ch 60, 61, 62, 63 original tb

The nurse is caring for a middle-aged female client who is experiencing premenopausal symptoms. Which client statement indicates the need for further teaching?

"Bone resorption slows with aging due to a decrease in estrogen levels."

A client is instructed to take an oral calcium preparation with vitamin D daily for the prevention of osteoporosis. What statement made by the client demonstrates understanding of the medication instructions?

"I can't take the medication with my other medication."

A client suffered a fractured femur during a football game. The client asks how long until the bone is back to its former structural strength. What should the client be informed?

12 months

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?

3 to 6 weeks

The nurse is assigned to care for a client who has had a total knee arthroplasty yesterday. What type of pharmacologic therapy does the nurse anticipate administering to this client to prevent complications related to the surgery?

Anticoagulation therapy

A client is scheduled to have an x-ray examination of his shoulder in which the synovial fluid will be aspirated and sent to the laboratory for analysis. This will be followed by administration of a contrast medium and x-rays. The nurse understands that the client will be undergoing which of the following?

Arthrogram

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?

Arthroscopy

A client is scheduled for a total left knee arthroplasty in 2 weeks. When would the best time for postoperative nursing management begin?

Before surgery

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?

Crackles in the lung bases

The nurse is providing client education on growth and development throughout the life span. When stating periods of most rapid bone growth, which period is the nurse most correct to state?

From birth through puberty

The physician orders a 24-hour urine test for a client on a medical unit. At what time would the nurse document the start of the specimen collection?

From the time of the first morning void to 24 hours later

A client has been diagnosed with temporomandibular disorder and has not been able to eat. What suggestion can the nurse make to modify the diet so that the client will be able to eat?

Have the client eat soft rather than coarse food.

A client suffered a subtrochanteric hip fracture after falling out of the bed. What complication should the nurse monitor closely for related to this type of fracture?

Hypovolemic shock

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?

Impacted

A client is diagnosed with carpal tunnel syndrome. Which of the following assessment findings would the nurse expect?

Inability to flex index and middle fingers

The nurse is preparing a client for a hip replacement with the use of porous-coated cementless joint components. What does the nurse know is the benefit of this type of component?

It allows the bone to grow into the prosthesis and securely fix the joint replacement in place.

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?

Left hip arthroplasty

The nurse is employed at a long-term care facility caring for geriatric clients. Which assessment finding is characteristic of an age-related change?

Loss of height

A client with ankylosing spondylitis has a stooped position and is being positioned in the bed prior to the nurse taking vital signs. The nurse listens to the client's lungs after positioning. What finding does the nurse hear when listening to lung sounds?

Lung sounds are diminished in the apical area.

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?

Muscle

A client is scheduled to undergo an electromyography. The nurse understands that this test is performed to evaluate which of the following?

Muscle weakness

The nurse is assessing the client who states a decline in muscle strength. Which is the primary source essential to allow muscle contraction?

Myofibrils

A client is informed that he has a benign bone tumor but is the type of tumor that may become malignant. What type of tumor does the nurse know that this is characteristic of?

Osteoclastoma

A client with metastatic bone cancer sustained a left hip fracture without injury. What type of fracture does the nurse understand occurs without trauma or fall?

Pathologic fracture

The nurse is demonstrating how to perform range-of-motion (ROM) exercises for a patient with tendinitis of the wrist. What intervention can the nurse encourage the client to use in order to decrease discomfort when performing the exercises?

Perform the exercises with the hand and wrist under warm water.

Which of the following would the nurse use to determine that a client is exhibiting signs and symptoms of chronic osteomyelitis?

Persistent draining sinus

A patient has had surgery to repair a fractured hip. What intervention is important for the nurse to perform when turning the client from side to side?

Place abductor pillows between the legs.

A client has had several diagnostic tests to determine if he has systemic lupus erythematosus (SLE). What result is very specific indicator of this diagnosis?

Positive Anti-dsDNA antibody test

The nurse is caring for a client who had an amputation of the left leg above the knee. What position can the nurse place the client in several times per day to promote stump extension and prevent contractures?

Prone

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

Provide age-related calcium intake recommendations.

Which of the following would a nurse encourage a client with gout to limit?

Purine-rich foods

A client has a history of dislocations of the same joint. The nurse understands that this is most likely due to an insufficient deposit of collagen during the healing process leading to which of the following?

Reduced tensile strength

When performing pin care, which of the following would be most appropriate?

Use an applicator only once, gently remove rusts around pin sites

A client is recovering from a fractured hip. The nurse would suggest that the client increase intake of which of the following to facilitate calcium absorption from food and supplements?

Vitamin D

Which of the following would the nurse expect to assess as the most common finding associated with fibromyalgia?

Widespread chronic pain

The nurse is caring for a newly admitted client to an orthopedic unit. Which of the following nursing actions is helpful in reducing client anxiety? Select all that apply.

be confident in action and instructions, speak quietly and in simple terms, relieve discomfort as able, be attentive to client needs

A patient is scheduled for hip replacement surgery in a month. Which statement made by the client demonstrates understanding for the preoperative instructions?

"I will stop taking my aspirin prior to my surgery"

The nurse is caring for a client who had a surgical amputation of the left leg related to complication from diabetes. The client asks the nurse, "If my leg is really gone, then why am I having such bad pain?" What is the best response by the nurse?

"It is called phantom pain and may come and go."

A client is seen in the emergency department for an injury acquired from falling off of a bicycle and fracturing the arm. The client also has a long laceration that has been sutured in the same area. The client asks the nurse why a splint is applied and not a cast. What is the best explanation by the nurse?

"We will need to monitor the status of the laceration to be sure it does not get infected."

A client calls the clinic and tells the nurse that he was bitten by a tick and is afraid he has Lyme disease. How long does the nurse understand that the tick must be attached to have Lyme disease?

36 to 48 hours

The nurse is caring for a client who was involved in an automobile accident and sustained multiple trauma. The client has a Volkmann's contracture to the right hand. What objective data does the nurse document related to this finding?

Clawlike deformity of the right hand without ability to extend fingers

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?

Closed reduction

Which suggestion would be most important to give a client who has a mild case of bunions?

Don proper footwear.

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

Staphylococcus aureus

A nurse is preparing a presentation for a health class about ways to ensure bone health, including the need for an adequate calcium intake. The participants are high school-aged girls. The nurse would encourage them to consume adequate calcium to maximize peak bone mass by which age?

30 to 35 years

A patient has sustained a left femur fracture in a skiing accident. When is the nurse aware that the complication of a fat emboli typically occurs and should be monitored for closely?

48 to 72 hours

A client has had a knee replacement and will be discharged in the morning. What does the nurse understand the goal for bending the knee is by discharge?

90

An older adult female has a bone density test that reveals severe osteoporosis. What does the nurse understand can be a problem for this client due to the decrease in bone mass and density?

Compression fractures

A client sustained a stable fracture of the cervical spine and is having skeletal traction applied. What type of traction does the nurse educate the client about?

Crutchfield tongs

A client is receiving treatment for rheumatoid arthritis but states that he is allergic to eggs. What medication would the client not be able to receive?

Synvisc

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

A bone biopsy

The nurse is required to design a teaching plan for a client with a ruptured Achilles tendon. Which of the following would the nurse emphasize?

Activity restrictions

The nurse is planning care for a client with a musculoskeletal injury. Which nursing diagnosis would be the highest priority?

Acute Pain

An older adult client slipped on an area rug at home and fractured the left hip. The client is unable to have surgery immediately and is having severe pain. What interventions should the nurse provide for the patient to minimize energy loss in response to pain?

Administer prescribed analgesics around-the-clock.

The nurse is caring for a client with rheumatoid arthritis who suffers with chronic pain in the hands. When would be the best time for the nurse to perform range-of-motion exercises?

After the client has had a warm paraffin hand bath

A client arrives at the orthopedic physician's office stating knee pain sustained while playing soccer. A history and physical assessment is completed. The knee appears reddened with edema. Which other diagnostic testing would the nurse anticipate?

An arthroscopy

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?

An electromyography

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?

Any chronic disorder or recent injury

A client was playing softball and was hit in the right ankle by the ball sustaining a contusion. What is the first action taken to help alleviate pain and swelling?

Apply a cold pack to the ankle.

A client comes to the clinic 2 days after sustaining a sprain to the left ankle. What intervention can the nurse encourage the client to perform that will help improve circulation?

Applying heat

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

Electrical stimulation

A client is receiving treatment for a head injury. Which of the following would the nurse do related to positioning to reduce the risk of further injury?

Elevate the client's head slightly while keeping the neck neutral

A client's cast is removed. The client is worried because the skin appears mottled and is covered with a yellowish crust. What advice should the nurse give the client to address the skin problem?

Apply lotions and take warm baths or soaks.

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?

Better molding to the client

A client is experiencing symptoms that are suspected to be related to systemic lupus erythematosus. What cutaneous symptom occurs in about 50% of clients affected by this disease?

Butterfly-shaped rash on the face over the bridge of the nose and cheeks

The nurse is assigned to care for a client who has had an open reduction and internal fixation of a fractured right femur 2 days ago. The nurse is listening to the client's lungs and, when moving the gown, observes petechial hemorrhages on the skin of the chest. What is the first action by the nurse?

Call the physician to inform them of the findings.

The orthopedic nurse is caring for a client diagnosed with a fracture of the radius. When the nurse is considering all of the various types of bone fractures, which bone type is most anticipated?

Cancellous

The nurse is assessing the capillary refill on a client who has a new, lower extremity cast. Which documented finding provides the best evidence of an abnormality?

Capillary refill within 4 seconds

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?

Cutting a cast window

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

Difficulty lying on affected side

The nurse is assessing the client following orthopedic surgery for a deep vein thrombosis. When performing this assessment, the nurse is most correct to perform which movement?

Dorsiflexion

A client is suspected to have Lyme disease and has a red macule at the site of the tick bite with a bull's-eye rash with round rings surrounding the center. In addition, the client has a severe headache with neck stiffness. What stage of Lyme disease is the client experiencing?

Early stage 1

The nurse is reviewing the diagnostic test findings of a client with rheumatoid arthritis. Which of the following would the nurse expect to find?

Elevated erythrocyte sedimentation rate

A client is complaining of severe pain in the left great toe. What lab studies that the nurse reviews indicate that the client may have gout?

Elevated uric acid levels

A client had a surgical amputation of an arm and is having a myoelectric arm applied. What does the nurse understand are the benefits of this type of device? Select all that apply.

Eliminates the need to wear a harness; terminal device looks natural; better function than cosmetic hand

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?

Osteoblasts

The nurse is assisting with an examination of a client suspected of having carpal tunnel syndrome. The physician has the patient flex the wrist for 30 seconds and percusses the median nerve. The client complains of pain and numbness when this is done. What does the nurse know this positive sign is documented as?

Phalen's sign

When assisting a client following an arthroscopy of the knee to a comfortable position, which standard is maintained?

Place the client's joint in a neutral position.

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?

Pulselessness

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?

Raloxifene (Evista)

A client undergoes an invasive joint examination of the knee. The nurse would closely monitor the client for which of the following?

Serous drainage

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?

Short leg cast

A client with rheumatoid arthritis has infiltration of the lacrimal and salivary glands with lymphocytes as a result of the disease. What does the nurse understand that this clinical manifestation is?

Sicca syndrome

The nurse is caring for a patient with a fractured right femur who is not a candidate to repair the femur immediately. What intervention should the nurse anticipate the physician will order to relieve muscle spasm and pain until surgery is performed?

Skin traction

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?

Splint

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?

Subluxation

The emergency room nurse is reporting the location of a fracture to the client's primary care physician. When stating the location of the fracture on the long shaft of the femur, the nurse would be most correct to state which terminology locating the fractured site?

The fracture is on the diaphysis.

A client arrives in the emergency room complaining of severe pain in her left hip after falling out of the bed. What indication upon assessment does the nurse recognize as a dislocated left hip? Select all that apply.

The left leg is shorter than the right, limited range of motion of the left hip, the skin of the lower left leg is pale.

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

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

A client arrives at the orthopedic clinic and informs the nurse that he thinks he has another stress fracture of the right foot. The physician orders an x-ray with negative results. What does the nurse understand that these negative results can mean?

The stress fracture may not be seen on x-ray for a few weeks.

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.

muscle spasms will be relieved, the bones of the left leg will be aligned, immobilization of the left leg will be maintained.

A client sustains a fractured right humerus in an automobile accident. The arm is edematous, the client states that he cannot feel or move his fingers, and the nurse does not feel a pulse. What condition should the nurse be concerned about that requires emergency measures?

Compartment syndrome

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?

Compound

A client comes to the emergency department complaining of localized pain and swelling of his lower leg. Ecchymotic areas are noted. History reveals that the client got hit in the leg with a baseball bat. Which of the following would the nurse suspect as most likely?

Contusion

A professional tennis player comes to the orthopedic clinic and informs the nurse that he is having pain that radiates down the forearm and is unable to grasp the racket firmly. What does the nurse suspect is occurring with the client?

Epicondylitis

A 68-year-old female client who had a total hip replacement is to be discharged because her healing is almost complete. Which of the following would be most important for this client?

Exploring factors related to the client's home environment

A client with a fracture develops compartment syndrome that requires surgical intervention. The nurse would most likely prepare the client for which of the following?

Fasciotomy

A client has a cast that extends from below the elbow to the palmar crease and is secured around the base of the thumb. The thumb is also casted. The nurse identifies this as which type of cast?

Gauntlet cast

The nurse is reporting on the results of client blood work to the oncoming nurse. Upon reviewing the data, it is noted that the client has an elevated uric acid level. Which inflammatory process would the nurse screen for on shift rounds?

Gout

A client informs the nurse that he has been diagnosed with degenerative joint disease of the fingers but now has these bumps on his fingers that don't hurt. The nurse observes bony nodules on the distal interphalangeal joints. What type of "bumps" does the nurse understand these are?

Heberden's nodes

The physician's office nurse is tracking pediatric growth data. As the nurse evaluates trends in assessment findings, which is expected?

Height increases are noted on gender specific growth charts.

A client has just undergone a leg amputation. The nurse would closely monitor the client for which of the following during the immediate postoperative period?

Hematoma

A client with degenerative joint disease asks the nurse for suggestions to avoid unusual stress on the joints. Which suggestion would be most appropriate?

Maintain good posture.

The nurse is working in the emergency department interacting with clients of various disease processes and injuries. When completing a head-to-toe assessment, which standard assessment technique is most important?

Maintain standard precautions throughout the exam.

The nurse is caring for a client in traction that is immobile. What measures can the nurse provide to prevent further injury and potential infection and promote circulation to the area?

Massage bony prominences subject to pressure unless red when pressure relieved.

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

Matrix

The nurse is discussing the new medication that a client will be taking for treatment of rheumatoid arthritis. Which disease-modifying antirheumatic drug (DMARD) will the nurse educate the client about?

Methotrexate (Rheumatrex)

When caring for a client with a fracture, assessment of which of the following would be the priority?

Neurovascular compromise

A family member is caring for an older adult client with osteomalacia in the home. When the home health nurse comes to evaluate the client, what should be a focus point of the visit?

Observing for safety hazards that could be a fall risk

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?

Obtaining a culture

During the assessment of a client scheduled for orthopedic surgery, the nurse discovers that the client was previously treated for the disorder. In such a case, what additional data need to be collected?

Occurrence of complications or problems during treatment

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?

Ossification and calcification

A client had a dislocated shoulder, and when healing, the client had insufficient deposits of collagen during the repair stage. What complication is the nurse aware can occur from this lack of collagen?

Recurrent dislocations

A nurse is monitoring a client diagnosed with Lyme disease. Which finding would suggest that the disease is in the early stages?

Red macule or papule

The physician orders an opioid analgesic for a client with a traumatic injury. The nurse would monitor the client closely for which of the following as the priority?

Respiratory depression

A client sustained a sprained ankle while skiing, and the physician ordered RICES. What will the nurse inform the client to do related to the physician's order upon discharge?

Rest, ice, compression, elevation, stabilization

A client is diagnosed with systemic lupus erythematosus (SLE). Which of the following would be most appropriate for the nurse to use to evaluate the client' s stage of disease?

Review the client's medical record.

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?

Right shoulder slopes downward and droops inward.

A client is taking large amounts of salicylates for the treatment of bursitis of the left shoulder. The client should be aware to report which symptoms of salicylism?

Ringing in the ears

The nurse is caring for clients with spinal deformities. Which type of deformity would the nurse prioritize as having the most significant consequences on the respiratory system?

Scoliosis

The nurse is caring for a client who has had a fracture reduction using a cast. Which of the following would be most important for the nurse to assess?

Sensation and mobility status

The nurse is caring for a client with a fractured tibia and fibula. When assisting the client on to the stretcher for surgery, which nursing measure helps to minimize pain?

Support the leg by placing a hand under the knee and under the heel.

The nurse is gathering objective data for a client at the clinic complaining of arthritic pain in the hands. The nurse observes that the fingers are hyperextended at the proximal interphalangeal joint with fixed flexion of the distal interphalangeal joint. What does the nurse recognize this deformity as?

Swan neck deformity

A client has been prescribed nonsteroidal anti-inflammatory medications for treatment of carpal tunnel syndrome. What should the nurse be sure to include when educating the client about taking this medication?

Take the medication with food.

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?

Temporomandibular disorder

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 of the following?

Tendon

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?

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

A client has severe osteoarthritis in the left hip and is having surgery to replace both articular surfaces of the hip. What type of surgical procedure will the nurse prepare the client for?

Total arthroplasty

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?

Wear properly fitting shoes.

A client is a passenger in a vehicle that was hit in the rear by another vehicle. The client is complaining of pain in the neck from the head rapidly moving forward and then back against the headrest. What type of injury does the nurse suspect the client sustained in the accident?

Whiplash injury

A client has a fractured jaw sustained in an automobile accident and has had the fracture surgically reduced and immobilized with a wire loop. What should the nurse ensure is present at the client's bedside in case of vomiting?

Wire cutters

A client is scheduled for a joint replacement surgery. Which action would be most important?

Withhold administration of aspirin before the surgery.

A client in skeletal traction has a nursing diagnosis of Impaired Tissue Integrity: Related to puncture wound; pins. What expected outcome would be appropriate for this client?

Wounds heal without infection.

The nurse is preparing to assess Phalen's sign. Which of the following would the nurse identify as indicative of a positive indicator for this sign?

Wrist flexion for 30 seconds causes pain and numbness.

A client sustains an injury to the left ankle when he fell down three steps. There was immediate swelling and pain from the injury, and the client was taken to the local emergency department. What initial test does the nurse anticipate the physician will order to rule out a fracture?

X-ray

A client arriving at the emergency department is diagnosed with a dislocation. Assessment would most likely reveal which of the following? Select all that apply.

complaint of a popping sound, swelling, pain

A client is receiving treatment for an acute episode of gout with colchicine. The nurse is administering the medication every 2 hours. What should the nurse be sure the client communicates so that the drug can be temporarily stopped? Select all that apply.

diarrhea, intestinal cramping, nausea and vomiting