Chapter 36 med surg Prep U

In chronic osteomyelitis, antibiotics are adjunctive therapy in which situation? Wound packing Wound irrigation Surgical debridement Vitamin supplements

In chronic osteomyelitis, antibiotics are adjunctive therapy to surgical debridement pg 1143

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

Raloxifene

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

Splint

Morton neuroma is exhibited by which clinical manifestation? High arm and a fixed equinus deformity Diminishment of the longitudinal arch of the foot Swelling of the third (lateral) branch of the median plantar nerve Inflammation of the foot-supporting fascia

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

Which term refers to a disease of a nerve root? Sequestrum Contracture Involucrum Radiculopathy

When the client reports radiating pain down the leg, the client is describing radiculopathy. Involucrum refers to new bone growth around the sequestrum. Sequestrum refers to dead bone in an abscess cavity. Contracture refers to abnormal shortening of muscle or fibrosis of joint structures.

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? "Bunions are caused by a metabolic condition called gout." "Bunions are congenital and can't be prevented." "Some bunions are congenital; others are caused by wearing shoes that are too short or narrow." "Bunions may result from wearing shoes that are too big, causing friction when the shoes slip back and forth."

Bunions may be congenital or may be acquired by wearing shoes that are too short or narrow, which increases pressure on the bursa at the metatarsophalangeal joint. Acquired bunions can be prevented. Wearing shoes that are too big may cause other types of foot trauma but not bunions. Gout doesn't cause bunions. Although a client with gout may have pain in the big toe, such pain doesn't result from a bunion.

A nurse is caring for an elderly female client with osteoporosis. When teaching the client, the nurse should include information about which major complication? Dowager's hump Loss of estrogen Negative calcium balance Bone fracture

Bone fracture is a major complication of osteoporosis; it results when loss of calcium and phosphate increases the fragility of bones. Estrogen deficiencies result from menopause — not osteoporosis. Calcium and vitamin D supplements may be used to support normal bone metabolism, but a negative calcium balance isn't a complication of osteoporosis. Dowager's hump results from bone fractures. It develops when repeated vertebral fractures increase spinal curvature. page 1134

What food can the nurse suggest to the client at risk for osteoporosis? Bananas Chicken Carrots Broccoli

Calcium is important for the prevention of osteoporosis. Broccoli is high in calcium. page 1137

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

Compartment syndrome occurs in cases of fracture when the normal pressure of a compartment is altered by the force of the injury itself, by development of edema, or by hemorrhaging at the site of the injury, which increases the contents of the compartment, or from outside pressure caused by constriction from a dressing or cast. A client with elevated muscle pressure is at risk for compartment syndrome. The application of a plaster cast immediately after the injury places the client at risk for compartment syndrome because the cast will not allow for edema and therefore will compress the tissue. Clavicle fractures are not a risk factor for compartment syndrome because of the location of the fracture. Ice will assist in decreasing edema and may help prevent compartment syndrome.

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? Bunion Hammer Toe Corn Clawfoot

Corn

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? Risk for infection Impaired physical mobility Inadequate nutrition Disturbed body image

Disturbed body image

What term refers to a flexion deformity caused by a slowly progressive contracture of the palmar fascia? Callus Hallux valgus Hammertoe Dupuytren contracture

Dupuytren disease results in a slowly progressive contracture of the palmar fascia, called Dupuytren contracture. A callus is a discretely thickened area of skin that has been exposed to persistent pressure or friction. A hammertoe is a flexion deformity of the interphalangeal joint, which may involve several toes. Hallux valgus is a deformity in which the great toe deviates laterally

The primary nursing intervention that will control swelling while treating a musculoskeletal injury is: Apply cold (moist or dry). Elevate the affected area. Apply an elastic compression bandage. Immobilize the injured area.

Elevation is used to control swelling. It is facilitated by cold, immobilization, and compression. Refer to Box 42-1 in the text. RICE

A client is transported to the emergency department for a femur fracture following a motor vehicle crash. What action by the nurse is the highest priority?

Femur fractures can lead to hypovolemic shock due to blood loss in the tissue. By assessing the vital signs and level of consciousness, the nurse can assess for shock. Assessing the pedal pulses and measuring the diameter of the thigh are appropriate interventions for someone with a femur fracture, but assessing for hypovolemic shock would be a priority. Pain medication should be safely administered per orders to help control pain. Many pain medications lower blood pressure (BP). If the client is in shock, BP may be too low to administer the pain medication safely.

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? Heberden's nodes hammer toe hallux valgus (bunion) mallet toe

Hammer toe is a flexion deformity of the proximal interphalangeal joint. Mallet toe is a flexion deformity of the distal interphalangeal joint. Bunion is a deformity of the great toe at its metatarsophalangeal joint. Heberden's nodes are bony enlargements of the distal interphalangeal joints. page 1120

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? Have the client make a fist and open the hand against resistance. Have the client stretch the fingers around a ball and squeeze with force. Have the client pronate the hand while the nurse palpates the radial nerve. Have the client hold the palm of the hand up while the nurse percusses over the median nerve.

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

When teaching a client how to prevent low back pain as a result of lifting, the nurse should instruct the client to: use a narrow base of support. bend the knees and loosen the abdominal muscles. place the load away from the body. avoid overreaching.

Instructions for the client with low back pain should include that, when lifting, the client should avoid overreaching. The client should also keep the load close to the body, bend the knees and tighten the abdominal muscles, use a wide base of support, and use a back brace to protect the back

When an infection is bloodborne, the manifestations include which symptom? Hypothermia Hyperactivity Bradycardia Chills

Manifestations of bloodborne infection include chills, high fever, rapid pulse, and generalized malaise.

Which classic symptom will the nurse assess for to detect the development of plantar fasciitis? Shortening of affected leg Elevated temperature Morning heel pain Shortened height

Morning heel pain

A client has been diagnosed with a rotator cuff tear. What are the options for treating this condition? Select all that apply. arthroscopic surgery traction NSAIDs activity modification and joint rest

NSAIDs, modifying activities and resting the joint, arthroscopic surgery, and open acromioplasty with tendon repair are all options. Traction is not an option.

A physician prescribes raloxifene to a hospitalized client. The client's history includes a right hip fracture, hysterectomy, deep vein thrombosis, and hypertension. Which action by the nurse demonstrates safe nursing care? Administering the raloxifene with food or milk Administering the raloxifene in the evening Holding the raloxifene and notifying the physician Having the patient sit upright for 30-60 minutes following administration

Raloxifene is contraindicated in clients with a history of deep vein thrombosis. The nurse should hold the medication and notify the physician. Raloxifene can be given without regard to food or time of day. Raloxifene is a selective estrogen receptor modulation medication. Sitting upright for 30-60 minutes is indicated with drugs classified as bisphosphonates.

A patient is diagnosed with osteogenic sarcoma. What laboratory studies should the nurse monitor for the presence of elevation? Potassium level Magnesium level Alkaline phosphatase Troponin levels

Serum alkaline phosphatase levels are frequently elevated with osteogenic sarcoma or bone metastasis. Hypercalcemia is also present with bone metastases from breast, lung, or kidney cancer. Symptoms of hypercalcemia include muscle weakness, fatigue, anorexia, nausea, vomiting, polyuria, cardiac dysrhythmias, seizures, and coma. Hypercalcemia must be identified and treated promptly.

The RICE acronym is helpful for remembering treatment interventions for musculoskeletal injuries. Which of the following are components of the RICE acronym? Select all that apply. Rest Edema Ice Corticosteroids Compression Elevation

The acronym RICE stands for Rest, Ice, Compression, and Elevation. Edema and corticosteroids are not part of the RICE acronym.

A client has Paget's disease. An appropriate nursing diagnosis for this client is: Risk for falls Risk for infection Delayed wound healing Fatigue

The client with Paget's disease is at risk for falls secondary to pathological fractures and impaired gait/mobility.

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? Trigeminal neuralgia Temporomandibular disorder Loose teeth Dislocated jaw

The disorder can be confused with trigeminal neuralgia and migraine headaches. The client experiences clicking of the jaw when moving the joint, or the jaw can lock, which interferes with opening the mouth. Loose teeth will not cause a clicking of the jaw. The client does not have a dislocated jaw.

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? immobilization external rotation enhancing complications surgical repair

Treatment of musculoskeletal trauma involves immobilization of the injured area until it has healed.

A client is reporting jaw pain, and is experiencing muscle spasm and tenderness of the masseter and temporalis muscles. The physician has diagnosed a temporomandibular disorder (TMD). What would the treatment course for this client include? Select all that apply. corticosteroids analgesics custom-fitted mouth guard during sleep referral to a dentist who has experience managing clients with TMD

referral to a dentist who has experience managing clients with TMD analgesics custom-fitted mouth guard during sleep

Which term refers to an injury to ligaments and other soft tissues surrounding a joint? Dislocation Strain Subluxation Sprain

A sprain is caused by a wrenching or twisting motion. Dislocation refers to the separation of joint surfaces. Subluxation refers to partial separation or dislocation of joint surfaces. Strain refers to a muscle pull or tear.

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? Paresthesia and ischemia Hemorrhage and shock Paralytic ileus and a lacerated urethra Thrombophlebitis and infection

Hemorrhage and shock are two of the most serious consequences that may occur in a pelvic fracture.

Morton neuroma is exhibited by which clinical manifestation? High arm and a fixed equinus deformity Inflammation of the foot-supporting fascia Swelling of the third (lateral) branch of the median plantar nerve Diminishment of the longitudinal arch of the foot

Morton neuroma is swelling of the third branch of the median plantar nerve. Pes cavus refers to a foot with an abnormally high arch and a fixed equinus deformity of the forefoot. Flatfoot is a common disorder in which the longitudinal arch of the foot is diminished. Plantar fasciitis is an inflammation of the foot-supporting fascia. pg 1121

Which of the following presents with an onset of heel pain with the first steps of the morning? Hallux valgus Ganglion Plantar fasciitis Morton's neuroma

Plantar fasciitis, an inflammation of the foot-supporting fascia, present as an acute onset of heal pain experienced with the first steps in the morning. Hallux valgus (commonly called a bunion) is a deformity in which the great toe deviates laterally. Morton's neuroma is a swelling of the third (lateral) branch of the median plantar nerve. A ganglion, a collection of gelatinous material near the tendon sheaths and joints, appears as a round, firm compressible cystic swelling, usually on the dorsum of the wrist.

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? Benign prostatic hyperplasia Renal calculi Dehydration Urinary tract infection (UTI)

Renal calculi commonly occur with Paget's disease, causing pain and difficulty when urinating. A UTI commonly causes fever, urgency, burning, and hesitation with urination. Benign prostatic hyperplasia is common in men older than age 50; however, because the client has Paget's disease, the nurse should suspect renal calculi, not benign prostatic hyperplasia. Dehydration causes a decrease in urine production, not a problem with urination.

The nurse teaches the client with a high risk for osteoporosis about risk-lowering strategies, including which action? Increase fiber in the diet Walk or perform weight-bearing exercises outdoors Reduce stress Decrease the intake of vitamin A and D

Risk-lowering strategies for osteoporosis include walking or exercising outdoors, performing a regular weight-bearing exercise regimen, increasing dietary calcium and vitamin D intake, smoking cessation, and consuming alcohol and caffeine in moderation.

Which group is at the greatest risk for osteoporosis?

Small-framed, nonobese European American women are at greatest risk for osteoporosis. Asian American women of slight build are at risk for low peak bone mineral density. African American women, who have a greater bone mass than European American women and Asian American Women, are less susceptible to osteoporosis. Men have a greater peak bone mass and do not experience sudden estrogen reduction.

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? Client complains of tingling and numbness in the right shoulder. Client complains of pain in the unaffected shoulder. Right shoulder is elevated above the left. Right shoulder slopes downward and droops inward

The client with a fractured clavicle has restricted motion, and the affected shoulder appears to slope downward and droop inward. The client will have pain, not typically tingling and numbness in the right shoulder. Pain is not felt in the unaffected shoulder.

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? Decrease in estrogen Increase of vitamin D Increase in calcitonin Decrease in parathyroid hormone

Age related processes that contribute to loss of bone mass and osteoporosis are decreases in estrogen, calcitonin, and vitamin D and an increase in parathyroid hormone.

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? Fat embolism Avascular necrosis Osteomyelitis Compartment syndrome

Clinical manifestations of osteomyelitis include signs and symptoms of sepsis and localized infection. A client with avascular necrosis does not have fever and chills. Clients with fat emboli will have a rash and breathing complications. A client with compartment syndrome will have numbness, not a fever.

Which is not one of the general nursing measures employed when caring for the client with a fracture? cranial nerve assessment administering analgesics providing comfort measures assisting with ADLs

Cranial nerve assessment would only be carried out for head-related injuries or diseases. General nursing measures include administering analgesics, providing comfort measures, assisting with ADLs, preventing constipation, promoting physical mobility, preventing infection, maintaining skin integrity, and preparing client for self-care.

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? Do active range of motion on the toes. Wear properly fitting shoes. Have surgery to fix them. Bind the toes so that they will straighten.

Hammer toe is a flexion deformity of the PIP joint and may involve several toes and may result from wearing poorly fitting shoes. They will not straighten by binding the toes or doing active range of motion exercises. Surgery is an option but should be discussed with an orthopedic surgeon or podiatrist.

Which are true about Lyme disease? Select all that apply. Early stage symptoms may include a red macule or papule at the site of the tick bite, a characteristic bullseye rash with round rings around the center, headache, neck stiffness, pain, fever, chills, malaise, nausea, vomiting, and sore throat. Nephrotic syndromes occur in the later stages. Cardiac and neurologic symptoms occur mid-stage, followed by arthritis and joint problems. If untreated, the disease moves through three stages.

If untreated, the disease moves through three stages. Early stage symptoms may include a red macule or papule at the site of the tick bite, a characteristic bullseye rash with round rings around the center, headache, neck stiffness, pain, fever, chills, malaise, nausea, vomiting, and sore throat. Cardiac and neurologic symptoms occur mid-stage, followed by arthritis and joint problems

Which nursing intervention is essential in caring for a client with compartment syndrome? Wrapping the affected extremity with a compression dressing to help decrease the swelling Starting an I.V. line in the affected extremity in anticipation of venogram studies Keeping the affected extremity below the level of the heart Removing all external sources of pressure, such as clothing and jewelry

Nursing measures should include removing all clothing, jewelry, and external forms of pressure (such as dressings or casts) to prevent constriction and additional tissue compromise. The extremity should be maintained at heart level (further elevation may increase circulatory compromise, whereas a dependent position may increase edema). A compression wrap, which increases tissue pressure, could further damage the affected extremity. There is no indication that diagnostic studies would require I.V. access in the affected extremity.

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. 1,600 mg; 1,400 IU 1,400 mg; 1,200 IU 1,800 mg; 1,600 IU 1,200 mg; 1,000 IU

The daily recommended dosage is 1,200 mg of calcium and 1,000 IU of vitamin D.

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? "A foul smell from the cast is normal." "Keep your right leg elevated above heart level." "Cover the cast with a blanket until the cast dries." "Use a knitting needle to scratch itches inside the cast."

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. page 1162

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? Have surgery to fix them. Wear properly fitting shoes. Do active range of motion on the toes. Bind the toes so that they will straighten.

Wear properly fitting shoes.

Which of the following diagnostics are used to evaluate spinal nerve root disorders (radiculopathies)? Bone scan Electromyogram Computed tomography Magnetic resonance imaging

An electromyogram and nerve conduction studies are used to evaluate spinal nerve toot disorders (radiculopathies) for patients with low back pain. A bone scan may disclose information about infections, tumors, and bone marrow abnormalities. A computed tomography scan is useful in identifying underlying problems, such as obscure soft tissue lesions adjacent to the vertebral column and problems of vertebral disks. Magnetic resonance imaging permits visualization of the nature and location of spinal pathology.

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

Hematoma, hemorrhage, and infection are potential complications in the immediate postoperative period. Sleeplessness, nausea, and vomiting may occur but are adverse reactions, not complications. Chronic osteomyelitis and causalgia are potential complications that are likely to arise in the late postoperative period. A neuroma occurs when the cut ends of the nerves become entangled in the healing scar. This would occur later in the postoperative course.

A nurse is educating a client diagnosed with osteomalacia. Which statement by the nurse is appropriate? "You will need to decrease the amount of dairy products you consume." "You may need to be evaluated for an underlying cause, such as renal failure." "You will need to avoid foods high in phosphorus and vitamin D." "You will need to engage in vigorous exercise three times a week for 30 minutes."

The client may need to be evaluated for an underlying cause. If an underlying cause is discovered, that will guide the medical treatment. The client needs to maintain an adequate to increased supply of calcium, phosphorus, and vitamin D. Dairy products are a good source of calcium. The client is at risk for pathological fractures and therefore should not engage in vigorous exercise.

A client with low back pain is being seen in the clinic. In planning care, which teaching point should the nurse include? Avoid twisting and flexion activities. Use the large muscles of the leg when lifting items. A soft mattress is most supportive by conforming to the body. Sleep on the stomach to alleviate pressure on the back.

The large muscles of the leg should be used when lifting. page 1114

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? Carpal tunnel syndrome Dupuytren's contracture Morton's neuroma Impingement syndrome

Tinel's sign (numbness, tingling, and pain in response to light percussion over the median nerve) is a positive finding for carpal tunnel syndrome. Morton's neuroma is assessed as a painful condition that affects the ball of the foot. Dupuytren's contracture is when knots of tissue beneath the skin cause one or more fingers stay bent toward the palm. Impingement syndrome is a shoulder condition.

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. Do active range of motion on the toes. Have surgery to fix them. Bind the toes so that they will straighten.

Wear properly fitting shoes.

A patient is having low back pain. What position can the nurse suggest to relieve this discomfort? High-Fowler's to allow for maximum hip flexion Supine, with the knees slightly flexed and the head of the bed elevated 30 degrees Supine, with the bed flat and a firm mattress in place Prone, with a pillow under the shoulders

A medium to firm, not sagging mattress (a bed board may be used) is recommended; there is no evidence to support the use of a firm mattress (National Guideline Clearinghouse, 2010). Lumbar flexion is increased by elevating the head and thorax 30 degrees by using pillows or a foam wedge and slightly flexing the knees supported on a pillow. Alternatively, the patient can assume a lateral position with knees and hips flexed (curled position) with a pillow between the knees and legs and a pillow supporting the head (Fig. 42-1). A prone position should be avoided because it accentuates lordosis.

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? "I will bend at the waist when I am lifting objects from the floor." "I will lie prone with my legs slightly elevated." "I will avoid prolonged sitting or walking." "Instead of turning around to grasp an object, I will twist at the waist."

The nurse encourages the patient to alternate lying, sitting, and walking activities frequently, and advises the patient to avoid sitting, standing, or walking for long periods.

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? The nurse is caring for this client on the intensive care unit. The nurse caring for this client is also caring for four other immunosuppressed clients on the medical floor. The nurse caring for this client is also caring for four clients receiving chemotherapy for cancer treatment on the oncology floor. The nurse caring for this client is also caring for two other immunosuppressed clients on the medical intensive care unit.

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

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? Compartment syndrome Volkmann's contracture Subluxation Sprain

A partial dislocation is referred to as a subluxation. A Volkmann's contracture is a claw like deformity that results from compartment syndrome or obstructed arterial blood flow to the forearm and hand. Compartment syndrome is a condition in which a structure such as a tendon or nerve is constricted in a confined space and affects nerve innervation, leading to subsequent palsy. A sprain is injury to the ligaments surrounding the joint.

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?

A short leg cast extends from below the knee to the base of the toes. The foot is flexed at a right angle in a neutral position. A long leg cast extends from the junction of the upper and middle third of the thigh to the base of the toes. The knee may be slightly flexed. A walking cast is a short or long leg cast reinforced for strength. A hip spica cast encloses the trunk and a lower extremity.

Which evaluation finding requires follow up by the nurse caring for a client with a total knee replacement? Select all that apply. Client ambulates 10 feet by postoperative day 2 650 ml bloody drainage in drain wound Pedal pulses strong and equal bilaterally Knee flexion at 30 degrees Client reports pain rating of 2.

A suction drain removes fluid accumulating in the wound. Typical drainage ranges from 200 to 400 ml the first 24 hours after surgery and declines to fewer then 25 ml by 48 hours. Knee mobility is increased with a continuous passive motion (CPM) device. Initial settings of the CPM are usually 10 degrees of extension and 50 degrees of flexion with an ultimate goal of full extension (0 degrees) and 90 degrees of flexion by discharge. A pain rating of 2 is an indicator of effective pain management. Strong and equal pedal pulses are an expected finding. Progressive ambulation begins on the day after surgery; ambulating 10 feet on postoperative day would be expected.

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? Raloxifene Alendronate Denosumab Teriparatide

Alendronate is a bisphosphonate medication. Raloxifene is a selective estrogen receptor modulator. Teriparatide is an anabolic agent, denosumab is a monoclonal antibody agent.

A nurse is performing discharge teaching for an elderly client with osteoporosis. Which instruction about a calcium supplement should the nurse include? Take the supplement on an empty stomach with a full glass of water. Take the supplement with meals or with orange juice. Remain in an upright position 30 minutes after taking the supplement. Take weekly on the same day and at the same time.

Calcium supplements should be taken with meals or with a beverage high in vitamin C for increased absorption. Calcium supplements are taken daily, not weekly. There are no special instructions about staying upright when taking calcium supplements.

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

Chronic osteomyelitis may occur after persistent infection in the late postoperative period. Hematoma, hemorrhage, and infection are potential complications in the immediate postoperative period.

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? "When a spica cast is ordered, the arm must be immobilized." "The method allows for the fastest healing time and the greatest mobility." "This allows for the strength in the arm to remain consistent." "The joint above the fracture and below the fracture must be immobilized."

Generally, the joints proximal and distal to the fracture are immobilized to promote healing. The purpose is not for the strength to remain consistent; most clients will lose strength. A spica cast would not be ordered for an ulnar fracture. Although immobilizing the joints above and below fractures may shorten healing time, it does not allow for increased mobility.

A female client is at risk for developing osteoporosis. Which action will reduce the client's risk? Living a sedentary lifestyle to reduce the incidence of injury Taking a 300-mg calcium supplement to meet dietary guidelines Initiating weight-bearing exercise routines Stopping estrogen therapy

Hammer toe is a flexion deformity of the PIP joint and may involve several toes and may result from wearing poorly fitting shoes. They will not straighten by binding the toes or doing active range of motion exercises. Surgery is an option but should be discussed with an orthopedic surgeon or podiatrist.

The nurse is providing instructions to the client who is being prepared for skeletal traction. Which statement by the client indicates teaching was effective? "Metal pins will go through my skin to the bone." "The traction can be removed once a day so I can shower." "I will wear a boot with weights attached." "A belt will go around my pelvis and weights will be attached."

In skeletal traction, metal rods or pins are used to apply continuous traction directly to the bone. Weights are used to apply the traction. Casts, external fixators, or splints are used when the traction is discontinued.

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? L2, L3, and L5 L4, L5, and S1 L1, L2, and L4 C3, C4, and L1

L4, L5, and S1

A client comes to the clinic complaining of low back pain radiating down the left leg. After diagnostic studies rule out any pathology, the health care provider orders a serotonin-norepinephrine reuptake inhibitor (SNRI). Which medication does the nurse anticipate educating the client about? Gabapentin Duloxetine Cyclobenzaprine Amitriptyline

Nonprescription analgesics such as acetaminophen (Tylenol) and nonsteroidal anti-inflammatory drugs (NSAIDs) and short-term prescription muscle relaxants (e.g., cyclobenzaprine [Flexeril]) are effective in relieving acute low back pain. Tricyclic antidepressants (e.g., amitriptyline [Elavil) and the newer dual-action serotonin-norepinephrine reuptake inhibitors (e.g., duloxetine [Cymbalta]) (Karp et al., 2010) or atypical seizure medications (e.g., gabapentin [Neurontin], which is prescribed for pain from radiculopathy) are used effectively in chronic low back pain.

A client comes to the emergency department complaining of pain in the right leg. When obtaining the history, the nurse learns that the client has a history of obesity and hypertension. Based on this information the nurse anticipates the client having which musculoskeletal disorder? Paget's disease Degenerative joint disease Muscular dystrophy Scoliosis

Obesity predisposes the client to degenerative joint disease. Obesity isn't a predisposing factor for muscular dystrophy, scoliosis, or Paget's disease

Which client would the nurse identify as having the greatest risk for osteoporosis? A 16-year-old male with a history of asthma A small-framed, thin 45-year-old white woman A 20-year-old male athlete with repeated injuries A 40-year-old overweight African American woman

Small-framed, thin white women are at greatest risk for osteoporosis. African American women have a greater bone density and thus are less susceptible to osteoporosis. Men have an increased bone mass and do not have hormonal changes, and do not acquire osteoporosis as frequently and get it at a later age. Asthma does not increase the risk for osteoporosis. page 1136

A client undergoes a total hip replacement. Which statement made by the client indicates to the nurse that the client requires further teaching? "I need to remember not to cross my legs. It's such a habit." "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 don't know if I'll be able to get off that low toilet seat at home by myself."

The client requires additional teaching if he is 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.

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? "There may be some slight discrepancy between the measuring tools used." "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" "The posture begins to stoop after middle age."

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.

During a routine physical examination of a client, the nurse observes a flexion deformity of the proximal interphalangeal (PIP) joint of two toes on the right foot. How would the nurse document this finding? Bunion Hammer toe Hallux valgus Mallet toe

Hammer toe is a flexion deformity of the proximal interphalangeal (PIP) joint and may involve several toes. Mallet toe is a flexion deformity of the distal interphalangeal joint (DIP), and also can affect several toes. Hallux valgus, also called a bunion, is a deformity of the great (large) toe at its metatarsophalangeal joint.

Two days after application of a cast to treat a fractured femur, the client reports severe, deep, and constant pain in the leg. What will the nurse suspect? Phlebitis. Infection. Chronic venous insufficiency. Compartment syndrome.

Compartment syndrome refers to the compression of nerves, blood vessels, and muscle within a closed space. This leads to tissue death from lack of oxygenation.

A client is reporting pain following orthopedic surgery. Which intervention will help relieve pain? Apply antiembolism stockings as indicated. Breathe deeply and cough every 2 hours until ambulation is possible. Elevate the affected extremity and use cold applications. Do ROM exercises as indicated.

Elevating the affected extremity and using cold applications reduce swelling. Deep breathing and coughing helps with maintenance of effective respiratory rate and depth. ROM exercises maintain full ROM of unaffected joints. Antiembolism stockings help prevent deep vein thrombosis (DVT) page 1171

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? Needle aspiration Arthroplasty Arthroscopy Open reduction

Arthroscopic examination may be carried out to visualize the extent of joint damage as well as to obtain a sample of synovial fluid. An open reduction would be used for the treatment of a fracture. Needle aspiration will not allow visualization of the joint damage but will allow obtaining the sample of synovial fluid. Arthroplasty is the restructure of the joint surface after diagnosis is made.