Medical Surgical Nursing Musculoskeletal System Ch. 40-43 **IMPORTANT* YASSSS

Medications for osteoporosis?

-Bisophosphonates daily or weekly oral preparations. Alendronate (fosamax), risedronate (actonel), monthly oral preparations ibandronate (Boniva), or yearly IV infusions of zoledronic acid (reclast) which all increase bone mass and decrease bone loss by inhibiting osteoclast function. -People who take these must take on an empty stomach with a full glass of water and must sit upright 30-60 mins

How long should antibiotics be taken for osteomyelitis?

3-6 weeks

What is pes cavus "claw foot"?

A foot with an abnormally high arch and a fixed equine deformity of the forefoot.

What is an avulsion fracture?

A fragment of bone has been pulled away by a tendon and its attachment.

What is scoliosis?

A lateral curving deviation of the spine. May be congenital, idiopathic, or the result of damage to the paraspinal muscles (muscular dystrophy)

A nurse is caring for a patient who is postoperative day 1 right hip replacement. How should the nurse position the patient? A) Keep the patient's hips in abduction at all times. B) Keep hips flexed at no less than 90 degrees. C) Elevate the head of the bed to high Fowler's. D) Seat the patient in a low chair as soon as possible.

Answer- A keep the patients hip in abduction at all times. Explanation: The hips should be kept in abduction by an abductor pillow. Hips should not be flexed more than 90 degrees, and the head of bed should not be elevated more than 60 degrees. The patient's hips should be higher than the knees; as such, high seat chairs should be used.

A bone biopsy has just been completed on a patient with suspected bone metastases. What assessment should the nurse prioritize in the immediate recovery period? A) Assessment for dehiscence at the biopsy site B) Assessment for pain C) Assessment for hematoma formation D) Assessment for infection

Answer- B assessment for pain Explanation: Bone biopsy can be painful and the nurse should prioritize relevant assessments. Dehiscence is not a possibility, since the incision is not linear. Signs and symptoms of infection would not be evident in the immediate recovery period and hematoma formation is not a common complication.

What is the term for a rhythmic contraction of a muscle? A. Clonus B. Atrophy C. Hypertrophy D. Crepitus

Answer- Clonus Explanation: Clonus is a rhythmic contraction of the muscle. Atrophy is a shrinkagelike decrease in the size of a muscle. Hypertrophy is an increase in the size of a muscle. Crepitus is a grating or crackling sound or sensation that may occur with movement of ends of a broken bone or irregular joint surface.

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

Answer- Contusion Explanation:The client's description of blunt trauma by a baseball bat and localized pain in conjunction with swelling and ecchymosis would most likely suggest a contusion. A fracture would be manifested by pain, loss of function, deformity, swelling, and spasm. A sprain would be manifested by pain and swelling; ecchymosis may appear later. A strain is characterized by inflammation, local tenderness, and muscle spasms.

A nurse is caring for a patient who has an MRI scheduled. What is the priority safety action prior to this diagnostic procedure? A) Assessing the patient for signs and symptoms of active infection B) Ensuring that the patient can remain immobile for up to 3 hours C) Assessing the patient for a history of nut allergies D) Ensuring that there are no metal objects on or in the patient

Answer- D Ensuring that there are no metal objects on or in the patient Explanation: Absolutely no metal objects can be present during MRI—their presence constitutes a serious safety risk. The procedure takes up to 90 minutes. Nut allergies and infection are not contraindications to MRI.

A patient with a fractured femur is in balanced suspension traction. The patient needs to be repositioned toward the head of the bed. During repositioning, what should the nurse do? A) Place slight additional tension on the traction cords. B) Release the weights and replace them immediately after positioning. C) Reposition the bed instead of repositioning the patient. D) Maintain consistent traction tension while repositioning.

Answer- D Maintain consistent traction tension while repositioning. Explanation: Traction is used to reduce the fracture and must be maintained at all times, including during repositioning. It would be inappropriate to add tension or release the weights. Moving the bed instead of the patient is not feasible.

An older adult patient has come to the clinic for a regular check-up. The nurse's initial inspection reveals an increased thoracic curvature of the patient's spine. The nurse should document the presence of which of the following? A) Scoliosis B) Epiphyses C) Lordosis D) Kyphosis

Answer: D kyphosis Explanation: Kyphosis is the increase in thoracic curvature of the spine. Scoliosis is a deviation in the lateral curvature of the spine. Epiphyses are the ends of the long bones. Lordosis is the exaggerated curvature of the lumbar spine.

A nurse is explaining a patient's decreasing bone density in terms of the balance between bone resorption and formation. What dietary nutrients and hormones play a role in the resorption and formation of adult bones? (Select all that apply.) A) Thyroid hormone B) Growth hormone C) Estrogen D) Vitamin B12 E) Luteinizing hormone

Answers- A,B,C thyroid hormone, growth hormone, estrogen Explanation: The balance between bone resorption and formation is influenced by the following factors: physical activity; dietary intake of certain nutrients, especially calcium; and several hormones, including calcitriol (i.e., activated vitamin D), parathyroid hormone (PTH), calcitonin, thyroid hormone, cortisol, growth hormone, and the sex hormones estrogen and testosterone. Luteinizing hormone and vitamin B12 do not play a role in bone formation or resorption.

What is isometric contraction?

The length of the muscles remains constant but the force generated by the muscles is increased; an example is pushing against an immovable wall.

Describe phase 3 of bone healing?

"Remodeling phase" the final phase of fracture healing remodels new bone onto the old structural arrangement. Necrotic bone is removed by the osteoclasts. A thickened area may remain on the bone. Remodeling can take months to years depending on severity of the break and the stressors on the area.

Describe phase 2 of bone healing?

"Reparative phase" the granulation tissue is initially replaced with a callus precursor called a procallus, then fibroblasts invade and produce a denser callus made of fibrocartilage. In 3-4 weeks this callus post injury. Lamellar bone then forms as the bony callus calcifies months post injury.

Describe phase 1 of bone healing?

"reactive phase" After damage occurs bleeding and vasoconstriction occur a hematoma is formed. Cytokines are then released, initiating the healing process by replicating cells known as fibroblasts to proliferate, which causes growth of blood vessels. Granulation tissue forms and becomes dense. This phase is typically the most painful.

What is impingement syndrome?

-Impaired movement of the rotator cuff of the shoulder. Usually occurs from repetitive overhead movement of the arm or from acute trauma resulting in irritation and eventual inflammation of the cuff and tendons or subacromial bursa. -Early signs are edema from hemorrhage, pain, shoulder tenderness, limited movement, muscle spasm, and eventual disuse atrophy. May eventually be a parial or complete rotator cuff tear. -Early treatment NSAIDs, intra-articular injections of corticosteroids. artifical heat or cold therapy can improve symptoms though a therapeutic exercise program is necessary to improve outcomes.

What is a contusion?

A soft tissue injury produced by blunt force, such as a blow, kick, or fall causing small blood vessels to rupture and bleed into soft tissues.

What is lordosis?

Aka swayback, an exaggerated curvature of the lumbar spine. Can affect any age group, common causes are tight low back muscles, excessive visceral fat, and pregnancy as women adjust their posture in response to changes in her center of gravity.

Examples of saddle joints

Allow movement in two planes at right angles to each other. The joint at the base of the thumb is a saddle joint.

Examples of pivot joints

Allow one bone to move around a central axis without displacement. an example is the articulation between the radius and ulna. Permit such actions as turning a door knob.

Steadily increasing pain may indicate?

An infectious process (osteomyelitis), malignant tumor, or neurovascular complications

A patient was brought to the emergency department after a fall. The patient is taken to the operating room to receive a right hip prosthesis. In the immediate postoperative period, what health education should the nurse emphasize? A) "Make sure you don't bring your knees close together." B) "Try to lie as still as possible for the first few days." C) "Try to avoid bending your knees until next week." D) "Keep your legs higher than your chest whenever you can."

Answer- A "make sure you don't bring your knees together." Explanation: After receiving a hip prosthesis, the affected leg should be kept abducted. Mobility should be encouraged within safe limits. There is no need to avoid knee flexion and the patient's legs do not need to be higher than the level of the chest.

A nurse is caring for a patient with a diagnosis of cancer that has metastasized. What laboratory value would the nurse expect to be elevated in this patient? A) Bilirubin B) Potassium C) Alkaline phosphatase D) Creatinine

Answer- C alkaline phosphatase Explanation: Alkaline phosphatase is elevated during early fracture healing and in diseases with increased osteoblastic activity (e.g., metastatic bone tumors). Elevated bilirubin, potassium, and creatinine would not be expected in a patient with metastatic bone tumors.

The nurse's musculoskeletal assessment of a patient reveals involuntary twitching of muscle groups. How would the nurse document this observation in the patient's chart? A) Tetany B) Atony C) Clonus D) Fasciculations

Answer- D Fasciculations Explanation: Fasciculation is involuntary twitching of muscle fiber groups. Clonus is a series of involuntary, rhythmic, muscular contractions and tetany is involuntary muscle contraction, but neither is characterized as "twitching." Atony is a loss of muscle strength.

Most cases of osteomyelitis are caused by which of the following microorganisms? A. Staphylococcus B. Proteus C. Pseudomonas D. Escherichia colli

Answer- Staphylococcus Explanation: Staphylococcus aureus causes 70% to 80% of bone infections. Proteus species are frequently found in osteomyelitis, but they do not cause the majority of bone infections. Pseudomonas species are frequently found in osteomyelitis, but they do not cause most bone infections. While E. coli is frequently found in osteomyelitis, it does not cause the majority of bone infections.

When assessing a patient's peripheral nerve function, the nurse uses an instrument to prick the fat pad at the top of the patient's small finger. This action will assess which of the following nerves? A) Radial B) Ulnar C) Median D) Tibial

Answer: B ulnar Explanation: The ulnar nerve is assessed for sensation by pricking the fat pad at the top of the small finger. The radial, median, and tibial nerves are not assessed in this manner.

An older adult patient has symptoms of osteoporosis and is being assessed during her annual physical examination. The assessment shows that the patient will require further testing related to a possible exacerbation of her osteoporosis. The nurse should anticipate what diagnostic test? A) bone densitometry B) hip bone radiography C) Computed tomography (CT) D) Magnetic resonance imaging (MRI)

Answer: a Explanation: Bone densitometry is considered the most accurate test for osteoporosis and for predicting a fracture. As such, it is more likely to be used than CT, MRI, or x-rays.

What are osteocytes function?

Are mature bone bone cells involved in lacunae ( bone matrix units)

When does pain worsen with someone who has osteoarthritis?

As the day progresses

What is an oblique fracture?

At an angle across the bone

What is a compression fracture?

Bone has been compressed (seen in vertebral fractures)

What is a comminuted fracture?

Bone has splintered into several fragments.

What is an isotonic contraction?

Characterized by the shortening of the muscle without an increase in tension within the muscle; an example of this is flexing the forearm.

What is an open fracture?

Damage also involves the skin or mucous membranes "compound fracture"

Bone pain

Described as a dull deep ache that is "boring" in nature

Muscular pain

Described as soreness or aching and is referred to as "muscle cramps"

What is disuse syndrome?

Deterioration of body systems as a result of prescribed or unavoidable musculoskeletal inactivity. To prevent this isometric exercises are recommended. Muscle setting exercises are useful in maintaining muscles needed for running.

What worsens pain in compartment syndrome?

Elevating the extremity.

What is a fat emboli?

Fat embolism syndrome is characterized by fever, tachycardia, tachypnea, and hypoxia. Arterial blood gas findings include a partial pressure of oxygen (PaO2) less than 60 mm Hg, with early respiratory alkalosis and later respiratory acidosis.

What are the normal uric acid levels?

Female: 2.4-6.0 mg/dL Male: 3.4-7.0 mg/dL

What is an epiphyseal fracture?

Fracture of the epiphysis

What is a depressed fracture?

Fragments are driven inward (skull and facial bones)

Examples of ball and socket joints

Hip and shoulder permit full freedom of movement

When is pain worse in someone with a rheumatic disorder or tendinitis?

In the morning for rheumatic disorder and for tendinitis worsens early morning and eases by midday.

What is kyphosis?

Increased forward curvature of the thoracic spine that causes bowing or rounding of the back. Can occur at any age and may be caused by degenerative disorders of the spine (arthritis or disk degeneration), fractures related to osteoporosis, and injury or trauma.

What is a sprain?

Injury to ligaments and tendons that surround a joint. Caused by a twisting motion or hyper extension of a joint.

Joint pain

Is felt around or in the joint and typically worsens with movement.

When someone has decreased mobility from a cast, traction, or bed rest what can they do to keep their strength up?

Isometric exercises

What is gout?

It is a musculoskeletal joint disorder which causes inflammation of joints and is very painful. Diagnosed by the levels of uric acid in the body.

Pain that increases with activity may indicate?

Joint sprain, muscle strain, or compartment syndrome

What are osteoclasts?

Located in howships lacunae (small pits in bone) multi nuclear cells involved in dissolving and resorbing bone.

What is a chrondosarcoma?

Malignant tumors of hyaline cartilage

What is the nurses first priority when someone is wearing a cast, brace, or splint?

Neurovascular status!

What is a greenstick fracture?

One side of bone is broken and the other is bent.

What is their risk for in an open fracture?

Osteomyelitis, gas gangrene, and tetanus. IV antibiotics are given immediately at arrival at the hospital.

What is the most common bone tumor? Metastatic bone tumors that is.

Osteosarcoma which is a fatal primary malignant tumor. Most are secondary to other types of cancer

What is a subluxation?

Parital dislocation and does not cause as much deformity as a complete dislocation.

Examples of hinge joints

Permit bending in only one direction either flexion or extension.

What are long bones designed for?

Protect vital organs

Unstable hip fracture?

Requires immediate treatment in the ED.

What are osteoblasts function?

Secrete bone matrix

Fracture pain

Sharp and piercing and is relieved by immobilization

When is skin traction needed?

Short term stabilization of a fractured leg, to control muscle spasms, immobilize an area before surgery.

Who is at highest risk of developing osteoporosis?

Small framed Asian or Caucasian women.

What is petaling?

Smooths the edges of the cast

What is a Volkmann contracture?

Specific type of compartment syndrome. Contracture of the wrist and fingers from obstructed arterial blood flow to the forearm and hand. Unable to extend fingers, describes abnormal sensation (unrelenting pain, pain on passive stretch), and exhibits signs of diminished circulation to the hand.

Why are splints and braces used instead of casts?

Splints dont require rigid immobilization, when swelling is anticipated, and those that need special skin care. Braces are used to provide support, control movement, and prevent additional injury. Used longer than splints are used.

What are long bones designed for?

Weight bearing and movement

What should be avoided in someone with osteomyelitis?

Weight bearing exercise and stress to the bone.

When should a sling be used?

When they ambulate to prevent pressure on the cervical spinal nerves, the sling should distribute the supported weight over a large area of the shoulders and trunk not just the back of the neck. Encourage them to remove arm and elevate it frequently.

How much vitamin D is needed daily?

Young adults need 600 IU, older adults need 800-1,000 IU

Which of the following diagnostic studies are done to relieve joint pain due to effusion?

answer-arthrocentesis

When someone gets an external fixation device inserted what are the nursing actions?

-Monitor every 2-4 hours report changes. -Assess each pin site 8-12 hours for signs of infection warmth purulent drainage. -in the first 48 hours serous drainage and mild redness are normal -aseptic technique is required. -cleanse each pin site separately with a cotton tip swab or gauze. -Never tighten or loosen pins, if you notice one has come loose notify immediately.

How is hip dislocation prevented after a hip replacement?

-Never put your legs together or cross them -An abductor pillow will be used to keep the legs apart -Hip should never be flexed more than 90 degrees -Remind them not to flex the affected hip.

Explain a quadriceps setting exercise?

-Position them supine with leg extended -Instruct them to "push back" onto the mattress by contracting the anterior thigh muscles. -Encourage them to hold the position 5-10 seconds. -Let them relax. -Have them repeat 10x each hour when awake.

What is hypercalcemia?

-Symptoms are muscular weakness, in coordination, anorexia, nausea, and vomiting, constipation, electrocardiographic changes(shortened QT interval and ST segment, bradycardia, heart blocks), altered mental status (confusion, lethargy, psychotic behavior) -Treated with IV infusion of normal saline, diuresis, mobilization, and bisophosphinates. -Encourage patient to increase activity and walking.

Which statement by a staff nurse on the orthopedic floor indicates the need for further staff education? A. B. C. D.

Answer- "The client is receiving physical therapy twice per day, so he doesn't need a continuous passive motion device." Explanation: Further staff education is needed when the nurse states that the continuous passive motion device isn't needed because the client receives physical therapy twice per day. The continuous passive motion device should be used in conjunction with physical therapy because the device helps prevent adhesions. Bleeding is a complication associated with the continuous passive motion device; skin integrity should be monitored while the device is in use.

A patient is scheduled for a bone scan to rule out osteosarcoma of the pelvic bones. What would be most important for the nurse to assess before the patient's scan? A) That the patient completed the bowel cleansing regimen B) That the patient emptied the bladder C) That the patient is not allergic to penicillins D) That the patient has fasted for at least 8 hours

Answer- B that the patient emptied their bladder Explanation: Before the scan, the nurse asks the patient to empty the bladder, because a full bladder interferes with accurate scanning of the pelvic bones. Bowel cleansing and fasting are not indicated for a bone scan and an allergy to penicillins is not a contraindication.

A public health nurse is organizing a campaign that will address the leading cause of musculoskeletal-related disability in the United States. The nurse should focus on what health problem? A) Osteoporosis B) Arthritis C) hip fractures D) Lower back pain

Answer- b Explanation: The leading cause of musculoskeletal-related disability in the United States is arthritis.

Which medication taken by the client in the previous 24 hours would be of greatest concern to the nurse caring for a client undergoing a bone biopsy? A. Aspirin B. C. D.

Answer-Aspirin Explanation: Aspirin has anti-clotting properties, and bone is a very vascular tissue. The client taking aspirin in close proximity to a bone biopsy is at increased risk for excessive bleeding.

A patient injured in a motor vehicle accident has sustained a fracture to the diaphysis of the right femur. Of what is the diaphysis of the femur mainly constructed? A) Epiphyses B) Cartilage C) Cortical bone D) Cancellous bone

Answer: C Explanation: The long bone shaft, which is referred to as the diaphysis, is constructed primarily of cortical bone.

What is a stable hip fracture?

-Treated with a few days of bed rest, and symptom management until discomfort is gone. Fluids, anti-embolism stockings, dietary fiber, ankle and leg exercises, logrolling, deep breathing, and skin care reduce the risk of complications -fractured sacrum is at risk for paralytic ileus so monitor bowel sounds.

What are signs of a DVT?

-Unilateral calf tenderness, warmth, redness, and swelling. -Notify provider immediately.

A patient is receiving ongoing nursing care for the treatment of Parkinson's disease. When assessing this patient's gait, what finding is most closely associated with this health problem? A) Spastic hemiparesis gait B) Shuffling gait C) Rapid gait D) Steppage gait

Answer- B shuffling gait Explanation: A variety of neurologic conditions are associated with abnormal gaits, such as a spastic hemiparesis gait (stroke), steppage gait (lower motor neuron disease), and shuffling gait (Parkinson's disease). A rapid gait is not associated with Parkinson's disease.

When performing a physical assessment of a client, the client reports numbness, tingling, and pain when the nurse percusses lightly over the median nerve. The nurse recognizes that this finding is consistent with: A. B. C. D.

Answer- Carpel tunnel syndrome Explanation: Tinel's sign (numbness, tingling, and pain in response to light percussion over the median nerve) is a positive finding for carpal tunnel syndrome.

Which of the following terms refers to a fracture in which one side of a bone is broken and the other side is bent? A. Greenstick B. Spiral C. Avulsion D. Oblique

Answer- Greenstick Explanation: A greenstick fracture is a fracture in which one side of a bone is broken and the other side is bent. A spiral fracture is a fracture twisting around the shaft of the bone. An avulsion is the pulling away of a fragment of bone by a ligament or tendon and its attachment. An oblique is a fracture occurring at an angle across the bone

What is an impacted fracture?

A bone fragment is driven into another bone fragment.

A nurse is caring for a patient who has just had an arthroscopy as an outpatient and is getting ready to go home. The nurse should teach the patient to monitor closely for what postprocedure complication? A) Fever B) Crepitus C) Fasciculations D) Synovial fluid leakage

Answer- A fever Explanation: Following arthroscopy, the patient and family are informed of complications to watch for, including fever. Synovial fluid leakage is unlikely and crepitus would not develop as a postprocedure complication. Fasciculations are muscle twitches and do not involve joint integrity or function.

The results of a nurse's musculoskeletal examination show an increase in the lumbar curvature of the spine. The nurse should recognize the presence of what health problem? A) Osteoporosis B) Kyphosis C) Lordosis D) Scoliosis

Answer- C lordosis Explanation: The nurse documents the spinal abnormality as lordosis. Lordosis is an increase in lumbar curvature of the spine. Kyphosis is an increase in the convex curvature of the spine. Scoliosis is a lateral curvature of the spine. Osteoporosis is the significant loss of bone mass and strength with an increased risk for fracture.

While assessing a patient, the patient tells the nurse that she is experiencing rhythmic muscle contractions when the nurse performs passive extension of her wrist. What is this pattern of muscle contraction referred to as? A) Fasciculations B) Contractures C) Effusion D) Clonus

Answer- D clonus Explanation: Clonus may occur when the ankle is dorsiflexed or the wrist is extended. It is characterized as rhythmic contractions of the muscle. Fasciculation is involuntary twitching of muscle fiber groups. Contractures are prolonged tightening of muscle groups and an effusion is the pathologic escape of body fluid.

Explain a gluteal setting exercise?

-Position them supine with legs extended, if possible. -Instruct them to contract the muscles of their butt. -Hold the contraction for 5-10 seconds -Let them relax -Repeat 10x every hour while awake.

What is tinel's sign?

-Tell-tale sign of carpal tunnel syndrome, occurs when the median nerve area is palpated and tingling, numbness, and pain are reported. This is a positive tinel's sign.

A patient is complaining of pain in her casted leg. The nurse has administered analgesics and elevated the limb. Thirty minutes after administering the analgesics, the patient states the pain is unrelieved. The nurse should identify the warning signs of what complication? A) Subcutaneous emphysema B) Skin breakdown C) Compartment syndrome D) Disuse syndrome

Answer- C compartment syndrome Explanation: Compartment syndrome may manifest as unrelenting, uncontrollable pain. This presentation of pain is not suggestive of disuse syndrome or skin breakdown. Subcutaneous emphysema is not a complication of casting.

The nurse is assessing a patient for dietary factors that may influence her risk for osteoporosis. The nurse should question the patient about her intake of what nutrients? Select all that apply. A) Calcium B) Simple carbohydrates C) Vitamin D D) Protein E) Soluble fiber

(Answers- A, C) Calcium and vitamin D Explanation: A patient's risk for osteoporosis is strongly influenced by vitamin D and calcium intake. Carbohydrate, protein, and fiber intake do not have direct effect on the development of osteoporosis.

How many mg of calcium daily to maintain adult bone mass and what are good sources?

1,000-1,200 mg daily and low-fat milk, yogurt, and cheese. Orange juice, cereals, and bread are also beneficial. Calcium is needed to absorb vitamin D.

The orthopedic surgeon has prescribed balanced skeletal traction for a patient. What advantage is conferred by balanced traction? A) Balanced traction can be applied at night and removed during the day. B) Balanced traction allows for greater patient movement and independence than other forms of traction. C) Balanced traction is portable and may accompany the patient's movements. D) Balanced traction facilitates bone remodeling in as little as 4 days.

Answer- B Balanced traction allows for greater patient movement and independence than other forms of traction. Explanation: Often, skeletal traction is balanced traction, which supports the affected extremity, allows for some patient movement, and facilitates patient independence and nursing care while maintaining effective traction. It is not portable, however, and it cannot be removed. Bone remodeling takes longer than 4 days.

A nurse's assessment of a teenage girl reveals that her shoulders are not level and that she has one prominent scapula that is accentuated by bending forward. The nurse should expect to read about what health problem in the patient's electronic health record? A) Lordosis B) Kyphosis C) Scoliosis D) Muscular dystrophy

Answer- C scoliosis Explanation: Scoliosis is evidenced by an abnormal lateral curve in the spine, shoulders that are not level, an asymmetric waistline, and a prominent scapula, accentuated by bending forward. Lordosis is the curvature in the lower back; kyphosis is an exaggerated curvature of the upper back. This finding is not suggestive of muscular dystrophy.

A client who is undergoing skeletal traction complains of pressure on bony areas. Which action would be most appropriate to provide comfort for the client? A. Changing position within prescribed limits B. Give analgesics as prescribed C. Warm compresses D. Patient should exercise

Answer- Change positions within prescribed limits. Explanation: Changing the position of a client within prescribed limits helps relieve pressure on bony areas and promotes comfort. Analgesics help to relive pain but may not help relieve pressure on bony areas. Warm compresses aid blood circulation. The client should not exercise while on traction unless prescribed to regain strength in the affected limb

A nurse is performing a musculoskeletal assessment of a patient with arthritis. During passive range-of-motion exercises, the nurse hears an audible grating sound. The nurse should document the presence of which of the following? A) Fasciculations B) Clonus C) Effusion D) Crepitus

Answer- D crepitus Explanation: Crepitus is a grating, crackling sound or sensation that occurs as the irregular joint surfaces move across one another, as in arthritic conditions. Fasciculations are involuntary twitching of muscle fiber groups. Clonus is the rhythmic contractions of a muscle. Effusion is the collection of excessive fluid within the capsule of a joint.

A nurse is assessing a child who has a diagnosis of muscular dystrophy. Assessment reveals that the child's muscles have greater-than-normal tone. The nurse should document the presence of which of the following? A) Tonus B) Flaccidity C) Atony D) Spasticity

Answer- D spasticity Explanation: A muscle with greater-than-normal tone is described as spastic. Soft and flabby muscle tone is defined as atony. A muscle that is limp and without tone is described as being flaccid. The state of readiness known as muscle tone (tonus) is produced by the maintenance of some of the muscle fibers in a contracted state.

A nurse is caring for a patient who has had a plaster arm cast applied. Immediately postapplication, the nurse should provide what teaching to the patient? A) The cast will feel cool to touch for the first 30 minutes. B) The cast should be wrapped snuggly with a towel until the patient gets home. C) The cast should be supported on a board while drying. D) The cast will only have full strength when dry.

Answer- D the cast will only have full strength when it's dried. Explanation: A cast requires approximately 24 to 72 hours to dry, and until dry, it does not have full strength. While drying, the cast should not be placed on a hard surface. The cast will exude heat while it dries and should not be wrapped.

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

Answer- Large doses of IV antibiotics Explanation: Treatment of acute osteomyelitis includes large doses of I.V. antibiotics (after blood cultures identify the infecting organism). Surgical drainage may be indicated, and the affected bone is immobilized. The client usually requires I.V. fluids to maintain hydration, but oral intake isn't necessarily prohibited.

Which of the following is an appropriate priority nursing diagnosis for the client following an arthrocentesis? A. B. C. D.

Answer- Risk for infection: The priority nursing diagnosis following an arthrocentesis is risk for infection. The client may experience acute pain. The client needs adequate information before experiencing the procedure

A family member is caring for an older adult client with osteomalacia in the home. When the home health nurse comes to evaluate the client, what should be a focus point of the visit? A. Observe for safety hazards that could cause falls B. Give a daily bath C. Make sure they have enough to eat D. Make sure they have enough money

Answer-Observing for safety hazards that could be a fall risk Explanation: Clients with osteomalacia exhibit a waddling type of gait, putting them at risk for falls and fractures. Safety would be the priority in this circumstance such as scatter rugs, loose boards, and stairs. Older adult clients do not require a daily bath, and it may dry the skin. Nutrition is a necessity to question but the priority would be safety. Whether the client has adequate financial resources would be referred to social service.

What is hallux valgus?

A deformity in which the big toe deviates laterally.

A nurse on the orthopedic unit is assessing a patient's peroneal nerve. The nurse will perform this assessment by doing which of the following actions? A) Pricking the skin between the great and second toe B) Stroking the skin on the sole of the patient's foot C) Pinching the skin between the thumb and index finger D) Stroking the distal fat pad of the small finger

Answer- A Explanation: The nurse will evaluate the sensation of the peroneal nerve by pricking the skin centered between the great and second toe. None of the other listed actions elicits the function of one of the peripheral nerves.

A nurse is performing a nursing assessment of a patient suspected of having a musculoskeletal disorder. What is the primary focus of the nursing assessment with a patient who has a musculoskeletal disorder? A) Range of motion B) Activities of daily living C) Gait D) Strength

Answer- B activities of daily living Explanation: The nursing assessment is primarily a functional evaluation, focusing on the patient's ability to perform activities of daily living. The nurse also assesses strength, gait, and ROM, but these are assessed to identify their effect on functional status rather than to identify a medical diagnosis.

Which of the following orthopedic surgeries is done to correct and align a fracture after surgical dissection and exposure of the fracture? A. Open reduction B. Arthrodesis C. Joint arthroplasty D. Total joint arthroplasty

Answer- Open reduction An open reduction is the correction and alignment of the fracture after surgical dissection and exposure of the fracture. Arthrodesis is immobilizing fusion of a joint. A joint arthroplasty or replacement is the replacement of joint surfaces with metal or synthetic materials. A total joint arthroplasty is the replacement of both the articular surfaces within a joint with metal or synthetic materials.

Diagnostic tests show that a patient's bone density has decreased over the past several years. The patient asks the nurse what factors contribute to bone density decreasing. What would be the nurse's best response? A) "For many people, lack of nutrition can cause a loss of bone density." B) "Progressive loss of bone density is mostly related to your genes." C) "Stress is known to have many unhealthy effects, including reduced bone density." D) "Bone density decreases with age, but scientists are not exactly sure why this is the case."

Answer- A "For many people, lack of nutrition can cause a loss of bone density." Explanation: Nutrition has a profound effect on bone density, especially later life. Genetics are also an important factor, but nutrition has a more pronounced effect. The pathophysiology of bone density is well understood and psychosocial stress has a minimal effect.

The nurse is performing an assessment of a patient's musculoskeletal system and is appraising the patient's bone integrity. What action should the nurse perform during this phase of assessment? A) Compare parts of the body symmetrically. B) Assess extremities when in motion rather than at rest. C) Percuss as many joints as are accessible. D) Administer analgesia 30 to 60 minutes before assessment.

Answer- A compare pets of the body symmetrically Explanation: When assessing bone integrity, symmetric parts of the body, such as extremities, are compared. Analgesia should not be necessary and percussion is not a clinically useful assessment technique. Bone integrity is best assessed when the patient is not moving.

A patient is undergoing diagnostic testing for suspected Paget's disease. What assessment finding is most consistent with this diagnosis? A) Altered serum magnesium levels B) Altered serum calcium levels C) Altered serum potassium levels D) Altered serum sodium levels

Answer- B altered serum calcium levels Explanation: Serum calcium levels are altered in patients with osteomalacia, parathyroid dysfunction, Paget's disease, metastatic bone tumors, or prolonged immobilization. Paget's disease is not directly associated with altered magnesium, potassium, or sodium levels

A patient with a total hip replacement is progressing well and expects to be discharged tomorrow. On returning to bed after ambulating, he complains of a new onset of pain at the surgical site. What is the nurse's best action? A) Administer pain medication as ordered. B) Assess the surgical site and the affected extremity. C) Reassure the patient that pain is a direct result of increased activity. D) Assess the patient for signs and symptoms of systemic infection.

Answer- B assess the surgical site and the affected extremity Explanation: Worsening pain after a total hip replacement may indicate dislocation of the prosthesis. Assessment of pain should include evaluation of the wound and the affected extremity. Assuming he's anxious about discharge and administering pain medication do not address the cause of the pain. Sudden severe pain is not considered normal after hip replacement. Sudden pain is rarely indicative of a systemic infection.

A nurse is caring for an older adult who has been diagnosed with geriatric failure to thrive. This patient's prolonged immobility creates a risk for what complication? A) Muscle clonus B) Muscle atrophy C) Rheumatoid arthritis D) Muscle fasciculations

Answer- B muscle atrophy Explanation: If a muscle is in disuse for an extended period of time, it is at risk of developing atrophy, which is the decrease in size. Clonus is a pattern of rhythmic muscle contractions and fasciculation is the involuntary twitch of muscle fibers; neither results from immobility. Lack of exercise is a risk factor for rheumatoid arthritis.

A nurse is caring for a patient who has been scheduled for a bone scan. What should the nurse teach the patient about this diagnostic test? A) "The test is brief and requires that you drink a calcium solution 2 hours before the test." B) "You will not be allowed fluid for 2 hours before and 3 hours after the test." C) "You'll be encouraged to drink water after the administration of the radioisotope injection." D) "This is a common test that can be safely performed on anyone."

Answer- C "You'll be encouraged to drink water after the administration of the radioisotope injection." Explanation: It is important to encourage the patient to drink plenty of fluids to help distribute and eliminate the isotopic after it is injected. There are important contraindications to the procedure, include pregnancy or an allergy to the radioisotope. The test requires the injection of an intravenous radioisotope and the scan is preformed 2 to 3 hours after the isotope is injected. A calcium solution is not utilized.

A patient broke his arm in a sports accident and required the application of a cast. Shortly following application, the patient complained of an inability to straighten his fingers and was subsequently diagnosed with Volkmann contracture. What pathophysiologic process caused this complication? A) Obstructed arterial blood flow to the forearm and hand B) Simultaneous pressure on the ulnar and radial nerves C) Irritation of Merkel cells in the patient's skin surfaces D) Uncontrolled muscle spasms in the patient's forearm

Answer- A Obstructed arterial blood flow to the forearm and hand Explanation: Volkmann contracture occurs when arterial blood flow is restricted to the forearm and hand and results in contractures of the fingers and wrist. It does not result from nerve pressure, skin irritation, or spasms.

A child is growing at a rate appropriate for his age. What cells are responsible for the secretion of bone matrix that eventually results in bone growth? A) Osteoblasts B) Osteocytes C) Osteoclasts D) Lamellae

Answer- A osteoblasts Explanation: Osteoblasts function in bone formation by secreting bone matrix. Osteocytes are mature bone cells and osteoclasts are multinuclear cells involved in dissolving and resorbing bone. Lamellae are circles of mineralized bone matrix.

A patient has been experiencing progressive increases in knee pain and diagnostic imaging reveals a worsening effusion in the synovial capsule. The nurse should anticipate which of the following? A) Arthrography B) Knee biopsy C) Arthrocentesis D) Electromyography

Answer- C arthrocentesis Explanation: Arthrocentesis (joint aspiration) is carried out to obtain synovial fluid for purposes of examination or to relieve pain due to effusion. Arthrography, biopsy, and electromyography would not remove fluid and relieve pressure.

A patient has just had an arthroscopy performed to assess a knee injury. What nursing intervention should the nurse implement following this procedure? A) Wrap the joint in a compression dressing. B) Perform passive range of motion exercises. C) Maintain the knee in flexion for up to 30 minutes. D) Apply heat to the knee.

Answer- A wrap the joint in a compression dressing. Explanation: Interventions to perform following an arthroscopy include wrapping the joint in a compression dressing, extending and elevating the joint, and applying ice or cold packs. Passive ROM exercises, static flexion, and heat are not indicated.

A nurse is caring for a patient whose cancer metastasis has resulted in bone pain. Which of the following are typical characteristics of bone pain? A) A dull, deep ache that is "boring" in nature B) Soreness or aching that may include cramping C) Sharp, piercing pain that is relieved by immobilization D) Spastic or sharp pain that radiates

Answer- a Explanation: Bone pain is characteristically described as a dull, deep ache that is "boring" in nature, whereas muscular pain is described as soreness or aching and is referred to as "muscle cramps." Fracture pain is sharp and piercing and is relieved by immobilization. Sharp pain may also result from bone infection with muscle spasm or pressure on a sensory nerve.

The nurse's comprehensive assessment of an older adult involves the assessment of the patient's gait. How should the nurse best perform this assessment? A) Instruct the patient to walk heel-to-toe for 15 to 20 steps. B) Instruct the patient to walk in a straight line while not looking at the floor. C) Instruct the patient to walk away from the nurse for a short distance and then toward the nurse. D) Instruct the patient to balance on one foot for as long as possible and then walk in a circle around the room.

Answer- C Instruct the patient to walk away from the nurse for a short distance and then toward the nurse. Explanation: Gait is assessed by having the patient walk away from the examiner for a short distance. The examiner observes the patient's gait for smoothness and rhythm. Looking at the floor is not disallowed and gait is not assessed by observing balance on one leg. Heel-to-toe walking ability is not gauged during an assessment of normal gait.

A clinic nurse is caring for a patient with a history of osteoporosis. Which of the following diagnostic tests best allows the care team to assess the patient's risk of fracture? A) Arthrography B)vBone scan C) Bone densitometry D) Arthroscopy

Answer- C bone densitometry Explanation: Bone densitometry is used to detect bone density and can be used to assess the risk of fracture in osteoporosis. Arthrography is used to detect acute or chronic tears of joint capsule or supporting ligaments. Bone scans can be used to detect metastatic and primary bone tumors, osteomyelitis, certain fractures, and aseptic necrosis. Arthroscopy is used to visualize a joint.

A nurse is caring for a patient who is in skeletal traction. To prevent the complication of skin breakdown in a patient with skeletal traction, what action should be included in the plan of care? A) Apply occlusive dressings to the pin sites. B) Encourage the patient to push up with the elbows when repositioning. C) Encourage the patient to perform isometric exercises once a shift. D) Assess the pin insertion site every 8 hours.

Answer- D assess pin insertion site every 8 hours. Explanation: The pin insertion site should be assessed every 8 hours for inflammation and infection. Loose cover dressings should be applied to pin sites. The patient should be encouraged to use the overhead trapeze to shift weight for repositioning. Isometric exercises should be done 10 times an hour while awake.

A patient is admitted to the unit in traction for a fractured proximal femur and requires traction prior to surgery. What is the most appropriate type of traction to apply to a fractured proximal femur? A) Russell's traction B) Dunlop's traction C) Buck's extension traction D) Cervical head halter

Answer- C buck's extension traction Explanation: Buck's extension is used for fractures of the proximal femur. Russell's traction is used for lower leg fractures. Dunlop's traction is applied to the upper extremity for supracondylar fractures of the elbow and humerus. Cervical head halters are used to stabilize the neck.

The human body is designed to protect its vital parts. A fracture of what type of bone may interfere with the protection of vital organs? A) Long bones B) Short bones C) Flat bones D) Irregular bones

Answer- C flat bones Explanation: Flat bones, such as the sternum, provide vital organ protection. Fractures of the flat bones may lead to puncturing of the vital organs or may interfere with the protection of the vital organs. Long, short, and irregular bones do not usually have this physiologic function.

The nurse is caring for a patient who underwent a total hip replacement yesterday. What should the nurse do to prevent dislocation of the new prosthesis? A) Keep the affected leg in a position of adduction. B) Have the patient reposition himself independently. C) Protect the affected leg from internal rotation. D) Keep the hip flexed by placing pillows under the patient's knee.

Answer- C protect the affected leg from internal rotation. Explanation: Abduction of the hip helps to prevent dislocation of a new hip joint. Rotation and adduction should be avoided. While the hip may be flexed slightly, it shouldn't exceed 90 degrees and maintenance of flexion isn't necessary. The patient may not be capable of safe independent repositioning at this early stage of recovery.

A patient has had a cast placed for the treatment of a humeral fracture. The nurse's most recent assessment shows signs and symptoms of compartment syndrome. What is the nurse's most appropriate action? A) Arrange for a STAT assessment of the patient's serum calcium levels. B) Perform active range of motion exercises. C) Assess the patient's joint function symmetrically. D) Contact the primary care provider immediately.

Answer- D contact the provider immediately Explanation: This major neurovascular problem is caused by pressure within a muscle compartment that increases to such an extent that microcirculation diminishes, leading to nerve and muscle anoxia and necrosis. Function can be permanently lost if the anoxic situation continues for longer than 6 hours. Therefore, immediate medical care is a priority over further nursing assessment. Assessment of calcium levels is unnecessary.

An x-ray demonstrates a fracture in which a bone has splintered into several pieces. Which type of fracture is this? A. Comminuted fracture B. Compound fracture C. Depressed fracture D. Impacted fracture

Answer-Comminuted Explanation:A comminuted fracture may require open reduction and internal fixation. A compound fracture is one in which damage also involves the skin or mucous membranes. A depressed fracture is one in which fragments are driven inward. An impacted fracture is one in which a bone fragment is driven into another bone fragment.

A nurse is taking a health history on a patient with musculoskeletal dysfunction. What is the primary focus of this phase of the nurse's assessment? A) Evaluating the effects of the musculoskeletal disorder on the patient's function B) Evaluating the patient's adherence to the existing treatment regimen C) Evaluating the presence of genetic risk factors for further musculoskeletal disorders D) Evaluating the patient's active and passive range of motion

Answer- A Evaluating the effects of the musculoskeletal disorder on the patient's function Explanation: The nursing assessment of the patient with musculoskeletal dysfunction includes an evaluation of the effects of the musculoskeletal disorder on the patient. This is a vital focus of the health history and supersedes the assessment of genetic risk factors and adherence to treatment, though these are both valid inclusions to the interview. Assessment of ROM occurs during the physical assessment, not the interview.

The nurse educator on an orthopedic trauma unit is reviewing the safe and effective use of traction with some recent nursing graduates. What principle should the educator promote? A) Knots in the rope should not be resting against pulleys. B) Weights should rest against the bed rails. C) The end of the limb in traction should be braced by the footboard of the bed. D) Skeletal traction may be removed for brief periods to facilitate the patient's independence.

Answer- A Knots in the rope should not be resting against pulleys. Explanation: Knots in the rope should not rest against pulleys, because this interferes with traction. Weights are used to apply the vector of force necessary to achieve effective traction and should hang freely at all times. To avoid interrupting traction, the limb in traction should not rest against anything. Skeletal traction is never interrupted.

A patient has been experiencing an unexplained decline in knee function and has consequently been scheduled for arthrography. The nurse should teach the patient about what process? A) Injection of a contrast agent into the knee joint prior to ROM exercises B) Aspiration of synovial fluid for serologic testing C) Injection of corticosteroids into the patient's knee joint to facilitate ROM D) Replacement of the patient's synovial fluid with a synthetic substitute

Answer- A injection of a contrast agent into the knee joint prior to ROM exercises. Explanation: During arthrography, a radiopaque contrast agent or air is injected into the joint cavity to visualize the joint structures such as the ligaments, cartilage, tendons, and joint capsule. The joint is put through its range of motion to distribute the contrast agent while a series of x-rays are obtained. Synovial fluid is not aspirated or replaced and corticosteroids are not administered.

A patient's fracture is healing and callus is being deposited in the bone matrix. This process characterizes what phase of the bone healing process? A) The reparative phase B) The reactive phase C) The remodeling phase D) The revascularization phase

Answer- A reparative phase Explanation: Callus formation takes place during the reparative phase of bone healing. The reactive phase occurs immediately after injury and the remodeling phase builds on the reparative phase. There is no discrete revascularization phase.

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

Answer- Arthrogram Explanation:An arthrogram is a radiographic examination of a joint, usually the knee or shoulder. The physician first injects a local anesthetic and then inserts a needle into the joint space. Fluoroscopy may be used to verify correct placement of the needle. The synovial fluid in the joint is aspirated and sent to the laboratory for analysis. A contrast medium is then injected, and x-ray films are taken. Arthroscopy is the internal inspection of a joint using an instrument called an arthroscope. Arthrocentesis is the aspiration of synovial fluid. The client receives local anesthesia just before this procedure. The physician inserts a large needle into the joint and removes the fluid. This can be done during an arthrogram or arthroscopy. Bone densitometry estimates bone density using radiography or advanced radiographic techniques

While assessing a patient who has had knee replacement surgery, the nurse notes that the patient has developed a hematoma at the surgical site. The affected leg has a decreased pedal pulse. What would be the priority nursing diagnosis for this patient? A) Risk for Infection B) Risk for Peripheral Neurovascular Dysfunction C) Unilateral Neglect D) Disturbed Kinesthetic Sensory Perception

Answer- B Risk for Peripheral Neurovascular Dysfunction Explanation: The hematoma may cause an interruption of tissue perfusion, so the most appropriate nursing diagnosis is Risk of Peripheral Neurovascular Dysfunction. There is also an associated risk for infection because of the hematoma, but impaired neurovascular function is a more acute threat. Unilateral neglect and impaired sensation are lower priorities than neurovascular status.

A nurse is taking a health history on a new patient who has been experiencing unexplained paresthesia. What question should guide the nurse's assessment of the patient's altered sensations? A) How does the strength in the affected extremity compare to the strength in the unaffected extremity? B) Does the color in the affected extremity match the color in the unaffected extremity? C) How does the feeling in the affected extremity compare with the feeling in the unaffected extremity? D) Does the patient have a family history of paresthesia or other forms of altered sensation?

Answer- C "How does the feeling in the affected extremity compare with the feeling in the unaffected extremity?" Explanation: Questions that the nurse should ask regarding altered sensations include "How does this feeling compare to sensation in the unaffected extremity?" Asking questions about strength and color are not relevant and a family history is unlikely.

A nurse is caring for a patient who has a leg cast. The nurse observes that the patient uses a pencil to scratch the skin under the edge of the cast. How should the nurse respond to this observation? A) Allow the patient to continue to scratch inside the cast with a pencil but encourage him to be cautious. B) Give the patient a sterile tongue depressor to use for scratching instead of the pencil. C) Encourage the patient to avoid scratching, and obtain an order for an antihistamine if severe itching persists. D) Obtain an order for a sedative, such as lorazepam (Ativan), to prevent the patient from scratching.

Answer- C Encourage the patient to avoid scratching, and obtain an order for an antihistamine if severe itching persis Explanation: Scratching should be discouraged because of the risk for skin breakdown or damage to the cast. Most patients can be discouraged from scratching if given a mild antihistamine, such as diphenhydramine, to relieve itching. Benzodiazepines would not be given for this purpose.

The nurse is caring for a client with an external fixator that requires pin care twice a day. The nurse observes that there is a new purulent drainage around one of the pins. What intervention should the nurse anticipate doing? A. Obtain a culture B. Scrub drainage off C. Use iodine based products D. Apply ointment

Answer- Obtaining a culture Explanation:A culture should be obtained if purulent drainage is present. Drainage should be gently removed, not scrubbed. Iodine-based products interfere with tissue healing and are not recommended for cleaning pin sites. Ointment should not be applied to the pin site unless specifically ordered

A 12-year-old client fractured her right leg several weeks ago while skiing and is returning to the orthopedist to have her cast removed. What would you expect the physician to prescribe as further treatment? A. B. C. D.

Answer- Physical therapy Explanation: For some time, the limb will need support. An elastic bandage may be wrapped on a leg, the client may use a cane, and an arm may be kept in a sling until progressive active exercise and physical therapy help the client regain normal strength and motion.

A client's cast is removed. The client is worried because the skin appears mottled and is covered with a yellowish crust. What advice should the nurse give the client to address the skin problem? A. Apply lotions/ take warm baths B. Consult a skin specialist C. Scrub vigorously until the skin is gone D. Avoid direct exposure to the sun

Answer- apply lotions/take warm baths Explanation:The client should be advised to apply lotions and take warm baths or soaks. This will help in softening the skin and removing debris. The client usually sheds this residue in a few days so the client need not consult a skin specialist. It is not advisable to scrub the area vigorously. The client need not avoid exposure to direct sunlight because the area is not photosensitive.

A nurse is assessing a patient who is experiencing peripheral neurovascular dysfunction. What assessment findings are most consistent with this diagnosis? A) Hot skin with a capillary refill of 1 to 2 seconds B) Absence of feeling, capillary refill of 4 to 5 seconds, and cool skin C) Pain, diaphoresis, and erythema D) Jaundiced skin, weakness, and capillary refill of 3 seconds

Answer- b Explanation: Indicators of peripheral neurovascular dysfunction include pale, cyanotic, or mottled skin with a cool temperature; capillary refill greater than 3 seconds; weakness or paralysis with motion; and paresthesia, unrelenting pain, pain on passive stretch, or absence of feeling. Jaundice, diaphoresis, and warmth are inconsistent with peripheral neurovascular dysfunction.

A nurse is providing care for a patient whose pattern of laboratory testing reveals longstanding hypocalcemia. What other laboratory result is most consistent with this finding? A) An elevated parathyroid hormone level B) An increased calcitonin level C) An elevated potassium level D) A decreased vitamin D level

Answer-A Explanation: In the response to low calcium levels in the blood, increased levels of parathyroid hormone prompt the mobilization of calcium and the demineralization of bone. Increased calcitonin levels would exacerbate hypocalcemia. Vitamin D levels do not increase in response to low calcium levels. Potassium levels would likely be unaffected.

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

Answer-Elevating the stump for the first 24 hours Explanation: Stump elevation for the first 24 hours after surgery helps reduce edema and pain by increasing venous return and decreasing venous pooling at the distal portion of the extremity. Bed rest isn't indicated and could predispose the client to complications of immobility. Heat application would be inappropriate because it promotes vasodilation, which may cause hemorrhage and increase pain. The initial pressure dressing usually remains in place for 48 to 72 hours after surgery.