332 Test 5 prep U

Kyphosis

The nurse is performing an assessment on an older adult patient and observes the patient has an increased forward curvature of the thoracic spine. What does the nurse understand this common finding is known as?

Arthroscopy

The nurse is preparing a client for a surgical procedure that will allow visualization of the extent of joint damage of the knee for a client with rheumatoid arthritis and also obtain a sample of synovial fluid. What procedure will the nurse prepare the client for?

The skin may be covered with a yellowish crust that will shed in a few days.

The nurse is preparing a client to have his cast cut off after having it for 6 weeks to treat a fractured tibia. What should the nurse inform the client prior to the cast being removed?

"You must remain very still during the procedure."

The nurse is preparing the client for computed tomography. Which information should be given by the nurse?

7

The nurse is preparing to discharge a client from the PACU using a PACU room scoring guide. With what score can the client be transferred out of the recovery room?

Administering the prescribed analgesic.

The nurse is providing care to a client following a knee arthroscopy. What would the nurse expect to include in the client's plan of care?

"Metal pins will go through my skin to the bone."

The nurse is providing instructions to the client who is being prepared for skeletal traction. Which statement by the client indicates teaching was effective?

Therapeutic drug levels can be maintained more evenly with patient-controlled analgesia.

The nurse is teaching the client about patient-controlled analgesia. Which of the following would be appropriate for the nurse to include in the teaching plan?

Headache

The nurse is teaching the client about usual side effects associated with spinal anesthesia. Which of the following should the nurse include when teaching?

Muscle

The nurse is working on an orthopedic floor caring for a client injured in a football game. The nurse is reviewing the client's chart noting that the client has previously had an injured tendon. The nurse anticipates an injury between the periosteum of the bone and which of the following?

Hallux valgus

The nurse notes that the client's left great toe deviates laterally. This finding would be recognized as which condition?

Outline the drainage with a pen and record the date and time next to the drainage.

The nurse observes bloody drainage on the surgical dressing of the client who has just arrived on the nursing unit. Which intervention should the nurse plan to do next?

Reinforcing the dressing or applying pressure if bleeding is frank

The nurse observes that a postsurgical client has hemorrhaged and is in hypovolemic shock. Which nursing intervention will manage and minimize hemorrhage and shock?

Perineal surgery

The nurse positions the client in the lithotomy position in preparation for

Client with chronic alcoholism

The nurse recognizes that the client most at risk for mortality associated with surgery is the:

decreased renal function

The nurse recognizes that the older adult is at risk for surgical complications due to:

A client who has a history of arthritis

The nurse recognizes that which of the following clients is at the lowest risk for perioperative complications?

Peripherally-inserted central catheter.

The nurse recognizes that written informed consent is required for insertion of a(n):

Has small pupils that react to light

The nurse recognizes the client has reached stage III of general anesthesia when the client:

lies quietly on the table

The nurse recognizes the client has reached stage III of general anesthesia when the client:

The client takes a deep abdominal breath and then "huff" or "hack" coughs three or four times.

The nurse should determine that a client is coughing effectively after surgery if the nurse observes which of the following activities?

Decreased sensory function Excruciating pain Loss of motion

The nurse suspects "compartment syndrome" for a casted extremity. What characteristic symptoms would the nurse assess that would confirm these suspicions? (Select all that apply.)

Dry a wet fiberglass cast thoroughly to avoid skin problems

The nurse teaching the client with a cast about home care includes which instruction?

diaphysis.

The nurse working in the emergency department receives a call from the x-ray department communicating that the client the nurse is caring for has a fracture in the shaft of the tibia. The nurse tells the physician that the client's fracture is in the

Tear in the joint capsule

The nurse working in the orthopedic surgeon's office is asked to schedule a shoulder arthrography. The nurse determines that the surgeon suspects which finding?

A staff member dressed in street clothes enters the semirestricted zone.

The nurse would intervene when making which of the following observations in the surgical environment?

"Weight-bearing exercises can strengthen bones."

The older client asks the nurse how best to maintain strong bones. What is the nurse's best response?

"Your child had life-threatening injuries that required immediate surgery."

The parent of a 16-year-old client asks the nurse, "How could the surgeon operate without my consent?" What is the best response by the nurse?

Verifies that operative consent is signed

The perioperative nurse has a number of major responsibilities when a patient is admitted to a surgical unit or center. Which of the following is the most important function?

The epinephrine causes vasoconstriction. The epinephrine prevents rapid absorption of the anesthetic drug. The epinephrine prolongs the local action of the anesthetic agent.

The physician requests lidocaine 2% with epinephrine for use in local infiltration anesthesia. What does the nurse understand is the purpose of adding epinephrine to the lidocaine? (Select all that apply.)

All options are correct.

The primary functions of cartilage are to reduce friction between articular surfaces, absorb shocks, and reduce stress on joint surfaces. Where in the human body is cartilage found?

Hypoxemia and hypercapnia.

The primary nursing goal in the immediate postoperative period is maintenance of pulmonary function and prevention of:

Elevate the affected area.

The primary nursing intervention that will control swelling while treating a musculoskeletal injury is:

Preparing the sterile instruments for the surgical procedure

The scrub nurse is responsible for:

Stage IV

The surgical client has been intubated and general anesthesia has been administered. The client exhibits cyanosis, shallow respirations, and a weak, thready pulse. The nurse recognizes that the client is in which stage of general anesthesia?

Peripheral pulses palpable

The surgical client is at risk for injury related to positioning. Which of the following clinical manifestations exhibited by the client would indicate the goal was met of avoiding injury?

Stage II: excitement

There are four stages of general anesthesia. Select the stage during which the OR nurse knows not to touch the patient (except for safety reasons) because of possible uncontrolled movements.

movement of skeletal bones.

There are thousands of components of the musculoskeletal system that facilitate mobility and independent function. The function of skeletal muscle is promoting:

encourage the client to walk in the hall.

To help minimize calcium loss from a hospitalized client's bones, the nurse should:

Ambulating the client as soon as possible

To prevent pneumonia and promote the integrity of the pulmonary system, an essential postoperative nursing intervention includes:

<30 mL

What abnormal postoperative urinary output should the nurse report to the physician for a 2-hour period?

Educating clients on signs and symptoms of infection

What action by the nurse best encompasses the preoperative phase?

Broccoli

What food can the nurse suggest to the client at risk for osteoporosis?

Prevent aspiration

What is the major purpose of withholding food and fluid before surgery?

Count the sponges.

What is the priority action by the scrub nurse when the surgeon begins to close the surgical wound?

Obtain the attention of all members of the surgical team.

What is the priority action when the circulating nurse is completing a second verification of the surgical procedure and surgical site?

Dantrolene sodium

What medication should the nurse prepare to administer in the event the client has malignant hyperthermia?

Dupuytren contracture

What term refers to a flexion deformity caused by a slowly progressive contracture of the palmar fascia?

Up to 72 hours after alcohol withdrawal

When a client with a history of chronic alcoholism is admitted to the hospital for surgery, the nurse anticipates that the client may show signs of alcohol withdrawal delirium during which time period?

Chills

When an infection is bloodborne, the manifestations include which symptom?

"Limit hip flexion to 90 degrees."

When discussing physical activities with the client who has just undergone a right total hip replacement, which instruction should the nurse provide?

Ensuring gown sleeves remain sterile 2 inches above the elbow to cuff

When integrating the principles for maintaining surgical asepsis during surgery, which of the following would be most appropriate?

After 2 days

When is it advisable for the nurse to apply heat to a sprain or a contusion?

preadmission visit

When is the ideal time to discuss preoperative teaching

Apply ice to the fracture site.

When providing discharge teaching to a client with a fractured toe, the nurse should include which instruction?

avoid overreaching.

When teaching a client how to prevent low back pain as a result of lifting, the nurse should instruct the client to:

complex regional pain syndrome.

When the client who has experienced trauma to an extremity reports severe burning pain, vasomotor changes, and muscles spasms in the injured extremity, the nurse recognizes that the client is likely demonstrating signs of

emergency

When the indication for surgery is without delay, the nurse recognizes that the surgery will be classified as

Assess the client's heart rhythm and nail beds.

When the nurse observes that a postoperative client demonstrates a constant low level of oxygen saturation via the O2 saturation monitor despite the client's breathing appearing normal, what action should the nurse take first?

In the thoracic vertebrae

Where would the nurse would assess for kyphosis.

Assisting in early ambulation.

Which action would be most important postoperatively for a client who has had a knee or hip replacement?

Lower lumbar

Which area of the spinal column is subject to the greatest mechanical stress and degenerative changes?

Osteoclasts

Which cells are involved in bone resorption?

Chlorhexidine

Which cleansing solution is the most effective for use in completing pin site care?

The 35-year-old client with non-insulin dependent diabetes.

Which client would the nurse recognize as having the greatest risk for complications during the intraoperative or postoperative period?

Osteomalacia

Which condition is a metabolic bone disease characterized by inadequate mineralization of bone?

650 ml bloody drainage in drain wound Knee flexion at 30 degrees

Which evaluation finding requires follow up by the nurse caring for a client with a total knee replacement? Select all that apply.

Local malignancy

Which factor inhibits fracture healing?

Encourage participation in ADLs

Which general nursing measure is used for a client with a fracture reduction?

European American women

Which group is at the greatest risk for osteoporosis?

Physician

Which health care profession has the ultimate responsibility to provide appropriate information regarding a nonemergent surgery?

Calcitonin

Which hormone inhibits bone reabsorption and increases calcium deposit in the bone?

"Place pillows between your legs when you lay on your side." "Avoid bending forward when sitting in a chair." "Use a raised toilet seat and high-seated chair."

Which instruction should the nurse include when teaching the client following hip replacement surgery? (Select all that apply.)

Instruct the client to avoid internal rotation of the leg.

Which intervention should the nurse implement with the client who has undergone a hip replacement?

Apply cold packs Administer analgesics Elevate the involved part

Which interventions should a nurse implement as part of initial pain relief for the client with a cast? Select all that apply.

It promotes healing by increasing circulation and movement of the knee joint.

Which is a benefit of a continuous passive motion (CPM) device when applied after knee surgery?

Cool skin

Which is a circulatory indicator of peripheral neurovascular dysfunction?

Pallor

Which is a classic sign of hypovolemic shock?

Pain

Which is a hallmark sign of compartment syndrome?

Smoking cessation

Which is a risk-lowering strategy for osteoporosis?

Skeletal traction is interrupted to turn and reposition the client.

Which is an inaccurate principle of traction?

The hip may be flexed to put on clothing such as pants, stockings, socks, or shoes.

Which is not a guideline for avoiding hip dislocation after replacement surgery.

being male

Which is not a risk factor for osteoporosis?

cranial nerve assessment

Which is not one of the general nursing measures employed when caring for the client with a fracture?

Medications

Which is the most common cause of anaphylaxis?

Arthrography

Which is useful in identifying acute or chronic tears of the joint capsule or supporting ligaments of the knee, shoulder, ankle, hip, or wrist?

Serum osteocalcin

Which laboratory study indicates the rate of bone turnover?

Volkmann's contracture

Which may occur if a client experiences compartment syndrome in an upper extremity?

Calcitonin (Miacalcin)

Which medication directly inhibits osteoclasts, thereby reducing bone loss and increasing BMD?

Second-intention healing

Which method of wound healing is one in which wound edges are not surgically approximated and integumentary continuity is restored by granulation?

Peroneal

Which nerve is being assessed when the nurses asks the client to dorsiflex the ankle and extend the toes?

Apply ice to the joint.

Which nursing action is most important in caring for the client following an arthrogram?

Infection related to effects of trauma

Which nursing diagnosis takes highest priority for a client with a compound fracture?

Provide age-related calcium intake recommendations.

Which nursing instruction is most important to stress when teaching on calcium intake?

Removing all external sources of pressure, such as clothing and jewelry

Which nursing intervention is essential in caring for a client with compartment syndrome?

"Let me explain to you what will happen next."

Which nursing statement would best decrease a client's anxiety before an emergency operative procedure?

Discarding an object that comes in contact with the 1-inch border

Which of the following actions by the nurse is appropriate?

Valsalva maneuver

Which of the following clinical manifestations increases the risk for evisceration in the postoperative client?

flaccid

Which of the following describes a muscle that is limp and without tone?

Nonunion

Which of the following describes failure of the ends of a fractured bone to unite in normal alignment?

Electromyogram

Which of the following diagnostics are used to evaluate spinal nerve root disorders (radiculopathies)?

Disseminated intravascular coagulation (DIC)

Which of the following disorders results in widespread hemorrhage andmicrothrombosis with ischemia?

Any chronic disorder or recent injury

Which of the following factors would the nurse need to keep in mind about the focus of the initial history when assessing a new client with a musculoskeletal problem?

Calcitonin

Which of the following inhibits bone resorption and promotes bone formation?

Risk for infection

Which of the following is an appropriate priority nursing diagnosis for the client following an arthrocentesis?

Carpal bones in the wrist

Which of the following is an example of a gliding joint?

knee

Which of the following is an example of a hinge joint?

Wearing sterile gloves over artificial nails

Which of the following is an inappropriate nursing action by the surgical nurse?

Risk for deficient knowledge: procedure

Which of the following is an inappropriate nursing diagnosis for the client following casting?

Remodeling

Which of the following is the final stage of fracture repair?

knee

Which of the following is the most common site of joint effusion?

Raloxifene

Which of the following is the only selective estrogen receptor modulator approved for osteoporosis in post menopausal women?

Ambulate the length of the client's house Get out of bed without assistance Be able to self-toilet

Which of the following mobility criteria must a postoperative client meet to be discharged to home? Select all that apply.

Rotator cuff tears

Which of the following musculoskeletal injuries is manifested by acromioclavicular joint pain?

Prone

Which of the following positions should be avoided in severe back pain?

Sims position

Which of the following positions would the nurse expect the client to be positioned on the operating table for renal surgery?

Sufficient oxygenation

Which of the following stimulates the wound healing process?

Suctioning the nasopharyngeal cavity of a client

Which of the following techniques least exhibits surgical asepsis?

Hallux valgus

Which of the following was formerly called a bunion?

Difficulty lying on affected side

Which of the following would lead a nurse to suspect that a client has a rotator cuff tear?

Splint

Which of the following would the nurse expect a physician to use on a short-term basis for a client with an injured body part that does not require rigid immobilization?

Skeletal traction is never interrupted.

Which principle applies to the client in traction?

"When is the last time you ate or drank?"

Which question is most important for the nurse to ask the client when obtaining the preoperative admission history?

Management of plantar fasciitis includes stretching exercises.

Which should be included in the teaching plan for a client diagnosed with plantar fasciitis?

III

Which stage of anesthesia is referred to as surgical anesthesia?

"The client is receiving physical therapy twice per day, so the client doesn't need a continuous passive motion device."

Which statement by a staff nurse on the orthopedic floor indicates the need for further staff education?

"I will become unconscious."

Which statement by the client indicates further teaching about epidural anesthesia is necessary?

The surgeon inserts metal pins into the bone or bones from outside the skin surface and then attaches a compression device to the pins.

Which statement describes external fixation?

Radiculopathy

Which term refers to a disease of a nerve root?

Dupuytren's contracture

Which term refers to a flexion deformity caused by a slowly progressive contracture of the palmar fascia?

Greenstick

Which term refers to a fracture in which one side of a bone is broken and the other side is bent?

Sprain

Which term refers to an injury to ligaments and other soft tissues surrounding a joint?

Lamellae

Which term refers to mature compact bone structures that form concentric rings of bone matrix?

Isotonic contraction

Which term refers to muscle tension being unchanged with muscle shortening and joint motion?

Nonunion

Which term refers to the failure of fragments of a fractured bone to heal together?

Evisceration

Which term refers to the protrusion of abdominal organs through the surgical incision?

Hip spica

Which type of cast encloses the trunk and a lower extremity?

Incomplete

Which type of fracture involves a break through only part of the cross-section of the bone?

Cover the cast with plastic to insulate it

Which would be contraindicated as a component of self-care activities for the client with a cast?

Handing instruments to the surgeon and assistants

Which would be included as a responsibility of the scrub nurse?

abnormal sensations.

While reading a client's chart, the nurse notices that the client is documented to have paresthesia. The nurse plans care for a client with

Hemorrhage and shock

While riding a bicycle on a narrow road, the patient was hit from behind and thrown into a ditch, sustaining a pelvic fracture. What complications does the nurse know to monitor for that are common to pelvic fractures?

Carpal tunnel syndrome

While the nurse is performing a physical assessment, the client reports numbness, tingling, and pain when the nurse percusses lightly over the median nerve. What should this assessment indicate to the nurse?

shortened, adducted, and externally rotated.

With fractures of the femoral neck, the leg is

Tolerance

You are caring for a client who needs to ambulate. What considerations should be included when planning the postoperative ambulatory activities for the older adult?

Potential growth problems may result from damage to the epiphyseal plate.

A 10-year-old boy who was brought to the emergency room after a skiing accident is diagnosed with a fracture of the distal end of the femur. Why is this type of fracture significant?

continuously monitors the sedated client.

A 17-year-old client is having same-day surgery. Solely during the intraoperative phase of perioperative care, the nurse:

Risk for perioperative positioning injury related to operative position

A 55-year-old patient arrives at the operating room. The nurse is reviewing the medical record and notes that the patient has a history of osteoporosis in her lower back and hips. The patient is scheduled to receive epidural anesthesia. Which of the following nursing diagnoses would be a priority for this patient?

Decreased lean tissue mass

A 70-year-old patient who is to undergo surgery arrives at the operating room (OR). The nurse, when reviewing the patient's medical record, understands that this patient will require a lower dose of anesthetic agent because of which of the following?

Continue with frequent client assessments.

A PACU nurse is caring for a postoperative client who received general anesthesia and has a hard, plastic oral airway in place. The patient has clear lung sounds, even and unlabored respirations of 16, and 98% oxygen saturation. The client is minimally responsive to painful stimuli. What action by the nurse is most appropriate?

experiences pain within tolerable limits.

A PACU nurse is caring for an older adult who presents with clinical manifestations of delirium. What short-term outcome would be most important for this client?

Sharp and piercing

A client arrives in the emergency department with a suspected bone fracture of the right arm. How does the nurse expect the client to describe the pain?

"Some possible negative effects include difficulty waking up and slow heart rate."

A client asks the nurse about possible ill effects from general anesthesia. What is the best response by the nurse?

"The lungs primarily eliminate the anesthesia."

A client asks the nurse how an inhalant general anesthetic is expelled by the body. What is the best response by the nurse?

"Elevating the leg might lead to a flexion contracture."

A client asks the nurse why his residual limb cannot be elevated on a pillow. What is the best response by the nurse?

Contusion

A client comes to the emergency department and reports localized pain and swelling in the lower leg. Ecchymotic areas are noted. History reveals that the client got hit in the leg with a baseball bat. What will the nurse most likely suspect?

within the first few hours, and has darkly colored blood that flows quickly.

A client develops a hemorrhage one hour post surgery. The nurse knows this is most likely an intermediary hemorrhage from a vein because it occurred:

Apply a tourniquet.

A client had an above-the-knee amputation of the left leg related to complications from peripheral vascular disease. The nurse enters the client's room and observes the dressing and bed covers saturated with blood. What is the first action by the nurse?

Risk for falls

A client has Paget's disease. An appropriate nursing diagnosis for this client is:

Cutting a cast window

A client has a cast applied to the leg for treatment of a tibia fracture and also has a wound on the leg that requires dressing changes due to drainage. For what should the nurse prepare the client?

NSAIDs activity modification and joint rest arthroscopic surgery

A client has been diagnosed with a rotator cuff tear. What are the options for treating this condition? Select all that apply.

immobilization

A client has been in a motor vehicle collision. Radiographs indicate a fractured humerus; the client is awaiting the casting of the upper extremity and admission to the orthopedic unit. What is the primary treatment for musculoskeletal trauma?

All options are correct.

A client has been involved in a motor vehicle collision. Radiographs indicate a fractured humerus; the client is awaiting the casting of the upper extremity and admission to the orthopedic unit. Other than the bone, what physical structures could be affected by this injury?

Have the client sit upright for at least 30 minutes following administration

A client has been prescribed alendronate for the prevention of osteoporosis. Which is the highest priority nursing intervention associated with the administration of the medication?

Temporomandibular disorder

A client has been treated for migraine headaches for several months and comes to the clinic stating he is getting no better. The nurse is talking with the client and hears an audible click when the client is moving his jaw. What does the nurse suspect may be happening?

hammer toe

A client has come to the clinic with foot pain. The physician has described the client's condition as a flexion deformity of the proximal interphalangeal joint. What is the name of this disorder?

Electrical stimulation

A client has delayed bone healing in a fractured right humerus. What should the nurse prepare the client for that promotes bone growth?

Hematoma

A client has just undergone a leg amputation. What will the nurse closely monitor the client for during the immediate postoperative period?

Report joint crackling or clicking noises occurring after the second day.

A client has just undergone arthrography. What is the most important instruction for the nurse to include in the teaching plan?

"Keep your right leg elevated above heart level."

A client has sustained a right tibial fracture and has just had a cast applied. Which instruction should the nurse provide in client cast care?

Maintaining pin care.

A client has undergone an external fixation. Which actions would be the priority for this client?

7 to 10 days

A client having a surgical procedure takes aspirin 325 mg daily for prevention of platelet aggregation. When should the client stop taking the aspirin before the surgery?

"A splint is applied when more swelling is expected at the site of injury."

A client in the emergency department is being treated for a wrist fracture. The client asks why a splint is being applied instead of a cast. What is the best response by the nurse?

Notify the surgical team.

A client is administered succinylcholine and propofol for induction of anesthesia. One hour after administration, the client demonstrates muscle rigidity with a heart rate of 180. What should the nurse do first?

"I'll make sure to keep my ankle elevated as much as possible."

A client is being discharged from the Emergency Department after being diagnosed with a sprained ankle. Which client statement indicates the client understands the discharge teaching?

contusion

A client is brought to the emergency department after being struck with a baseball bat on the upper arm while diving for a pitched ball. Diagnostic tests reveal that the humerus is not broken but that the client has suffered another type of injury. What type of injury would the physician likely diagnose?

Right shoulder slopes downward and droops inward.

A client is brought to the emergency department by a softball team member who states the client and another player ran into each other, and the client is having severe pain in the right shoulder. What symptoms of a fractured clavicle does the nurse recognize?

Verify consent.

A client is brought to the operating room for an elective surgery. What is the priority action by the circulating nurse?

The client has some edema of the left ankle with muscle spasms but is able to walk without assistive devices.

A client is diagnosed with a first-degree strain of the left ankle related to running 5 miles daily. How would the nurse differentiate the first-degree strain from other strains and sprains?

Elbow

A client is diagnosed with a fracture of a diarthrosis joint. What is an example of this type of joint?

Staphylococcus aureus

A client is diagnosed with osteomyelitis. This is most commonly caused by which of the following?

Alkaline phosphate of 165 IU/L (2750 mmol/L)

A client is evaluated for a diagnosis of Paget's disease. Which laboratory value would the nurse find to confirm the diagnosis?

An electromyography

A client is experiencing muscle weakness in the upper extremities. The client raises an arm above the head but then loses the ability to maintain the position. Muscular dystrophy is suspected. Which diagnostic test would evaluate muscle weakness or deterioration?

traction

A client is experiencing pain, joint instability, and difficulty walking due to an injury to the knee ligaments. The injury was judged not to require surgery. Which intervention would not be included in this client's care?

adrenal insufficiency

A client is preparing for a surgical procedure is taking corticosteroids for Crohn's disease. What is most important for the nurse to monitor during the operative experience with the client?

Removal of a tumor Removal of a diseased appendix

A client is preparing to undergo a curative surgical procedure. Which of the following is the type of surgery the client could be having? Select all that apply.

II

A client is receiving general anesthesia. The nurse anesthetist starts to administer the anesthesia. The client begins giggling and kicking her legs. What stage of anesthesia would the nurse document related to the findings?

Elevate the affected extremity and use cold applications.

A client is reporting pain following orthopedic surgery. Which intervention will help relieve pain?

Osteoporosis

A client is scheduled for a cholecystectomy. Which finding by the nurse is least likely to contribute to surgical complications?

prednisone

A client is scheduled for elective surgery. To prevent the complications of hypotension and cardiovascular collapse, the nurse should report the use of which medication?

Muscle weakness

A client is scheduled to undergo an electromyography. When performed, what will this test evaluate?

Tendon

A client is seen in the emergency room for a knee injury that happened during a basketball game. Diagnostic tests reveal torn cords of fibrous connective tissue that connect muscles to bones. What type of tear has this client sustained?

Left hip arthroplasty

A client is seen in the orthopedic clinic for complaints of severe pain in the left hip. After a series of diagnostic tests, the client is diagnosed with severe degenerative joint disease of the left hip and suggested to have the hip reconstructed. What procedure will the nurse schedule the client for?

Splint the incision site using a pillow during deep breathing and coughing exercises.

A client is undergoing thoracic surgery. What priority education should the nurse provide to assist in preventing respiratory complications?

Sprain

A client reports pain in the right knee, stating, "My knee got twisted when I was going down the stairs." The client was diagnosed with an injury to the ligaments and tendons of the right knee. Which terminology, documented by the nurse, best reflects the injury?

hallucinations

A client requires minor surgery for removal of a basal cell tumor. The anesthesiologist administers the anesthetic ketamine hydrochloride 60 g IV. After administration, the nurse will monitor the client for what symptom?

Increasing fluid intake Maintaining antiembolic stockings Administering enoxaparin

A client returns to the nursing unit following an open reduction with internal fixation of the right hip. Which nursing interventions would be appropriate for the prophylactic treatment of deep vein thrombosis? Select all that apply.

Serous drainage

A client undergoes an invasive joint examination of the knee. What will the nurse closely monitor the client for?

maintaining adequate circulation

A client undergoes an open reduction of a femur fracture, and returns to the orthopedic unit with a cast in place. What is the rationale for frequently assessing the client's pedal pulses?

Keeping a pillow between the client's legs at all times

A client undergoes open reduction with internal fixation to treat an intertrochanteric fracture of the right hip. The nurse should include which intervention in the postoperative care plan?

Apply a warm air blanket, gradually increasing body temperature.

A client undergoing coronary artery bypass surgery is subjected to intentional hypothermia. The client is ready for rewarming procedures. Which action by the nurse is appropriate?

L4, L5, and S1

A client visits an orthopedic specialist because of pain beginning in the low back and radiating behind the right thigh and down below the right knee. The doctor suspects a diagnosis of sciatica. The nurse knows that the origin of the pain is between which intervertebral disks?

Thoracic

A client visits the health care provider for a routine checkup. The history reveals that the client was diagnosed with a spinal curvature. Which region of the spine should the nurse assess for complications?

Turn the client's head completely to one side to prevent aspiration of vomitus into the lungs.

A client vomits postoperatively. What is the most important nursing intervention?

Coughing and deep breathing with pillow splinting

A client was climbing a ladder, slipped on a rung, and fell on the right side of the chest. X-ray studies reveal three rib fractures, and the client reports pain with inspiration. What is the anticipated treatment for this client?

Performing guided imagery Putting on soothing music Changing the client's position

A client who is receiving the maximum levels of pain medication for postoperative recovery asks the nurse if there are other measures that the nurse can employ to ease pain. Which of the following strategies might the nurse employ? Select all that apply.

"The client can be involved in marking the knee, the site for the surgery." "The surgical team performs a 'time-out' prior to surgery to conduct a final verification." "The client will be involved in the verification process prior to surgery."

A client who is scheduled for knee surgery is anxious about the procedure, saying, "You hear stories on the news all the time about doctors working on the wrong body part. What if that happens to me?" What is the nurse's best response? Select all that apply.

Changing the client's position within prescribed limits.

A client who is undergoing skeletal traction reports pressure on bony areas. Which action would be most appropriate to provide comfort for the client?

Maintain bed rest with the head of the bed at 20 degrees.

A client who was in a motor vehicle crash is diagnosed with a stable T7 spinal fracture with no neurologic deficits. Which nursing intervention should the nurse implement?

Renal calculi

A client with Paget's disease comes to the hospital and reports difficulty urinating. The emergency department health care provider consults urology. What should the nurse suspect is the most likely cause of the client's urination problem?

Explain that the sensation being felt is normal and will not burn the client.

A client with a fractured ankle is having a fiberglass cast applied. The client starts yelling, "My leg is burning, take it off." What action by the nurse is most appropriate?

Cut a cast window.

A client with a fractured distal left radius reports discomfort at the cast site, with pain specifically in the upper forearm. What would the nurse expect the physician to do?

dehisced

A client with an abdominal surgical wound sneezes and then states, "Something doesn't feel right with my wound." The nurse asses the upper half of the wound edges, noticing that they are no longer approximated and the lower half remains well approximated. The nurse would document that following a sneeze, the wound

Elevating the stump for the first 24 hours

A client with arterial insufficiency undergoes below-knee amputation of the right leg. Which action should the nurse include in the postoperative care plan?

Surgical debridement

A client with chronic osteomyelitis has undergone 6 weeks of antibiotic therapy. The wound appearance has not improved. What action would the nurse anticipate to promote healing?

3 to 6 weeks

A client with diabetes punctured his foot with a broken acorn in the yard. Within a week, the client developed osteomyelitis of the foot. The client was admitted for IV antibiotic therapy. How long does the nurse anticipate the client will receive IV antibiotics?

Use the large muscles of the leg when lifting items.

A client with low back pain is being seen in the clinic. In planning care, which teaching point should the nurse include?

Prochlorperazine (Compazine)

A client with nausea and vomiting is to receive an antiemetic that inhibits the vomiting center in the brain. Which of the following would the nurse expect the physician to order most likely?

Raloxifene (Evista)

A client with osteoporosis is prescribed a selective estrogen receptor modifier (SERM) as treatment. The nurse would identify which drug as belonging to this class?

0.5

A client with osteoporosis is prescribed calcitonin 100 units subcutaneously. The medication is available 200 units per ml. How many milliliters will the nurse administer to the client?

Open reduction

A client's fracture was reduced by surgically exposing the bone and realigning it. What type of treatment does the nurse identity this as?

Teach the client how to prevent problems caused by immobility.

A client's left leg is in skeletal traction with a Thomas leg splint and Pearson attachment. Which intervention should the nurse include in this client's care plan?

The physician orders the amount of extension and flexion produced by the machine. The physician orders the frequency of use of the machine. The amount of flexion for clients with hip replacements should never exceed 30 degrees in the CPM machine.

A continuous passive motion (CPM) machine is used to promote healing and flexibility in the knee and hip joint and increase circulation to the operative area. What is true about the use of CPM? Select all that apply.

Initiating weight-bearing exercise routines

A female client is at risk for developing osteoporosis. Which action will reduce the client's risk?

occurs through an area of diseased bone.

A fracture is considered pathologic when it

Osteoclasts are involved in the destruction and remodeling of bone.

A group of students are reviewing information about bones in preparation for a quiz. Which of the following indicates that the students have understood the material?

Better molding to the client

A group of students are reviewing information about cast composition in preparation for a discussion on the advantages and disadvantages of each. The students demonstrate understanding of the topic when they cite which of the following as an advantage of a plaster cast?

Skull at the temporal and occipital bones

A group of students are studying for an examination on joints. The students demonstrate understanding of the material when they identify which of the following as an example of a synarthrodial joint?

Have the client hold the palm of the hand up while the nurse percusses over the median nerve.

A healthcare provider asks a nurse to test a client for Tinel's sign to diagnose carpal tunnel syndrome. What should the nurse do to perform this assessment?

"If the wound edges are red or raised, you should call your doctor."

A novice nurse provides aftercare instructions to a client who has just had sutures removed. Which statement by the novice nurse requires the nurse preceptor to clarify?

Encourage the client to ambulate as soon as possible after surgery.

A nurse asks a client who had abdominal surgery 1 day ago if he has moved his bowels since surgery. The client states, "I haven't moved my bowels, but I am passing gas." How should the nurse intervene?

Evisceration

A nurse assesses a postoperative client as having abdominal organs protruding through the surgical incision. Which term best describes this assessment finding?

diuretics

A nurse evaluates the potential effects of a client's medication therapies before surgery. Which drug classification may cause respiratory depression from an associated electrolyte imbalance during anesthesia?

it may be necessary to raise the head of this client's bed.

A nurse is administering moderate sedation to a client with chronic obstructive pulmonary disease (COPD). The nurse bases her next action on the principle that:

The client has an absence of bowel sounds.

A nurse is assessing the postoperative client on the second postoperative day. What assessment finding requires the nurse to immediately notify the health care provider?

Perform neuromuscular assessment every hour.

A nurse is caring for a client following foot surgery. Which nursing intervention is most important for the nurse to include in the nursing care plan?

Position the client in the side-lying position.

A nurse is caring for a client in the PACU after surgery requiring general anesthesia. The client tells the nurse, "I think I'm going to be sick." What is the primary action taken by the nurse?

Assessing the extremity for neurovascular integrity

A nurse is caring for a client placed in traction to treat a fractured femur. Which nursing intervention has the highest priority?

Encouraging the client to care for the residual limb Allowing the client to express grief Introducing the client to local amputee support groups

A nurse is caring for a client who has had an amputation. What interventions can the nurse provide to foster a positive self-image? (Select all that apply.)

Assist with a gradual introduction of activity.

A nurse is caring for a client who has sustained ligament and a meniscal injury to the knee. Which action would be most appropriate to allow the client to progress without causing further injury?

The client is displaying early signs of shock.

A nurse is caring for a client who is three hours post op from open abdominal surgery. During routine assessment, the nurse notes the previously stable client now appears anxious, apprehensive, and has a blood pressure of 90/56. What does the nurse consider is the most likely cause of the client's change in condition?

first intention.

A nurse is caring for a client who underwent a skin biopsy and has three stitches in place. This wound is healing by:

The nurse is caring for this client on the intensive care unit.

A nurse is caring for a client who's experiencing septic arthritis. This client has a history of immunosuppressive therapy and the immune system is currently depressed. Which assignment is the most appropriate for the nurse caring for this client?

Ossification and calcification

A nurse is caring for a client with an undiagnosed bone disease. When instructing on the normal process to maintain bone tissue, which process transforms osteoblasts into mature bone cells?

Chlorpheniramine

A nurse is caring for a client with eczema. Which medication would be prescribed when an allergy is a factor causing the skin disorder?

Bone abscess formation

A nurse is caring for a client with osteomyelitis. What complication should the nurse consider that the client is at risk to develop?

Ensure that the room temperature is set at 25°C to 26.6°C (78°F to 80°F).

A nurse is caring for a postoperative client who started shivering. What is the best action for the nurse?

"You may need to be evaluated for an underlying cause, such as renal failure."

A nurse is educating a client diagnosed with osteomalacia. Which statement by the nurse is appropriate?

Take the supplement with meals or with orange juice.

A nurse is performing discharge teaching for an elderly client with osteoporosis. Which instruction about a calcium supplement should the nurse include?

"You will receive IV antibiotics for 3 to 6 weeks."

A nurse is planning discharge instructions for the client with osteomyelitis. What instructions should the nurse include in the discharge teaching?

Walking

A nurse is planning discharge teaching regarding exercise for a client at risk for osteoporosis. Which exercise would the nurse be most likely to suggest?

Increased fatty tissue prolongs elimination of anesthesia. Decreased ability to compensate for hypoxia increases the risk of an embolism. Loss of collagen increases the risk of skin complications. Reduced tactile sensitivity can lead to assessment and communication problems.

A nurse is planning preoperative teaching for an older client. Which structural or functional changes in the older adult impact the surgical experience? Select all that apply.

Atracurium

A nurse is reviewing the intraoperative record of a patient who has just returned from surgery. The patient received general anesthesia with intravenous agents. Which of the following would the nurse identify as a nondepolarizing muscle relaxant?

Prednisone

A nurse is reviewing the medications of a postoperative client. What medication related to the recent surgery may be of concern to the nurse?

The client exhales forcefully with a short expiration.

A nurse is teaching a client about diaphragmatic breathing. What client action indicates that further teaching is needed?

"I will support my incision with my hands when I cough and do my deep breathing exercises."

A nurse is teaching a client about pain management after surgery. Which client statement indicates the teaching was effective?

The recommended daily allowance of calcium may be found in a wide variety of foods.

A nurse is teaching a client about preventing osteoporosis. Which teaching point is correct?

"Ergonomic changes can be incorporated into your workday to reduce stress on your wrist."

A nurse is teaching a client who was recently diagnosed with carpal tunnel syndrome. Which statement should the nurse include?

Use diaphragmatic breathing.

A nurse is teaching a client with chronic bronchitis about breathing exercises. Which instruction should the nurse include in the teaching?

Request that the surgeon come and answer the questions.

A nurse is witnessing a client sign the consent form for surgery. After signing the consent form, the client starts asking questions regarding the risks and benefits of a surgical procedure. What action by the nurse is most appropriate?

New capillaries producing a bridge between the fractured bones.

A nurse knows that a person with a 3-week-old femur fracture is at the stage where angiogenesis is occurring. What are the characteristics of this stage?

Arteriography Open reduction of a fracture Cystoscopy Paracentesis

A nurse knows that she must obtain a signed informed consent for which of the following procedures? Select all that apply.

Prick the distal fat pad on the small finger.

A nurse performs a neurovascular assessment on a client 2 weeks after a wrist cast had been removed. The nurse documents in the client's chart that there is normal sensation in the ulnar nerve. What finger assessment test will the nurse perform on this client?

Supination.

A nurse practitioner assesses a patient's movement in his left hand after a cast is removed. The nurse asks the patient to turn his wrist so the palm of his hand is facing up. This movement is known as:

Joint fracture

A nurse would most likely expect the need for open reduction for a client with which of the following?

Cover the protruding coils of intestines with sterile dressings moistened with sterile saline solution.

A nursing measure for evisceration is to:

Volkmann's ischemic contracture

A patient falls while skiing and sustains a supracondylar fracture. What does the nurse know is the most serious complication of a supracondylar fracture of the humerus?

Abduction

A patient had a total hip replacement. What recommended leg position should the nurse ensure is maintained to prevent prosthesis dislocation?

Performing hourly neurovascular assessments for the first 24 hours

A patient had hand surgery to correct a Dupuytren's contracture. What nursing intervention is a priority postoperatively?

Reactive phase, reparative phase, remodeling phase

A patient has a fracture of the right femur sustained in an automobile accident. What process of fracture healing does the nurse understand will occur with this patient?

Between 24 and 48 hours

A patient has stepped in a hole in the yard, causing an ankle injury. The ankle is edematous and painful to palpation. How long should the nurse inform the patient that the acute inflammatory stage will last?

Hypovolemic shock

A patient has suffered a femoral shaft fracture in an industrial accident. What is an immediate nursing concern for this patient?

Have the patient extend each leg and dorsiflex each foot to determine if pain or tenderness is present in the lower leg.

A patient in pelvic traction needs circulatory status assessed. How should the nurse assess for a positive Homans' sign?

Alkaline phosphatase

A patient is diagnosed with osteogenic sarcoma. What laboratory studies should the nurse monitor for the presence of elevation?

Pain Erythema Fever

A patient is diagnosed with osteomyelitis of the right leg. What signs and symptoms does the nurse recognize that are associated with this diagnosis? (Select all that apply.)

Circulating nurse

A patient is in the operating room for surgery. Which individual would be responsible for ensuring that procedure and site verification occurs and is documented?

optional

A patient is scheduled for a reduction mammoplasty. What classification of surgery does the nurse understand that this is?

An open reduction of a fracture

A patient is scheduled for a surgical procedure. For which surgical procedure should the nurse prepare an informed consent form for the surgeon to sign?

As soon as tolerated, after a reasonable period of immobilization

A patient sustains a fracture of the arm. When does the nurse anticipate pendulum exercise should begin?

III

A patient sustains an open fracture with extensive soft tissue damage. The nurse determines that this fracture would be classified as what grade?

"Your muscles were in a state of hypertrophy from the weight lifting but it will persist only if the exercise is continued."

A patient tells the nurse, "I was working out and lifting weights and now that I have stopped, I am flabby and my muscles have gone!" What is the best response by the nurse?

8:40 to 8:50 a.m.

A patient undergoes induction for general anesthesia at 8:30 a.m. and is being assessed continuously for the development of malignant hyperthermia. At which time would the patient be most likely to exhibit manifestations of this condition?

A blood urea nitrogen level of 42 mg/dL

A patient with renal failure is scheduled for a surgical procedure. When would surgery be contraindicated for this patient due to laboratory results?

urgent

A perioperative nurse is assigned to complete a preoperative assessment on a client who is scheduled for surgery for kidney stones the next day. What category of surgery does this procedure fall into?

The edges of a sterile package, once opened, are considered unsterile.

A perioperative nurse is conducting an in-service education program about maintaining surgical asepsis during the intraoperative period. Which of the following would the nurse emphasize?

Call the health care provider.

A post op client reports severe abdominal pain. The nurse cannot auscultate bowel sounds and notes the client's abdomen is rigid. What is the nurse's priority action?

Review the instructions with the client and an accompanying adult.

A postanesthesia care unit (PACU) nurse is preparing to discharge a client home following ankle surgery. The client keeps staring at the ceiling while being given discharge instructions. What action by the nurse is appropriate?

The client can be discharged from the PACU.

A postoperative client is being evaluated for discharge and currently has an Aldrete score of 8. Which of the following is the most likely outcome for this client?

Obtain the wound culture specimen.

A postoperative client with an open abdominal wound is currently taking corticosteroids. The physician orders a culture of the abdominal wound even though no signs or symptoms of infection are seen. What action by the nurse is appropriate?

Report the infection to an immediate supervisor.

A scrub nurse is diagnosed with a skin infection to the right forearm. What is the priority action by the nurse?

On the second or third day.

A significant mortality rate exists for patients with alcoholism who experience delirium tremens postoperatively. When caring for the patient with alcoholism, the nurse should assess for symptoms of alcoholic withdrawal:

Mask is placed over nose and extends to bottom lip.

A student nurse is scheduled to observe a surgical procedure. The nurse provides the student nurse with education on the dress policy and provides all attire needed to enter a restricted surgical zone. Which observation by the nurse requires immediate intervention?

osteomyelitis

A variety of complications can occur after a leg amputation. Which is not a possibility in the immediate postoperative period?

Fat embolism

After a car accident, a client is admitted to an acute care facility with multiple traumatic injuries, including a fractured pelvis. For 24 to 48 hours after the accident, the nurse must monitor the client closely for which potential complication of a fractured pelvis?

Remodeling

After a fracture, during which stage or phase of bone healing is devitalized tissue removed and new bone reorganized into its former structural arrangement?

Maintaining traction continuously to ensure its effectiveness

After a traumatic back injury, a client requires skeletal traction. Which intervention takes priority?

With the leg on the affected side abducted

After surgery to treat a hip fracture, a client returns from the postanesthesia care unit to the medical-surgical unit. Postoperatively, how should the nurse position the client?

Discuss the complications that the client may experience if there is lack of cooperation with the care plan.

After undergoing surgery the previous day for a total knee replacement, a client states, "I am not ready to ambulate yet." What should the nurse do?

Subluxation

An adult is swinging a small child by the arms, and the child screams and grabs his left arm. It is determined in the emergency department that the radial head is partially dislocated. What is this partially dislocated radial head documented as?

imagery

An anxious client being prepared for surgery is encouraged to concentrate on a pleasant experience or restful scene. What cognitive coping strategy would the nurse document as being used?

Older adults have less physiologic reserve (or ability to regain physical equilibrium) than younger clients.

An elderly client is preparing to undergo surgery. The nurse participates in preoperative care knowing that which of the following is the underlying principle that guides preoperative assessment, surgical care, and postoperative care for older adults?

sternum.

An example of a flat bone is the

Capillary refill.

An important nursing assessment, post fracture, is to evaluate neurovascular status. Therefore, the nurse should check for:

Osteoblasts

An instructor is describing the process of bone development. Which of the following would the instructor describe as being responsible for the process of ossification?

More pleasant onset of anesthesia Ease of administration Need for little equipment

An instructor is developing for a class a teaching plan about agents used for intravenous (IV) anesthesia. Which of the following would the instructor include in this plan about these agents and this type of anesthesia? Select all that apply.

Prevention of respiratory complications

An obese client is scheduled for open abdominal surgery. What priority education should the nurse provide to this client?

Promoting weight-bearing exercises

An older adult client with a diagnosis of left-sided stroke is admitted to the facility. To prevent the development of disuse osteoporosis, which objective is most appropriate?

24 hours

An older adult patient had a hip replacement. When should the patient begin with assisted ambulation with a walker?

Surgical anesthesia

An unconscious patient with normal pulse and respirations would be considered to be in what stage of general anesthesia?

Notify the physician.

An unresponsive client had a plaster cast applied to the right lower leg 8 hours ago. When moving the client, the nurse notices an indentation on the posterior lower portion of the cast. What is the best action by the nurse?

Comminuted

An x-ray demonstrates a fracture in which a bone has splintered into several pieces. Which type of fracture is this?

Keeping records.

As a circulating nurse, what task are you solely responsible for?

Review preoperative instructions.

As a nurse working in an ambulatory surgery center, you are admitting a client who is going to have a biopsy of a skin lesion. What is an important part of the preoperative process?

During the preoperative period

At which time does the nurse realize that it is best to begin teaching about care needed during the postoperative period?

painful movement of a joint a distinct lump

Bursitis is an inflammation of the bursa, a fluid-filled sac that cushions bone ends to enhance a gliding movement. What possible assessment findings would be present in a client with bursitis? Select all that apply.

Skin traction

Conservative treatment of a compressed nerve root is first line treatment. What conservative treatment is used to increase the distance between vertebrae and decrease severe muscle spasm?

Mask the presence of infection

Corticosteroids have which effect on wound healing?

Fourth and fifth fingers

Dupuytren contracture causes flexion of which area(s)?

malignant hyperthermia

During a procedure, a client's temperature begins to rise rapidly. This is likely the result of which complication?

"After menopause, the body's bone density declines, resulting in a gradual loss of height."

During a routine physical examination on an older female client, a nurse notes that the client is 5 feet, 3/8 inches (1.6 m) tall. The client states, "How is that possible? I was always 5 feet and 1/2? (1.7 m) tall." Which statement is the best response by the nurse?

Every 4 hours

During the first 24 hours after surgery, how often will the nurse evaluate the client's temperature?

Relaxation of the ligaments

During the interview an older adult client reports joint pain with movement. The client states, "But if I rest it, the pain gets better." What is the most likely cause of client's pain?

Notify the surgical team to remove all latex-based items.

During the preoperative assessment, the client mentions allergies to avocados, bananas, and hydrocodone. What is the priority action by the nurse?

Blood pressure of 90/50 mm Hg

Following a splenectomy, a client has a hemoglobin (Hb) level of 7.5 g/dL, and a blood pressure lying in bed of 110/70 mm Hg. The nurse suspects abnormal orthostatic changes when the client gets out of bed and reports vertigo. What vital sign value most supports the client's orthostatic changes?

"CPM increases range of motion of the joint."

Following a total knee replacement, the surgeon orders a continuous passive motion (CPM) device. The client asks about the purpose of this treatment. What is the best response by the nurse?

Oxygen saturation of 82%

Following admission of the postoperative client to the clinical unit, which of the following assessment data requires the most immediate attention?

1,200 mg; 1,000 IU

Health education for a woman over age 50 includes providing information about the importance of adequate amounts of calcium and vitamin D to prevent osteoporosis. Select the daily dosage of calcium and vitamin D that the nurse should recommend.

There is a deficiency of activated vitamin D (calcitriol). Calcium and phosphate are not moved to the bones. The bone mass is structurally weaker, and bone deformities occur.

Identify descriptors of the pathophysiologic process seen in osteomalacia. Select all that apply.

Compartment syndrome

In a client with a dislocation, the nurse should initially perform neurovascular assessments a minimum of every 15 minutes until stable. Which complication does the assessments help the nurse to monitor in the client?

Surgical debridement

In chronic osteomyelitis, antibiotics are adjunctive therapy in which situation?

Hallux valgus

In which deformity does the great toe deviate laterally?

lack of exposure to sunshine.

Lifestyle risk factors for osteoporosis include

Paget disease

Localized rapid bone turnover, most commonly affecting the skull, femur, tibia, pelvic bones, and vertebrae, is characterized by which bone disorder?

excision of damaged joint fibrocartilage.

Meniscectomy refers to the

may result in the administration of general anesthesia.

Monitored anesthesia care differs from moderate sedation in that monitored anesthesia care:

Swelling of the third (lateral) branch of the median plantar nerve

Morton neuroma is exhibited by which clinical manifestation?

Surgeon

Nursing assessment findings reveal that the client is afraid of dying during the surgical procedure. Which surgical team member would be most helpful in addressing the client's concern?

Decreased cardiac output

Nursing assessment findings reveal urinary output < 30 ml/hr, tachycardia, tachypnea, decreased hemoglobin, and acute confusion. The findings are indicative of which nursing diagnosis?

Halothane

Nursing students are reviewing information about agents used for anesthesia. The students demonstrate understanding when they identify which of the following as an inhalation anesthetic?

"Some bunions are congenital; others are caused by wearing shoes that are too short or narrow."

On a visit to the family health care provider, a client is diagnosed with a bunion on the lateral side of the great toe at the metatarsophalangeal joint. Which statement should the nurse include in the teaching session?

Packing the wound bed with sterile saline-soaked dressing and covering it with a dry dressing

On postoperative day 2, a client requires care for a surgical wound using second-intention healing. What type of dressing change should the nurse anticipate doing?

30 years.

Patient education for musculoskeletal conditions for the aging is based on the understanding that there is a gradual loss of bone after a peak of bone mass at age:

Lack of distal tissue perfusion

Pulselessness, a very late sign of compartment syndrome, may signify

Synarthrosis

Skull sutures are an example of which type of joint?

Pavulon (pancuronium bromide)

The anesthesiologist is administering a stable and safe nondepolarizing muscle relaxant. What medication does the nurse anticipate will be administered?

orthostatic hypotension

The client complains of weakness and dizziness as the nurse assists the client to sit on the side of the bed. The nurse recognizes the client is experiencing:

A fasciotomy

The client displays manifestations of compartment syndrome. What treatment will the nurse expect the client to be scheduled for?

chlorpromazine

The client is experiencing intractable hiccups following surgery. What would the nurse expect the surgeon to order?

ondansetron

The client is experiencing nausea and vomiting following surgery. What will the nurse expect the surgeon to order?

Excision of damaged joint fibrocartilage

The client is scheduled for a meniscectomy of the right knee. The nurse would plan postoperative care based on what surgical procedure?

Risk for perioperative positioning injury related to positioning in the OR

The client is undergoing a surgical procedure that is expected to last several hours. Which nursing diagnosis is most related to the duration of the procedure?

Lordosis

The client presents with an exaggeration of the lumbar spine curve. How does the nurse interpret this finding?

Suction the client to remove saliva and gastric secretions.

The client vomits during the surgical procedure. The best action by the nurse is:

Dislocation of the hip

The client who had a total hip replacement was discharged home and developed acute groin pain in the affected leg, shortening of the leg, and limited movement of the fractured leg. The nurse interprets these findings as indicating which complication?

Make the client NPO and notify the health care provider.

The client with a newly applied cast reports severe unrelenting pain. What is the nurse's best response?

Femoral neck.

The femur fracture that commonly leads to avascular necrosis or nonunion because of an abundant supply of blood vessels in the area is a fracture of the:

Decreased right-sided muscle strength

The homecare nurse is evaluating the musculoskeletal system of a geriatric client whose previous assessment was within normal limits. The nurse initiates a call to the health care provider and/or emergency services when which change is found?

nutritional status age physical condition health status

The nurse assesses a client to determine if there is increased risk for complications intraoperatively or postoperatively. Which are general risk factors? Select all that apply.

A safe environment

The nurse assesses an older adult patient who complains of dimmed vision. What does this alert the nurse to plan for?

The patient has rheumatoid arthritis.

The nurse assesses soft subcutaneous nodules along the line of the tendons in a patient's hand and wrist. What does this finding indicate to the nurse?

Fat embolism syndrome

The nurse assesses subtle personality changes, restlessness, irritability, and confusion in a client who has sustained a fracture. The nurse suspects which complication?

Do not flex the hip more than 90 degrees.

The nurse caring for a client, who has been treated for a hip fracture, instructs the client not to cross their legs and to have someone assist with tying their shoes. Which additional instruction should the nurse provide to client?

Pink to red and soft, bleeding easily

The nurse documents the presence of granulation tissue in a healing wound. How should the nurse describe the tissue?

A gastrostomy tube

The nurse expects informed consent to be obtained for insertion of:

a gastrostomy tube

The nurse expects informed consent to be obtained for insertion of:

"I will avoid prolonged sitting or walking."

The nurse has educated a patient with low back pain about techniques to relieve the back pain and prevent further complications. What statement by the patient shows understanding of the education the nurse provided?

Client will have a shorter recovery period.

The nurse has just admitted a 12-year-old client who is going to have an above-the-knee amputation of their left leg due to osteosarcoma. The nurse knows that adequate preoperative teaching and learning is important for what reason?

"The nurse will explain the details of the surgery before I sign a consent."

The nurse has provided preoperative instructions to a client scheduled for surgery at an ambulatory care center. Which statement, made by the client, would indicate that further instruction is needed?

Place the side rails in the up position and make sure the call button is in reach.

The nurse in the preoperative area has just medicated her client according to the anesthesiologist's orders. What is the nurse's priority action at this time?

"I was worried I would have an incision and scar."

The nurse is admitting a client who is to undergo an open reduction with internal fixation for a fractured femur. About which comment by the client should the nurse be most concerned?

Does the client have a history of dementia-like symptoms?

The nurse is admitting the older adult to the PACU. Which information about this client would be most important for the PACU nurse to obtain?

Decrease in estrogen

The nurse is asked to explain to the client the age-related processes that contribute to bone loss and osteoporosis. What is the nurse's best response?

Corn

The nurse is assessing the feet of a patient and observes an overgrowth of the horny layer of the epidermis. What does the nurse recognize this condition as?

Wear properly fitting shoes.

The nurse is assisting a client with removing shoes prior to an examination and observes that the client has a flexion deformity of several toes on both feet of the proximal interphalangeal (PIP) joints. What can the nurse encourage the client to do?

Cleaning the skin surface.

The nurse is assisting with the application of a cast. What will the nurse expect to be done first?

Arginine

The nurse is aware that which of the following helps to stimulate T-cell response:

Urine retention

The nurse is caring for a client 6 hours post surgery. The nurse observes that the client voids urine frequently and in small amounts. The nurse knows that this most probably indicates what?

Temperature of 102.5°F (39°C)

The nurse is caring for a client during an intra operative procedure. When assessing vital signs, which result indicates a need to alert the anesthesiologist immediately?

Post-discharge diet

The nurse is caring for a client needing emergency surgery. Which preoperative teaching is least important to prepare the client for surgery?

Encourage the client to move legs frequently and do leg exercises.

The nurse is caring for a client postoperatively. What nursing interventions help prevent venous stasis and other circulatory complications in a client who has undergone surgery?

Pulselessness

The nurse is caring for a client who experienced a crushing injury of the lower extremities. Which of the following symptoms is essential to be reported to the physician?

Matrix

The nurse is caring for a client who has a deficiency in the formation of cartilage in joints. Which essential substance is absent?

Crackles in the lung bases

The nurse is caring for a client who sustained rib fractures in an automobile accident. What symptoms does the nurse recognize as a complication of rib fractures and should immediately be reported to the physician?

Alendronate

The nurse is caring for a client with a hip fracture. The physician orders the client to start taking a bisphosphonate. Which medication would the nurse document as given?

Keep the cast clean and dry.

The nurse is caring for a client with a spica cast. What is the nurse's priority intervention?

Obtaining a culture

The nurse is caring for a client with an external fixator that requires pin care twice a day. The nurse observes that there is a new purulent drainage around one of the pins. What intervention should the nurse anticipate doing?

Fat emboli syndrome

The nurse is caring for a patient postoperatively following orthopedic surgery. The nurse assesses an oxygen saturation of 89%, confusion, and a rash on the upper torso. What does the nurse suspect is occurring with this patient?

Pulmonary embolism

The nurse is caring for a patient who had a total hip replacement. What lethal postoperative complication should the nurse closely monitor for?

45 degrees onto the unoperated side if the affected hip is kept abducted

The nurse is caring for a patient with a total hip replacement. How should the nurse allow the patient to turn?

When the patient's blood ammonia concentration reaches 180 mg/dL

The nurse is caring for a patient with liver disease who had a surgical procedure. When should the nurse alert the physician?

Clonus

The nurse is caring for a pregnant patient with pregnancy-induced hypertension. When assessing the reflexes in the ankle, the nurse observes rhythmic contractions of the muscle when dorsiflexing the foot. What would the nurse document this finding as?

80-year-old man recently widowed.

The nurse is conducting a community education program on hip fracture risk. The nurse evaluates that the participants understand the program when the participants determine that client at highest risk for a hip fracture is a(n)

Notify the surgeon to possibly delay the surgery.

The nurse is conducting a preoperative assessment on a client scheduled for gallbladder surgery. The client reports a frequent cough producing green sputum for 3 days and denies fever. Upon auscultation, the nurse notes rhonchi throughout the right lung, with an occasional expiratory wheeze. Respiratory rate is 20, temperature is 99.8 (taken orally), heart rate is 87, and blood pressure is 124/70. What is the best action by the nurse?

places the load close to the body.

The nurse is educating a client with low back pain on proper lifting techniques. The nurse recognizes that the education was effective when the client

"We need an adequate amount of exposure to sunshine."

The nurse is educating a group of women on the prevention of osteoporosis. The nurse recognizes the education as being effective when the group members make which statement?

Three phases of surgery and safety measures for each phase

The nurse is educating clients who require surgery for various ailments about the perioperative experience. What education provided by the nurse is most appropriate?

Quadriceps

The nurse is educating the patient with low back pain about the proper way to lift objects. What muscle should the nurse encourage the patient to maximize?

Cool skin

The nurse is evaluating a client's peripheral neurovascular status. Which would the nurse report to the health care provider as a circulatory indicator of peripheral neurovascular dysfunction?

heart rate over 150 beats per minute

A client develops malignant hyperthermia. What client symptom would the nurse most likely observe as the first indicator of the disorder?

Roll the client onto his or her side.

A client receiving moderate sedation for a minor surgical procedure begins to vomit. What should the nurse do first?

joint manipulation and immobilization

A client who has injured a hip in a fall cannot place weight on the leg and is in significant pain. After radiographs indicate intact yet malpositioned bones, what repair would the physician perform?

Covers the marrow cavity of long bones

Choose the correct statement about the endosteum, a significant component of the skeletal system:

Impacted

Radiographic evaluation of a client's fracture reveals that a bone fragment has been driven into another bone fragment. The nurse identifies this as which type of fracture?

Platelets White blood cells (WBCs) Red blood cells (RBCs)

Red bone marrow produces which of the following? Select all that apply.

Splint

Which device is designed specifically to support and immobilize a body part in a desired position?

Encourage participation in ADLs

Which nursing intervention is appropriate for a client with a closed-reduction extremity fracture?

The cast can be dented while it is damp.

Which statement is accurate regarding care of a plaster cast?

It is performed in the operating room. The bone is surgically exposed and realigned. The client usually receives general or spinal anesthetic.

Which statements describe open reduction of a fracture? Select all that apply.

Distal radius

Colles fracture occurs in which area?

7

For the client who is taking aspirin, it is important to stop taking this medication at least how many day(s) before surgery?

Raise the left leg above the level of the heart.

A client comes to the emergency department with reports of pain in the left ankle. The client states, "I missed a step coming down the stairs, and landed funny." The ankle is swollen and tender to the touch. What will the nurse do to help control the swelling?

"The joint above the fracture and below the fracture must be immobilized."

A client diagnosed with a right ulnar fracture asks why the cast needs to go all the way up the arm. What is the best response by the nurse?

Tendon

A client experiences a musculoskeletal injury that involves the structure that connects a muscle to the bone. The nurse understands that this injury involves which structure?

auscultate bowel sounds.

A client had a nephrectomy 2 days ago and is now complaining of abdominal pressure and nausea. The first nursing action should be to:

Serial x-rays will be taken.

A client has a fracture that is being treated with open rigid compression plate fixation devices. What teaching will the nurse reinforce to the client about how the progress of bone healing will be monitored?

Hyaline cartilage

A client has an elbow injury that involves the cartilage in that joint. The nurse understands that which type of cartilage has been affected?

Frequently monitoring vital signs

A client has been administered ketamine for moderate sedation. What is the priority nursing intervention?

common adverse effects

A client has experienced increasing pain and progressing inflammation of the hands and feet. The rheumatologist has prescribed NSAID use to treat the condition. What client education is most important for the nurse to address with the use of these medications?

skin breakdown wound infection pneumonia

A client has had surgical repair of a hip injury after joint manipulation was unsuccessful. After surgery, the nurse implements measures to prevent complications. Which complications is the nurse seeking to prevent? Select all that apply.

Advise the client to use a trochanter roll. Advise the client to adduct the stump so it presses against the other leg when the client is lying on the stomach.

A client has undergone a leg amputation. What teachings should the nurse offer such a client to prevent abduction deformity? Select all that apply.

Apply a cold pack at the insertion site.

A client has undergone arthroscopy. After the procedure, the site where the arthroscope was inserted is covered with a bulky dressing. The client's entire leg is also elevated without flexing the knee. What is the appropriate nursing intervention required in caring for a client who has undergone arthroscopy?

Compound

A client is admitted to the emergency room after being hit by a car while riding a bicycle. The client sustained a fracture of the left femur, and the bone is protruding through the skin. What type of fracture does the nurse recognize requires emergency intervention?

Administering large doses of I.V. antibiotics as ordered

A client is admitted with acute osteomyelitis that developed after an open fracture of the right femur. When planning this client's care, the nurse should anticipate which measure?

Assess for signs and symptoms of fluid volume deficit.

A client is at postoperative day 1 after abdominal surgery. The client is receiving 0.9% normal saline at 75 mL/h, has a nasogastric tube to low wall suction with 200 mL every 8 hours of light yellow fluid, and a wound drain with 50 mL of dark red drainage every 8 hours. The 24-hour urine output total is 2430 mL. What action by the nurse is most appropriate?

Use of isometric exercises

A client is being discharged home with a long arm cast. What education should the nurse include to prevent disuse syndrome in the arm?

Short leg cast

A client is having a cast applied for a fractured leg that extends from below the knee to the base of the toes. The foot is flexed at a right angle in a neutral position. What type of cast is the client having applied?

Apply a compression bandage to the area. Administer a mild analgesic. Inform the client that a clicking or crackling noise in the joint may persist for a couple of days.

A client is having repeated tears of the joint capsule in the shoulder, and the health care provider orders an arthrogram. What intervention should the nurse provide after the procedure is completed? Select all that apply.

Muscle spasms will be relieved. The bones of the left leg will be aligned. Immobilization of the left leg will be maintained.

A client is having traction applied to a fractured left lower extremity prior to surgery. What outcomes does the nurse expect from the application of the traction for the client? Select all that apply.

Administer oxygen.

A client is hospitalized for open reduction of a fractured femur. During the postoperative assessment, the nurse notes that the client is restless and observes petechiae on the client's chest. Which nursing action is indicated first?

Osteoclastoma

A client is informed that he has a benign bone tumor but that this type of tumor that may become malignant. The nurse knows that this is characteristic of which type of tumor?

Realignment of the fracture Reduction of deformity Minimization of muscle spasms

A client is placed in traction for a femur facture. The nurse would document which expected outcomes of traction? Select all that apply.

"Apply ice packs for the first 24 to 48 hours, then apply heat packs."

A client is treated in the emergency department for acute muscle strain in the left leg caused by trying a new exercise. During discharge preparation, the nurse should provide which instruction?

"You will be lying on your side with your knees to your chest."

A client is undergoing a lumbar puncture. The nurse educates the client about surgical positioning. Which statement by the nurse is appropriate?

postoperative pain control cough and deep-breathing exercises intravenous fluids and other lines and tubes

A client is undergoing a surgical procedure to repair an ulcerated colon. Which client education topics will be discussed preoperatively? Select all that apply.

Osteomyelitis

A client presents to the emergency department with fever, chills, restlessness, and limited movement of a fractured jaw. What complication should the nurse interpret as the findings?

Allow the client to wear the ring and cover it with tape.

A client refuses to remove her wedding band when preparing for surgery. What is the best action for the nurse to take?

"I don't know if I'll be able to get off that low toilet seat at home by myself."

A client undergoes a total hip replacement. Which statement made by the client indicates to the nurse that the client requires further teaching?

"I should use my heating pad this evening to reduce some of the pain in my knee."

A client undergoes an arthroscopy at the outpatient clinic. After the procedure, the nurse provides discharge teaching. Which response by the client indicates the need for further teaching?

Closed reduction

A client was playing softball and dislocated four of his fingers when diving for a ball. The physician manipulated the fingers into alignment and applied a splint to maintain alignment. What type of procedure does the nurse document this as?

Complex regional pain syndrome

A client who has extremity right wrist fracture complains of severe burning pain, frequent changes in the skin from hot and dry to cold, and feeling clammy skin that is shiny and growing more hair in the injured extremity. The nurse should anticipate providing care for what complication?

complex regional pain syndrome.

A client who has extremity right wrist fracture complains of severe burning pain, frequent changes in the skin from hot and dry to cold, and feeling clammy skin that is shiny and growing more hair in the injured extremity. The nurse should anticipate providing care for what complication?

"Immobilization of the fracture will promote healing by maximizing contact of bone fragments." "Fractured bones require a good blood supply and adequate nutrition for healing." "Weight bearing stimulates healing of the long bones of the leg, if the fracture is stabilized."

A client who has fractured the radial head asks the nurse about factors that will promote bone healing. Which statement should the nurse include when responding to the client? Select all that apply.

Avascular necrosis

A client who has sustained a fracture reports an increase in pain and decreased function of the affected extremity. What will the nurse suspect?

"I cannot seem to catch my breath." "I have a pins-and-needles sensation in my toes." Dorsoplantar weak and unequal bilaterally T 101.2 degrees F; HR 110; RR 28; pulse oximetry 90%

A client with a fractured femur is admitted to the nursing unit. Which assessment finding requires follow up by the nurse? Select all that apply.

Assess for complications.

A client with a long arm cast continues to complain of unrelieved throbbing pain even after receiving opioid pain medication. Which is the priority action by the nurse?

"Describe the pain and rate it on the pain scale."

A client with a recent left above-the-knee amputation states, "I can feel pain in my left toes." Which is the best response by the nurse?

the client that he or she won't be cut.

A client with a right leg fracture is returning to the orthopedist to have the cast removed. During cast removal, it is important for the nurse to assure:

Document the findings.

A client with a tibia fracture was placed in an external fixator 24 hours ago. The nurse is completing pin care and notices redness at the pin site and a small amount of serous drainage. What action by the nurse is appropriate?

A bone biopsy

A client with suspected osteomalacia has a fractured tibia and fibula. What test would give a definitive diagnosis of osteomalacia?

Calcium level of 11.6 mg/dl

A home care nurse assesses for disease complications in a client with bone cancer. Which laboratory value may indicate the presence of a disease complication?

Prevent internal rotation of the affected leg.

A nurse is caring for a client who underwent a total hip replacement. What should the nurse and other caregivers do to prevent dislocation of the new prosthesis?

Supine, with the knees slightly flexed and the head of the bed elevated 30 degrees

A patient is having low back pain. What position can the nurse suggest to relieve this discomfort?

The Hemovac drain isn't compressed; instead it's fully expanded.

A physician calls the nurse for an update on his client who underwent abdominal surgery 5 hours ago. The physician asks the nurse for the total amount of drainage collected in the Hemovac since surgery. The nurse reports that according to documentation, no drainage has been recorded. When the nurse finishes on the telephone, she goes to assess the client. Which assessment finding explains the absence of drainage?

Maintain a patent airway. Frequently monitor neurological status. Administer blood products per orders. Apply oxygen per orders.

A postanesthesia care unit (PACU) nurse is caring for a client with the following assessment data: pale, cool, moist skin; thready pulse of 122; blood pressure 78/60; urine output of 25 mL/h; temperature 99.2°F. What interventions by the nurse are appropriate? Select all that apply.

Pink color

A postoperative client is experiencing a flash pulmonary edema. What finding in the client's sputum is consistent with this problem?

dantrolene sodium (Dantrium)

During the surgical procedure, the client exhibits tachycardia, generalized muscle rigidity, and a temperature of 103°F. The nurse should prepare to administer:

Review the scheduled procedure, site, and client.

Once the operating team has assembled in the room, the circulating nurse calls for a "time out." What action should the nurse take during the time out?

Cosmetic Diagnostic Palliative

Several of the clients at the clinic are preparing to have surgery within the next 2 weeks. They are completing preoperative paperwork today with their visit. What are some of the reasons that people might need to have surgery? Select all that apply.

Circulating nurse

The OR personnel responsible for maintaining the safety of the client and the surgical environment is the:

Remove the entire sterile field from use.

The circulating nurse is unsure whether proper technique was followed when an object was placed in the sterile field during a surgical procedure. What is the best action by the nurse?

Disturbed body image

The client diagnosed with osteosarcoma is scheduled for a surgical amputation. Which nursing diagnosis would be a priority for this client compared with other surgical clients?

Wound approximation

The nurse cares for a client who is three hours post op abdominal hysterectomy and begins to develop hiccups. What nursing assessment will the nurse monitor more closely with the client's new symptoms?

Hypertonic

The nurse is assessing the muscle tone of a client with cerebral palsy. Which description does the nurse determine to be an expected assessment of this client's muscle tone?

During the postoperative phase

The nurse is assigned a client scheduled for an outpatient colonoscopy in an ambulatory care setting. During which phase of perioperative care would the nurse document the admission vital signs in the recovery room?

Hypovolemic

The nurse is monitoring a patient who sustained an open fracture of the left hip. What type of shock should the nurse be aware can occur with this type of injury?

Dusky or mottled skin color

The nurse is performing a neurovascular assessment of a client's injured extremity. Which would the nurse report?

Pale, cyanotic, or mottled color Cool temperature of the extremity More than 3-second capillary refill

The nurse is performing an assessment for a patient who may have peripheral neurovascular dysfunction. What signs does the patient present with that indicate circulation is impaired? (Select all that apply.)

"Are you wearing any jewelry?" "Have you removed your hearing aid?" "Do you have a pacemaker?"

The nurse is preparing the client with a right neck mass for magnetic resonance imaging (MRI). Which question should the nurse ask? Select all that apply.

"I can resume my usual activities as soon as I get home."

The nurse is preparing the client with an abdominal incision for discharge. Which statement by the client indicates that further teaching is required?

potassium 6.2 mEq/L

The nurse is reviewing the pre-admission laboratory findings of the client scheduled for surgery. Which laboratory value would be of greatest concern to the nurse?

Vitamin D

The nurse is teaching a client about a vitamin that supports calcium's absorption. What vitamin is the nurse teaching the client about?

dual-energy x-ray absorptiometry

The nurse is teaching a client about osteoporosis. What diagnostic test will the nurse include with the client teaching?

first intention

The nursing assessment of the postoperative client reveals an incision that is well-approximated with sutures intact, minimal redness and edema, and absence of drainage. The nurse recognizes the wound is healing by:

"The anesthetic may last for 3 hours."

The patient asks the nurse how long the local infiltration anesthetic will last. What is the nurse's best response?

Lithotomy position

The patient is having a repair of a vaginal prolapse. What position does the nurse place the patient in?

Increase fiber intake.

To reduce the incidence of complications in a client in traction, which intervention should be included in the care plan?

Administer medication, as ordered, for the reported discomfort.

Two days after surgery to amputate the left lower leg, a client reports pain in the missing extremity. Which action by the nurse is most appropriate?

Lift with the large leg muscles (quadriceps), not the back muscles.

Using proper body mechanics to lift objects is essential to prevent exacerbations of low back pain. Which of the following is the most important teaching point?

Coordinating the surgical team

What are the circulating nurse's responsibilities, in contrast to the scrub nurse's responsibilities?

Pulmonary embolism

What complication is the nurse aware of that is associated with deep venous thrombosis?

80 to 110 mg/dL

What is the blood glucose level goal for a diabetic client who will be having a surgical procedure?

"Remain supine for the time specified by the physician."

What is the most important postoperative instruction a nurse must give to a client who has just returned from the operating room after receiving a subarachnoid block?

A systolic blood pressure lower than 90 mm Hg

What measurement should the nurse report to the physician in the immediate postoperative period?

The patient participates willingly in the preoperative preparation.

When does the nurse understand the patient is knowledgeable about the impending surgical procedure?

Column B

Which assessment findings would the nurse expect to find in the postoperative client experiencing fat embolism syndrome?

The client with elevated pressure within the muscles The client with hemorrhage in the site of injury The client with a plaster cast applied immediately after injury

Which client(s) is most likely to have compartment syndrome after sustaining a fracture? Select all that apply.

Tachycardia (heart rate >150 beats per minute)

Which clinical manifestation is often the earliest sign of malignant hyperthermia?

Toes mottled and cool Complaints of pins and needles in feet

Which clinical manifestation would the nurse recognize as an indicator of peripheral neurovascular dysfunction? Select all that apply.

Splint

Which device is designed specifically to initially support and immobilize a body part in a desired position until swelling subsides?

Compound

Which type of fracture is one in which the skin or mucous membrane wound extends to the fractured bone?

First intention

Which type of healing occurs when granulation tissue is not visible and scar formation is minimal?

Application of a new cast

Which would be an inappropriate initial pain relief measure for the client with a cast?

Acute gallbladder infection

Which would be considered to require an urgent surgical procedure?

Anxious clients have a poor response to surgery and are prone to complications.

You are caring for a client preoperatively who is very anxious and fearful about their surgery. You know that this client's anxiety can cause problems with the surgical experience. What type of problems can this client have because of their anxiety and fear?

"Many people have diagnostic or short therapeutic surgical procedures."

You are the nurse working in an ambulatory surgery center. A teenage son of your clients ask you why so many people have surgery. What would be your best reply?