Medical-Surgical Nursing - Musculoskeletal system

Which factor may cause a client neck pain? 1 Headache 2 Poor posture 3 Low body weight 4 Sedentary lifestyle

2 - Poor posture Poor posture may affect the nerves innervating the neck, thereby causing pain in the neck. Headache may be associated with neck pain, but it cannot precipitate neck pain. Low body weight and sedentary lifestyle may cause osteoporosis.

Which hormones are involved in building and maintaining healthy bone tissue? Select all that apply. 1 Insulin 2 Thyroxine 3 Glucocorticoids 4 Growth hormone 5 Parathyroid hormone

1 - Insulin 4 - Growth hormone Insulin works together with growth hormone to increase bone length, which helps to build and maintain healthy bone tissue. Thyroxine increases the rate of protein synthesis in all types of tissues. Glucocorticoids regulate protein metabolism to reduce or intensify the organic matrix of bone. Parathyroid hormone secretion stimulates bones to promote osteoclastic activity and release calcium into the blood when serum calcium levels are lowered.

A client has an open reduction and internal fixation for a fractured hip. Postoperatively the nurse should place the client's affected extremity in which position? 1 External rotation 2 Slight hip flexion 3 Moderate abduction 4 Anatomic body alignment

3 - Moderate abduction Abduction reduces stress on anatomic structures and maintains the head of the femur in the acetabulum. External rotation places stress on the acetabulum and the head of the femur. Hip flexion may dislodge the head of the femur from the acetabulum. Functional alignment places stress on the bone, soft tissue, and nail plate; it can cause damage and dislocation of the head of the femur.

Which synovial joint movement is involved in turning the client's palm downward? 1 Eversion 2 Inversion 3 Pronation 4 Supination

3 - Pronation Pronation is the movement involved in turning the palm inward. Eversion involves turning the sole outward away from the midline of the body. Inversion involves turning the sole inward towards the midline of the body. Supination involves turning the palm upward.

Which child is at the highest risk for blunt trauma associated with the indirect entry (hematogenous stage) of microorganisms? 1 8-year-old boy 2 10-year-old girl 3 13-year-old girl 4 14-year-old boy

1 - 8-year-old boy The indirect entry of microorganisms, which is the hematogenous stage of osteomyelitis, most frequently affects the growing bones of boys younger than 12 years of age. Therefore an 8-year-old boy would be at the highest risk for blunt trauma.

A client is scheduled for a closed magnetic resonance imaging test (MRI) for a knee problem. The client states, "I'm a little scared of small places." Which is the nurse's most appropriate response? 1 "Mild sedation is available if you are anxious about lying in a confined area." 2 "Maybe it is best that you not have this test. Let me talk with your primary healthcare provider." 3 "We will make sure that all metal objects are removed from the immediate area to avoid injury." 4 "You will be able to communicate with us by an intercom system, so you have nothing to worry about."

1 - "Mild sedation is available if you are anxious about lying in a confined area." The response "Mild sedation is available if you are anxious about lying in a confined area" acknowledges the client's concern and offers a potential intervention that may reduce the client's anxiety. "Maybe it is best that you not have this test. Let me talk with your primary healthcare provider" is an inappropriate response, because the test may be significant for diagnosing the client's health problem. If necessary, an open MRI may be performed; however, a closed, high-magnet scanner may produce more significant results than will be produced by an open, low-magnet scanner. Although the response "We will make sure that all metal objects are removed from the immediate area to avoid injury" is a true statement, this response may increase the client's anxiety and does not address the concern of a small space. The response "You will be able to communicate with us by an intercom system, so you have nothing to worry about" dismisses the client's concerns and provides false reassurance.

A client who is scheduled for a muscle biopsy tells the nurse, "They better give me a general anesthetic. I don't want to feel anything." Which is the most therapeutic initial response by the nurse? 1 "You seem to be worried about the test." 2 "This test is done under local anesthesia." 3 "Tell them when you have pain so they can take care of it." 4 "You probably will not have pain so try not to think about it."

1 - "You seem to be worried about the test." The response "You seem to be worried about the test" acknowledges the client's apprehension and encourages further communication. The response "This test is done under local anesthesia" does not address the client's feelings and may cause more anxiety. The response "Tell them when you have pain so they can take care of it" is perhaps true, but it does not foster communication; the client may focus on the word "pain." The response "You probably will not have pain so try not to think about it" negates the client's feelings and promotes false reassurance.

After an amputation of a limb, a client begins to experience extreme discomfort in the area where the limb once was. What is the nurse's greatest concern at this time? 1 Addressing the pain 2 Reversing feelings of hopelessness 3 Promoting mobility in the residual limb 4 Acknowledging the grieving for the lost limb

1 - Addressing the pain Phantom limb sensation is a real experience with no known cause or cure. The pain must be acknowledged and interventions to relieve the discomfort explored. There are no data indicating that the client is hopeless. Although promoting mobility in the residual limb may be effective for some people, it may not be effective for others; all possible interventions should be explored. There are no data indicating that the client is grieving.

A 70-year-old client is diagnosed with cartilaginous degeneration. Which action should the nurse take? 1 Advise the client to use moist heat 2 Teach the client isometric exercises 3 Provide the client with supportive armchairs 4 Demonstrate weight-bearing exercises to the client

1 - Advise the client to use moist heat Clients with cartilaginous degeneration are advised to take moist heat showers because they increase blood flow to the region. Isometric exercises are indicated for clients with muscular atrophy. Sitting in a supportive armchair provides support to bony structures and prevents further deformities in a client with kyphosis. Weight-bearing exercises are indicated in clients with decreased bone density.

Which diagnostic test is used for the direct visualization of ligaments, menisci, and articular surfaces of joints? 1 Arthroscopy 2 Muscle biopsy 3 Ultrasonography 4 Electromyography

1 - Arthroscopy Arthroscopy is a diagnostic test that uses an arthroscope to directly visualize the ligaments, menisci, and articular surfaces of a joint. A muscle biopsy is conducted to diagnose atrophy and inflammation. An ultrasonography is used to view soft tissue disorders, traumatic joint injuries, and osteomyelitis. An electromyography may be performed to evaluate diffuse or localized muscle weakness.

What is the main reason a nurse raises three of the four side rails on the bed of an 83-year-old client who had surgery for a fractured hip? 1 As a safety measure because of the client's age 2 Because clients older than 60 years of age should use side rails 3 To be used as handholds to facilitate the client's ability to move in bed 4 Because all older adults are disoriented for several days after anesthesia

1 - As a safety measure because of the client's age The need to use side rails for safety is important with any older client because the client could fall or try to get out of bed without assistance. Side rails are not always used on all clients over 60 years of age. Each individual must be evaluated based on mental and physical status. The client may use the side rails to move around in bed, but safety is always first. Some older adults become disoriented for a few days after anesthesia, but not all older adults.

A nurse notes gentamycin in the prescription of an older adult with osteomyelitis. Which nursing interventions should be conducted before starting therapy? Select all that apply. 1 Assessing renal function 2 Assessing hydration status 3 Checking the erythrocyte count 4 Checking the blood platelet count 5 Assessing serum thyroxin levels

1 - Assessing renal function 2 - Assessing hydration status Because gentamycin can increase the risk of nephrotoxicity, the nurse should assess a client's renal function before starting therapy. Dehydration can further increase the risk of nephrotoxicity; therefore the client's hydration status should also be checked before starting therapy. Gentamycin generally does not impact erythrocyte and blood platelet counts nor does it affect serum thyroxin levels.

Which radiographic test is used to view the entire skeleton? 1 Bone scan 2 Gallium and thallium scan 3 Computed tomography (CT) 4 Magnetic resonance imaging (MRI) scan

1 - Bone scan A bone scan is a radionuclide test in which radioactive material is injected so that the client's entire skeleton can be viewed. Gallium and thallium scans are similar to bone scans but are more specific and sensitive in detecting bone disorders. A CT scan is used to detect musculoskeletal problems, primarily in the vertebral column and joints. An MRI scan is used to diagnose musculoskeletal disorders.

Which is a clinical manifestation of the Landouzy-Déjérine type of muscular dystrophy (MD)? 1 Loss of hearing 2 Cardiomyopathy 3 Respiratory failure 4 Mental impairment

1 - Loss of hearing Loss of hearing is the clinical manifestation of Landouzy-Déjérine MD. Cardiomyopathy and respiratory failure are the clinical manifestations of both Duchenne and Becker MD. Duchenne MD is clinically manifested by mental impairment.

The medical history of a client with osteoporosis indicates renal calculi. Which medication would be contraindicated? 1 Os-cal 2 Raloxifene 3 Ibandronate 4 Zoledronic acid

1 - Os-cal Os-cal (a calcium supplement) should not be prescribed to a client with osteoporosis with a history of urinary stones. Raloxifene may increase liver function test values and worsen hepatic disease. Ibandronate should not be prescribed to clients with gastric problems because of the risks of esophagitis and gastric ulcers. Zoledronic acid should not be prescribed to clients with poor oral hygiene because the medication may cause maxillary osteonecrosis.

In which part of the client's body is the amphiarthroidial joint located? 1 Pelvis 2 Elbow 3 Cranium 4 Shoulder

1 - Pelvis Amphiarthrodial joints are slightly movable joints located in the pelvis. The elbow joint is freely movable; it is referred to as a diarthrodial joint. The joint at the cranium is an immovable synarthrodial joint. The shoulder joint is movable (ball and socket) and is referred to as a diarthrodial joint.

A client has an above-the-knee amputation of the left leg because of arterial insufficiency. To prevent a hip flexion contracture, in what position should the nurse periodically place this client? 1 Prone position 2 Sitting position 3 Supine position with a pillow under the residual limb 4 Right side-lying position with a pillow between the thighs

1 - Prone position The prone position maintains the hips in extension, which helps to prevent flexion contractures of the hips. The sitting position flexes the hips and knees, which promotes hip and knee flexion contractures. The supine position with a pillow under the residual limb will flex the hip, promoting a hip flexion contracture. In the right side-lying position the left hip will be flexed, which will promote the development of a hip flexion contracture.

Which estrogen antagonist is specifically used to prevent and treat osteoporosis in postmenopausal women? 1 Raloxifene 2 Denosumab 3 Alendronate 4 Zoledronic acid

1 - Raloxifene Raloxifene is used to prevent and treat osteoporosis in postmenopausal women by increasing bone mineral density, reducing bone desorption, and reducing incidences of osteoporotic vertebral fractures. Denosumab is a monoclonal antibody used to treat osteoporosis when other drugs are not effective. Alendronate and zoledronic acid are commonly used for the prevention and treatment of osteoporosis.

After an open reduction and internal fixation of a fractured hip, what assessments of the client's affected leg should the nurse make? Select all that apply. 1 Skin temperature 2 Mobility of the hip 3 Sensation in the toes 4 Condition of the pins 5 Presence of pedal pulse

1 - Skin temperature 3 - Sensation in the toes 5 - Presence of pedal pulse Increased skin temperature may indicate the presence of an infection; decreased skin temperature suggests impaired circulation. Sensation in the toes assesses the neural integrity distal to the surgical site. Presence of a pedal pulse assesses the circulatory integrity distal to the surgical site. Flexion and abduction of the hip are contraindicated because they may dislodge the head of the femur from the acetabulum. No external pins are present with an internal fixation.

The nurse considers that a 70-year-old female client can best limit further progression of osteoporosis by doing what? 1 Taking supplemental calcium and vitamin D 2 Increasing the consumption of eggs and cheese 3 Taking supplemental magnesium and vitamin E 4 Increasing the consumption of milk and milk products

1 - Taking supplemental calcium and vitamin D Research demonstrates that women past menopause need at least 1500 mg of calcium a day, which is almost impossible to obtain through dietary sources; because the average daily consumption of calcium is 300 to 500 mg. Vitamin D promotes the deposition of calcium into the bone. Consumption of eggs and cheese does not contain adequate calcium to meet requirements to prevent osteoporosis; these do not contain vitamin D unless fortified. If large amounts of magnesium are present, calcium absorption is impeded because magnesium and calcium absorption are competitive; vitamin E is unrelated to osteoporosis. Milk and milk products may not be consumed in quantities adequate to meet requirements to prevent osteoporosis.

Which treatment is beneficial for a client with muscle spasm? 1 Thermotherapy 2 Muscle massage 3 Frequent position changes 4 Muscle-strengthening exercise regimen

1 - Thermotherapy Thermotherapy, the use of heat therapy, eases pain and muscle contraction; therefore it is useful in treating muscle spasms. Muscle massage stimulates muscle tissue contraction and may worsen a muscle spasm. Frequent position changes are beneficial for a client with contracture. A muscle-strengthening exercise regimen is beneficial for a client with muscle atrophy.

What is a goniometer used for? 1 To assess range of motion 2 To reduce phantom limb sensation 3 To prevent hip flexion contractures 4 To immobilize a joint during fracture

1 - To assess range of motion A goniometer is a device that measures the angle of a joint and is used to assess range of motion. Mirror therapy is used to reduce phantom limb sensation. Buck's traction boot is a type of skin traction used to prevent hip flexion contractures. Splints are used to immobilize a joint following a fracture.

Which joint in the human body is an example of a condyloid joint? 1 Wrist joint 2 Elbow joint 3 Shoulder joint 4 Sacroiliac joint

1 - Wrist joint The wrist joint is an example of a condyloid joint. It is a joint between the radial and carpals. The elbow joint is an example of a hinge joint. The shoulder joint is an example of a ball and socket joint. The sacroiliac joint is an example of a gliding joint.

Which structure protects a client's internal organs, supports blood cell production, and stores minerals? 1 Joints 2 Bones 3 Muscles 4 Cartilages

2 - Bones Bones are the framework of the body; they support and protect internal organs. They also help in stem cell production from bone marrow, and they store minerals. Joints (articulations) help to articulate the bones. Muscles are the bundles of fibrous tissue that contract to produce movement and maintain body posture. Cartilage is a hyaline, elastic, and fibrous tissue that often functions as a shock absorber.

Which term should the nurse use to describe a flat, poorly defined mass on the sole over a bony prominence caused by pressure? 1 Plantar wart 2 Callus 3 Ingrown nail 4 Hypertrophic ungual labium

2 - Callus In foot problems, callus is described as a flat, poorly defined mass on the sole over a bony prominence that is caused by pressure. Plantar wart is a painful papillomatous growth caused by a virus. A sliver of toenail penetrating the skin and causing inflammation results in ingrown nail. Hypertrophic ungual labium is described as chronic hypertrophy of the nail lip caused by improper nail trimming.

Which medications are useful to relieve pain associated with muscle spasms? Select all that apply. 1 Cefazolin 2 Carisoprodol 3 Fondaparinux 4 Methocarbamol 5 Cyclobenzaprine

2 - Carisoprodol 4 - Methocarbamol 5 - Cyclobenzaprine Central and peripheral muscle relaxants such as carisoprodol, methocarbamol, and cyclobenzaprine are used to reduce muscle spasm pain. Cefazolin is a bone-penetrating antibiotic used prophylactically before surgery. Fondaparinux is a low molecular weight heparin used to prevent venous thromboembolism (VTE) in client scheduled for orthopedic surgery.

What should a nurse assess after applying a body jacket brace to a client with severe spine injuries following a car accident? Select all that apply. 1 Pin sites 2 Development of cast syndrome 3 Signs of compartment syndrome 4 Abdomen for decreased bowel sounds 5 Areas of pressure over the bony prominences

2 - Development of cast syndrome 4 - Abdomen for decreased bowel sounds 5 - Areas of pressure over the bony prominences A client with a severe spine injury due to an accident would benefit from application of a body jacket brace, which immobilizes and supports the thoracic and lumbar spine. After application of the brace, the nurse should assess the client for the development of cast syndrome. This condition occurs when a brace is tightly applied, compressing the superior mesenteric artery against the duodenum. A window in the brace may be left over the umbilicus. The nurse should monitor the reduction in bowel sounds to prevent abdominal pressure and pain. The nurse should assess the areas of pressure over the bony prominences such as the iliac crest and then adjust or remove the brace based upon any complications. A client with an external fixator will need pin sites assessed. A client with a lower extremity cast must regularly be assessed for signs of compartment syndrome and increased pressure at the heel, anterior tibia, head of the fibula, and malleoli.

A nurse is caring for a client who will have a below-the-knee amputation with an immediate postoperative prosthesis. The client asks the nurse the advantage of having an immediate prosthesis. What should the nurse explain is the advantage? 1 Decreases phantom limb sensations 2 Encourages a normal walking pattern 3 Reduces the incidence of wound infection 4 Allows for fitting of the prosthesis before discharge

2 - Encourages a normal walking pattern Without a prosthesis, a walker or crutches are necessary, and these require readjustment of weight bearing on one leg. Early use of a prosthesis does not affect the incidence of phantom limb pain, which occurs in about 10% of clients with amputations. Early use of a prosthesis has no effect on wound infection. Although true, fitting of the prosthesis before discharge is not the major purpose; a prosthesis can be fitted easily after discharge when the residual limb has healed completely and is no longer edematous.

Which type of cast will the nurse be caring for in a child with a fractured femur? 1 Cylinder 2 Hip spica 3 Prefabricated knee 4 Robert Jones

2 - Hip spica A hip spica cast is now mainly used for femur fractures in children. A cylinder cast is used for knee fractures because it extends from the groin to the malleoli of the ankle. A prefabricated knee splint is a commonly used cast for lower extremity injuries. A Robert Jones dressing is composed of bulky padding materials, splints, and elastic wrap or stockinette used for lower extremity injuries.

A nurse teaches about osteochondroma. Which information should the nurse include in the teaching session? 1 It is a common malignant tumor. 2 It occurs most often in the age group of 10 to 25. 3 It has a high rate of local occurrence after surgery. 4 It frequently arises in cancellous ends of arm and leg bones.

2 - It occurs most often in the age group of 10 to 25. Osteochondroma is common in age group of 10 to 25 years. It is a primary benign tumor. Osteoclastoma has a high rate of local occurrence after surgery and chemotherapy. Osteoclastoma frequently arises in cancellous ends of arm and leg bones; osteocondroma occurs in the metaphyseal portion of long bones.

While assessing a knee injury, the nurse asks the client to flex the knee to 30 degrees, pulling the tibia forward while the femur is stabilized. Which test is the nurse performing? 1 Drop arm test 2 Lachman's test 3 McMurray's test 4 Straight-leg-raising test

2 - Lachman's test In Lachman's test, the knee is flexed 15 to 30 degrees, pulling the tibia forward while the femur is stabilized; this test helps determine anterior cruciate ligament tear. The drop arm test involves abducting the arm to 90 degrees and slowly lowering the arm to the other side; this test helps determine rotator cuff injury. McMurray's test involves flexing, rotating, and extending the knee which produces pain; this test helps determine a torn meniscus. The straight-leg-raising test is performed in a client who is supine by raising the leg to 60 degrees; this test helps determine intervertebral disc prolapse and herniation.

A registered nurse is teaching isometric exercises to an 80-year-old client. Which age change in the client necessitates the teaching of this exercise? 1 Kyphotic posture 2 Muscular atrophy 3 Decreased bone density 4 Cartilaginous degeneration

2 - Muscular atrophy Isometric exercises that increase muscle strength are indicated in older clients with muscular atrophy. Clients with kyphotic posture are taught exercises to maintain body mechanics. Clients with decreased bone density are taught weight-bearing exercises and safety tips to prevent falls. Clients with cartilaginous degeneration are advised to take moist heat showers because they increase blood flow to the region.

After an above-the-knee amputation of a right leg, a client reports pain in the right foot. The nurse should inform the client that phantom limb pain is the result of what? 1 Tactile illusions associated with severed blood vessels 2 Nerve endings in the limb that are still intact and react to stimuli 3 An unconscious phenomenon to aid with grieving over the lost body part 4 Hallucinations secondary to emotional symptoms associated with the distress of amputation

2 - Nerve endings in the limb that are still intact and react to stimuli The neural endings that innervated the limb are still intact and may be stimulated (e.g., touch, environmental temperature, barometric pressure changes) within the residual limb. Severed blood vessels are not involved in phantom limb sensation. Although an individual must grieve over a lost body part, the grieving is unrelated to phantom limb sensation. Although phantom limb sensation is a hallucinatory-type experience, it is not part of a psychotic process.

A 90-year-old resident of a nursing home falls and fractures the proximal end of the right femur. The surgeon plans to reduce the fracture with an internal fixation device. What general fact about the older adult should the nurse consider when caring for this client? 1 Aging causes a lower pain threshold. 2 Physiologic coping defenses are reduced. 3 Most confused states result from dementia. 4 Older adults psychologically tolerate changes well.

2 - Physiologic coping defenses are reduced. Aging causes a lowering of the physiologic coping reserve of various systems of the body. The pain threshold increases with aging. There are many etiologies for confusion (e.g., drug intolerance, altered metabolic state, unfamiliar surroundings). As individuals age they become more entrenched in ideas, environment, and objects that are familiar, and thus do not tolerate change well.

A client falls at home and is brought to the emergency department by family members. The client reports intercostal pain and is confused and disoriented. Which is the best way for the nurse to determine whether this behavior is new for the client? 1 Interview the client to identify when the confusion started. 2 Question the family members about the client's usual behavior. 3 Ask the primary healthcare provider when the confusion was noted first. 4 Observe the client for a few hours before determining the onset of confusion.

2 - Question the family members about the client's usual behavior. Family members usually know the client's behavior and serve as important sources of information when a client is confused. The primary healthcare provider is an additional source, but family members are the nurse's best source of information when the client is confused. In the presence of confusion, the client is an unreliable source. Observing the client will not alter the information.

While caring for a client with a second-degree left ankle sprain, a nurse raises the injured part above heart level. What is the reason behind this nursing intervention? 1 To promote bone density 2 To prevent further edema 3 To reduce pain perception 4 To increase muscle strength

2 - To prevent further edema A client with a second-degree sprain may have a deeply torn ankle ligament with swelling and tenderness. Elevation of the injured lower limb above heart level helps mobilization of the excess fluid from the area and prevents further edema. Strengthening exercises help to build bone density and muscle strength and significantly reduce the risk of sprains and strains. Cryotherapy and adequate rest help to reduce pain by reducing the transmission and perception of pain impulses.

The nurse is providing discharge teaching to a 30-year-old client who was hospitalized for exacerbation of rheumatoid arthritis. Which statement by the client indicates correct understanding of the treatment plan? 1 "I will plan to rest in bed for the next 2 weeks." 2 "I will only take my medications when I am having joint pain." 3 "When I exercise, I will reduce the number of repetitions when I have pain." 4 "When I get out of bed, I will push off with my fingers rather than the palms of my hands."

3 - "When I exercise, I will reduce the number of repetitions when I have pain." The amount of exercise and number of repetitions should be reduced to prevent further joint damage if the client is experiencing increased pain. Activity should be balanced with rest. Medications should not be discontinued without consulting the primary healthcare provider. Pushing off with fingers may cause further damage to the phalangeal joints.

While grading a client's muscle strength, the nurse records a score of 4. What does this indicate? 1 No detection of muscular contraction 2 A barely detectable flicker or trace of contraction 3 Active movement against gravity and some resistance 4 Active movement against gravity only, not against resistance

3 - Active movement against gravity and some resistance According to the muscle-strength scale, a sore of 4 indicates active movement of the muscle against gravity and some resistance. A score of 0 indicates no muscular contraction. A score of 1 indicates a barely detectable flicker or trace of contraction. A score of 3 indicates active movement against gravity only, not against resistance.

A client who had an above-the-knee amputation has an elastic bandage around the residual limb. The prescriptions include bathing the residual limb daily and rewrapping the elastic bandage as needed. What should the nurse do when wrapping the bandage on the client's residual limb? 1 Apply it tightly so it does not slip off. 2 Reapply it only if it loosens or slips off. 3 Apply it smoothly without wrinkles or creases. 4 Reapply it while the residual limb is in the dependent position.

3 - Apply it smoothly without wrinkles or creases. The elastic bandage must be applied smoothly without wrinkles, folds, or creases, because these can cause excessive pressure or irritation. Applying it tightly may impede circulation; the bandage should be snug, not tight. The bandage should be reapplied whenever necessary; this may be necessary if it slips off, if it is too tight or too loose, or if it becomes wrinkled or creased. The dependent position allows the blood vessels to become engorged; the bandage should be applied with the residual limb level with the heart.

Which type of bone tumor is commonly seen in elderly clients? 1 Endochroma 2 Osteosarcoma 3 Chondrosarcoma 4 Osteochondroma

3 - Chondrosarcoma Chondrosarcoma occurs most commonly in cartilage in the arm, leg, and pelvic bones of older adults in the age group of 50 to 70 years old. Endochroma occurs in clients in the age group of 10 to 20 years old. Osteosarcoma and osteochondroma occur in the age group of 10 to 25 years old.

A nurse is caring for a client who is hospitalized because of injuries sustained in a major automobile collision. As the client is describing the accident to a friend, the client becomes very restless, and pulse and respirations increase sharply. Which factor is most likely related to the client's physical responses? 1 Client's method of seeking sympathy 2 Bleeding from an undiscovered injury 3 Delayed psychological response to trauma 4 Parasympathetic nervous system response to anxiety

3 - Delayed psychological response to trauma Reliving the experience brings back the feelings, such as anxiety and fear, associated with it; the alterations described reflect sympathetic nervous system activity. There are not enough data present to determine the client's usual method of seeking sympathy. The increased pulse and restlessness may indicate bleeding; however, the other data presented support anxiety. Additional assessment is necessary to confirm bleeding. These changes are indicative of a sympathetic, not a parasympathetic, response.

Which diagnostic study is used to detect deep vein thrombosis in the client's lower extremities? 1 Thermography 2 Plethysmography 3 Duplex venous doppler 4 Somatosensory evoked potential

3 - Duplex venous doppler Duplex venous doppler records an ultrasound of the veins, including blood flow abnormalities of the lower extremities, aiding detection of deep vein thrombosis. Thermography, which measures the heat radiating from the skin surface, is used to determine client response to antiinflammatory drug therapy and inflamed joints. Plethysmography is used to record variations in volume and pressure of blood passing through tissues; test is nonspecific. Somatosensory evoked potential is used to identify subtle dysfunction of lower motor neurons and primary muscle disease.

After a painful exacerbation of rheumatoid arthritis, a client is scheduled to begin a walking and exercise program. Which is an expected outcome for this client? 1 Only when pain free, begin exercising as part of a formal activity program. 2 Avoid exercising when there is a moderate amount of discomfort. 3 Exercise and be active unless the discomfort becomes too great. 4 Walk and exercise even when the pain is severe.

3 - Exercise and be active unless the discomfort becomes too great. Some pain is to be expected, but the activity should not be continued when the pain becomes severe, because it can further traumatize the inflamed synovial membranes. It is unrealistic to expect the client to be pain free, so exercise would never begin. Some discomfort is expected; inactivity promotes the development of muscle atrophy and joint contracture. Activity should be curtailed when pain is severe.

Non-weight bearing with crutches has been prescribed for a client with a leg injury. The nurse provides teaching before ambulation is begun. To facilitate walking with crutches, what is the most important activity the nurse should teach the client? 1 Sit up in a chair to help strengthen back muscles. 2 Keep the unaffected leg in extension and abduction. 3 Exercise the triceps, finger flexors, and elbow extensors. 4 Use a trapeze frequently to strengthen the biceps muscles.

3 - Exercise the triceps, finger flexors, and elbow extensors. The triceps, finger flexors, and elbow extensors are used in crutch walking and therefore need strengthening. Although back muscles keep the person erect, the most important muscles for walking with crutches are the triceps, elbow extensors, finger flexors, and the muscles in the unaffected leg. Keeping the unaffected leg in extension and abduction will do nothing to promote crutch walking. A pushing, not a pulling, motion is used with crutches; the triceps, not the biceps, are used.

Which hormone aids in regulating intestinal calcium and phosphorous absorption? 1 Insulin 2 Thyroxine 3 Glucocorticoids 4 Parathyroid hormone

3 - Glucocorticoids Adrenal glucocorticoids aid in regulating intestinal calcium and phosphorous absorption by increasing or decreasing protein metabolism. Insulin acts together with growth hormone to build and maintain healthy bone tissue. Thyroxine increases the rate of protein synthesis in all types of tissues. Parathyroid hormone secretion increases in response to decreased serum calcium concentration and stimulates the bones to promote osteoclastic activity.

A client signs a legal consent for hip replacement surgery. Shortly before surgery, the client states, "I decided not to go through with the surgery." Which is the best initial response by the nurse? 1 "Then you shouldn't have signed the consent." 2 "I can understand why you changed your mind." 3 "Tell me why you decided to refuse the operation." 4 "Let's talk about your concerns regarding the procedure."

4 - "Let's talk about your concerns regarding the procedure." The response "Let's talk about your concerns regarding the procedure" attempts to explore why the client is refusing the procedure and promotes communication. The response "Then you shouldn't have signed the consent" is accusatory; the client has the right to withdraw consent at any time. The response "I can understand why you changed your mind" draws a conclusion without adequate data; also, it may increase the client's anxiety level. The response "Tell me why you decided to refuse the operation" may be too direct and authoritative; also it may put the client on the defensive.

An x-ray film indicates that an older client has a fractured femur. The client asks the nurse, "Will I be able to walk again?" What is the best response by the nurse? 1 "I have no idea because only time will tell." 2 "You only broke a bone. It could have been worse." 3 "You'll walk again. This is a common issue in older people." 4 "Tell me more about your concerns about being able to walk."

4 - "Tell me more about your concerns about being able to walk." The phrase "Tell me more" shows interest in the client's concerns, is nonjudgmental, and encourages expression and exploration of feelings. First the client's feelings must be explored before providing a direct answer that may cut off communication. The responses "I have no idea" and "You only broke a bone. It could have been worse" places the client on the defensive; it is demeaning to the client and discourages further communication. The general response "You'll walk again. This is a common issue in older people" dismisses the client's concerns; the client is not recognized as an individual whose injury is a traumatic and personal event.

What does grade 3 indicate according to the muscle-strength scale? 1 Active movement against gravity and some resistance 2 Active movement of body part with elimination of gravity 3 Active movement against full resistance without evident fatigue 4 Active movement against gravity only and not against resistance

4 - Active movement against gravity only and not against resistance According to the muscle-strength scale, a score of 3 indicates active movement against gravity only and not against resistance. A score of 4 indicates active movement against gravity and some resistance. A score of 2 indicates active movement of a body part with elimination of gravity. A score of 5 indicates active movement against full resistance without evident fatigue.

A client with arthritis reports receiving several dietary suggestions over the years. Which recommendation for a daily diet should the nurse reinforce? 1 Wheat germ and yeast 2 Yogurt and blackstrap molasses 3 Multiple vitamin supplements in large doses 4 Adequate foods in a variety of different food groups

4 - Adequate foods in a variety of different food groups There is no special diet for arthritis. A balanced diet, consisting of foods from all groups of the MyPlate dietary guidelines, is essential in maintaining nutrition. Limiting the diet to particular foods does not provide all the essential nutrients. If nutritional intake is adequate, large doses of multivitamins are unnecessary and are dangerous.

A nurse is caring for a client with scoliosis of the thoracic spine and lumbar spine. Which risk does the nurse suspect in the client? 1 Osteoarthritis 2 Muscle spasticity 3 Intervertebral disc prolapse 4 Cardiac function impairment

4 - Cardiac function impairment Scoliosis can lead to cardiac function impairment. A client with an S-shaped thoracic and lumbar spine, and unequal shoulder and scapula height, may have scoliosis. A thoracic rib prominence in the lumbar spine deformity of 45 degrees indicates that the client is at a risk of lung and cardiac function impairment. Osteoarthritis is an inflammatory joint condition that is uncommon in a client with scoliosis of the thoracic spine and lumbar spine. Muscle spasticity, an increased muscle tone that may interfere with gait, movement, and speech, is uncommon in the client with scoliosis of the thoracic and lumbar spine. Passively raising the client's leg 60 degrees or less during a straight-leg-raising test indicates nerve root irritation due to intervertebral disc prolapse.

A client with severe chronic rheumatoid arthritis reports that pain lasts for 2 to 3 hours after exercising. What should the nurse should teach the client to do? 1 Substitute isometric exercises for isotonic exercises. 2 Stop the exercises for one day and then resume the exercises. 3 Delay doing aerobic exercises until the pain subsides. 4 Decrease the total time and number of repetitions of the exercise,

4 - Decrease the total time and number of repetitions of the exercise, Exercise should be decreased to a level of tolerance. Isometric exercises promote muscle contraction, not joint movement. The exercise should not be stopped. The purpose of aerobic exercises is to improve cardiovascular functioning, not joint movement; there is no reason to interrupt aerobic exercises if they are tolerated.

A nurse performs full range-of-motion exercises on a client's extremities. When putting an ankle through range-of-motion exercises, what must the nurse perform? 1 Flexion, extension, and rotation 2 Abduction, flexion, adduction, and extension 3 Pronation, supination, rotation, and extension 4 Dorsiflexion, plantar flexion, eversion, and inversion

4 - Dorsiflexion, plantar flexion, eversion, and inversion Dorsiflexion, plantar flexion, eversion, and inversion movements include all possible ranges of motion for the ankle joint. Although the ankle can be moved in a circular motion, flexion and extension more specifically are called dorsiflexion and plantar flexion in relation to the ankle. Also, eversion and inversion should be done when manipulating the ankle. The ankle cannot be abducted or adducted but can be inverted and everted. Pronation, supination, rotation, and extension refer to the upper extremities.

Which type of joint is present in between the client's tarsal bones? 1 Pivot joint 2 Hinge joint 3 Saddle joint 4 Gliding joint

4 - Gliding joint The gliding joint is present in between the tarsal bones. The pivot joint is present in the proximal radioulnar joint. The hinge joint is present in the elbows and knees. The saddle joint is present in between the carpometacarpal joints of the thumb.

The nurse is caring for a client with rheumatoid arthritis. When should the nurse expect the client to experience the most pain and limited movement of the joints? 1 After assistive exercise 2 When the room is cool 3 During the evening hours 4 In the morning on awakening

4 - In the morning on awakening Inactivity over an extended time increases stiffness and pain in joints. The client typically has morning stiffness, or gel phenomenon. Assistive exercises help maintain joint mobility. Whether the room is cool is not a factor; cold applications may decrease joint discomfort. The pain is not as severe in the evening as in the morning.

After an open reduction and internal fixation of a fractured hip, the nurse is helping a client to get out of bed into a chair. What should the nurse do to best accomplish this transfer? 1 Use a transfer board to slide the client from the bed to the chair. 2 Ask the client to put weight equally on both legs and step to the chair. 3 Have several people assist with lifting the client from the bed to the chair. 4 Instruct the client to bear most of the weight on the unaffected leg and pivot to the chair.

4 - Instruct the client to bear most of the weight on the unaffected leg and pivot to the chair. Weight bearing on the unaffected leg will help maintain muscle strength; weight bearing on the affected leg may be limited initially by the primary healthcare provider's prescription or by the client's inability to tolerate weight bearing. Using a transfer board to slide the client from the bed to the chair does not involve weight bearing; weight bearing helps maintain muscle strength in the unaffected leg and independence and should be encouraged unless contraindicated by a primary healthcare provider's prescription. Asking the client to put weight equally on both legs and step to the chair may be contraindicated; weight bearing on the affected leg without a prescription can disrupt the repair, or the client may not be able to fully bear weight initially because of discomfort. Having several people assist with lifting the client from the bed to the chair does not involve weight bearing; weight bearing helps maintain muscle strength in the unaffected leg and independence and should be encouraged unless contraindicated by a primary healthcare provider's prescription.

Which structure connects the client's tibia to the femur at the knee joint? 1 Fascia 2 Bursae 3 Tendons 4 Ligaments

4 - Ligaments A ligament is a dense, fibrous connective tissue that connects bone to bone, such as the tibia to the femur at the knee joint. Ligaments provide stability while permitting controlled movement at the joint. Fascia is a connective tissue that can withstand limited stretching; it provides strength to muscle tissues. Bursae are small sacs of connective tissue lined with synovial membrane and synovial fluid that are located at bony prominences and joints to relieve pressure. A tendon is a dense, fibrous connective tissue that attaches muscle to bone.

A nurse is caring for a client who developed aseptic necrosis after a fracture of the head of the femur. The nurse prepares to administer care based on which factor? 1 Infection at the site of the wound 2 Weight-bearing before the fracture is healed 3 Immobilization after reduction of the fracture 4 Loss of blood supply to the head of the femur

4 - Loss of blood supply to the head of the femur After a fracture, if blood supply is cut off or impaired, necrosis of the bone may occur from lack of oxygen and nutrient perfusion. The word aseptic indicates that infection is not present. Early weight-bearing at the fracture site may result in trauma to the bone; circulation is not impaired. Immobilization does not cut off circulation to the bone; it may cause contractures.

Which nursing intervention prevents footdrop in a client with osteomyelitis? 1 Elevating the foot with the use of pillows 2 Consistently flexing the affected extremity 3 Encouraging the client to change positions 4 Neutral positioning of the foot with the use of a splint

4 - Neutral positioning of the foot with the use of a splint A client with osteomyelitis is at an increased risk for footdrop, which results in an abnormal gait. Neutral positioning of the foot with the use of a splint can reduce the risk of footdrop in the client with osteomyelitis. Elevating the client's foot on pillows can reduce the risk of edema. Asking the client with osteomyelitis to flex the affected extremity can result in flexion contracture. Encouraging the client with osteomyelitis to change positions helps prevent complications associated with immobility and promotes comfort; carefully handle the involved limb and avoid excessive manipulation which may lead to a pathologic fracture.

Which hormone promotes bone resorption in a client? 1 Estrogen 2 Calcitonin 3 Growth hormone 4 Parathyroid hormone (PTH)

4 - Parathyroid hormone (PTH) When serum calcium levels are lowered, secretion of PTH increases and stimulates bones to promote osteoclastic activity, which promotes bone resorption. Estrogens stimulate osteoblastic (bone-building) activity and inhibit PTH. Calcitonin inhibits bone resorption and increases the renal excretion of calcium and phosphorus as needed to maintain balance in the body. Growth hormones secreted by the anterior lobe of the pituitary gland are responsible for increasing bone length.

A client reports burning sensation and sharp pain on the sole of a foot. Which condition does the nurse suspect in the client? 1 Torticollis 2 Pes planus 3 Crepitation 4 Plantar fasciitis

4 - Plantar fasciitis Plantar fasciitis is the burning sensation and sharp pain on the sole of the foot. It is caused by chronic degeneration and inflammation. Torticollis is the twisting of the neck to one side to an unusual position. Pes planus is the abnormal flatness of the sole and arch of the foot. Crepitation is a frequent, audible crackling sound with a palpable grating that accompanies movement.

Which joint in the client's body is an example of a gliding joint? 1 Wrist 2 Elbow 3 Shoulder 4 Sacroiliac

4 - Sacroiliac The sacroiliac joint connects the sacrum with the pelvis. It is a type of gliding joint, because one surface of the bone moves over another surface. The wrist joint is an example of a condyloid joint. The elbow joint is an example of a hinge joint. The shoulder joint is an example of a ball-and-socket joint.

Which type of joint is present in the client's shoulders? 1 Pivotal 2 Saddle 3 Condyloid 4 Spheroidal

4 - Spheroidal The spheroidal joint is a ball and socket joint that provides flexion, extension, adduction, abduction, and circumduction in the shoulders and hips. The pivotal joint provides rotation in the atlas and axis, and at the proximal radioulnar joint. The saddle joint, which is at the carpometacarpal joint of the thumb, provides flexion, extension, abduction, adduction, and circumduction of the thumb-finger. The condyloid joint is a wrist joint between the radial and carpals; it provides flexion, extension, abduction, adduction, and circumduction.

Upon palpation, the nurse identifies spongy swelling caused by synovial fluid. Which joint was most likely palpated? 1 Biaxial joint 2 Pivotal joint 3 Synovial joint 4 Temporomandibular joint

4 - Temporomandibular joint The temporomandibular joint is palpated by asking the client to open his or her mouth; the nurse checks for any pain or weakness in the face. Common abnormal findings include tenderness, crepitus (a grating sound), and a spongy swelling caused by excess synovial fluid. Biaxial joints help in the gliding movement of the wrist. Pivot joints permit rotation in the radioulnar area. Synovial joints provide movement at the point of contact of articulating bones such as the hip, shoulders, and knees.

Why is Phalen's test performed in a client? 1 To diagnose atrophy 2 To diagnose bone tumor 3 To detect rotator cuff injuries 4 To detect carpal tunnel syndrome

4 - To detect carpal tunnel syndrome Phalen's test is used to detect carpal tunnel syndrome. A muscle biopsy is done for the diagnosis of atrophy. A computed tomography scan is done to diagnose a bone tumor. The drop arm test is performed to detect rotator cuff injuries.

1 - Fat embolism The client most likely is experiencing fat embolism syndrome (FES). The average time of onset of FES is 18 to 24 hours after injury to long bones or a crushing injury. Fat globules and tissue thromboplastin exit from bone marrow and local tissue as a result of injury. Fat molecules enter venous circulation, move to lungs, and embolize small capillaries. Petechial rash on the neck, chest, conjunctivae, or axillae is a classic sign of FES (occurs in 50% to 60% of clients with FES). Increased temperature, pulse rate, and respirations are associated with FES; 75% of clients with FES exhibit neurologic signs, such as altered mental state, restlessness, agitation, lethargy, confusion, or coma. The client is not experiencing urinary retention, because output indicates adequate hourly output of at least 50 mL/hr. The client is not experiencing hypovolemic shock. Although the client may experience tachypnea, tachycardia, and an increased temperature with hypovolemic shock, the blood pressure will decrease and the urine output will decrease to less than 30 mL/hr. The client is not experiencing a pulmonary embolism; this is more likely to occur 4 to 10 days after trauma. Although tachypnea, tachycardia, an increased temperature, restlessness, and agitation are common with pulmonary embolism, the client is not exhibiting sudden chest pain, dyspnea, cough, hemoptysis, or areas of dullness or crackles when auscultating breath sounds.

A nurse receives a change-of-shift report for a client who had a total hip replacement 24 hours ago. After reviewing the client's clinical record and completing a physical assessment, the nurse should conclude that the client is experiencing which complication? 1 Fat embolism 2 Urinary retention 3 Hypovolemic shock 4 Pulmonary embolism

Which disorder of the foot is caused by continual pressure over bony prominences? 1 Corn 2 Plantar wart 3 Hammer toe 4 Hallux rigidus

1 - Corn A corn is a foot disorder caused by continual pressure over bony prominences. A plantar wart is a foot disorder caused by a virus. Hammer toe is a foot disorder caused by flexion and deformity in the joints. Hallux rigidus is caused by osteoarthritis.

A client injures an amphiarthrodial joint. Which joint did the client injure? 1 Knee joint 2 Pelvic joint 3 Elbow joint 4 Cranial joint

2 - Pelvic joint Amphiarthrodial joints are those that permit slight movements. The pelvic joint is an example of amphiarthrodial joint. Knee and elbow joints are the examples of diarthrodial joints, which are freely movable. A cranial joint is an example of a synarthrodial joint, which is immovable.

1 - Scoliosis Scoliosis is a lateral S-shaped curvature of the thoracic and lumbar spine. A client with scoliosis has unequal shoulder and scapular height when observed from the back. Kyphosis is an excessive outward curvature of the spine. Torticollis is the twisting of the neck in an unusual position to one side. Pes planus is an abnormal flatness of the sole and arch of the foot.

Upon assessment of a female client the nurse finds the following (see image). Which musculoskeletal deformity is illustrated in the figure? 1 Scoliosis 2 Kyphosis 3 Torticollis 4 Pes planus

The nurse is caring for a client who is 1 day postoperative for a left hip fracture repair. During the assessment, which finding should the nurse assess further? 1 Pain at the surgical site 2 Small amount of serosanguinous drainage 3 Decreased range of motion to the left extremity 4 Sudden shortness of breath

4 - Sudden shortness of breath The sudden onset of shortness of breath is indicative of a fat embolism, which can occur after a fracture of the long bones. This is a serious complication that could result in death. It is normal to have pain at the surgical site, a small amount of serosanguinous drainage, and decreased range of motion to the affected extremity.

4 - Client D Joint fluid is normally transparent and colorless or straw-colored. Therefore client D's joint fluid is normal. The presence of uric acid crystals in client A's fluid suggests gout. Floating fat globules in client B's joint fluid indicate a bone injury. The thick, purulent joint fluid found in client C indicates infection.

The nurse is reviewing the joint fluid examination reports of four clients. Which client's report indicates a normal finding? 1 Client A 2 Client B 3 Client C 4 Client D

Which synovial joint movement is described as turning the sole outward away from the midline of the body? 1 Pronation 2 Eversion 3 Adduction 4 Supination

2 - Eversion Eversion is a synovial joint movement that describes turning the sole outward away from the midline of the body. Pronation is a synovial joint movement that describes turning the palm downward. Adduction is a synovial joint movement that describes movement toward midline of the body. Supination is a synovial joint movement that describes turning the palm upward.

The nurse is caring for a client who may have Paget's disease and osteomalacia. Which laboratory tests can be conducted to confirm the nurse's suspicion? Select all that apply. 1 Aldolase 2 Serum calcium 3 Alkaline phosphatase 4 Lactic dehydrogenase 5 Aspartate aminotransferase

2 - Serum calcium 3 - Alkaline phosphatase Serum calcium and alkaline phosphate tests are used for musculoskeletal assessment. Elevated levels of serum calcium and alkaline phosphate are symptoms of Paget's disease and osteomalacia. Elevated aldolase levels indicate polymyositis, dermatomyositis, and muscular dystrophy. Elevated levels of lactic dehydrogenase levels indicate skeletal muscle necrosis, extensive cancer, and progressive muscular dystrophy. Elevated aspartate aminotransferase levels indicate skeletal muscle trauma and progressive muscular dystrophy.

A client who had a total hip replacement is receiving continuous regional analgesia. The nurse recognizes what as the benefit of this treatment over conventional methods? 1 It is easy to adjust the dose. 2 Neuropathic pain can be relieved. 3 Systemic side effects are minimal. 4 The need for parenteral medication is prevented.

3 - Systemic side effects are minimal. Regional analgesia uses a local anesthetic to control pain; the local effect prevents systemic reactions. The dose adjustment involves the same level of complexity as conventional methods. The hip replacement involves somatic, not neuropathic, pain. Parenteral medication is used in conjunction with regional analgesia.

A client has injured a short bone. Which is an example of a short bone? 1 Tibia 2 Femur 3 Tarsals 4 Humerus

3 - Tarsals Tarsals are short bones, unlike the tibia, femur, and humerus, which are long bones. Short bones do not have epiphysis and diaphysis.

According to the common scale for grading muscle strength, what rating will be given to a client who can complete range of motion with some resistance? 1 1 2 2 3 3 4 4

4 - 4 According to the common scale for grading muscle strength, a client who can complete range of motion with some resistance is given the rating 4. Rating 1 is given to a client with no joint motion and slight evidence of muscle contractility. Rating 2 is given to a client who can complete range of motion with gravity eliminated. Rating 3 is given to a client who can complete range of motion against gravity.

Which joint permits movement in any direction? 1 Pivot joint 2 Hinge joint 3 Biaxial joint 4 Ball-and-socket joint

4 - Ball-and-socket joint Ball-and-socket joints permit movement in any direction. Pivot joints permit rotation. Hinge joints allow motion in one plane. Biaxial joints permit gliding movement.

3 - Push with the palms rather than the fingers when rising from a chair. Pushing off with the palms of the hands rather than the fingers uses the strongest joints available to rise from a chair. Pressing water from a sponge rather than wringing maintains the joints of the hands in a neutral position. Wringing a sponge requires finger flexion, which places strain on the joints of the hand. The client with ulnar drift deformities of both hands should have faucets and doorknobs that require pushing rather than turning. Pushing exerts less stress on the joints of the hands during routine activities. Turning a doorknob or faucet requires grasping and twisting motions that strain the small joints of the hands. An ulnar drift deformity limits the ability to grasp small objects. Sewing projects require gripping a needle or hook as well as repetitive motions that should be avoided because they strain the joints of the hands.

A nurse is caring for a client attending a community-based health center and reviews the client's medical record. What should the nurse encourage the client to do? 1 Wring a sponge repeatedly when washing dishes. 2 Install faucets that require turning rather than pushing. 3 Push with the palms rather than the fingers when rising from a chair. 4 Actively use the hands for several hours each morning, sewing or knitting.

A client with osteomyelitis has a slow rate of healing. Which factors can contribute to reduced healing in the client? Select all that apply. 1 Diabetes 2 Cataract 3 Smoking 4 Dermatitis 5 Alcoholism

1 - Diabetes 3 - Smoking 5 - Alcoholism Diabetes causes narrowing of blood vessels, thereby causing diminished blood supply to the affected organ or tissue; clients with diabetes have a slow healing rate. Intake of tobacco through smoking may reduce the blood supply to the affected area, thereby slowing down the healing process. Alcohol abuse reduces the amount of nutrients and vitamins required for muscle growth, thereby affecting the healing process. Cataract is a disease of the eye and does not affect the musculoskeletal system. Similarly, dermatitis is a skin condition that does not affect the musculoskeletal system.

A registered nurse (RN) is giving home care instructions to a client who was treated for injuries due to a fall. Which statement made by the client indicates a need for correction? 1 "I should walk on scatter rugs at home." 2 "I should drink 3000 mL of water every day." 3 "I should eat fruits and vegetables six times a day." 4 "I should exercise the joints above and below the cast daily."

1 - "I should walk on scatter rugs at home." A client with injuries due to a fall must avoid having throw or scattered rugs at home to reduce the incidence of falls. The registered nurse (RN) should encourage the client to drink 3000 mL of water per day to promote optimal bladder and bowel function. The client should eat six small meals with foods rich in fiber, such as fruits and vegetables, to prevent constipation. The RN has to encourage the client to perform exercise above and below the cast daily for a speedy recovery.

After teaching the client about the precautions to be taken during bisphosphonate therapy, the nurse is evaluating the statements of the client. Which statement made by the client indicates the need for further teaching? 1 "I should take the medication with water." 2 "I should take the medication with a meal." 3 "I should not stop taking the medication abruptly." 4 "I should remain upright for at least 30 minutes after taking the medication."

2 - "I should take the medication with a meal." Bisphosphonates have the potential to cause erosive esophagitis and should therefore be taken with a large glass of water and the client should remain upright for at least 30 minutes after taking the medication to facilitate passage through the esophagus. They are poorly absorbed in the oral formulation, so should be taken on an empty stomach, first thing in the morning. Bisphosphonates should not be stopped abruptly unless on the orders of the primary healthcare provider.

A client has had a below-the-knee amputation of the leg. What is important for the nurse to consider when providing postoperative care for a client who had an amputation of a lower extremity? 1 Strict bed rest is maintained for at least several days. 2 The residual limb should not be elevated for the first 24 hours. 3 Hemorrhage rarely occurs during the early postoperative period. 4 Primary healthcare providers usually change the dressing on the residual limb within 48 hours.

2 - The residual limb should not be elevated for the first 24 hours. Elevation of the residual limb helps prevent edema; however, should not be done on the first 24 hours and continued elevation may lead to hip contractures. The client usually is out of bed on the second postoperative day. Hemorrhage and infection are the two most common complications. The dressing usually is a pressure dressing and is not changed this soon postoperatively.

A client with cancer is scheduled for a bone scan to determine the presence of metastasis. The nurse evaluates that the teaching before the scheduled bone scan is effective when the client makes which comment? 1 "X-rays will be taken to identify where I may have lost calcium from my bones." 2 "Portions of my bone marrow will be removed and examined for cell composition." 3 "A radioactive chemical will be injected into my vein that will destroy cancer cells present in my bones." 4 "A substance of low radioactivity will be injected into my vein and my body inspected by an instrument to detect where it is deposited."

4 - "A substance of low radioactivity will be injected into my vein and my body inspected by an instrument to detect where it is deposited." A bone scan maps the uptake of a bone-seeking radioactive isotope; an increased uptake is seen in metastatic bone disease, osteosarcoma, osteomyelitis, and certain fractures. A bone scan measures the uptake of radioactive material, not the absence of calcium, which is seen in an x-ray examination of bone. The response "Portions of my bone marrow will be removed and examined for cell composition" refers to a bone marrow aspiration, when a small amount of marrow is examined to determine the presence of abnormal cells in diseases such as leukemia. A bone scan involves a small diagnostic dosage of a radioactive substance; it is not therapeutic.

Which condition is characterized by infection of a client's bone or bone marrow? 1 Osteomalacia 2 Osteomyelitis 3 Herniated disc 4 Spinal stenosis

2 - Osteomyelitis Osteomyelitis is infection of bone or bone marrow. Osteomalacia is a condition characterized by softening of bones due to calcium or vitamin D deficiency. Herniated disc is caused by structural damage of the intervertebral discs in which the nucleus pulposus seeps through a torn or stretched annulus. Spinal stenosis is narrowing of the spinal canal.

After surgery for a fractured hip, a client states, "I don't remember when I have ever been so uncomfortable." What should the nurse's initial response be? 1 Notify the primary healthcare provider. 2 Use distraction techniques. 3 Medicate the client as prescribed. 4 Perform a complete pain assessment.

4 - Perform a complete pain assessment. A complete assessment must be performed to determine the location, characteristics, intensity, and duration of the pain. The pain may be incisional, result from a pulmonary embolus, or be caused by neurovascular trauma to the affected leg, and the intervention for each is different. Notifying the primary healthcare provider, using distraction techniques, and medicating the client as prescribed may be done after a complete assessment reveals that this is the appropriate intervention; assessment is the priority.

A client with rheumatoid arthritis asks the nurse about ways to decrease morning stiffness. What should the nurse suggest? 1 Wearing loose but warm clothing 2 Planning a short rest break periodically 3 Avoiding excessive physical stress and fatigue 4 Taking a hot tub bath or shower in the morning

4 - Taking a hot tub bath or shower in the morning Moist heat increases circulation and decreases muscle tension, which help relieve chronic stiffness. Although wearing loose but warm clothing is advisable for someone with arthritis, it does not relieve morning stiffness. Inactivity promotes stiffness. The practice of avoiding excessive physical stress and fatigue is related to muscle fatigue, not to stiffness of joints.

Which principle should the nurse consider when assisting a client with crutches to learn the four-point gait? 1 Elbows should be kept in rigid extension. 2 Most of the weight should be supported by axillae. 3 The client must be able to bear weight on both legs. 4 The affected extremity should be kept off the ground.

3 - The client must be able to bear weight on both legs. In the four-point gait, the client brings the left crutch forward first, followed by the right foot; then the right crutch is brought forward, followed by the left foot. Thus, both legs must be able to bear some weight. Although the arms are extended to allow the hands to bear weight, the elbows are not maintained in this position. Pressure on the axillae may damage nerves in the area. Both extremities must be able to bear weight.

Which term should the nurse use to describe synovial joint movement that moves away from the midline of the body? 1 Inversion 2 Extension 3 Pronation 4 Abduction

4 - Abduction Abduction is a synovial joint movement that involves movement of a part away from the midline of the body. Inversion is turning of the sole inward toward the midline of the body. Pronation is a synovial joint movement that involves the turning of the palm downward. Extension is a synovial joint movement that involves a straightening of joint that increases the angle between two bones.

A nurse develops a teaching plan for a client with rheumatoid arthritis. What should the nurse include in the plan about ways to reduce joint stress? 1 "If experiencing pain after 1 to 2 hours of activity, actively take measures to address the pain." 2 "When performing day-to-day tasks, use smaller muscles more frequently than large muscles." 3 " Schedule all of the heavy tasks at one time, and then schedule a long rest period." 4 "When the joints are swollen, an increase in exercise will help reduce swelling."

1 - "If experiencing pain after 1 to 2 hours of activity, actively take measures to address the pain." Addressing and managing joint pain protects the joints, especially if the pain lasts more than 1 or 2 hours after a particular activity. The client should use large muscles, such as pushing doors open with arms rather than fingers. Doing heavy tasks at one time will increase joint stress; heavy and light tasks should be alternated. When the inflammatory process is active, the joint should be at rest as much as possible.

A client who had an above-the-knee amputation (AKA) has a pressure dressing on the end of the residual limb. The client asks, "Why do I have to have this tight dressing on my leg?" Which answer by the nurse is correct? 1 "It decreases the swelling of the area." 2 "It decreases the formation of scar tissue." 3 "It prevents the formation of blood clots." 4 "It reduces phantom limb pain."

1 - "It decreases the swelling of the area." The pressure dressing prevents fluid from shifting into the interstitial compartment; this promotes shrinkage of the residual limb to facilitate use of a prosthesis. Bandaging will not affect the formation of a scar, prevent blood clots, or reduce phantom limb pain.

Which is the first line treatment for Paget disease? 1 Oral alendronate 2 1500 mg of calcium 3 Intravenous pamidronate 4 Intravenous zoledronic acid

1 - Oral alendronate Oral alendronate, a bisphosphonate, is the first line treatment for Paget disease. 1500 mg of calcium is given as a supplement to reduce the risk for hypocalcemia. When oral drugs are not effective, pamidronate and zoledronic acid are administered intravenously.

Which ethnic group has a greater incidence of osteoporosis due to musculoskeletal differences? 1 Irish Americans 2 African Americans 3 Chinese Americans 4 Egyptian Americans

3 - Chinese Americans Chinese Americans have an increased incidence of osteoporosis because they have shorter and smaller bones with lower bone density. Irish Americans have taller and broader bones than other Euro-Americans. African Americans have a decreased incidence of osteoporosis. Egyptian Americans are shorter in stature than Euro-Americans and African Americans.

While awaiting the biopsy report before removal of a bone tumor, the client reports being afraid of a diagnosis of cancer. How should the nurse respond? 1 "Worrying is not going to help the situation." 2 "Let's wait until we hear what the biopsy report says." 3 "It is very upsetting to have to wait for a biopsy report." 4 "Operations are not performed unless there are no other options."

3 - "It is very upsetting to have to wait for a biopsy report." "It is very upsetting to have to wait for a biopsy report" addresses the fact that the client's feelings of anxiety are valid. Stating "Worrying is not going to help the situation" or "Let's wait until we hear what the biopsy report says" does not address the client's concerns and may inhibit the expression of feelings. Telling the client that operations are not performed unless there are no other options is irrelevant and does not address the client's concerns.

A client with pain and paresthesia of the left leg is scheduled for an electromyogram. What should the nurse discuss with the client before the test is performed? 1 Bed rest must be maintained after the procedure. 2 The involved area will be shaved before the procedure. 3 Needles will be inserted into the affected muscles during the test. 4 Monitoring of the heart rate and rhythm will be done throughout the test.

3 - Needles will be inserted into the affected muscles during the test. Small needles will be inserted into the affected muscles during the test to assess electrical activity and to determine whether symptoms are primarily musculoskeletal or neurologic. Bed rest is not required after the procedure. Special preparation, like shaving, is not required for electromyography. Special care, like monitoring the heart, is not required during the procedure.

When providing discharge teaching to a client who had a total hip replacement, what should the nurse instruct the client to avoid? 1 Climbing stairs 2 Stretching exercises 3 Sitting in a low chair 4 Lying prone for more than 15 minutes

3 - Sitting in a low chair Excessive flexion of the hip can cause dislocation of the femoral head. Climbing stairs should not cause undue strain on the operative site. Stretching exercises should be encouraged as long as no extremes of position are implemented. The client is permitted to lie prone for more than 15 minutes; lying prone should be encouraged because it prevents hip flexion contractures.

A nurse administers an estrogen agonist to a client. Which nursing actions would be beneficial? Select all that apply. 1 Observing the client for signs of hypercalcemia 2 Ensuring that the client has a dental examination before starting the drug 3 Teaching the client about signs and symptoms of venous thromboembolism (VTE) 4 Monitoring the client's liver function tests (LFTs) in collaboration with the primary healthcare provider 5 Observing the client for central nervous system (CNS) adverse effects, such as drowsiness, anxiety, and agitation

3 - Teaching the client about signs and symptoms of venous thromboembolism (VTE) 4 - Monitoring the client's liver function tests (LFTs) in collaboration with the primary healthcare provider Estrogen agonists may cause adverse effects that result in VTE; the client should be taught about the signs and symptoms of VTE that may occur in the first four months of estrogen agonist therapy. Monitoring LFTs in collaboration with the primary healthcare provider is also beneficial because this action may reduce the risk of hepatic disease. Clients taking calcium supplements should be observed for signs of hypercalcemia. Ensuring that the client has had a dental examination before starting bisphosphonate therapy would avoid jaw or maxillary osteonecrosis. Clients taking bisphosphonates should also be observed for CNS adverse effects, such as drowsiness, anxiety, and agitation.

Which diagnostic scan is used to detect diffuse or localized muscle weakness? 1 Arthroscopy 2 Radiography 3 Myelography 4 Electromyography

4 - Electromyography An electromyography is performed to detect diffuse or localized muscle weakness by determining the electric potential generated in an individual. Arthroscopy is used for the direct visualization of ligaments, menisci, and articular surfaces of a joint. A radiography is performed to detect bone density, alignment, swelling, and intactness of a joint. A myelography is performed to visualize the vertebral column, intervertebral discs, spinal nerve roots, and blood vessels.

An older female client is seen in the primary healthcare provider's office. Upon initial nursing assessment the nurse notes the client's height has decreased by 1 inch (2.5 cm) since the last visit 1 year ago. The nurse knows that what is the most likely reason for this finding? 1 The nurse was in error. 2 Older adults are not active enough so they lose bone mass. 3 Older adults have poor posture so they are shorter. 4 Older adults may have osteoporosis-related height changes.

4 - Older adults may have osteoporosis-related height changes. Because of the decreasing amounts of estrogen in older women, there is a loss of calcium as well, which can lead to bone loss and a loss in height. Most likely the nurse was not in error because of the age of the client and likelihood of osteoporosis. Sweeping statements about older adults not being active enough or having poor posture are not accurate.

1 - Ulnar drift Ulnar drift occurs when the long axis of the fingers makes an angle with the long axis of the wrist so that the fingers are deviated to the ulnar side of the hand; it is caused by changes in the metacarpophalangeal joints. Hallux valgus occurs when the great toe is angulated away from the midline of the body toward the other toes. Swan-neck deformity occurs with flexion of the distal interphalangeal joint and hyperextension of the proximal interphalangeal joint. Boutonnière deformity occurs with fixed flexion of the proximal interphalangeal joint and hyperextension of the distal interphalangeal joint.

A nurse is performing an admission health history and physical assessment for a client who has severe rheumatoid arthritis. When assessing the client's hands, the nurse identifies that they are similar to the hand in the illustration. What should the nurse document in the medical record when describing this typical physiologic change associated with rheumatoid arthritis? 1 Ulnar drift 2 Hallux valgus 3 Swan-neck deformity 4 Boutonnière deformity

A client with a history of a herniated nucleus pulposus is scheduled for total hip replacement surgery. To prevent the most common complication associated with this type of surgery, the nurse should instruct the client to perform which activity? 1 Straight-leg raises 2 Buerger-Allen exercises 3 Deep breathing and coughing 4 Plantar flexion and dorsiflexion exercises

4 - Plantar flexion and dorsiflexion exercises Plantar flexion and dorsiflexion exercises promote venous return, which helps prevent venous thrombus formation, the most common complication after hip surgery. Straight-leg raises are contraindicated for a client who has a history of a herniated nucleus pulposus. Buerger-Allen exercises stimulate collateral circulation for clients with peripheral vascular disease; they are seldom used, because walking is considered a more effective exercise. Although deep breathing and coughing should be encouraged to prevent respiratory complications, thrombus formation is a more common complication than respiratory complications after a total hip replacement.

A home care nurse is visiting a client who had a below-the-knee amputation. Which client statement indicates to the nurse that further teaching is needed? 1 "At night, I sleep with a pillow under my knees." 2 "When I sit in a chair, I put my legs out straight on an ottoman." 3 "I apply a firm, even bandage around the end of my affected leg every day." 4 "I press the end of my affected leg against a soft surface several times during the day."

1 - "At night, I sleep with a pillow under my knees." A pillow may promote a flexion contracture of the hip and knee and may interfere with use of a prosthesis and ambulation. The response "When I sit in a chair, I put my legs out straight on an ottoman" expresses an action that prevents pooling of blood and edema in the extremities. The response "I apply a firm, even bandage around the end of my affected leg every day" explains an activity that prevents edema and promotes residual limb shrinkage. Pressing the end of the affected leg against a soft surface several times during the day prepares the residual limb for weight-bearing and for use of a prosthesis.

While assessing the health of a 69-year-old client, the nurse finds an age-related change. Which finding in the client supports the nurse's conclusion? 1 Big eyes, wide open 2 Presence of facial hair 3 A bruise on the elbow 4 Walking with neck bent forward

4 - Walking with neck bent forward Aging is associated with changes in gait. Walking with neck bent forward suggests a gait change, supporting the nurse's conclusion. Wide opening of eyes is not an age-related change. The release of sex hormones in both men and women causes growth of facial hair, which is normal. A bruise could be a result of an injury and does not occur with aging.

A college basketball player complains of a "click" in the knee when walking. The client states that the knee occasionally gives way when running and sometimes locks. The client does not recall any specific injury. What does the nurse suspect that the diagnostic tests will reveal? 1 Cracked patella 2 Ruptured Achilles tendon 3 Injured cartilage in the knee 4 Stress fracture of the tibial plateau

3 - Injured cartilage in the knee These adaptations are consistent with torn cartilage; this injury is common among basketball players. A fractured patella will cause pain and usually manifests itself at the time of the injury. A ruptured Achilles tendon is painful and prevents plantar flexion of the foot; adaptations usually are manifested at the time of the injury. A stress fracture is associated with pain, not with a clicking or locking of the knee.

A client with a distal femoral fracture has a long leg cast applied. Which important element of a discharge program should the nurse focus on when teaching crutch-walking? 1 Establishing a schedule for pain medication 2 Maintaining a fixed schedule of daily activities 3 Modifying the home environment to prevent accidents 4 Understanding that a more sedentary lifestyle is necessary

3 - Modifying the home environment to prevent accidents Modifications in the home may be needed to permit safe use of crutches. Pain medications should not be required on a regular basis. The client may vary the schedule of activities based on abilities and responses to activities. The client does not have to be sedentary; crutches are used for ambulation.

Which musculoskeletal system change is associated in older adult clients? 1 Decreased in height 2 Decreased neck rigidity 3 Increased fine-motor dexterity 4 Increased range of motion (ROM)

1 - Decreased in height Loss of height and deformity and shortening of the trunk are common in older adults due to vertebral compression and degeneration. Rigidity in the neck, shoulders, back, hips, and knees increases with age due to loss of elasticity in ligaments, tendons, and cartilage. A decline in fine-motor dexterity occurs in the older adult due to slow impulse conduction along motor units. Range of motion (ROM) is limited in the older adult due to cartilage erosion, increased friction between the bones, and overgrowth of bone around joint margins.

A client who has paraplegia often loses calcium from the skeletal system. The nurse concludes that what factor contributes to calcium loss in this client? 1 Decreased activity 2 Inadequate fluid intake 3 Decreased calcium intake 4 Inadequate kidney function

1 - Decreased activity The bones respond to the stress of activity (walking, running, etc.) by laying down new bone substance along the lines of stress. Inactivity leads to reduced bone deposition and actual bone decalcification. Fluid intake has no effect on bone decalcification. Calcium intake does not alter bone demineralization in clients with paraplegia. Kidney function may be altered as bone decalcification occurs and stones are formed in the kidneys, but this is not the cause of demineralization.

Which bursae are found between the client's elbow and the skin? 1 Olecranon 2 Prepatellar 3 Subacromial 4 Trochanteric

1 - Olecranon Bursae are small sacs of connective tissue lined with synovial membrane and synovial fluid that decrease the friction between moving parts. Olecranon bursae are found between the olecranon process of the elbow and the skin. Prepatellar bursae are found between the patella and the skin. Subacromial bursae are found between the head of the humerus and the acromion process of the scapula. Trochanteric bursae are found between the greater trochanter of the proximal femur and the skin.

One week after an above-the-knee amputation, a client refuses to go to physical therapy and tells the nurse, "I'll never be a whole person again!" What is the nurse's best response? 1 "You're still the same person you've always been. Just relax." 2 "You've lost a part of yourself. That must be very difficult for you." 3 "You may feel that way, but I'm sure your family considers you a whole person." 4 "You must go to physical therapy every day or you will develop muscle contractures."

2 - "You've lost a part of yourself. That must be very difficult for you." The response "You've lost a part of yourself. That must be very difficult for you" acknowledges and reflects the client's feelings and encourages further communication. The response "You're still the same person you've always been. Just relax" negates the client's feelings. The nurse does not know how the client's family members feel; the response "You may feel that way, but I'm sure your family considers you a whole person" takes the focus off the client. The response "You must go to physical therapy every day or you will develop muscle contractures" is true, but telling the client this serves no therapeutic purpose at this time.

The x-ray report of a client shows the presence of a greenstick fracture. What is a greenstick fracture? 1 A fracture with more than two fragments 2 An incomplete fracture with one side bent 3 A spontaneous fracture at the site of bone disease 4 A fracture that extends across the longitudinal axis of the bone shaft

2 - An incomplete fracture with one side bent An incomplete fracture with one side splintered and the other side bent indicates a greenstick fracture. A fracture with more than two fragments that appear to be floating is known as a comminuted fracture. A pathological fracture is a spontaneous fracture found at the site of bone disease. A transverse fracture extends across the longitudinal axis of the bone shaft.

Three days after a cast is applied to a client's fractured tibia, the client reports that there is a burning pain over the ankle. The cast over the ankle feels warm to the touch, and the pain is not relieved when the client changes position. What is the nurse's priority action? 1 Obtain a prescription for an antibiotic. 2 Report the client's concern to the primary healthcare provider. 3 Administer the prescribed medication for pain. 4 Explain that this is typical after a cast is applied.

2 - Report the client's concern to the primary healthcare provider. The client's concern indicates tissue hypoxia or breakdown and should be reported to the primary healthcare provider. Other data, such as elevated temperature or increased white blood cells, are not present to support the presence of an infection. Although administering the prescribed medication for pain will be done to provide relief of pain, the priority is to notify the primary healthcare provider. This is not a typical response to a cast and may indicate a complication.

What are examples of a client's flat bones? Select all that apply. 1 Sacrum 2 Scapula 3 Sternum 4 Humerus 5 Mandible

2 - Scapula 3 - Sternum Flat bones such as the scapula and sternum are compact bones separated by a layer of cancellous bone that contains bone marrow. Bones such as the sacrum and mandible are irregular bones; they appear in a variety of shapes and sizes. The humerus is a long bone with a central shaft and two widened ends.

While assessing a client, the nurse suspects that the client has acute osteomyelitis. Which symptoms in the client support the nurse's suspicion? Select all that apply. 1 Foot ulcer 2 Temperature of 102° F 3 Erythema of the affected area 4 Tenderness of the affected area 5 Drainage from the affected area

2 - Temperature of 102° F 3 - Erythema of the affected area 4 - Tenderness of the affected area Osteomyelitis is the infection of bone caused by bacteria, viruses, or fungi. The symptoms of acute osteomyelitis are fever (temperature above 101° F), erythema, and tenderness near the affected area. The symptoms of chronic osteomyelitis are the presence of foot ulcers and drainage from the affected area.

A 52-year-old client reports fatigue and reduced strength in the limbs. Which suggestion given to the client will be most beneficial? 1 "Include protein-rich food in your diet." 2 "Drink two cups of skim milk each day." 3 "Perform push-ups in the morning." 4 "Give warm compresses to the limbs."

3 - "Perform push-ups in the morning." Decreased muscle strength (deconditioning) occurs with age and can be reduced by performing isometric exercises; therefore, suggesting that the client perform push-ups in the morning would be most beneficial. Proteins provide energy and promote healing and milk is rich in calcium and is good for overall health (especially bones), but neither of these will reduce fatigue or increase limb strength like exercise can. Warm compresses can reduce pain and inflammation caused by an injury but they will not reduce fatigue or increase limb strength.

A client who is receiving radiation therapy for bone cancer lives alone and works full time. What should the nurse encourage this client to do? 1 Perform regularly scheduled aerobic activity daily. 2 Take a leave of absence from work when receiving therapy. 3 Include rest periods during the day while receiving radiation. 4 Continue the activities usually performed before becoming ill.

3 - Include rest periods during the day while receiving radiation. Radiation is fatiguing; therefore, rest periods will combat fatigue. Rest ultimately will promote performance of activities of daily living and independence. Increasing activity at this time is not advised because fatigue is a side effect of radiation. Maintaining independence is important, and a leave of absence may not be emotionally or financially feasible. Although normalizing activities is desirable, this may be unrealistic when the side effects of radiation therapy are considered.

Which diagnostic study is used to investigate the cause of an inflamed joint and determines a client's response to antiinflammatory drug therapy? 1 Duplex venous Doppler 2 Plethysmography 3 Thermography 4 Somatosensory evoked potential

3 - Thermography Thermography uses an infrared detector that measures the degree of heat radiating from the skin's surface. Therefore it is used to investigate the cause of an inflamed joint and in determining the client's response to antiinflammatory drug therapy. Plethysmography is used to record variations in volume and pressure of blood passing through tissues. Duplex venous Doppler records blood flow abnormalities to the lower extremities, which helps to detect deep vein thrombosis. Somatosensory evoked potential is used to identify subtle dysfunction of lower motor neuron and primary muscle disease.

A client with osteomyelitis receiving ciprofloxacin therapy is taught about the pros and cons of the therapy. Which statement made by the client indicates effective learning? 1 "I should go for a weekly change of dressing." 2 "I should stop taking the medication once symptoms decrease." 3 "I should not the remove soiled dressing without someone's assistance." 4 "I should contact the primary healthcare provider in case of white patches in the mouth."

4 - "I should contact the primary healthcare provider in case of white patches in the mouth." Ciprofloxacin causes adverse effects like formation of whitish-yellow or curd-like lesions in the mouth and itching in the perianal area. Therefore, the client's statement that the primary healthcare provider should be contacted in case of white patches in the mouth indicates effective learning. Dressings should be changed once soiled, not weekly. The client must take the antibiotic even after the symptoms have subsided and feels better. If the drug is abruptly discontinued, this may cause drug resistance. There are no restrictions as to who should change the dressing; the client can also change the dressing as needed.

The school nurse is attending to a student athlete who reports muscle pain after a practice session. Which should the nurse identify as a cause of this pain when providing instruction to the student? 1 Lactic acid 2 Acetoacetic acid 3 Hydrochloric acid 4 Beta-hydroxybutyric acid

1 - Lactic acid The ache in muscles that have been vigorously worked without adequate oxygen supply is caused in part by the buildup of lactic acid. During rest, the lactic acid is oxidized completely to carbon dioxide and water, providing adenosine triphosphate (ATP) for further muscular contraction. Beta-hydroxybutyric acid and acetoacetic acid are not products of muscle contraction; they are ketone bodies resulting from incomplete oxidation of fatty acids. Hydrochloric acid is not a product of muscle contraction; it is present in the stomach to facilitate the digestive process.

What is the nurse's primary consideration when caring for a client with rheumatoid arthritis? 1 Surgery 2 Comfort 3 Education 4 Motivation

2 - Comfort Because pain is an all-encompassing and often demoralizing experience, the client should be kept as pain-free as possible. Surgery is used to correct deformities and facilitate movement, which is not the priority. Concentration and motivation are difficult when a client is in severe pain.