxia -Petechial rash (pin-sized purplish spots that do not blanch with pressure), which appears on the neck, chest, and axilla due to microvascular occlusion. This defining characteristic differentiates a fat embolus from a PE -Fever (>101.4 F) which is due to a cerebral embolism leading to hypothalamus dysfunction

The nurse completes the preoperative assessment for a client scheduled for a total knee replacement today. Which information should the nurse report to the HCP as soon as possible before the surgery? 1. Has allergy to strawberries 2. Is experiencing burning on urination starting yesterday 3. Rates knee pain as a 9 4. Stopped taking celecoxib 7 days ago

2 A recent/current infection is a contraindication to total joint replacement surgery as a wound infection is more likely to occur in a client with a preexisting infection. The nurse should report the new onset of burning on urination Option 4: Clients are directed to stop taking NSAIDs, including selective COX-2 inhibitors (celecoxib, Celebrex), 7 days before surgery to decrease the risk of bleeding

The nurse teaches a client with osteopenia, who is lactose intolerant, how to increase dietary calcium and vitamin D intake. Which lunch food is the best choice? 1. Broiled chicken breast 2. Canned sardines 3. Egg white omelet 4. Peanut butter

2 Osteopenia is more than normal bone loss for the client's age and sex. Adequate dietary intake of calcium and vitamin D is necessary to promote bone growth, prevent resorption (bone loss), and prevent progression to osteoporosis. Other food sources that are high in calcium are fish (sardines, salmon, trout), tofu, some green veggies (spinach, kale, broccoli), and almonds. Good food sources of vitamin D include egg yolk and oily fish (salmon, sardines, tuna)

The nurse provides discharge teaching to a client who had a total knee replacement 4 days ago. Which client statement indicates the need for additional teaching? 1. "I have to give myself shots in the belly because my spouse is afraid of needles!" 2. "I have to use a walker because I can't bear any weight on this knee yet." 3. "I will call my HCP if i get short of breath or sore or swollen below my knee." 4. "The raised toilet seat makes it easier for me to get on and off the toilet by myself."

2 The average hospital length of stay following total knee arthroplasty is 3-5 days. After the surgery, immediate initiation of physical therapy is a priority. An isometric quadriceps setting is initiated on the 1st post op day. The client should be FULLY WEIGHT BEARING BY DISCHARGE. Clients use an assistive device to help the sit, rise safely from a sitting to standing position, and to negotiate steps

The nurse has provided education for a client with newly diagnosed ankylosing spondylitis. Which client statements indicate a correct understanding of teaching? Select all that apply 1. "I should continue strenuous exercise during flare-ups." 2. "I should include spine-stretching activities such as swimming." 3. "I should quite smoking and perform breathing exercises." 4."I will sleep on a soft mattress to decrease my morning stiffness." 5. "I will take the prescribed ibuprofen on an empty stomach."

2, 3 Ankylosing spondylitis is an inflammatory disease affecting the spine, has no known cause or cure. AS is characterized by stiffness and fusion of the axial joints, leading to restricted spinal mobility. Low back pain and morning stiffness that improve with activity are the classic findings. Involvement of the thoracic spine (costovertebral) and costosternal junctions can limit chest wall expansion, leading to hypoventilation The client with AS should: -Promote extension of the spine with proper posture, daily stretching, and spine-stretching exercises (swimming, racquet sports) -Stop smoking and practice breathing exercises to increase chest expansion and reduce lung compliance -Manage pain with moist heat and NSAIDs -Take immunosuppressant and anti-inflammatory medications as prescribed to reduce inflammation and increase mobility Option 4: Clients with AS are encouraged to sleep on their backs on a firm mattress to prevent spinal flexion and the resulting deformity

After rolling the ankle outwards when jogging, a client develops ankle pain and swelling. The HCP diagnoses a lateral ankle sprain. Which interventions does the nurse include in the discharge instructions? Select all that apply 1. Apply heat to reduce swelling during the first 24 hours 2. Begin an exercise rehab program when the pain subsides 3. Elevate the leg above the heart level on 2 pillows 4. Flex and dorsiflex the foot to prevent stiffness during the first 24 hours 5. Take ibuprofen every 6 hours as needed 6. Wrap the ankle with an elastic compression bandage

2, 3, 5, 6 Treatment for a sprained ankle includes: -Rest: Activity should be stopped and movement limited for 24-48 hours to promote healing. The HCP may prescribe a no weight-bearing on the joint for 48 hours, and crutches may be required -Ice: Cold therapy or an ice pack should be applied for 10-15 min every hour for the first 24-48 hours. Ice should not be applied directly to the skin -Compression (ACE wrap, splint: Pressure/compression can help prevent edema and promote fluid return -Elevation: The extremity should be kept elevated above the heart on pillows for 24-48 hours to help reduce swelling by promoting fluid return

A client in the postoperative period after an open reduction and internal fixation of a left wrist fracture reports constant, severe arm pain that is unrelieved by prescribed morphine administered 30 minutes ago. The client's nail beds appear dusky. What are the nurse's appropriate actions? Select all that apply 1. Apply a heating pad and encourage range of motion exercises 2. Assess the temperature and movement of the fingers 3. Elevate the arm on pillows above the level of the heart 4. Notify the HCP 5. Reassure the client, document findings, and reassess in 1 hour

2, 4 Compartment syndrome is a serious postoperative complication that is caused by decreased blood flow to the tissue distal to the injury. It results from either decreased compartment size (restrictive dressings, splints, or casts) or increased pressure within the compartment (bleeding, inflammation, and edema). Earliest symptoms may include pain or numbness that is unrelieved by medication. Failure to treat this condition can lead to loss of limb function, paralysis, and tissue necrosis Option 3: Elevating the arm on pillows and providing additional analgesia may help reduce symptoms but may also reduce perfusion of the extremity. Instead, the extremity should be positioned at the level of the heart

A graduate nurse is caring for a client who underwent a total knee replacement 1 day earlier. Which intervention by the GN would cause the supervising nurse to intervene? 1. Applied a cold pack over the operative knee 2. Initiates a continual passive motion device 3. Obtains a leg-immobilizing device for ambulation 4. Places a support pillow under the operative knee

4 Contracture of the operative joint is a serious complication of knee arthroplasty that impairs the client's mobility. To prevent contracture formation, the nurse should maintain the operative knee in an extended position with a knee immobilizer or pillow placed under the lower leg or heel. Placing a pill behind the knee causes joint flexion, which increases the risk of contracture Option 3: Applying a leg immobilizer during ambulation provides support, maintains alignment, and prevents dislocation of unstable operative joints

An elderly client with osteoporosis falls onto an out-stretched hand and injures the wrist. The client has severe wrist edema, deformity, and pain rated at a 10. What should be the nurse's first action? 1. Administer analgesia 2. Apply an ice pack to the wrist 3. Assess capillary refill and sensation 4. Elevate the wrist above the heart level

3 A Colles' fracture is a type of wrist fracture (distal radius fracture) that causes a characteristic dinner fork deformity of the wrist. It usually occurs when the client tries to break a FALL WITH AN OUTSTRETCHED ARMA or hand, and lands on the hell of the hand. It is one of the most common fractures in women age >50 and is related to osteopenia or osteoporosis While the client is undergoing evaluation by the HCP in the ED, nursing intervention should be: -Performing a neurovascular assessment (pulse, temperature, color, capillary refill, sensation, movement). This is the priority nursing action as neurovascular insufficiency related to swelling (compartment syndrome) or arterial/nerve damage by the bone fragments is associated with Colles' fracture

The nurse is reviewing new prescriptions from the HCP. Which prescription would require further clarification? 1. Atorvastatin for hyperlipidemia in a client with angina pectoris 2. Bupropion for smoking cessation in a client with emphysema 3. Cyclobenzaprine for muscle spasms in a client with hepatitis 4. Metronidazole for trichamoniasis in a client with Crohn disease

3 Cyclobenzaprine (Flexeril) is a common, centrally acting skeletal muscle relaxant prescribed for muscle spasticity, muscle rigidity, and acute or chronic muscle pain/injury. Centrally acting muscle relaxants interfere within the CNS to decrease muscle spasms and rigidity. Like many medications muscle relaxants are metabolized by the LIVER. The presence of liver disease decreases hepatic metabolism and can cause a buildup of medication, leading to medication toxicity and increased CNS DEPRESSION (weakness, confusion, drowsiness, lethargy) Option 1: Atorvastatin (Lipitor) is a statin prescribed for hyperlipidemia. It is used for primary and secondary prevention of cardiovascular disease and would not warrant further clarification when used in a client with angina Option 2: Bupropion (Wellbutrin, Zyban) and varenicline (Chantix, Champix) are commonly prescribed for smoking cessation

A home health nurse is assessing for complications in a client who has been using crutches for 2 weeks. Assessing for which finding is most important? 1. Biceps muscle spasm 2. Forearm swelling 3. Hand and wrist weakness 4. Shoulder range of motion

3 Excessive and prolonged pressure on the axillae can cause localized damage to the radial nerve at the axilla. This leads to a reversible condition known as crutch paralysis, or palsy, which manifests as muscle weakness and/or sensory symptoms (tingling, numbness) of the arm, wrist, and hand. It is caused by crutches that are too long or by leaning on the top of the crutches when ambulating. Therefore, clients are taught to SUPPORT BODY WEIGHT ON THE HANDS and arms, not the axillae, when ambulating to ensure that there is a 1-2 inch space between the axilla and the axilla crutch pad. Crutches should be checked for proper length Option 1: Triceps muscle spasm can occur due to increased muscle use, especially in clients with decreased upper body strength. Triceps and biceps muscle spasms are not complications associated with crutch walking

The nurse is caring for a client with a fractured femur. Which nursing intervention is most effective in helping reduce the risk for fat emboli? 1. Administering prophylactic enoxaparin as prescribed 2. Frequent use of incentive spirometry 3. Minimizing movement of the fractured extremity 4. Use of an intermittent pneumatic compression device

3 Fat embolism syndrome is a life-threatening condition that has no specific treatment. Therefore, prevention, early diagnosis, and immediate management of symptoms are critical. When a long bone is fractured, pressure within the bone marrow leads to release of fat globules into the bloodstream. These combine with platelets (fat embolus) and can travel to the brain, lungs, and kidneys, leading to small-vessel occlusion and tissue ischemia. Therefore, early stabilization of the injury and surgery as soon as possible to repair long bone (humerus, radius, ulna, femur, tibia, fibula) fractures is recommended to reduce further injury to soft tissue

A client with rheumatoid arthritis tells the home health nurse, "my fatigue and stiffness are getting worse and i'm having trouble moving around, especially in the morning. What can I do?" Which intervention would be best for the client to perform first? 1. Eat a high-calorie carbohydrate breakfast immediately after awakening 2. Perform range of motion exercises before getting out of bed 3. Take a warm shower or bath immediately after getting out of bed 4. Take prescribed NSAIDs on awakening

3 Prolonged morning stiffness of the affected joints is a major complication of rheumatoid arthritis. Taking a warm shower or bath first on awakening would be the best intervention as heat decreases stiffness and promotes muscle relaxation and mobility Option 2: Range of motion exercises are more effective after a warm bath or shower as stiffness is decreased, thereby improving flexibility Option 4: NSAIDs should not be taken on an empty stomach as these can cause GI upset

The clinic nurse evaluates the treatment plan of a client with long-standing rheumatoid arthritis. Which question is most important for the nurse to ask? 1. "Have the assistive devices helped with dressing and grooming?" 2. "How do you feel about the changes in your appearance?" 3. "How is your pain control with the current medication regimen?" 4. "Is your level of energy adequate for completing your daily activities?"

3 Rheumatoid arthritis is an autoimmune disorder that affects joints and other body systems. Chronic inflammation of the synovial joints causes increasing pain and swelling in the joints and eventual joint deformities with decreased or absent range of motion and loss of function Clients become easily fatigued and must learn to pace themselves and use assistive devices to accomplish activities of daily living. Goals of treatment are to manage pain, minimize loss of joint mobility, maximize self-care, and maintain self-esteem and a positive body image. Assessing for adequate pain control is the priority, as inadequate pain control will cause disuse of joints, leading to stiffness and decreased joint mobility Options 1, 2, and 4: If pain is not adequately controlled, the client will be unlikely to use assistive devices and be too fatigued to perform activities of daily living

The HCP suspects a rotator cuff injury in a client who is an avoid tennis player. The nurse would most likely assess which of the following? 1. Complete stiffness of the shoulder 2. Paresthesia over the first 3 fingers 3. Shoulder pain with arm abduction 4. Tenderness over the lateral epicondyle

3 The rotator cuff is a group of 4 shoulder muscles and tendons that attach to the humeral head. It allows for rotation of the arm. A partial or full thickness rotator cuff tear can occur gradually over time as a result of aging, repetitive use, or an injury to the shoulder. It can also occur as a result of a sports injury involving repetitive overhead arm motion Characteristic symptoms of rotator cuff injury usually include shoulder pain and weakness. Severe pain when the arm is abducted between 60 and 120 degrees (painful arc) is characteristic Option 1: Restriction of active and passive range of motion of the shoulder (complete stiffness) is seen with frozen shoulder Option 2: Pain and paresthesia over the first 3 1/2 fingers suggest carpal tunnel syndrome Option 4: Tenderness over the lateral epicondyle is seen with tennis elbow

A client comes to the ED after being assaulted. Imagining studies show a simple fracture of the mandible. The nurse assesses edema of the face and jaw, drooling, and bleeding in the mouth; the client rates pain as a 9 out of 10. What is the priority nursing intervention? 1. Administer nasal oxygen at 3 L/min 2. Administer opioids for pain 3. Apply ice pack to the face for 20 minutes each hour 4. Suction the mouth and oropharynx

4 A direct blow to the face or a motor vehicle collision is usually the cause of mandibular fracture. The client drools due to inability to close the mouth from edema and misalignment of the jaw. Structural damage, excessive saliva, and bleeding with pooled blood in the mouth can compromise the airway. Therefore, the priority nursing intervention is to suction the mouth and oropharynx to maintain airway patency

The nurse reinforces the physical therapist's teaching regarding the use of a cane when caring for a client with osteoarthritis of the left knee. Which client statement indicates the need for further teaching? 1. "I will hold the cane in my right hand." 2. "I will move my left leg forward after moving the cane." 3. "I will place the cane several inches in front of and to the side of my right foot." 4. "My cane should equal the distance from my waist to the floor."

4 Cane length should equal the distance from the client's GREATER TROCHANTER to the floor as incorrect length can cause back injury. A cane measured from the waist would be too long to provide optimal support Teaching points to assist a client in appropriate use of a cane include: 1. Hold the cane on the STRONGER side to provide maximum support and body alignment, keeping the elbow slightly flexed (20-30 degrees) 2. Place the cane 6-10inches in front of and to the side of the foot to keep the body weight on both legs to provide balance 3. For maximum stability, move the weaker leg forward to the level of the cane, so that body weight is divided between the cane and the stronger leg. If minimal support is needed, the cane and weaker leg are advanced forward at the same time 4. Move the stronger leg forward past the cane and the weaker leg, so the weight is divided between the cane and the weaker leg 5. Always keep at least 2 points of support on the floor at all times

The nurse is preparing a symptom management teaching plan for a client diagnosed with carpal tunnel syndrome. Which instruction is appropriate to include in the teaching plan? 1. Apply elastic compression hose to wrists 2. Avoid use of caffeinated or tobacco products 3. Perform repetitive hand exercises daily 4. Wear a wrist immobilization splint

4 Carpal tunnel syndrome is pain and paresthesia of the hand caused by medial nerve compression within the carpal tunnel at the wrist. Nerve compression can occur due to inflammation of the tendons; narrowing or compression of the carpal tunnel; or wrist flexion or extension. Symptoms of CTS are often exacerbated during sleep due to prolonged and unintentional wrist flexion Most clients with CTS can conservatively manage symptoms with wrist immobilization splints. Splints and immobilization of the wrist (particularly during sleep) reduces pain by preventing flexion or extension and subsequent nerve compression. Clients with CTS may require surgery to permanently relieve symptoms Options 1 and 3: Instructing clients to perform repetitive hand exercises or wear elastic compression hose could worsen symptoms of CTS by increasing median nerve compression

A client who underwent open reduction and internal fixation of a right tibial fracture 10 hours ago reports worsening leg pain that is unrelieved by PRN morphine. The nurse assesses that the client's right foot is cooler than the left. What is the nurse's priority action? 1. Administer the client's next dose of pain medication 2. Assess the client's vital signs 3. Maintain the extremity in a dependent position to promote blood flow 4. Report these findings to the HCP immediately

4 Compartment syndrome results from compression of vascular structures by either external compression (restrictive dressings/casts) or increased pressure within a compartment (bleeding, inflammation, and edema). After an injury or trauma (surgery), the vessels surrounding the injury site are compressed by swelling muscle and connective tissues. Muscle is encapsulated by a fibrous layer of fascia (compartment), which does not yield to swelling. Eventually, compression of tissues within the compartment restricts blood flow to the extremity

A nurse in the ED cares for 4 clients with orthopedic injuries. Which client should the nurse assess first? 1. Client who sustained a closed, incomplete ulnar fracture while playing sports 2. Client with bilateral metacarpal fractures after falling out of bed 3. Client with multiple myeloma who has a vertebral fracture and aching back pain 4. Client with pain and obvious shoulder deformity reporting a "pin-and-needles" sensation

4 Joint dislocations may become orthopedic emergencies because articular bone may compress surrounding vasculature, causing limb-threatening distal ischemia. When a joint is dislocated, the articular tissues, blood vessels, and nerves are often traumatized by stretching Option 3: Pathologic vertebral compression fractures and pain are expected in client with multiple myeloma. These clients commonly experience fractures of the vertebral column and spinal processes as the cancer weakens and decalcifies the vertebrae

A nurse is caring for a client diagnosed with rheumatoid arthritis. Which assessment finding does the nurse expect to assess? 1. Asymmetrical pain in the large weight bearing joints 2. Low back pain and stiffness that is worse in the morning 3. Pain, swelling, and redness of the great toe 4. Symmetrical pain and swelling in the small joints of the hands

4 RA is a chronic, systemic, inflammatory, autoimmune condition of unknown origin that has periods of exacerbation and remission. The body's immune system attacks the lining the the joints, leading to bone erosion and joint deformity. Characteristic features of RA include the following: -SYMMETRICAL PAIN AND SWELLING that initially affects the SMALL JOINTS OF THE HANDS AND FEET -MORNING JOINT STIFFNESS that lasts from 60 MINUTES TO SEVERAL HOURS -Elevated ESR and rheumatoid factor levels Option 1: Asymmetrical pain in the weight bearing joints is a characteristic of osteoarthritis. Crepitus, especially over the knee joints is also present in osteoarthritis Option 2: Low back pain and stiffness, worse in the morning and improving as the day progresses is a characteristic of ankylosing spondylitis Option 3: Pain, swelling, and redness of one or more extremity (typically the great toe) are characteristics of acute gout attack

A client with a mandibular fracture who has the upper and lower teeth wired together begins to choke on excessive oral secretions. What is the nurse's immediate action? 1. Cut the wires 2. Elevate the head of the bed 3. Notify the HCP 4. Suction the mouth and oropharynx

4 The priority for a client with a mandibular fracture whose teeth have been wired together is maintaining a PATENT AIRWAY. If the client begins to choke on oral secretions, the nurse should immediately attempt to clear the airway by suctioning via the oral or nasopharygneal route. If this intervention is ineffective, cutting the wires may be necessary Option 1: Cutting the wires can cause collapse of the fractured jaw and exacerbate the airway problem. This action is not the first priority unless the situation is an emergency (acute respiratory distress, cardiopulmonary arrest requiring intubation). A wire cutter must be taped to the head of the client's bed at all times, including during travel Option 2: Elevating the head of the bed is a preventative measure. Because the client is choking, the priority is suctioning secretions to clear the airway. The nurse should also TURN THE CLIENT TO THE SIDE if the client has excessive oral secretions or beings to vomit to decrease risk of aspiration