ch 39-42 quiz in class 35 q

After a person experiences a closure of the epiphyses, which statement is true? The bone increases in thickness and is remodeled. Both bone length and thickness continue to increase. No further increase in bone length occurs. The bone grows in length but not thickness.

After closure of the epiphyses, no further increase in bone length can occur. The other options are inappropriate and not related to closure of the epiphyses.

The nurse is teaching a postmenopausal client about strategies to prevent the development of osteoporosis. On which topic should the nurse focus as primary prevention for the disorder? increasing calcium and vitamin D in the diet participating in cardiovascular exercises regularly maintaining a body mass index of less than 20 taking regular estrogen replacement therapy

Primary prevention of osteoporosis includes maintaining optimal calcium and vitamin D intake. Although estrogen replacement can reduce the risk for osteoporosis, it can increase the risk for certain cancers and should therefore not be recommended as first-line prevention. Cardiovascular exercise will directly help in the prevention of osteoporosis only if it involves weight-bearing activity, such as walking or jogging. A lower body mass index (weight under 125 pounds for women of average height) is a risk factor for developing osteoporosis rather than preventing it.

A client is brought to the emergency department after injuring their right arm in a bicycle accident. The orthopedic surgeon tells the nurse that the client has a greenstick fracture of the arm. What does this mean? The fracture results from an underlying bone disorder. One side of the bone is broken and the other side is bent. Bone fragments are separated at the fracture line. The fracture line extends through the entire bone substance.

In a greenstick fracture, one side of the bone is broken and the other side is bent. A greenstick fracture also may refer to an incomplete fracture in which the fracture line extends only partially through the bone substance and doesn't disrupt bone continuity completely. (Other terms for greenstick fracture are willow fracture and hickory-stick fracture.) The fracture line extends through the entire bone substance in a complete fracture. A fracture that results from an underlying bone disorder, such as osteoporosis or a tumor, is a pathologic fracture, which typically occurs with minimal trauma. Bone fragments are separated at the fracture line in a displaced fracture.

During a routine physical examination on a 75-year-old 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 inches (1.7 m) tall." Which statement is the best response by the nurse? "The posture begins to stoop after middle age." "After menopause, the body's bone density declines, resulting in a gradual loss of height." "After age 40, height may show a gradual decrease as a result of spinal compression." "There may be some slight discrepancy between the measuring tools used."

The nurse should tell the client that after menopause, the loss of estrogen leads to a loss in bone density, resulting in a loss of height. This client's history doesn't indicate spinal compression. Telling the client that measuring tools used to obtain the client's height may have a discrepancy or that the posture begins to stoop after middle age doesn't address the client's question.

The nurse is providing teaching for a client being discharged after a fiberglass cast application for a fractured tibia. Which statement by the client indicates need for further teaching? "Pain at the fracture site and a small amount of swelling is to be expected." "I can shower with the cast as long as I keep it well covered." "Hot, painful, areas on the cast are normal and can be treated with ice packs." "I should be able to freely wiggle my toes while in the cast."

Teaching should include recognition of important signs and symptoms that would indicate circulation impairment; these include pale skin and coolness of the extremity. Additionally, the nurse teaches the client that hot, painful areas can be a sign of infection and should be addressed. Pain from the fracture and a small amount of swelling is normal. The client should be able to wiggle toes and can shower but should avoid getting the cast wet or getting water inside the cast. Remediation:

A client undergoes a total hip replacement. Which statement made by the client indicates to the nurse that the client requires further teaching? "I don't know if I'll be able to get off that low toilet seat at home by myself." "I'll need to keep several pillows between my legs at night." "The occupational therapist is showing me how to use a sock puller to help me get dressed." "I need to remember not to cross my legs. It's such a habit."

The client requires additional teaching if they are concerned about using a low toilet seat. To prevent hip dislocation after a total hip replacement, the client must avoid bending the hips beyond 90 degrees. The nurse should instruct the client to use assistive devices, such as a raised toilet seat, to prevent severe hip flexion. Using an abduction pillow or placing several pillows between the legs reduces the risk of hip dislocation by preventing adduction and internal rotation of the legs. Teaching the client to avoid crossing the legs also reduces the risk of hip dislocation. A sock puller helps a client get dressed without flexing the hips beyond 90 degrees

A client being discharged after treatment for a compound fracture asks why antibiotics are needed for a broken bone. Which response by the nurse is most appropriate? "You may discuss your prescriptions with your healthcare provider at your follow-up appointment." "The antibiotics are prescribed to help the bone heal more quickly and more strongly." "If your temperature is normal for 48 hours, you may discontinue the medication." "This prophylactic antibiotic therapy is required because your bone broke through your skin."

The client should be instructed that antibiotics are prescribed as a preventive measure after a compound fracture because such fractures expose the bone to the environment and possible infection. Directing the client to discuss prescribed medications with the healthcare provider at a follow-up appointment does not address the client's questions or immediate needs. The client needs this medication regardless of body temperature. Antibiotics are not used to enhance the healing of a bone fracture.

A client in a double hip spica cast is constipated. The surgeon cuts a window into the front of the cast. Which outcome is intended? The window in the cast will allow: The window will allow the nurse to palpate the superior mesenteric artery. the nurses to reposition the client. relief from pressure due to abdominal distention. the surgeon to manipulate the fracture site.

The hip spica cast is used for treatment of femoral fractures; it immobilizes the affected extremity and the trunk securely. It extends from above the nipple line to the base of the foot of both extremities in a double hip spica. Constipation, possible due to lack of mobility, can cause abdominal distention or bloating. When the spica cast becomes too tight due to distention, the cast will compress the superior mesenteric artery against the duodenum. The compression produces abdominal pain, abdominal pressure, nausea, and vomiting. To relieve the compression, the surgeon can cut a "window" in the cast. The nurse should assess the abdomen for decreased bowel sounds, not the superior mesenteric artery. The surgeon cannot manipulate a fracture through a small window in a double hip spica cast. The nurse cannot use the window to aid in repositioning because the window opening can break and negate the effect of the cast.

A client has sustained a right tibial fracture and has just had a cast applied. Which instruction should the nurse provide concerning cast care? "A foul smell from the cast is normal." "Keep your right leg elevated above heart level." "Use a knitting needle to scratch itches inside the cast." "Cover the cast with a blanket until the cast dries."

The nurse should instruct the client to elevate the leg to promote venous return and prevent edema. The cast shouldn't be covered while drying. Covering the cast will cause heat buildup and prevent air circulation. The client should be instructed not to insert foreign objects into the cast because of the risk of cutting the skin and causing an infection. A foul smell from a cast is never normal and may indicate an infection.

A nurse is caring for a client who recently underwent a total hip replacement. The nurse should: ease the client onto a low toilet seat. allow the client's legs to be crossed at the knees when out of bed. use soft chairs when the client is sitting out of bed. limit hip flexion of the client's hip when he sits.

The nurse should instruct the client to limit hip flexion to 90 degrees when he sits. The nurse should supply an elevated toilet seat so that the client can sit without having to flex his hip more than 90 degrees. The nurse should instruct the client not to cross his legs to avoid dislodging or dislocating the prosthesis. The nurse should caution the client against sitting in chairs that are too low or too soft; these chairs increase flexion, which is undesirable.

To assess the joints, a nurse asks a client to perform various movements. As the client moves their arm away from the midline, the nurse evaluates their ability to perform abduction. adduction. retraction. protraction.

A client performs abduction when moving a body part away from the midline. Protraction refers to drawing out or lengthening of a body part. Retraction, the opposite of protraction, refers to drawing back or shortening of a body part. Adduction, the opposite of abduction, is movement of a body part toward the midline.

When caring for a client with acute osteomyelitis in the right tibia, which measure is most appropriate to implement when repositioning the client's leg? Have the client move the leg by himself to decrease pain. Hold the leg by the ankle when repositioning to avoid touching the tibia. Support the leg above and below the affected area when positioning. Apply warm, moist compresses to the leg before repositioning.

Acute osteomyelitis can be very painful. Therefore, the extremity must be handled carefully and moved slowly. The most appropriate action when moving an extremity with acute osteomyelitis is to ensure that the extremity is carefully supported above and below the affected area. A splint may be useful to decrease discomfort.Holding the leg by the ankle or allowing the client to move the leg is inappropriate because doing so does not provide adequate support to the affected area.Applying warm, moist compresses does not decrease the need to adequately support the affected area.

A client is admitted to the hospital with a diagnosis of a right hip fracture. The client has right hip pain and cannot move the right leg. The nurse should further assess the right leg to determine if the leg is: rotated internally. held in a flexed position. shorter than the leg on the unaffected side. adducted.

After a hip fracture, the leg on the affected side is characteristically shorter than the unaffected leg.A fractured hip usually rotates externally.Holding the leg in a flexed position is seen in clients with a dislocated hip, not a fractured hip.Typically, the fractured hip is in an abducted position.

A client is in Buck's traction after fracturing the right hip. The nurse should include which action in the care plan? maintaining correct body alignment keeping the client in semi-Fowler's position removing the weights once every shift maintaining the bed in the knee-Gatch position

Buck's traction produces realignment by exerting a pulling force on the fractured hip. Therefore, the nurse must maintain correct body alignment. Traction should be continuous; if the weights must be removed, the nurse should apply manual traction until the weights are replaced. The nurse shouldn't use the knee-Gatch position, because it disrupts the constant pulling force needed for alignment. Using the semi-Fowler's position would cause the client to slide in the direction of the traction, defeating the purpose of traction.

The nurse is teaching a client with osteoporosis about taking alendronate sodium. The nurse emphasizes that the client is to take the medication: with food. with a full glass of water and remain upright for 30 minutes. at bedtime. with a full glass of juice and then rest for 30 minutes.

Clients are instructed to take alendronate on arising, 30 minutes before eating, with a full glass of water. Because it can cause severe esophageal irritation, the client must remain upright for 30 minutes after administration. Taking alendronate with food or juice significantly reduces absorption.

The nurse is planning an educational program about the prevention of osteoporosis for a group of women. Which preventive measures would be appropriate for the nurse to include in the teaching plan? increasing daily intake of protein sunbathing for 1 hour a day during the summer months ingesting 2,000 mg of calcium supplements daily encouraging weight-bearing exercise on a regular basis

Exercise, especially weight-bearing exercise such as walking or jogging, is recommended on a regular basis to maintain high-density bone mass. The diet should be high in calcium and vitamin D; increasing the daily intake of protein is not appropriate. It is recommended that premenopausal women consume about 1,000 to 1,200 mg of calcium daily. Sunbathing is not recommended.

The nurse is assessing the neurovascular status of a client's right arm, which has just had a cast applied. The nurse should notify the health care provider when which symptom occurs? no pain on passive movement of the fingers. slight swelling of the fingers localized pain in the right arm nail bed capillary refill time of 10 seconds

Normal capillary refill time is 3 to 5 seconds. A capillary refill time of 10 seconds is prolonged and may be indicative of inadequate circulation. This finding should be reported to the health care provider.Localized pain immediately after a fracture is to be expected.Slight swelling of the fingers is expected and can be relieved by elevating the extremity.The absence of pain on passive movement of the client's fingers is a normal, desirable finding.

A nurse notices a client lying on the floor at the bottom of the stairs. The client's alert and oriented and states that they fell down several stairs. The client denies pain other than in their arm, which is swollen and appears deformed. After calling for help, what should the nurse do? Immobilize the client's arm. Place the client in a sitting position. Raise the client's arm above their heart. Help the client walk to the nearest nurses' station.

Signs of a fracture in an extremity include pain, deformity, swelling, discoloration, and loss of function. When a nurse suspects a fracture, the nurse should immobilize the extremity before moving the body part. It isn't appropriate for the nurse to move the client into a sitting position without further assessment. The client shouldn't walk to the nurses' station; they should stay where they are until help arrives.

A client is in balanced suspension traction to maintain alignment of a fractured tibia. Which activities are safe for the client? Raise the hips using trapeze. Rotate side to side. Eat while lying flat. Flex and extend the ankle on affected side.

The client in balanced suspension traction can raise the hips using a trapeze. The client can then use the bedpan. The client can be in a sitting position to eat. The client should not move side to side but can turn toward the affected side. The client should not flex or extend the ankle on the affected side.

When a client is placed in balanced skeletal traction, the nurse should: apply and remove the traction weights at regular intervals throughout the day. ensure that the traction weights hang freely from the bed at all times. remove the weights briefly as necessary to reposition the client in bed. increase the traction weight gradually as the client's tolerance increases.

In balanced skeletal traction, the appropriate pressures and counter pressures are applied to the fracture site, with the traction weights hanging freely at all times.The amount of traction weight used is determined by radiography and the alignment of the fracture.These weights are in place continuously and should never be lifted, reduced, or eliminated.

A client was undergoing conservative treatment for a herniated nucleus pulposus, at L5 - S1, which was diagnosed by magnetic resonance imaging. Because of increasing neurological symptoms, the client undergoes lumbar laminectomy. The nurse should take which step during the immediate postoperative period? Logroll the client from side to side. Discourage the client from doing any range-of-motion (ROM) exercises. Have the client sit up in a chair as much as possible. Elevate the head of the bed to 90 degrees.

Logrolling the client maintains alignment of the hips and shoulders and eliminates twisting in the operative area. The nurse should encourage ROM exercises to maintain muscle strength. Because of pressure on the operative area, having the client sit up in a chair or with the head of the bed elevated should be allowed only for short durations.

A nurse is caring for a client who complains of lower back pain. Which instruction should the nurse give to the client to prevent back injury? "Push or pull an object using your arms." "Bend over the object you're lifting." "Stand close to the object you're lifting." "Narrow the stance when lifting."

Standing close to an object when lifting moves the body's center of gravity closer to the object, allowing the legs, rather than the back, to bear the weight. No one should bend over an object when lifting; instead, the back should be straight, and bending should be at the hips and knees. When lifting, spreading the legs apart widens the base of support and lowers the center of gravity, providing better balance. Pushing or pulling an object using the weight of the body, rather than the arms or back, prevents back strain. Using a larger number of muscle groups distributes the workload. Remediation:

A client has a total hip replacement. Which of the following client statements indicates a need for further teaching before discharge? "I will need an elevated toilet seat." "I will be careful not to cross my legs." "I will implement the exercise program as soon as I get home." "I can't wait to take a tub bath when I get home."

The client will need to avoid extremes of motion in the hip to avoid dislocation. The hip should not be flexed more than 90 degrees, internally rotated, or legs crossed. It is not possible to safely sit in the bathtub without flexing the hip beyond the recommended 90 degrees. The client can implement the prescribed exercise program at the time of discharge home. The client should take care not to stress the hip for 3 to 6 months after surgery. An elevated toilet seat will be necessary during the recovery from surgery.

When the nurse is assessing a client who reports a back injury, what should the nurse ask the client about first? family history of back problems previous hospitalizations personal history of illness mechanism of injury

The mechanism of injury is always the most critical information to obtain from a client with a musculoskeletal injury. In the event of a back injury, the mechanism of injury provides the greatest clue as to the extent of injury and the proper treatment plan. The other questions are important but will not give the critical information needed related to this specific problem and injury.

A client with an extracapsular hip fracture returns to the nursing unit after internal fixation and pin insertion with a drainage tube at the incision site. Her husband asks, "Why does she have this tube inserted in her hip?" Which response would be best? "We have a way to administer antibiotics into the wound." "The tube helps us to detect a wound infection." "This way we will not have to irrigate the wound." "Fluid will drain and not accumulate at the site."

The primary purpose of the drainage tube is to prevent fluid accumulation in the wound. Fluid, when it accumulates, creates dead space. Elimination of the dead space by keeping the wound free of fluid greatly enhances wound healing and helps prevent abscess formation. Although the characteristics of the drainage from the tube, such as a change in color or appearance, may suggest a possible infection, this is not the tube's primary purpose. The drainage tube does not eliminate the need for wound irrigation or provide a way to instill antibiotics into the wound.

A nurse suspects that a client with a recent fracture has compartment syndrome. Assessment findings may include inability to perform active movement and pain with passive movement. inability to perform passive movement and pain with active movement. body-wide decrease in bone mass. a growth in and around the bone tissue.

With compartment syndrome, the client can't perform active movement, and pain occurs with passive movement. A body-wide decrease in bone mass is seen in osteoporosis. A growth in and around the bone tissue may indicate a bone tumor.

Two days after surgery to amputate the left lower leg, a client states that they have pain in the missing extremity. There is an existing prescription for PRN pain medication. Which action by the nurse is most appropriate? Contact the health care provider. Do nothing because it isn't possible to have pain in a missing limb. Administer medication for the reported discomfort. Request a consult with a psychologist.

The sensation of pain and discomfort in an amputated extremity is known as phantom pain. Phantom pain is a normal occurrence after an amputation. Prescribed medication is one option for treating phantom pain. Since there is already a prescription for pain medication, the nurse doesn't need to contact the health care provider at this time. Consultation with the psychologist isn't indicated.

The nurse is caring for a client with a fractured fibula who has skeletal traction and skeletal pins. What would the nurse instruct the unlicensed assistive personnel (UAP) to report immediately? The client wants to change position. The client is reporting pain and muscle spasm. The traction weights are resting on the floor. There is a small amount of clear fluid at the pin sites.

The weights should always hang freely. When the weights are on this floor, they are not exerting pulling force to provide reduction and alignment or to prevent muscle spasm. Attending to the weights may reduce the client's pain and spasm. Skeletal pins usually have a small amount of clear fluid. It is most important to check the traction system after a client changes position, because position changes may alter the traction.

A nurse is caring for a client with a cast on their left arm after sustaining a fracture. Which assessment finding is most significant for this client? presence of a normal popliteal pulse cast edges are rough, with skin irritation present minimal pain in the left arm fingers on the left hand are swollen and cool SUBMIT ANSWER

Swollen and cool fingers on the left hand are the most significant assessment findings. They represent altered circulation to the hand caused by the cast. A normal radial, not popliteal, pulse should be present in the left arm; the popliteal pulse is found on the leg. Skin irritation is an abnormal assessment finding but it isn't as significant as altered circulation. Minimal pain in the left arm is expected.

A client who has skeletal traction to stabilize a fractured femur has not had a bowel movement for 2 days. The nurse should: administer an oil retention enema. increase the client's fluid intake to 3,000 mL/day. perform passive range of motion to extremities. place the client on the bedpan every 3 to 4 hours.

The most appropriate nursing action is to first increase the client's fluid intake to 3,000 mL/day to soften stool.A stool softener would be prescribed before resorting to an enema. Oil retention enemas are used to soften and lubricate impacted stool.Placing the client on the bedpan every 3 to 4 hours is not enough to stimulate a bowel movement.While activity can stimulate peristalsis, passive range of motion is not likely to provide enough stimulation to the abdominal muscles to stimulate a bowel movement.

The client sustained an open fracture of the femur from an automobile accident. The nurse should assess the client for which type of shock? anaphylactic neurogenic hypovolemic cardiogenic

A fractured femur, especially an open fracture, can cause much soft tissue damage and lead to significant blood loss. Hypovolemic shock can develop. Cardiogenic shock occurs when cardiac output is decreased as a result of ineffective pumping. Neurogenic shock occurs as a result of an impaired autonomic nervous system function. Anaphylactic shock is the result of an allergic reaction.

A pediatric client has just had a plaster cast placed on his lower left leg. Which action should the nurse take to provide safe cast care? Keep the child in the same position for 24 hours until the cast is dry. Notify the health care provider (HCP) if the client feels heat. Use only the palms of the hand when handling the cast. Petal the cast as soon as it is put on.

The wet plaster cast should be handled using only the palms of the hands to prevent indentations of the cast surface. Petaling a cast should be done only when the edges of the cast are rough and are causing irritation to the client's skin. The nurse should not keep the child in the same position until the cast is dry. Doing so would prohibit proper toileting and elimination and would produce undue pressure on the coccyx. The cast typically emits heat as it dries, so notifying a health care provider (HCP) is not necessary in this instance. If needed, a fan can be used to circulate the room air.

A client with a hip fracture has undergone surgery for insertion of a femoral head prosthesis. Which activity should the nurse instruct the client to avoid? rising straight from a chair to a standing position using an abductor splint while lying on the side crossing the legs while sitting down sitting on a raised commode seat

Any activity or position that causes flexion, adduction, or internal rotation of greater than 90 degrees should be avoided until the soft tissue surrounding the prosthesis has stabilized, at approximately 6 weeks. Crossing the legs while sitting down causes internal rotation and can lead to dislocation of the femoral head from the hip socket. Sitting on a raised commode seat prevents hip flexion and adduction. Using an abductor splint while side-lying keeps the hip joint in abduction, thus preventing adduction and possible dislocation. Rising straight from a chair to a standing position is acceptable for this client because this action avoids hip flexion, adduction, and internal rotation of greater than 90 degrees.

Which cells are involved in bone resorption? osteoblasts osteocytes chondrocytes osteoclasts

Osteoclasts carry out bone resorption by removing unwanted bone while new bone is forming in other areas. Chondrocytes are responsible for forming new cartilage. Osteoblasts are bone-forming cells that secrete collagen and other substances. Osteocytes, derived from osteoblasts, are the chief cells in bone tissue

A client is brought to the emergency department with a painful swollen ankle. What is the nurse's most appropriate action? Assess range of motion. Elevate the ankle. Administer I.V. morphine sulfate as needed. Apply a warm compress.

Soft tissue injuries should be treated with rest, ice, compression, and elevation (RICE). Elevation of the ankle will decrease tissue swelling. Moving the ankle through the ROM will increase the risk of further injury. Morphine is not the drug of choice for pain due to inflammation.