Musculoskeletal Trauma Surgeries and Disorders, Connective Tissue, and Arthritis
A female patient's complex symptomatology over the past year has culminated in a diagnosis of systemic lupus erythematosus (SLE). Which of the patient's following statements demonstrates the need for further teaching about the disease? A. "I'll try my best to stay out of the sun this summer." B. "I know that I probably have a high chance of getting arthritis." C. "I'm hoping that surgery will be an option for me in the future." D. "I understand that I'm going to be vulnerable to getting infections."
Correct answer: C. "I'm hoping that surgery will be an option for me in the future." Rationale: SLE carries an increased risk of infection, sun damage, and arthritis. Surgery is not a key treatment modality for SLE.
After teaching a patient with RA about the prescribed therapeutic regimen, the nurse determines that further instruction is needed when the patient says, a. it is important for me to perform my prescribed exercises every day b. I should perform most of my daily chores in the morning when my energy level is highest c. an ice pack to a joint for 10 minutes may help relieve pain and inflammation when I have an acute flare d. I can use assistive devices such as padded utensils, electric can openers, and elevated toilet seats to protect my joints
B. I should perform most of my daily chores in the morning when my energy level is highest
The nurse is working with a 73-year-old patient with osteoarthritis (OA). In assessing the patient's understanding of this disorder, the nurse concludes teaching has been effective when the patient describes the condition as which of the following? A. Joint destruction caused by an autoimmune process B. Degeneration of articular cartilage in synovial joints C. Overproduction of synovial fluid resulting in joint destruction D. Breakdown of tissue in non-weight-bearing joints by enzymes
Correct answer: B. Degeneration of articular cartilage in synovial joints Rationale: OA is a degeneration or breakdown of the articular cartilage in synovial joints. The condition has also been referred to as degenerative joint disease.
Assessment data in the patient with osteoarthritis commonly include a. gradual weight loss b. elevated WBC count c. joint pain that worsens with use d. straw-colored synovial fluid
Correct answer: C Rationale: Osteoarthritis pain ranges from mild discomfort to significant disability. Joint pain is the predominant symptom, and the pain generally worsens with joint use.
A client who has had an above-the-knee amputation develops a dime-sized bright red spot on the dressing after 45 minutes in the postanesthesia recovery unit. The nurse should: 1. Elevate the stump. 2. Reinforce the dressing. 3. Call the surgeon. 4. Draw a mark around the site.
4. DRAW A MARK AROUND THE SITE The priority action is to draw a mark around the site of bleeding to determine the rate of bleeding. Once the area is marked, the nurse can determine whether the bleeding is increasing or decreasing by the size of the area marked. Because the spot is bright red, the bleeding is most likely arterial in origin. Once the rate and source of bleeding are identified, the surgeon should be notified. The stump is not elevated because adhesions may occur, interfering with the ability to fit a prosthesis. The dressing would be reinforced if the bleeding is determined to be of venous origin, characterized by slow oozing of darker blood that ceases with the application of a pressure dressing. Typically, operative dressings are not changed for 24 hours. Therefore, the dressing is reinforced to prevent organisms from penetrating through the blood-soaked areas of the initial postoperative dressing.
A client in the postanesthesia care unit with a left below-the-knee amputation has pain in her left big toe. Which of the following should the nurse do first? 1. Tell the client it is impossible to feel the pain. 2. Show the client that the toes are not there. 3. Explain to the client that her pain is real. 4. Give the client the prescribed opioid analgesic.
4. GIVE THE CLIENT THE PRESCRIBED OPIOID ANALGESIC 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 phantom sensations are a real phenomenon, 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 patient taking ibuprofen (Motrin) for treatment of OA has good pain relief but is experiencing increased dyspepsia and nausea with the drug's use. The nurse consults the patient's primary care provider about a. adding misoprostol (Cytotec) to the patient's drug regimen b. substituting naproxen (Naprosyn) for the ibuprofen (Motrin) c. administering the ibuprofen with antacids to decrease the GI irritation d. returning to the use of acetaminophen, but at a dose of 5 g/day instead of 4 g/day
A. adding misoprostol (Cytotec) to the patient's drug regimen
The nurse is reinforcing general health teaching with a 64-year-old patient with osteoarthritis (OA) of the hip. Which of the following points would the nurse include in this review of the disorder (select all that apply)? A. OA cannot be successfully treated with any current therapy options. B. OA is an inflammatory disease of the joints that may present symptoms at any age. C.Joint degeneration with pain and disability occurs in the majority of people by the age of 60. D. OA is more common with aging, but usually it remains confined to a few joints and does not cause crippling. E.OA can be prevented from progressing when well controlled with a regimen of exercise, diet, and medication.
Correct answer: D. OA is more common with aging, but usually it remains confined to a few joints and does not cause crippling. E.OA can be prevented from progressing when well controlled with a regimen of exercise, diet, and medication. Rationale: OA occurs with greater frequency with increasing age, but it usually remains confined to a few joints and can be managed with a combination of exercise, diet, and medication. OA can lead to significant disability.
Teach the patient with ankylosing spondylitis the importance of a. regular exercise and maintaining proper posture b. continuing with physical activity during flare-ups c. avoiding extremes in environmental temperatures d. applying cool compresses for relief of local symptoms
Correct answer: A Rationale: Patients with ankylosing spondylitis (AS) should exercise after pain and stiffness are managed. Postural control is important to minimize spinal deformity. The exercise regimen should include back, neck, and chest stretches. The nurse should educate the patient with AS about regular exercise and attention to posture, local moist-heat applications, and knowledgeable use of drugs. The nurse should discourage excessive physical exertion during periods of active flare-up of the disease. Proper positioning at rest is essential. The mattress should be firm, and the patient should sleep on the back with a flat pillow, avoiding positions that encourage flexion deformity. Postural training emphasizes avoiding spinal flexion (e.g., leaning over a desk), heavy lifting, and prolonged walking, standing, or sitting.
When administering medications to the patient with gout, the nurse would recognize which of the following as a treatment for chronic disease? a. Colchicine b. Febuxostat c. Sulfasalazine d. Cyclosporine
Correct answer: B Rationale: Febuxostat (Uloric), a selective inhibitor of xanthine oxidase, is given for long-term management of hyperuricemia in persons with chronic gout. Acute gouty arthritis is treated with colchicine and nonsteroidal antiinflammatory drugs (NSAIDs).
In teaching a patient with SLE about the disorder, the nurse knows that the pathophysiology of SLE includes A. circulating immune complexes formed from IgG autoantibodies reacting with IgG B. an autoimmune T-cell reaction that results in destruction of the deep dermal skin layer C. immunologic dysfunction leading to chronic inflammation in the cartilage and muscles D. the production of a variety of autoantibodies directed against components of the cell nucleus
Correct answer: D Rationale: Systemic lupus erythematosus (SLE) is characterized by the production of many autoantibodies against nucleic acids (e.g., single-and double-stranded DNA), erythrocytes, coagulation proteins, lymphocytes, platelets, and many other self-proteins. Autoimmune reactions characteristically are directed against constituents of the cell nucleus (e.g., antinuclear antibodies [ANAs]), particularly DNA. Circulating immune complexes containing antibody against DNA are deposited in the basement membranes of capillaries in the kidneys, heart, skin, brain, and joints. Complement is activated, and inflammation occurs. The overaggressive antibody response is also related to activation of B and T cells. The specific manifestations of SLE depend on which cell types or organs are involved. SLE is a type III hypersensitivity response.
In assessing the joints of a patient with rheumatoid arthritis, the nurse understands that the joints are damaged by (select all that apply) A. bony ankylosis following inflammation of the joints B. the deterioration of cartilage by proteolytic enzymes C. the development of Heberden's nodes in the joint capsule D. increased cartilage and bony growth at the joint margins E. invasion of pannus into the joint causing a loss of cartilage
Correct answers: A, E Rationale: Bony ankylosis is the union of the bones of a joint by proliferation of bone cells, resulting in complete immobility. Bony ankylosis occurs with advanced rheumatoid arthritis. Joint changes from chronic inflammation begin when the hypertrophied synovial membrane invades the surrounding cartilage, ligaments, tendons, and joint capsule. Pannus (i.e., highly vascular granulation tissue) forms within the joint. It eventually covers and erodes the entire surface of the articular cartilage. The production of inflammatory cytokines at the pannus-cartilage junction further contributes to cartilage destruction. The pannus scars and shortens supporting structures such as tendons and ligaments, ultimately causing joint laxity, subluxation, and contracture.
A patient's ankle is severely sprained the dr directs the nurse to wrap the patients lower extremity with an elastic bandage. Where should the nurse begin applying the bandage?
At the metatarsals
When reinforcing health teaching about the management of osteoarthritis (OA), the nurse determines that the patient needs additional instruction after making which of the following statements? A. "I should take the Celebrex as prescribed to help control the pain." B. "I should try to stay standing all day to keep my joints from becoming stiff." C. "I can use a cane if I find it helpful in relieving the pressure on my back and hip." D. "A warm shower in the morning will help relieve the stiffness I have when I get up."
Correct answer: B. "I should try to stay standing all day to keep my joints from becoming stiff." Rationale: It is important to maintain a balance between rest and activity to prevent overstressing the joints with OA.
A client with a suspected rib fracture has a bone fragment protruding from the clients thigh as well as profuse bleeding from the wound. What should you do?
compress the femoral artery
The nurse is conducting the admission assessment for the client who is to undergo an arthrogram. What is the priority question the nurse should ask? a) "Are you claustrophobic?" b) "When did you last eat?" c) "When did you last urinate?" d) "Do you have any allergies?"
"Do you have any allergies?" Explanation: Many contrast dyes contain iodine. Therefore, it is essential for the nurse to determine whether the client has any allergies, especially to iodine, shellfish, and other seafood.
The client has returned from surgery with a leg cast, and the nurse is assisting the client back to bed. What is the highest priority when documenting the postoperative circulation status of the recently casted extremity?
Adequate neurovascular functioning
A patient with gout is treated with drug therapy to prevent future attacks. The nurse teaches the patient that is is the most important to a. avoid all foods high in purine, such as organ meats b. have periodic determination of serum uric acid levels c. perform active ROM of all joints that have been affected by gout d. increase the dosage of medication with the onset of an acute attack
B. have periodic determination of serum uric acid levels
A patient with newly diagnosed SLE asks the nurse how the disease will affect her life. The best response by the nurse is a. You can plan to have a near-normal life since SLE rarely causes death b. it is difficult to tell because to disease is so variable in its severity and progression c. life span is shortened somewhat in people with SLE, but the disease can be controlled with long-term use of corticosteroids d. most people with SLE have alternating periods of remissions and exacerbations with rapid progression to permanent organ damage
B. it is difficult to tell because the disease is so variable in its severity and progression
To preserve function and the ability to perform activities of daily living, the nurse teaches the patient with OA to a. avoid exercise that involves the affected joints b. plan and organize less stressful ways to perform tasks c. maintain normal activities during an acute episode to prevent loss of function d. use mild analgesics to control symptoms when performing tasks that cause pain
B. plan and organize less stressful ways to perform tasks
While backpacking with a youth group, a 17 year-old falls and sustains an injury to the lower leg. A nurse who is accompanying the group suspects a fracture of the tibia. To immobilize the suspected fracture, how should the nurse apply a splint?
Below the ankle to above the knee
During an acute exacerbation, a patient with SLE is treated with corticosteroids. The nurse would expect the steroids to begin to be tapered when serum laboratory results indicate a. increased RBCs b. decreased ESR c. decreased anti-DNA d. increased complement
C. decreased anti-DNA
A 70-year old patient is being evaluated for symptoms of RA. The nurse recognizes that a major problem in the management of RA in the older adult is that a. RA is usually more severe in older adults b. older patients are not as likely to comply with treatment regimens c. drug interactions and toxicity are more likely to occur with multidrug therapy d. laboratory and other diagnostic tests are not effective in identifying RA in older adults
C. drug interactions and toxicity are more likely to occur with multidrug therapy
During the physical assessment of the patient with moderate RA, the nurse would expect to find a. hepatomegaly b. Heberden's nodes c. spindle-shaped fingers d. crepitus on joint movement
C. spindle-shaped fingers
A client is to have a total hip replacement. The preoperative plan should include which of the following? Select all that apply. 1. Administer antibiotics as prescribed to ensure therapeutic blood levels. 2. Apply leg compression device. 3. Request a trapeze be added to the bed. 4. Teach isometric exercises of quadriceps and gluteal muscles. 5. Demonstrate crutch walking with a 3-point gait. 6. Place Buck's traction on the bed.
1, 3, 4. Administration of antibiotics as prescribed will aid in the acquisition of therapeutic blood levels during and immediately after surgery to prevent osteomyelitis. The nurse can request that a trapeze be added to the bed so the client can assist with lifting and turning. The nurse should also demonstrate and have the client practice isometric exercises (muscle setting) of quadriceps and gluteal muscles. The client will not use crutches after surgery; a physical therapy assistant will initially assist the client with walking by using a walker. The client will not use Buck's traction. The client will require anti-embolism stockings and use of a leg compression device to minimize the risk of thrombus formation and potential emboli; the leg compression device is applied during surgery and maintained per physician order.
The pathophysiology of systemic lupus erthematosus (SLE) is characterized by a. destruction of nucleic acids and other self-proteins by autoantibodies b. overproduction of collagen that disrupts the functioning of internal organs c. formation of abnormal IgG that attaches to cellular antigens, activating complement d. increased activity of T-suppressor cells with B-cell hypoactivity, resulting in an immunodeficiency
A. destruction of nucleic acids and other self-proteins by autoantibodies
Teaching that the nurse will plan for the patient with SLE includes a. ways to avoid exposure to sunlight b. increasing dietary protein and carbohydrate intake c. the necessity of genetic counseling before planning a family d. the use of no pharmacologic pain interventions instead of analgesics
A. ways to avoid exposure to sunlight
During treatment of the patient with an acute attack of gout, the nurse would expect to administer a. aspirin b. colchicine c. allopurinol (Zyloprim) d. probenecid (Benemid)
B. Colchicine
What evening snack would the nurse encourage for the client with immobility due to a fractured hip?
Peanut butter and celery
What is characteristic of systemic lupus erythematosus (SLE)?
Photosensitivity, rash to areas exposed to sunlight, butterfly rash over face, fever, raynauds, pericardial effusion, hypertension.
What risk factor found in an 80-year female client old client does the nurse identify as most significant for sustaining a hip fracture?
The client is postmenopausal
Which nursing diagnosis is most appropriate for an elderly client with osteoarthritis? 1. Risk for injury related to altered mobility 2. Impaired urinary elimination related to effects of aging 3. Ineffective breathing pattern related to immobility 4. Imbalanced nutrition: Less than body requirements related to effects of aging
1. Risk for injury related to altered mobility
During a senior citizen health screening, the nurse observes a 75-year-old female with a severely increased thoracic curve, or "humpback". What is this condition called? 1. Lordosis 2. Kyphosis 3. Scoliosis 4. Genus varum
2. Kyphosis
A nurse is evaluating the pin sites of a client in skeletal traction. The nurse would be least concerned with which finding? 1. Inflammation 2. Serous drainage 3. pain at the pin site 4. Purulent drainage
2. Serous drainage
A client with osteoarthritis tells the nurse she is concerned that the disease will prevent her from doing her chores. Which suggestion should the nurse offer? 1. "Do all your chores in the morning, when pain and stiffness are least pronounced." 2. "Do all your chores after performing morning exercises to loosen up." 3. "Pace yourself and rest frequently, especially after activities." 4. "Do all your chores in the evening, when pain and stiffness are least pronounced."
3. "Pace yourself and rest frequently, especially after activities."
A client has sustained a closed fracture and had a cast applied to the arm. The client has C/O intense pain. The nurse has elevated the limb, applied ice, and administered an analgesic, which was ineffective in relief of pain. The nurse interprets that this pain may be caused by: 1.Infection under the cast 2.The anxiety of the client 3.Impaired tissue perfusion 4.The newness of the fracture
3.Impaired tissue perfusion
A client is admitted with severe pain in the knees. Which form of arthritis is characterized by urate deposits and joint pain, usually in the feet and legs, and occurs primarily in men over age 30? 1. Septic arthritis 2. Traumatic arthritis 3. Intermittent arthritis 4. Gouty arthritis
4. Gouty arthritis
A 72-year-old female client reports that she has lost an inch in height since menopause. The nurse explains to the client that she has a musculoskeletal disorder. What's this disorder called? 1. Osteoarthritis (OA) 2. Rheumatoid arthritis (RA) 3. Paget's disease 4. Osteoporosis
4. Osteoporosis
A nurse is one of several people who witness a vehicle hit a pedestrian at a fairly low speed on a small street. The individual is dazed and the leg seems fractured. The nurse plans to : 1. Try to manually reduce the fracture 2. Assist the person to get up and walk to the sidewalk 3. Leave the person for a few moments to call an ambulance. 4. Stay with the person and encourage the person to remain still.
4. Stay with the person and encourage the person to remain still.
A cast has just been removed from a leg. Which clinical manifest is an abnormal finding? 1. restricted motion 2. smaller, atrophied muscle 3. skin peeling, wrinkled, and dry 4. the bony prominences are excoriated
4. the bony prominences are excoriated
Prior to surgery, the nurse is instructing a client who will have a total hip replacement tomorrow. Which of the following information is most important to include in the teaching plan at this time? 1. Teaching how to prevent hip flexion. 2. Demonstrating coughing and deep-breathing techniques. 3. Showing the client what an actual hip prosthesis looks like. 4. Assessing the client's fears about the procedure.
4.ASSESSING THE CLIENT'S FEARS ABOUT THE PROCEDURE Before implementing a teaching plan, the nurse should determine the client's fears about the procedure. Only then can the client begin to hear what the nurse has to share about the individualized teaching plan designed to meet the client's needs. In the preoperative period, the client needs to learn how to correctly prevent hip flexion and to demonstrate coughing and deep breathing. However, this teaching can be effective only after the client's fears have been assessed and addressed. Although the client may appreciate seeing what a hip prosthesis looks like, so as to understand the new body part, this is not a necessity.
A nurse is assigned to care for a client with multiple trauma who is admitted to the hospital. The client has a leg fracture, and a plaster cast has been applied. In positioning the casted leg, the nurse should: 1.Keep the leg in a level position 2.Elevate the leg for 3 hrs, and put it flat for 1 hr 3.Keep the leg level for 3 hrs, and elevate it for 1hr 4.Elevate the leg on pillows continuously for 24-48 hrs
4.Elevate the leg on pillows continuously for 24-48 hrs
What medications are used for an acute gout attack?
Colchicine (worried about vomiting and toxicity), indocin, and naproxen.
The nurse is caring for a patient who has osteoarthritis (OA) of the knees. The nurse teaches the patient that the most beneficial measure to protect the joints is to do which of the following? A. Use a wheelchair to avoid walking as much as possible. B. Eat a well-balanced diet to maintain a healthy body weight. C. Use a walker for ambulation to relieve the pressure on her hips. D. Sit in chairs that do not cause her hips to be lower than her knees.
Correct answer: B. Eat a well-balanced diet to maintain a healthy body weight. Rationale: Because maintaining an appropriate load on the joints is essential to the preservation of articular cartilage integrity, the patient should maintain an optimal overall body weight or lose weight if overweight.
A 60-year-old woman has pain on motion in her fingers and asks the nurse whether this is just a result of aging. The best response by the nurse includes the information that a. joint pain with functional limitation is a normal change that affects all people to some extent b. joint pain that develops with age is usually related to previous trauma or infection of the joints c. this is a symptom of a systemic arthritis that eventually affects all joints as the disease progresses d. changes in the cartilage and bones of joints may cause symptoms of pain and loss of function in some people as they age
D. changes in the cartilage and bones of joints may cause symptoms of pain and loss of function in some people as they age.
What nursing interventions should be done for a pt with a fracture?
ELEVATE, circulation checks, maintain immobilization, cast care, and watch for infection. Assess for abuse in kids and elders.
During discharge of a client with osteoporosis, which statement indicates the client needs more teaching?
"I take ibuprofen every morning as soon as i get up." Rationale: Dont take it on empty stomach! This is an ulcerogenic drug
The skin around the pin site is swollen red and crusty with dried drainage. What is this indicative of?
This indicates osteomalitis. Notify the health care provider.
In preparation for total knee surgery, a 200-lb client with osteoarthritis must lose weight. Which of the following exercises should the nurse recommend as best if the client has no contraindications? 1. Weight lifting. 2. Walking. 3. Aquatic exercise. 4. Tai chi exercise.
3.AQUATIC EXERCISE When combined with a weight loss program, aquatic exercise would be best because it cushions the joints and allows the client to burn off calories. Aquatic exercise promotes circulation, muscle toning, and lung expansion, which promote healthy preoperative conditioning. Weight lifting and walking are too stressful to the joints, possibly exacerbating the client's osteoarthritis. Although tai chi exercise is designed for stretching and coordination, it would not be the best exercise for this client to help with weight loss.
A nurse discovers that a client who is in traction for a long bone fracture has a slight fever, has SOB and is restless. What does the client most likely have?
A fat embolism, which is characterized by hypoxemia, respiratory distress, irritability, restlessness, fever, and petechiae.
While the client is waiting for the ankle to be x-rayed, which nursing measure is most helpful for relieving the soft-tissue swelling?
Apply ice to the ankle
The physician diagnoses rheumatoid arthritis and prescribes a total of 5 grams of aspirin per day. The client is surprised the physician prescribed a common drug such as aspirin to treat her condition
Aspirin reduces joint inflammation
Which assessment findings is the best indication that the client is experiencing secondary complications from fractured ribs?
Asymmetrical chest expansion
If the client is typical of most people with rheumatoid arthritis, when would the nurse expect the client's symptoms to first become evident?
During young childhood
Characteristics of spondyloarthritides associated with HLA-B27 antigen include a. symmetric polyarticular arthritis b. an absence of extraarticular disease c. presence of rheumatoid factor and autoantibodies d. high level of involvement of sacroiliac joints and the spine
D. high level of involvement is sacroiliac joints and the spine
Laboratory findings that the nurse would expect to be present in the patient with RA include a. polycythemia b. increased IgG c. decreased WBC d. increased C-reactive protein (CRP)
D. increased C-reactive protein (CRP)
An important nursing intervention for the patient with ankylosing spondylitis is to teach the patient to a. wear roomy shoes with good orthotic support b. sleep on the side with the knees and hips flexed c. keep the spine slightly flexed while sitting, standing, or walking d. perform back, neck, and chest stretches and deep breathing exercises
D. perform back, neck and chest stretches and deep breathing exercises
A patient is seen at the outpatient clinic for a sudden onset of inflammation and severe pain in the great toe. A diagnosis of gout is made on the basis of a. a family history of gout b. elevated urine uric acid levels c. elevated serum uric acid levels d. the presence of sodium urate crystals in synovial fluid
D. the presence of sodium urate cystals in synovial fluid
After teaching a patient with RA to use heat and cold therapy to relieve symptoms, the nurse determines that teaching has been effective when the patient says, a. heat treatments should not be used if muscle spasms are present b. cold applications can be applied for 15-20 minutes to relieve joint stiffness c. I should use heat applications for 20 minutes to relieve the symptoms of an acute flare d. when my joints are painful, I can use a bag of frozen corn for 10 to 15 minutes to relieve the pain
D. when my joints are painful, I can use a bag of frozen corn for 10 to 15 minutes to relive the pain
Which laboratory test value, if elevated is the best indicator of rheumatoid arthritis?
Erythrocyte sedimentation rate (ESR)
The human body has 206 bones, which are classified into four categories. Which types of bones are located in the forearm? a) Short bones b) Irregular bones c) Long bones d) Flat bones
Long bones Explanation: Long bones are the type of bone that is located in the forearm, specifically, the ulna.
The client presents with an exaggeration of the lumbar spine curve. The nurse interprets these findings as indicative of: a) Dowager's hump b) Scoliosis c) Lordosis d) Kyphosis
Lordosis Explanation: Lordosis is an exaggeration of the lumbar spine curve.
What is the best technique for a nurse applying an elastic bandage to a client's lower extremity sprain?
Making figure-eight turns with the bandage
A client has a comminuted fracture of the distal tibia. How do you describe this when explaining the injury to the client?
The bone is splintered into pieces
Differentiate between RA and osteoarthritis in terms of joint involvement.
RA occurs bilaterally, Osteoarthritis occurs asymmetrically.
A client is about to go to surgery but is still wearing a class ring. Which nursing action is most appropriate regarding care of the clients valuables?
Take the ring to the hospital safe
When is carpal tunnel most painful?
Throughout the night
What is allopurinol (zyloprim) used for?
To prevent GOUT. It decreases uric acid synthesis.
A client is complaining of pain underneath a cast in the area of a bony prominence. The nurse interprets that this client may need to have what?
a window cut in the cast. A window may be cut in a dried cast to relieve pressure, monitor pulses, relieve discomfort, or remove drains
A client is admitted to the nursing unit after a left BKA following a crush injury to the foot and lower leg. The client says "I feel my left foot itching". The nurse interprets this how?
a normal response, and indicates the presence of phantom limb sensation.
What are the three basic types of splints? a. Rigid, formable, and traction b. PASG, board and ladder c. Padded, soft and anatomical d. Air, cardboard, and vacuum
a. Rigid, formable, and traction
Your 19 year old female patient was snowboarding when she injured her right shoulder. It appears to be out of the socket and in an unusual position. When a joint is locked in the position like this, the EMT should: a. Splint the joint in the position found b. Pull traction and straighten the joint c. Use a long backboard as a full body splint d. Disregard splinting and transport immediately
a. Splint the joint in the position found
You are treating a 22 year old male who you suspect has sustained a fracture to his right forearm. The treatment of a possible fracture includes the steps below: 1. take standard precautions 2. elevate the extremity 3. splint the injury 4. apply a cold pack What is the correct order of the steps? a. 2,3,4,1 b. 1,3,2,4 c. 3,2,4,1 d. 1,4,2,3
b. 1,3,2,4
Your 19 year old male patient fell while playing basketball. You suspect that he broke his right tibia. Proper splinting of a closed fracture is: a. Done with an air splint and gentle traction b. Done with the pneumatic antishock garment c. Designed to prevent closed injuries from becoming open ones d. Completed in the hospital by a surgeon
c. Designed to prevent closed injuries from becoming open ones
Your 45 year old female patient has a grossly deformed ulnar and radius fracture that will need to be properly splinted. The objective of realignment is to: a. minimize blood loss and reduce pain b. immobilize the bone ends and adjacent joints c. assist in restoring circulation and to fit the extremity into a splint d. prevent incorrect healing and avoid surgery
c. assist in restoring circulation and to fit the extremity into a splint
A nurse is assigned to care for a client with multiple trauma who is admitted to the hospital. The client has a leg fracture, and a plaster cast had been applied. In positioning the casted leg, the nurse should do what?
elevate the leg on pillow continuously for 24-48 hours
While caring for a client with an external fixator on the lower leg for a fractured tibia, what is a complication that may arise?
infection
A client who sustained a crush injury to right lower leg c/o numbness and tingling of the affected extremity. The right leg appears pale and pedal pulse is weak. The nurse should do what?
notify the health care provider - this is consistent with signs of compartment syndrome
What is manipulation?
repositions the bone ends manually for a dislocation
A client with diabetes mellitus has had a right BKA (below knee amputation). The nurse should monitor for what?
separation of wound edges. Clients with diabetes mellitus are more prone to wound infection and delayed healing because of the disease
Bivalving a cast involves what?
splitting the cast along both sides to allow space for swelling, facilitate taking x rays, or make a half cast for use as intermittent splint
In the case of a teenager requiring surgery to realign the bones of a fracture tibia, from whom is it most important (for the physician with the nurse as a witness) to obtain consent to perform the surgical procedure?
the client's parent
Upon discharge, the nurse advises the client on the need for maintenance of the elastic bandage. When should the nurse advise the client with a sprained ankle to rewrap the elastic bandage?
when the toes look swollen
A 78-year-old client has a history of osteoarthritis. Which signs and symptoms would the nurse expect to find on physical assessment? 1. Joint pain, crepitus, Heberden's nodes 2. Hot, inflamed joints; crepitus; joint pain 3. Tophi, enlarged joints, Bouchard's nodes 4. Swelling, joint pain, and tenderness on palpation
1. Joint pain, crepitus, Heberden's nodes
The basic pathophysiologic process of rheumatoid arthritis (RA) is a. destruction of joint cartilage and bones by an autoimmune process b. initiated by a viral infection that destroys the synovial membranes of joints c. the presence of HLA-DR4 antigen that causes inflammatory responses throughout the body d. an immune response that activates complement and produces inflammation of joints and other organ systems
D. an immune response that activates complement and produces inflammation of joints and other organ systems
A nurse is caring for a client who has skeletal traction applied to the left leg. The client is complaining of severe left leg pain. Which action should the nurse take first? 1.Provide pin care 2.Call the physician immediately 3. Check the client's alignment in bed 4.Medicate the client with an analgesic
3. Check the client's alignment in bed
A client is diagnosed with osteoporosis. Which statements should the nurse include when teaching the client about the disease? (Select all that apply) 1. "It's common in females after menopause." 2. "It's a degenerative disease characterized by a decrease in bone density." 3. "It's a congenital disease caused by poor dietary intake of milk products." 4. "It can cause pain and injury." 5. "Passive range-of-motion exercises can promote bone growth." 6. "Weight-bearing exercise should be avoided."
1. "It's common in females after menopause." 2. "It's a degenerative disease characterized by a decrease in bone density." 4. "It can cause pain and injury."
A 69-year-old client asks the nurse what the difference is between osteoarthritis (OA) and rheumatoid arthritis (RA). Which response is correct? 1. "OA is a noninflammatory joint disease. RA is characterized by inflamed, swollen joints." 2. "OA and RA are very similar. OA affects the smaller joints and RA affects the larger, weight-bearing joints." 3. "OA affects joints on both sides of the body. RA is usually unilateral." 4. "OA is more common in women. RA is more common in men."
1. "OA is a noninflammatory joint disease. RA is characterized by inflamed, swollen joints."
A client seeks care for low back pain of 2 weeks' duration. Which assessment finding suggests a herniated intervertebral disk? 1. Pain radiating down the posterior thigh 2. Back pain when the knees are flexed 3. Atrophy of the lower leg muscles 4. Homans' sign
1. Pain radiating down the posterior thigh
A nurse is planning to provide instructions to the client about how to stand on crutches. In the written instructions, the nurse plans to tell the client to place the crutches: 1. 3" to the front and side of the toes 2. 8" to the front and side of the toes 3. 20" to the front and side of the toes 4. 15" to the front and side of the toes
2. 8" to the front and side of the toes
During a scoliosis screening in a college heath center, a student asks the public health nurse about the consequences of untreated scoliosis. The nurse would be accurate by identifying one of the direct complications as: 1. osteoporosis of the vertebra. 2. impingement on pulmonary function. 3. spontaneous spinal cord injury. 4. pituitary hyposecretion.
2. impingement on pulmonary function
A nurse is evaluating the client's use of a cane for left-sided weakness. The nurse would intervene and correct the client if the nurse observed that the client: 1.Holds the cane on the right side 2.Moves the cane when the right leg is moved 3.Leans on the cane when the right leg swings through 4.Keeps the cane 6" out to the side of the right foot
2.Moves the cane when the right leg is moved
A nurse witnesses a client sustain a fall and suspects that the client's leg may be fractured. Which action is the priority? 1. Take a set of vitals. 2. Call the radiology department. 3. Immobiliize the leg before moving the client. 4. Reassure the client that everything will be fine.
3. Immobiliize the leg before moving the client.
The nurse has established a goal with a client to improve mobility following hip replacement. Which of the following is a realistic outcome at the time of discharge from the surgical unit? 1. The client can walk throughout the entire hospital with a walker. 2. The client can walk the length of a hospital hallway with minimal pain. 3. The client has increased independence in transfers from bed to chair. 4. The client can raise the affected leg 6 inches with assistance.
3. THE CLIENT HAS INCREASED INDEPENDENCE IN TRANSFERS FROM BED TO CHAIR. Expected outcomes at the time of discharge from the surgical unit after a hip replacement include the following: increased independence in transfers, participates in progressive ambulation without pain or assistance, and raises the affected leg without assistance. The client will not be able to walk throughout the hospital, walk for a distance without some postoperative pain, or raise the affected leg more than several inches. The client may be referred to a rehabilitation unit in order to achieve the additional independence, strength, and pain relief.
A client with a hip fracture asks the nurse why Buck's extension traction is being applied before surgery. The nurse's response is based on the understanding that Buck's extension traction primarily: 1. Allows bone healing to begin before surgery. 2. Provides rigid immobilization of the fracture site. 3. Lengthens the fractured leg to prevent contraction 4. Provides comfort by reducing muscle spasms and provides fracture immobilization.
4. Provides comfort by reducing muscle spasms and provides fracture immobilization.
The client with an above-the-knee amputation is to use crutches while his prosthesis is being adjusted. In which of the following exercises should the nurse instruct the client to best prepare him for using crutches? 1. Abdominal exercises. 2. Isometric shoulder exercises. 3. Quadriceps setting exercises. 4. Triceps stretching exercises.
4. TRICEPS STRECTCHING EXERCISES Use of crutches requires significant strength from the triceps muscles. Therefore, efforts are focused on strengthening these muscles in anticipation of crutch walking. Bed and wheelchair push-ups are excellent exercises targeted at the triceps muscles. Abdominal exercises, range-of-motion and isometric exercises of the shoulders, and quadriceps and gluteal setting exercises are not helpful in preparing for crutch walking.
After knee arthroplasty, the client has a sequential compression device (SCD). The nurse should do which of the following? 1. Elevate the sequential compression device (SCD) on two pillows. 2. Change the settings on the SCD to make the client more comfortable. 3. Stop the SCD to remove dressings and bathe the leg. 4. Discontinue the SCD when the client is ambulatory.
4.DISCONTINUE THE SCD WHEN THE CLIENT IS AMBULATORY After knee arthroplasty, the knee will be extended and immobilized with a firm compression dressing and an adjustable soft extension splint in place. A sequential compression device (SCD) will be applied. The SCD can be discontinued when the client is ambulatory, but while the client is in bed the SCD needs to be maintained to prevent thromboembolism. The SCD should be positioned on the bed, but not on two pillows. Settings for the SCD are ordered by the orthopedic surgeon. Initial dressing changes are completed by the orthopedic surgeon and changed as needed per physician order.
A nurse has provided instructions regarding specific leg exercises for the client immobilized in the right skeletal lower leg traction. The nurse determines that the clients needs further instruction if the nurse observes the client: 1.Pulling up on the trapeze 2.Flexing and extending the feet 3.Doing quadriceps-setting and gluteal-setting exercises 4.Performing active range of motion (ROM) to the right ankle and knee
4.Performing active range of motion (ROM) to the right ankle and knee
A nurse is planning to provide instructions to the client how to stand on crutches. In the written instructions, the nurse plans to tell the client to place the crutches:
6-10 inches in front and to the side of the client depending on the body size. This provides a base of support to the client and improves balance
A patient recovering from an acute exacerbation of RA tells the nurse she is too tired to bathe. The nurse should a. give the patient a bed bath to conserve her energy b. allow the patient a rest period before showering with the nurses' help c. tell the patient that she can skip bathing if she will walk in the hall later d. inform the patient that it is important for her to maintain self-care activities
B. allow the patient a rest period before showering with the nurses' help
The nurse is assessing the recent health history of a 63-year-old patient with osteoarthritis (OA). The nurse determines that the patient is trying to manage the condition appropriately when the patient describes which of the following activity patterns? A. Bed rest with bathroom privileges B. Daily high-impact aerobic exercise C.A regular exercise program of walking D. Frequent rest periods with minimal exercise
Correct answer: C. A regular exercise program of walking Rationale: A regular low-impact exercise, such as walking, is important in helping to maintain joint mobility in the patient with osteoarthritis.
Which of the following patient statements most clearly suggests a need to assess the patient for ankylosing spondylitis (AS)? A. "My right elbow has become red and swollen over the last few days." B. "I wake up stiff every morning and my knees just don't want to bend." C. "My husband tells me that my posture has become so stooped this winter." D. "My lower back pain seems to be getting worse all the time and nothing seems to help."
Correct answer: D. "My lower back pain seems to be getting worse all the time and nothing seems to help." Rationale: AS primarily affects the axial skeleton. Based on this, symptoms of inflammatory spine pain are often the first clues to a diagnosis of AS. Knee or elbow involvement is not consistent with the typical course of AS. Back pain is likely to precede the development of kyphosis.
Following a total joint replacement, which of the following complications has the greatest likelihood of occurring? 1. Deep vein thrombosis (DVT). 2. Polyuria. 3. Intussception of the bowel. 4. Wound evisceration.
1. DVT Deep vein thrombosis is a complication of total joint replacement and may occur during hospitalization or develop later when the client is home. Clients who are obese or have previous history of a DVT or PE are at high risk. Immobility produces venous stasis, increasing the client's chance to develop a venous thromboembolism. Signs of a DVT include: unilateral calf tenderness, warmth, redness, and edema (increased calf circumference). Findings should be reported promptly to the physician for definitive evaluation and therapy. Polyuria may be indicative of diabetes mellitus. Intussusception of the bowel and wound evisceration tend to occur after abdominal surgeries.
A client comes to the outpatient department with suspected carpal tunnel syndrome. When assessing the affected area, the nurse expects to find which abnormality that's typically associated with this syndrome? 1. Positive Tinel's sign 2. Negative Phalen's sign 3. Positive Chvostek's sign 4. Negative Trousseau's sign
1. Positive Tinel's sign
A client is complaining of skin irritation from the edges of the cast applied the previous day. The nurse should plan for which of the following actions? 1.Massaging the skin at the rim of the cast 2.Petaling the cast edges with adhesive tape 3.Using a rough file to smooth the cast edges 4. Use a padded coat hanger end to scratch under the cast
2.Petaling the cast edges with adhesive tape
A client who had a total hip replacement 4 days ago is worried about dislocation of the prosthesis. The nurse should respond by saying which of the following? 1. "Don't worry. Your new hip is very strong." 2. "Use of a cushioned toilet seat helps to prevent dislocation." 3. "Activities that tend to cause adduction of the hip tend to cause dislocation, so try to avoid them." 4. "Decreasing use of the abductor pillow will strengthen the muscles to prevent dislocation."
3. "ACTIVITIES THAT TEND TO CAUSE ADDUCTION OF THE HIP TEND TO CAUSE DISLOCATION, SO TRY TO AVID THEM." Dislocation precautions include: avoid extremes of internal rotation, adduction, and 90-degree flexion of affected hip for at least 4 to 6 weeks after the procedure. Use of an abduction pillow prevents adduction. Decreasing use of the abductor pillow does not strengthen the muscles to prevent dislocation. Informing a client to "not worry" is not therapeutic. A cushioned toilet seat does not prevent hip dislocation.
The nurse is planning care for a group of clients who have had total hip replacement. Of the clients listed below, which is at highest risk for infection and should be assessed first? 1. A 55-year-old client who is 6 feet tall and weighs 180 lb. 2. A 90-year-old who lives alone. 3. A 74-year-old who has periodontal disease with periodontitis. 4. A 75-year-old who has asthma and uses an inhaler.
3. A 74 YO WHO HAS PERIODONTAL DISEASE WITH PERIODONTITIS Infection is a serious complication of total hip replacement and may necessitate removal of the implant. Clients who are obese, poorly nourished, elderly, have poorly controlled diabetes, rheumatoid arthritis, or concurrent infections (e.g., dental, urinary tract) are at high risk for infection. Clients who are of normal weight and have well-controlled chronic diseases are not at risk for infection. Living alone is not a risk factor for infection.
The nurse is assisting a client with range-of-motion exercises. The nurse moves the client's leg out and away from the midline of the body. What movement does the nurse document? 1. Pronation 2. Adduction 3. Abduction 4. Supination
3. Abduction
A nurse is checking the casted extremity of a client. The nurse would check for which of the following S&S indicative of infection? 1.Dependent edema 2.Diminished distal pulse 3.Presence of a "hot spot" on the cast 4.Coolness and pallor of the extremity
3.Presence of a "hot spot" on the cast
On the evening of surgery for total knee replacement, a client wants to get out of bed. To safely assist the client the nurse should do which of the following? 1. Encourage the client to apply full weight-bearing. 2. Order a walker for the client. 3. Place a straight-backed chair at the foot of the bed. 4. Apply a knee immobilizer.
4. APPLY A KNEE IMMOBILIZER The knee is usually protected with a knee immobilizer (splint, cast, or brace) and is elevated when the client sits in a chair. Pre- and post-surgery, the physician prescribes weight-bearing limits and use of assistive devices for progressive ambulation. Positioning a straight-backed chair at the foot of the bed is not an action conducive for getting the client out of bed on the evening of surgery for a total knee replacement.
