Musculoskeletal (Level 2)
The nurse witnesses a client sustain a fall and suspects that the right leg may be broken. The nurse should take which priority action? a. Take a set of vital signs b. Call the radiology department c. Reassure the client that everything will be fine d. Immobilize the right leg before moving the client
Correct answer: D When a fracture is suspected, it is imperative that the area be splinted before the client is moved. Emergency help should be called for if the client is not hospitalized, and a health care provider is called for the hospitalized client. The nurse should remain with the client and provide realistic reassurance. The nurse does not prescribe radiographs. Telling the client that everything will be fine is nontherapeutic. Although vital signs will be taken, the priority is to immobilize the leg.
A nurse is educating coworkers about how to minimize back strain and avoid repeated episodes of low back pain. Which of the following strategies should the nurse include? (Select all that apply.) a. Avoid prolonged sitting. b. Apply heat for 10 min every hour. c. Sleep in a side-lying position with flexed knees. d. Sleep on a soft mattress. e. Try padded shoe insoles.
Correct answers: A, C, E Avoid prolonged sitting is correct. Staying in any one position for too long, even lying down, can worsen back pain. Changing positions frequently is essential.Apply heat for 10 min every hour is incorrect. The recommendation for low back pain is applying moist heat for 20 to 30 min at least four times per day, to decrease pain and muscle spasms. Cold packs can also help with pain and swelling.Sleeping in a side-lying position with flexed knees is correct. This position prevents unnecessary pressure on the support muscles and lumbosacral joints.Sleep on a soft mattress is incorrect. The recommendation is to sleep on a firm mattress for added support.Try padded shoe insoles is correct. These can be especially helpful for people who must stand or walk for extended periods at work
The nurse is preparing to perform pin site care for a client in skeletal traction. On assessment of the pin site, the nurse notes the presence of serous drainage. Which nursing action would be appropriate? a. Document the findings b. Notify the healthcare provider c. Remove 2 pounds d. Lift the weights and put them on the bed so the HCP can assess the patient
Correct answer: A A small amount of serous oozing is expected at the pin insertion site. The nurse would document the findings. It is not necessary to notify the HCP. The nurse would not add or remove any weight from the client's traction setup because this would disrupt the alignment of the fracture
The nurse has provided discharge instructions to a client after a total hip replacement. Which statement by the client indicates a need for further instruction? a. "I should sit in my recliner when I get home" b. "I need to keep my legs apart when sitting or lying" c. "I should try to obtain an elevated toilet seat for use at home" d. "I should contact the healthcare provider if the incision becomes red or irritated or if I note any drainage"
Correct answer: A After total hip replacement, the client should be instructed to sit on a high, firm chair. The client should be instructed to keep the legs apart while sitting or lying to prevent disruption of the hip replacement; this may be accomplished by placing a blanket or a pillow between the legs. The use of an elevated toilet seat will prevent discomfort and pressure at the operative site. The health care provider should be notified if the client notes the development of any redness, irritation, or drainage at the incision site
The home health nurse visits a client who is having an acute attack of gout. The nurse determines that the client needs further instruction regarding the treatment of gout if the client states to take which action? a. Restricting fluids b. Maintaining bed rest c. Eating a low-purine diet d. Taking NSAIDs
Correct answer: A Ample fluid intake is encouraged to promote the excretion of uric acid. The client is placed on bed rest during an acute attack until the pain subsides. A diet low in purine normally is prescribed. Nonsteroidal antiinflammatory drugs (NSAIDs) are used to reduce pain and inflammation. Colchicine, which also may be prescribed, reduces the migration of leukocytes to the synovial fluid
The nurse is preparing to discharge a client diagnosed with gout. Which statement by the client indicates understanding of the dietary restrictions while managing gout? a. "I should avoid beer, anchovies, and liver." b. "I should avoid bananas, grapefruit, and oranges." c. "I should avoid dairy products such as milk and ice cream." d. "I should avoid red wine, dark chocolate, and aged cheeses."
Correct answer: A Beer, anchovies, and liver are higher in purine and should be avoided in clients prone to gout.Options B and C may be included in the diet, unless there are other reasons to avoid these foods.Option D lists foods high in tyramine, which should be avoided in clients taking certain medications such as MAOI.Unless the client is on one of these medications, they do not need to be avoided
A nurse in a medical clinic is providing teaching to an older adult client who has osteoarthritis that is affecting her knees. Which of the following client statements indicates an understanding of the teaching? a. "I can use either heat or ice to help relieve the discomfort." b. "Ibuprofen is the first step in medication therapy for osteoarthritis." c. "I should limit physical activity to prevent further injury." d. "I will elevate my legs by placing two pillows under my knees when I go to bed."
Correct answer: A The nurse should reinforce that different treatment modalities, such as heat or cold therapy, can be tried to determine which one is more effective for the client. Heat application can help with muscle relaxation in the area around the affected joint. The application of cold numbs nerve endings and decreases joint inflammation. The nurse should instruct the client that the primary medication of choice for the treatment of osteoarthritis is acetaminophen. NSAIDS, such as celecoxib and ibuprofen, might be tried if acetaminophen does not control discomfort. Nurse should encourage the client to include aerobic exercise and lower extremity strength training into her daily regimen. These activities have been shown to slow the progression of osteoarthritis and relieve the manifestations of the disorder. The nurse should instruct the client to avoid the use of pillows under the knees as this contributes to the development of flexion contractures
1) A client with a fractured femur experiences sudden dyspnea, tachypnea, and tachycardia. A set of arterial blood gas tests reveals the following: pH, 7.35 (7.35); PaCO₂, 43 mm Hg (43 mm Hg); PaO₂, 58 mm Hg (58 mm Hg); HCO₃, 23 mEq/L (23 mmol/L). The nurse interprets that the client probably has experienced fat embolus because of the result of which parameter? a. pH b. PaO₂ c. HCO₃ d. PaCO₂
Correct answer: B A significant feature of fat embolism is a significant degree of hypoxemia, with a Pao2often less than 60 mm Hg (60 mm Hg). The data in the question indicate that the items in the remaining options are normal blood gas results
Which teaching should be included for a patient with a right peripheral extremity a. Wear a clean nylon residual limb sock daily b. Use a mirror to inspect all areas of the residual limb each day c. Toughen the skin of the residual limb by rubbing it with alcohol d. Preventing cracking of the skin of the residual limb by applying lotion daily
Correct answer: B Following amputation, the client should inspect all surfaces of the residual limb daily for irritation, blisters, or breakdown. The other options are incorrect. The client should wear a clean woolen residual limb sock each day. Nylon is a synthetic material that does not allow the best air circulation and holds in moisture. The stump is cleansed daily with a gentle soap and water and is dried carefully. Alcohol is avoided because it could cause drying or cracking of the skin. Oils, creams, and lotions also are avoided because they are too softening to the skin for safe prosthesis use
The nurse is creating a plan of care for a client in skin traction. The nurse should monitor for which priority finding in this client? a. Urinary incontinence b. Signs of skin breakdown c. The presence of bowel sounds d. Signs of infection around the pin sites
Correct answer: B Skin traction is achieved by Ace wraps, boots, or slings that apply a direct force on the client's skin. Traction is maintained with 5 to 8 lb (2.3 to 3.6 kg) of weight, and this type of traction can cause skin breakdown. Urinary incontinence is not related to the use of skin traction. Although constipation can occur as a result of immobility and monitoring bowel sounds may be a component of the assessment, this intervention is not the priority assessment. There are no pin sites with skin traction
A client has just been admitted to the hospital with a fractured femur and pelvic fractures. The nurse should plan to carefully monitor the client for which signs/symptoms? a. Fever and bradycardia b. Fever and hypertension c. Tachycardia and hypotension d. Bradycardia and hypertension
Correct answer: C Clients who experience fractures of the femur, pelvis, thorax, and spine are at risk for hypovolemic shock. Bone fragments can damage blood vessels, leading to hemorrhage into the abdominal cavity and the thigh. This can occur with closed fractures as well as open fractures. Signs of hypovolemic shock include tachycardia and hypotension
The nurse is caring for a client at risk for fat embolism because of a fracture of the left femur and pelvis sustained in a fall. The client also sustained a head injury, is comatose, and is unable to communicate verbally. Which assessment findings should the nurse identify as early signs of possible fat embolism? a. Decreased heart rate and increased restlessness b. Decreased heart rate and decreased respirations c. Increased heart rate and adventitious breath sounds d. Increased heart rate and increased oxygen saturations
Correct answer: C Fat embolism commonly causes signs and symptoms related to respiratory or neurological impairment. Because the client is unable to speak, it may be difficult to immediately assess early changes in neurological status. However, adventitious breath sounds and an increased heart rate may be easily and quickly observed, even before the client demonstrates labored breathing. The remaining options are incorrect
Allopurinol is prescribed for a client who has chronic gout. Which comment indicates that the client understands how to take allopurinol? a. "I will take the medication whenever my joint hurts" b. "I must take this drug on an empty stomach" c. "I should drink plenty of fluids when taking allopurinol" d. "I should not take aspirin when taking allopurinol"
Correct answer: C It is important that the client forces fluids to 3,000 mL/day to avoid the development of renal calculi when taking allopurinol.Allopurinol must be taken consistently to be effective in the treatment of gout.The drug should be taken after meals to avoid GI distress.Although the client can take aspirin when taking allopurinol, both drugs cause GI irritation, and the practice is not recommended if the client is sensitive to the medication
The nurse is evaluating a client in skeletal traction. When evaluating the pin sites, the nurse would be most concerned with which finding? a. Redness around the pin sites b. Pain on palpation at the pin sites c. Thick, yellow drainage from the pin sites d. Clear, watery drainage from the pin sites
Correct answer: C The nurse should monitor for signs of infection such as inflammation, purulent drainage, and pain at the pin site. However, some degree of inflammation, pain at the pin site, and serous drainage would be expected; the nurse should correlate assessment findings with other clinical findings, such as fever, elevated white blood cell count, and changes in vital signs. Additionally, the nurse should compare any findings to baseline findings to determine if there were any changes
A client is admitted to the emergency department with an open fracture of the right tibia. What intervention is most appropriate for this client? a. Remove the client's shoes b. Place the client in a semi Fowler's position c. Check the neurovascular status of the area distal to the extremity d. Apply a tourniquet above the area of bleeding and loosen it every 15 minutes
Correct answer: C To prevent further damage, the neurovascular status must be assessed for temperature, color, sensation, movement, and capillary refill. Tourniquets are not used to control hemorrhage in extremities because of the risk of tissue ischemia. Direct pressure is applied at the site and over the proximal artery nearest the fracture if bleeding occurs. Clients need to be kept in a supine position to help prevent hypotension and shock. Shoes are not removed because this action may cause increased trauma
A client with rheumatoid arthritis tells the nurse "I know it is important to exercise my joints so that I will not lose mobility, but my joints are so stiff and painful that exercising makes it difficulty." Which response by the nurse is most appropriate: a. "You are probably exercising too much. Decrease your exercise to every other day" b. "Tell your healthcare providers about your symptoms. Maybe your analgesic medication can be increased" c. "Stiffness and pain are part of the disease. Learn to cope by focusing on the activities you enjoy" d. "Take a warm tub bath or shower before exercising. This may help with your discomfort"
Correct answer: D Superficial heat applications, such as tub baths, showers, warm compresses, can be helpful in relieving pain and stiffness.Exercise can be performed more comfortably and more effectively after heat applications.The client with rheumatoid arthritis must balance rest with exercise every day, not every other day.Typically, large doses of analgesics, which can lead to hepatotoxic effects, are not necessary.Learning to cope with the pain by refocusing is inappropriate
After a laminectomy, the client states "The doctor said I can do anything I want to" Which activity that the clients intends to do indicates the need for further teaching? a. Drying the dishes b. Sitting outside on firm cushions c. Making the bed walking from side to side d. Sweeping the front porch
Correct answer: D Sweeping causes a twisting motion, which should be avoided because twisting can cause undue stress on the recently ruptured disc site, muscle spasm, and a potential recurrent disc rupture.Although the client should not bend at the waist, such as when washing dishes at the sink, the client can dry dishes because no bending is necessary.The client can sit in a firm chair that keeps the back anatomically aligned.The client should not twist and pull, so when making the bed, the client should pull the covers up on one side and then walk around to the other side before trying to pull the covers up there
The nurse has provided instructions to a client with a diagnosis of rheumatoid arthritis about measures to protect the joints. Which statement by the client indicates a need for further instruction? a. "I should slide objects rather than lifting them." b. "I should try not to remain in the same position for a long period of time" c. "I should use large joints instead of small joints when performing activities" d. "Pain or fatigue is expected, and I should try to continue the activity if this occurs"
Correct answer: D The client should be instructed to use pain or fatigue as an indicator and guide to increase, maintain, or decrease an activity level. If pain or fatigue is experienced, the client should rest. The client should learn to slide objects rather than lifting them and not remain in the same position for a long time. Whenever possible, the client should use large joints instead of small joints for activities and should use the joints in their most natural position
A nurse is caring for a client who has an unrepaired femur fracture of the midshaft. Which of the following techniques should the nurse use when performing an assessment of the client's neurovascular status? a. Measure the circumference of the thigh. b. Palpate the femoral pulse. c. Monitor the client's calf for edema. d. Instruct the client to wiggle his toes
Correct answer: D The nurse should measure the client's thigh and compare it to the unaffected limb to monitor for continued bleeding into the site. The client is at risk for developing shock because of the large amounts of blood loss that can occur with a femur fracture. However, measuring thigh circumference does not indicate the client's neurovascular status. Nurse should palpate pulses distal to the fracture to determine whether the blood flow to the extremity has been compromised. However, the femoral pulse is proximal to the injury and does not indicate the neurovascular status of the injured extremity. The nurse should monitor the client's calf for edema, warmth, tenderness, and redness as they are indications of deep-vein thrombosis. However, monitoring the client's calf for edema does not indicate the client's neurovascular status. The nurse should observe the client's ability to move his toes when collecting data regarding neurovascular status distal to the fracture. Other means of evaluating neurovascular status include assessing skin color and temperature, sensation, pain, and capillary refill
A client in the post-anesthesia care unit with a left below-the-knee amputation has pain in the left big toe. What should the nurse do first? a. Tell the client it is impossible to feel the pain. b. Show the client that the toes are not there. c. Explain to the client that the pain is real. d. Give the client the prescribed opioid analgesic.
Correct answer: D The nurse's first action should be to administer the prescribed opioid analgesic to the client because this phenomenon is phantom sensation and interventions should be provided to relieve it.Pain relief is the priority.Phantom sensation is a real sensation.It is incorrect and inappropriate to tell a client that it is impossible to feel the pain.Although it does relieve the client's apprehensions to be told that the phantom sensations are a real phenomena, the client needs prompt treatment to relieve the pain sensation.Usually, phantom sensation will go away.However, showing the client that the toes are not there does nothing to provide the client with relief
A nurse is caring for an older adult client who has rheumatoid arthritis (RA) and is taking aspirin 650 mg every 4 hours. Which of the following diagnostic tests should the nurse monitor to evaluate the effectiveness of this medication? a. White blood cell (WBC) count b. Rheumatoid factor (RF) c. Antinuclear antibody (ANA) d. Erythrocyte sedimentation rate (ESR)
Correct answer: D WBC count is often done to monitor response to the treatment of infections, but it is not effective in monitoring the response to RA treatment. RF is helpful in diagnosing rheumatoid arthritis, but the levels do not always correlate with the severity of the disease activity. It will not accurately reflect the effectiveness of the aspirin therapy. ANAs are frequently present in clients who have systemic lupus erythematosus and other autoimmune disorders such as rheumatoid arthritis and scleroderma. Although this client's ANA is likely to be positive (indicating autoimmune disease), it is not reflective of the effectiveness of the aspirin therapy.Rheumatoid arthritis is a chronic inflammatory disease. ESR is useful in detecting and monitoring tissue inflammation in clients with RA. As the disease improves the ESR decreases
Which information should be included in the teaching plan for a patient with osteoporosis? Select all that apply. a. Maintain a diet with adequate amounts of vitamin D, as found in fortified milk and cereals b. Choose good calcium sources, such as figs, broccoli, and almonds c. Use alcohol in moderation d. Try swimming as a good exercise to maintain bone mass e. Avoid high-fat foods such as avocados, salad dressings, and fried foods
Correct answers: A, B, C A diet with adequate amounts of vitamin D aids in regulation, absorption, and subsequent utilization of calcium and phosphorous, which are necessary for the normal calcification of bone.Figs, broccoli, and almonds are very good sources of calcium.Moderate intake of alcohol has no known negative effects on bone density, but excessive alcohol intake does reduce bone density.Swimming, biking, and other non-weight bearing exercises do not maintain bone mass.Walking and running, which are weight-bearing exercises, do maintain bone mass.The client should eat a balanced diet but does not need to avoid high-fat foods
Which cast care instructions should the nurse provide to a client who just had a plaster cast applied to the right forearm? Select all that apply. a. Keep the cast clean and dry b. Allow the cast 24 to 72 hours to dry c. Keep the cast and extremity elevated d. Expect tingling and numbness in extremity e. Use a hair dryer set on a warm to hot setting to dry the cast f. Use a soft, padded object that will fit under the cast to scratch the skin under the cast
Correct answers: A, B, C A plaster cast takes 24 to 72 hours to dry (synthetic casts dry in 20 minutes). The cast and extremity should be elevated to reduce edema if prescribed. A wet cast is handled with the palms of the hand until it is dry, and the extremity is turned (unless contraindicated) so that all sides of the wet cast will dry. A cool setting on the hair dryer can be used to dry a plaster cast (heat cannot be used on a plaster cast because the cast heats up and burns the skin). The cast needs to be kept clean and dry, and the client is instructed not to stick anything under the cast because of the risk of breaking skin integrity. The client is instructed to monitor the extremity for circulatory impairment, such as pain, swelling, discoloration, tingling, numbness, coolness, or diminished pulse. The health care provider is notified immediately if circulatory impairment occurs
