Med/Surg -Ortho/MS

The nurse teaches the patient which of the following interventions in order to avoid hip dislocation after replacement surgery? a) Bend forward only when seated in a chair. b) Never cross the affected leg when seated. c) Keep the knees together at all times. d) Avoid placing a pillow between the legs when sleeping.

b) Never cross the affected leg when seated. Explanation: Crossing the affected leg may result in dislocation of the hip joint after total hip replacement. The patient should be taught to keep the knees apart at all times. The patient should be taught to put a pillow between the legs when sleeping. The patient should be taught to avoid bending forward when seated in a chair. pg.1119

Which of the following would be inconsistent as a component of self-care activities for the patient with a cast? a) Cushioning rough edges of the cast with tape b) Elevate the casted extremity to heart level frequently c) Do not attempt to scratch the skin under a cast d) Cover the cast with plastic to insulate it

d) Cover the cast with plastic to insulate it Explanation: The cast should be kept dry, but do not cover it with plastic or rubber because this causes condensation, which dampens the cast and skin. The other activities are consistent with cast care. pg.1104

A nurse is teaching a client with left leg weakness how to walk with a cane. The nurse should instruct the client to proceed in which manner?

hold cane in RIGHT hand (COAL: CANE OPPOSITE AFFECTED LEG - Cane moves with affected leg)

The client with a fractured femur is upset and agitated that skeletal traction will be necessary for 6 to 8 weeks. The client states, "How can I stay like this for weeks? I can't even move!" Based on these statements, the nurse would identify which of the following as the most appropriate nursing diagnosis? a) Ineffective Coping related to prolonged immobility b) Deficient Diversional Activity related to prolonged hospitalization c) Impaired Physical Mobility related to traction d) Activity Intolerance related to impaired mobility

a) Ineffective Coping related to prolonged immobility Explanation: The client is displaying clinical manifestations of anxiety and ineffective coping. pg.1115

Mr. Williams returned to the nursing unit following orthopedic surgery and is complaining of pain. Which of the following interventions will help relieve pain? a) Encourage client to do ROM exercises as indicated. b) Elevate the affected extremity and use cold applications. c) Apply antiembolism stockings as indicated. d) Instruct client to deep breathe and cough every 2 hours until he can ambulate.

b) Elevate the affected extremity and use cold applications. Explanation: Elevating the affected extremity and using cold applications reduce swelling. This intervention helps with maintenance of effective respiratory rate and depth. This intervention helps maintain full ROM of unaffected joints. They help prevent deep vein thrombosis (DVT). pg.1105

For a client with osteoporosis, the nurse should provide which dietary instruction? a) "Decrease your intake of red meat." b) "Eat more fruits to increase your potassium intake." c) "Decrease your intake of popcorn, nuts, and seeds." d) "Eat more dairy products to increase your calcium intake."

"Eat more dairy products to increase your calcium intake."

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

"I don't know if I'll be able to get off that low toilet seat at home by myself."

A client with osteoporosis is prescribed calcitonin (Miacalcin) 100 units subcutaneously. The medication is available 200 units per ml. How many milliliters will the nurse administer to the client?

0.5 Explanation: 100 units x 1 ml/200 units = 0.5 ml. pg.2065

The physician has prescribed plicamycin (Mithracin) to control serum calcium levels in a client with Paget's disease. The dose prescribed is 25 micrograms per kg. The client weighs 132 lbs. How many milligrams will the nurse expect the client to receive?

1.5 Explanation: The client weighs 60 kg (132 lbs/2.2 lbs per kg). The client will receive 1500 micrograms (60 kg x 25 micrograms/kg). 1500 micrograms/1000 micrograms per mg = 1.5 mg. pg.1148

The nurse is reviewing the client's admission assessment and notes that crepitus of the right knee joint was documented. The nurse recognizes that crepitus is: a) Characterized by limited range of motion of a joint b) A grating sound when a joint is put through range of motion c) Excessive fluid within the capsule of a joint d) Characterized by involuntary muscle twitching of the knee

A grating sound when a joint is put through range of motion

Which of the following terms refers to moving away from midline? a) Eversion b) Adduction c) Inversion d) Abduction

Abduction

Which of the following statements describes paresthesia? a) Abnormal sensations b) Involuntary twitch of muscle fibers c) Absence of muscle movement suggesting nerve damage d) Absence of muscle tone

Abnormal sensations

The nurse is required to design a teaching plan for a client with a ruptured Achilles tendon. Which of the following would the nurse emphasize? a) Effective pin care b) Use of nonprescription medications c) Dietary restrictions d) Activity restrictions

Activity restrictions

Which body movement involves moving toward the midline? a) Eversion b) Adduction c) Abduction d) Pronation

Adduction

A 78-year-old client is in the emergency department following a motor-vehicle collision. Radiographs indicate a fractured humerus; the client is awaiting the casting of her upper extremity and admission to the orthopedic unit. Other than her bone, what other physical structures could be affected by this injury? a) All options are correct b) Nerves c) Blood vessels d) Muscles

All options are correct

The primary functions of cartilage are to reduce friction between moving surfaces, absorb shocks, and reduce stress on joint surfaces. Where, in the human body, would you expect to find cartilage? a) Between the ribs b) Between the vertebrae c) Covering elbow joints d) All options are correct

All options are correct

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 and take warm baths or soaks. b) Avoid exposure to direct sunlight. c) Consult a skin specialist. d) Scrub the area vigorously to remove the crust.

Apply lotions and take warm baths or soaks.

During a general musculoskeletal assessment, which of the following would help the nurse determine the client's muscle strength? a) Asking the client to lift specified amounts of weights. b) Examining extremities for symmetry, size, and contour. c) Applying force to the client's extremity as the client pushes against that force. d) Palpating each of the client's muscles and joints.

Applying force to the client's extremity as the client pushes against that force.

The nurse would include which of the following in a neurological assessment? a) Inspect the foot for edema. b) Ask the client to plantar flex the toes. c) Capillary refill of the great toe. d) Palpate the dorsalis pedis pulse.

Ask the client to plantar flex the toes.

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

Bone fracture

Which group is at the greatest risk for osteoporosis? a) Men b) Caucasian women c) African American women d) Asian women

Caucasian women

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 the client's position within prescribed limits. b) Administering prescribed analgesics. c) Assisting with range-of-motion and isometric exercises. d) Applying warm compresses.

Changing the client's position within prescribed limits.

What is the term for a rhythmic contraction of a muscle? a) Atrophy b) Clonus c) Crepitus d) Hypertrophy

Clonus

Which of the following is a neurovascular problem caused by pressure within a muscle area that increases to such an extent that microcirculation diminishes? a) Remodeling b) Hypertrophy c) Compartment syndrome d) Fasciculation

Compartment syndrome

Which of the following refers to a blunt force injury to soft tissue? a) Fracture b) Dislocation c) Strain d) Contusion

Contusion

Which of the following terms refers to a grating or crackling sound or sensation? a) Crepitus b) Clonus c) Fasciculation d) Callus

Crepitus

Which of the following clinical manifestations would the nurse expect to find in a client who has had osteoporosis for several years?

Decreased height

Which of the following terms refers to the shaft of the long bone? a) Epiphysis b) Lordosis c) Diaphysis d) Scoliosis

Diaphysis

A 39-year-old client has been brought to the ED by his teammates. The client was fielding a fly ball, fell, and injured his hip. He cannot place weight on the leg and is in significant pain. After radiographs indicated intact but malpositioned bones, what would you expect the physician to diagnose? a) Dislocation b) Fracture c) Strain d) Sprain

Dislocation

A nurse is inspecting the area of contusion and notes numerous areas of bruising. The nurse would document this finding as which of the following? a) Palsy b) Callus c) Whiplash injury d) Ecchymosis

Ecchymosis

A client presents to the emergency department gently holding the left arm, which is slightly swollen and painful to the touch. Based on these findings, the nurse: a) Positions the arm below the level of the heart b) Elevates the arm and applies a heating pad c) Elevates the arm and applies an ice pack d) Has the client perform active range of motion

Elevates the arm and applies an ice pack

Which of the following are general nursing measures for a patient with a fracture reduction? a) Examining the abdomen for enlarged liver or spleen b) Promoting intake of omega-3 fatty acids c) Encourage participation in ADLs d) Assisting with intake of immune-enhancing tube feeding formulas

Encourage participation in ADLs

A 68-year-old female client who had a total hip replacement is to be discharged because her healing is almost complete. Which of the following would be most important for this client? a) Urging her to keep the affected limb in an elevated position. b) Exploring factors related to the client's home environment. c) Advising the client to avoid red meat. d) Educating the client about the effects of menopause.

Exploring factors related to the client's home environment.

Which term describes a surgical procedure to release constricting muscle fascia so as to relieve muscle tissue pressure? a) Arthroplasty b) Arthrodesis c) Fasciotomy d) Osteotomy

Fasciotomy

Which of the following terms refers to a break in the continuity of a bone? a) Malunion b) Fracture c) Dislocation d) Subluxation

Fracture

Which type of fracture occurs when a bone fragment is driven into another bone fragment? a) Oblique b) Spiral c) Impacted d) Transverse

Impacted

A client undergoes hip-pinning surgery to treat an intertrochanteric fracture of the right hip. The nurse should include which intervention in the postoperative care plan? a) Turning the client from side to side every 2 hours b) Performing passive range-of-motion (ROM) exercises on the client's legs once each shift c) Keeping a pillow between the client's legs at all times d) Maintaining the client in semi-Fowler's position

Keeping a pillow between the client's legs at all times

Which nursing assessment finding is indicative of scoliosis? a) Contractures of the wrists b) Lateral curvature of the spine c) Crepitus of the knee joint d) Loss of 1 inch in height

Lateral curvature of the spine

Which of the following is an inaccurate clinical manifestation of a fracture? a) Deformity b) Lengthening c) Pain d) Crepitus

Lengthening

The client presents with an exaggeration of the lumbar spine curve. The nurse interprets these findings as indicative of: a) Lordosis b) Kyphosis c) Dowager's hump d) Scoliosis

Lordosis

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

No further increase in bone length occurs.

A client's fracture was reduced by surgically exposing the bone and realigning it. The nurse identifies this as which of the following? a) Open reduction b) Internal fixation c) Skeletal traction d) Buck's traction

Open reduction

Which of the following orthopedic surgeries is done to correct and align a fracture after surgical dissection and exposure of the fracture? a) Arthrodesis b) Open reduction c) Joint arthroplasty d) Total joint arthroplasty

Open reduction

Elderly clients who fall are most at risk for which injuries? a) Humerus fractures b) Wrist fractures c) Pelvic fractures d) Cervical spine fractures

Pelvic fractures

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) Discontinue use of crutches b) Physical therapy c) No options are correct d) Apply cold compresses to leg for swelling

Physical therapy

A nurse is caring for a client who underwent a total hip replacement. What should the nurse and other caregivers do to prevent dislocation of the new prosthesis? a) Use measures other than turning to prevent pressure ulcers. b) Prevent internal rotation of the affected leg. c) Keep the hip flexed by placing pillows under the client's knee. d) Keep the affected leg in a position of adduction.

Prevent internal rotation of the affected leg.

After a fracture, during which stage or phase of bone healing is devitalized tissue removed and new bone reorganized into its former structural arrangement? a) Revascularization b) Inflammation c) Reparative d) Remodeling

Remodeling

Which of the following would be most important for the nurse to include in the teaching plan for a client who has undergone arthrography? a) Gently massage joints with any crackling or clicking joint noises. b) Avoid sunlight or harsh, dry climate. c) Avoid intake of dairy products. d) Report joint crackling or clicking noises occurring after the second day.

Report joint crackling or clicking noises occurring after the second day.

A male client, an ace professional tennis player, sprains his right ankle during a tennis match. The client is immediately rushed to the nurse who provides him with first-aid care. Which of the following would the nurse immediately provide? a) Heat, compression, analgesics, and exercise b) Rest, heat, compression, and elevation c) Exercise, ice, compression, and elevation d) Rest, ice, compression, and elevation

Rest, ice, compression, and elevation

The Emergency Department nurse teaches patients with sports injuries to remember the acronym RICE. This acronym stands for which of the following combinations of treatment? a) Rotation, ice, compression, and examination b) Rotation, immersion, compression and elevation c) Rest, ice, circulation, and examination d) Rest, ice, compression, elevation

Rest, ice, compression, elevation

A client is about to have a cast applied to his left arm. The nurse would alert the client to which of the following as the cast is applied? a) Sensation of warmth or heat with application b) Arm being moved to various positions c) Sensation of weakness d) Increased in pain in left arm

Sensation of warmth or heat with application

Which of the following is a risk-lowering strategy for osteoporosis? a) Diet low in calcium and vitamin D b) Smoking cessation c) Low initial bone mass d) Increased age

Smoking cessation

Which of the following terms refers to an injury to ligaments and other soft tissues of a joint? a) Subluxation b) Strain c) Dislocation d) Sprain

Sprain

The majority of bone infections are caused by which of the following organisms? a) Proteus b) Pseudomonas c) Staphylococcus aureus

Staphylococcus aureus

A 45-year-old softball player arrives at the emergency department following his injury while sliding into a base during a game. After his examination and radiographs, the physician diagnoses muscle strain and prescribes appropriate treatment. What does the physician mean with the term "strain"? a) Subluxation of a joint b) Stretched or pulled beyond capacity c) Injuries to ligaments surrounding a joint d) Injury resulting from a blow or blunt trauma

Stretched or pulled beyond capacity

In chronic osteomyelitis, antibiotics are adjunctive therapy in which of the following situations? a) Wound irrigation b) Wound packing c) Vitamin supplements d) Surgical debridement

Surgical debridement

A client experiences a musculoskeletal injury that involves the structure that connects a muscle to the bone. The nurse understands that this injury involves which of the following? a) Cartilage b) Joint c) Ligament d) Tendon

Tendon

A nurse is teaching a female client about preventing osteoporosis. Which teaching point is correct? a) Obtaining an X-ray of the bones every 3 years is recommended to detect bone loss. b) Obtaining the recommended daily allowance of calcium requires taking a calcium supplement. c) The recommended daily allowance of calcium may be found in a wide variety of foods. d) To prevent fractures, the client should avoid strenuous exercise.

The recommended daily allowance of calcium may be found in a wide variety of foods.

You are assuming care of a 16-year-old patient who is in skeletal traction following a motor vehicle accident. You take shift report and find out that the patient avoids using the urinal and bedpan because they "embarrass him." When you assess the patient you find that the patient's temperature is 101.5°F and his blood pressure and pulse are elevated. What would the nurse suspect? a) Infected pin sites b) Sacral skin breakdown c) Urinary incontinence d) Urinary infection

Urinary infection

Which of the following may occur if a client experiences compartment syndrome in an upper extremity? a) Callus b) Subluxation c) Whiplash injury d) Volkmann's contracture

Volkmann's contracture

The nurse teaches the patient with a high risk for osteoporosis about risk-lowering strategies including which of the following actions? a) Walk or perform weight-bearing exercises outdoors b) Increase fiber in the diet c) Reduce stress d) Decrease the intake of vitamin A and D

Walk or perform weight-bearing exercises outdoors

On a visit to the family physician, a client is diagnosed with a bunion on the lateral side of the great toe, at the metatarsophalangeal joint. Which statement should the nurse include in the teaching session? a) "Some bunions are congenital; others are caused by wearing shoes that are too short or narrow." b) "Bunions are congenital and can't be prevented." c) "Bunions are caused by a metabolic condition called gout." d) "Bunions may result from wearing shoes that are too big, causing friction when the shoes slip back and forth."

a) "Some bunions are congenital; others are caused by wearing shoes that are too short or narrow." Explanation: Bunions may be congenital or may be acquired by wearing shoes that are too short or narrow, which increases pressure on the bursa at the metatarsophalangeal joint. Acquired bunions can be prevented. Wearing shoes that are too big may cause other types of foot trauma but not bunions. Gout doesn't cause bunions. Although a client with gout may have pain in the big toe, such pain doesn't result from a bunion. pg.1140

The nurse is planning discharge instructions for the client with osteomyelitis. What instructions should the nurse include in the discharge teaching? a) "You will receive IV antibiotics for 3 to 6 weeks." b) "Use your continuous passive motion machine (CPM) 2 hours each day." c) "You need to perform weight-bearing exercises twice a week." d) "You need to limit the amount of protein and calcium in your diet."

a) "You will receive IV antibiotics for 3 to 6 weeks." Explanation: Treatment of osteomyelitis requires IV antibiotics for 3 to 6 weeks. pg.1148

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

a) Anticoagulation therapy Explanation: Anticoagulation therapy and early ambulation are very important for clients who have knee or hip replacement to prevent thrombus formation. The other therapy is not indicated solely for the knee or hip arthroplasty. pg.1118

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 and take warm baths or soaks. b) Scrub the area vigorously to remove the crust. c) Consult a skin specialist. d) Avoid exposure to direct sunlight.

a) Apply lotions and take warm baths or soaks. 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. pg.1108

Which of the following nursing actions would help prevent deep vein thrombosis in a patient who has had an orthopedic surgery? a) Applying antiembolism stockings b) Applying cold packs c) Instructing about exercise, as prescribed d) Instructing about using patient-controlled analgesia, if prescribed

a) Applying antiembolism stockings Explanation: Applying antiembolism stockings helps prevent deep vein thrombosis (DVT) in a patient who is immobilized due to orthopedic surgery. Regular administration of analgesics controls and prevents escalation of pain while ROM exercises help in maintaining muscle strength and tone and prevent contractions. On the other hand, cold packs are applied to help reduce swelling and this does not prevent deep vein thrombosis. pg.56

A patient with a long arm cast continues to complain of unrelieved throbbing pain even after receiving opioid pain medication. Which of the following is the priority action by the nurse? a) Assess for complications. b) Teach relaxation techniques. c) Reposition the patient for comfort. d) Assess for previous opioid drug use.

a) Assess for complications. Explanation: Unrelieved pain can be an indicator of a complication, such as, compartment syndrome. Previous opioid drug use should not influence a complete and thorough assessment. Repositioning the patient for comfort may be appropriate once all indications of a complication are ruled out. It is appropriate to teach relaxation techniques to help ease the pain, but assessing for a complication remains the highest priority. pg.10

Of the following, which is not a risk factor for osteoporosis? a) Being male b) Small-framed, thin White or Asian women c) Being postmenopausal d) Family history

a) Being male Explanation: Being male is not considered a risk factor. The following are some of the risk factors for osteoporosis: being a small-framed, thin White or Asian women; being postmenopausal; family history; inactivity; chronic low calcium intake; and excessive caffeine or tobacco use. pg.1142

A patient has been diagnosed with osteomalacia. What common symptoms does the nurse recognize that correlate with the diagnosis? a) Bone pain and tenderness b) Bone fractures and kyphosis c) Muscle weakness and spasms d) Softened and compressed vertebrae

a) Bone pain and tenderness Explanation: Osteomalacia is a metabolic bone disease characterized by inadequate mineralization of bone. As a result, the skeleton softens and weakens, causing pain, tenderness to touch, bowing of the bones, and pathologic fractures. On physical examination, skeletal deformities (spinal kyphosis and bowed legs) give patients an unusual appearance and a waddling gait. pg.1146

The nurse is assigned to care for a client who has had an open reduction and internal fixation of a fractured right femur 2 days ago. The nurse is listening to the client's lungs and, when moving the gown, observes petechial hemorrhages on the skin of the chest. What is the first action by the nurse? a) Call the physician to inform them of the findings. b) Increase the intravenous fluids for hemorrhage. c) Request an antihistamine for the allergic reaction. d) Administer pain medication.

a) Call the physician to inform them of the findings. Explanation: The findings of the nurse indicate that the client may have a fat embolus, and the physician should be informed immediately. Administration of pain medication is not indicated at this time. The rash is not indicative of an allergic reaction. There is no indication that the rash is related to hemorrhage, and there is no need to increase the IV fluids. pg.1164

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) Carpal tunnel syndrome b) Dupuytren's contracture c) Impingement syndrome d) Morton's neuroma

a) Carpal 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. pg.1136

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 the client's position within prescribed limits. b) Assisting with range-of-motion and isometric exercises. c) Applying warm compresses. d) Administering prescribed analgesics.

a) Changing the client's position 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. pg.1113

When an infection is blood borne the manifestations include which of the following symptoms? a) Chills b) Bradycardia c) Hypothermia d) Hyperactivity

a) Chills Explanation: Manifestations include chills, high fever, rapid pulse, and generalized malaise. pg.1148

Which would be consistent as a component of self-care activities for the patient with a cast? a) Cushioning rough edges of the cast with tape b) Use plastic hanger wrapped in gauze to scratch under the cast. c) Place the casted extremity in a dependent position frequently d) Cover the cast with plastic to insulate it

a) Cushioning rough edges of the cast with tape Explanation: The patient can cushion rough edges with tape to prevent skin irritation. The cast should be kept dry, but do not cover it with plastic or rubber because this causes condensation, which dampens the cast and skin. The casted extremity is to be elevated to heart level frequently; a dependent position will increase swelling. A patient should not use any object to scratch under the cast. pg.1108

A 34-year-old client fractured his distal left radius while weight lifting. He returns to the emergency department, reporting discomfort at the cast site, with pain specifically in his upper forearm. What would you expect the physician to do? a) Cut a cast window. b) Initiate physical therapy. c) Remove the cast. d) Apply a fiberglass cast.

a) Cut a cast window. Explanation: After the cast dries, a cast window, or opening, may be cut. This usually is done when the client reports discomfort under the cast or has a wound that requires a dressing change. The window permits direct inspection of the skin, a means to check the pulse in a casted arm or leg, or a way to change a dressing. pg.1108

A client seeks medical attention for a ganglion. Which statement about this musculoskeletal mass is true? a) Dorsiflexion exacerbates signs and symptoms of a ganglion. b) Surgical excision is the treatment of choice for a ganglion. c) A ganglion is a precursor to a primary bone tumor. d) A ganglion is the most common benign soft-tissue mass in the foot.

a) Dorsiflexion exacerbates signs and symptoms of a ganglion. Explanation: Dorsiflexion exacerbates signs and symptoms of a ganglion. A ganglion is the most common benign soft-tissue mass in the hand, not foot. It isn't a known precursor to a primary bone tumor. To treat a ganglion, the physician aspirates the ganglion, then injects a corticosteroid into the joint; the physician may also order nonsteroidal anti-inflammatory agents. Surgical excision is necessary only if signs and symptoms persist and the client's range of motion is impaired. pg.1137

Which is a flexion deformity caused by a slowly progressive contracture of the palmar fascia? a) Dupuytren's contracture b) Callus c) Hammertoe d) Hallux valgus

a) Dupuytren's contracture Explanation: Dupuytren's disease results in a slowly progressive contracture of the palmar fascia, called Dupuytren's contracture. A callus is a discretely thickened area of skin that has been exposed to persistent pressure or friction. A hammertoe is a flexion deformity of the interphalangeal joint, which may involve several toes. Hallux valgus is a deformity in which the great toe deviates laterally. pg.1137

Which of the following is a flexion deformity caused by a slowly progressive contracture of the palmar fascia? a) Dupuytren's contracture b) Callus c) Hallux valgus d) Hammertoe

a) Dupuytren's contracture Explanation: Dupuytren's disease results in a slowly progressive contracture of the palmar fascia, called Dupuytren's contracture. A callus is a discretely thickened area of skin that has been exposed to persistent pressure or friction. A hammertoe is a flexion deformity of the interphangeal joint, which may involve several toes. Hallux valgus is a deformity in which the great toe deviates laterally. pg.1137

Which of the following definitions describes the hip spica cast? a) Encloses the trunk and a lower extremity b) A short or long leg cast reinforced for strength c) Encircles the trunk d) Extends from the junction of the upper and middle third of the thigh to the base of the toes. The knee may be slightly flexed.

a) Encloses the trunk and a lower extremity Explanation: A hip spica cast encloses the trunk and a lower extremity. A double hip spica cast includes both legs. A body cast encircles the trunk. A walking cast is a short or long leg cast reinforced for strength. A long leg cast extends from the junction of the upper and middle third of the thigh to the base of the toes. The knee may be slightly flexed. pg.1104

The nurse suspects "compartment syndrome" for a casted extremity. What characteristic symptoms would the nurse assess that would confirm these suspicions? (Select all that apply.) a) Excruciating pain b) Capillary refill less than 3 seconds c) Decreased sensory function d) Loss of motion e) 2+ peripheral pulses in the affected distal pulse

a) Excruciating pain c) Decreased sensory function d) Loss of motion Explanation: Clinical manifestations include dusky, pale appearance of the exposed extremity; cool skin temperature; delayed capillary refill; paresthesia; and unrelenting pain not relieved by position changes, ice, or analgesia. A hallmark sign is pain that occurs or intensifies with passive range of motion (Johnston-Walker & Hardcastle, 2011). The patient may complain that the cast, brace, or splint is too tight. The primary provider must be notified immediately. pg.1107

A 68-year-old female client who had a total hip replacement is to be discharged because her healing is almost complete. Which of the following would be most important for this client? a) Exploring factors related to the client's home environment b) Educating the client about the effects of menopause c) Urging her to keep the affected limb in an elevated position d) Advising the client to avoid red meat

a) Exploring factors related to the client's home environment Explanation: Exploring factors related to the older adult client's home environment and determining a plan for continued rehabilitation before discharge is most important. The client should be encouraged to eat foods rich in protein, calcium, and vitamin D. Because the healing is almost complete, the client need not always keep the affected limb elevated unless prescribed to do so. Because the client is in her late 60s, she is most likely to have already undergone menopause. Therefore, educating her about the effects of menopause is not as important. pg.1123

Dupuytren's contracture causes flexion of which area(s)? a) Fourth and fifth fingers b) Ring finger c) Thumb d) Index and middle fingers

a) Fourth and fifth fingers Explanation: Dupuytren's contracture causes flexion of the fourth and fifth fingers, and frequently the middle finger. pg.1137

Of the definitions for surgical procedures to correct joint deformities listed as follows, which describes arthrodesis? a) Fusion of a joint (most often the wrist or knee) for stabilization and pain relief b) Total reconstruction or replacement of a joint (most often the knee or hip) with an artificial joint to restore function and relieve pain c) The replacement of one of the articular surfaces in a joint, such as the femoral head but not the acetabulum d) Cutting and removal of a wedge of bone (most often the tibia or femur) to change the bone's alignment, thereby improving function and relieving pain

a) Fusion of a joint (most often the wrist or knee) for stabilization and pain relief Explanation: Arthrodesis is fusion of a joint (most often the wrist or knee) for stabilization and pain relief. Arthroplasty is total reconstruction or replacement of a joint (most often the knee or hip) with an artificial joint to restore function and relieve pain. Hemiarthroplasty is the replacement of one of the articular surfaces in a joint, such as the femoral head but not the acetabulum. Osteotomy is the cutting and removal of a wedge of bone (most often the tibia or femur) to change the bone's alignment, thereby improving function and relieving pain. pg.1140

Which of the following was formerly called a bunion? a) Hallux valgus b) Ganglion c) Morton's neuroma d) Plantar fasciitis

a) Hallux valgus Explanation: Hallux valgus (commonly called a bunion) is a deformity in which the great toe deviates laterally. Plantar fasciitis, an inflammation of the foot-supporting fascia, present as an acute onset of heel pain experienced with the first steps in the morning. Morton's neuroma is a swelling of the third (lateral) branch of the median plantar nerve. A ganglion, a collection of gelatinous material near the tendon sheaths and joints, appears as a round, firm compressible cystic swelling, usually on the dorsum of the wrist. pg. 1140

To reduce the incidence of complications in a client in traction, which intervention should be included in the care plan? a) Increase fiber intake. b) Increase calorie intake. c) Reduce fluid intake. d) Remove the weights during linen changes.

a) Increase fiber intake. Explanation: Immobility increases the incidence of constipation. Increasing fiber intake will reduce GI complications. The weights in traction should never be removed. Inactivity results in fewer calories being burned. Increasing calories would be counterproductive. Reducing fluids will increase the likelihood of constipation. pg.1116

A client is seen in the orthopedic clinic for complaints of severe pain in the left hip. After a series of diagnostic tests, the client is diagnosed with severe degenerative joint disease of the left hip and suggested to have the hip reconstructed. What procedure will the nurse schedule the client for? a) Left hip arthroplasty b) Open reduction and internal fixation of the left hip. c) Closed reduction of the left hip. d) Left hip arthroscopy

a) Left hip arthroplasty Explanation: Clients with arthritis, trauma, hip fracture, or a congenital deformity may have an arthroplasty, or reconstruction of the joint. This procedure uses an artificial joint that restores previously lost function and relieves pain. An arthroscopy is not used to reconstruct a diseased hip. A closed reduction is not an invasive surgical procedure and would not be used to reconstruct the hip. An open reduction and internal fixation is not the treatment for reconstruction of the hip related to a diseased hip. pg.1116

A 12-year-old client fractured her right leg while skiing and is undergoing an open reduction of the femur fracture. She returns to the orthopedic unit where you practice nursing with a cast in place. What is the rationale for frequently assessing her pedal pulses? a) Maintaining adequate circulation b) Ensuring there wasn't nerve damage during surgery c) Making sure surgery was successful d) Typical postoperative nursing management

a) Maintaining adequate circulation Explanation: Circulation, sensation, and mobility of exposed fingers or toes must be assessed every 1 to 2 hours to ensure neurovascular status is not compromised. pg.1121

The client with a newly applied cast complains of severe unrelenting pain. Which of the following nursing actions should the nurse do next? a) Make the client NPO and notify the physician. b) Loosen the edges of the cast and elevate the leg. c) Reposition the extremity for comfort and apply ice. d) Administer a dose of morphine sulfate.

a) Make the client NPO and notify the physician. Explanation: The client is exhibiting symptoms of compartment syndrome. The physician needs to be contacted as treatment options include bivalving of the cast or a possible fasciotomy, a surgical procedure. pg.1107

The nurse is caring for a client who has had a fracture reduction using a cast. Which of the following would be most important for the nurse to assess? a) Neurovascular status b) Sleep status c) Cardiac status d) Renal function

a) Neurovascular status Explanation: When caring for a client with a fracture, the nurse should carefully assess neurovascular status, checking for possible complications. Assessment of cardiac and renal status would be priorities if the client experienced multiple fractures or had an open reduction. The client's sleep status would be a low priority. pg.1105

A variety of complications can occur after a leg amputation. All of the following are possibilities in the immediate postoperative period, except? a) Osteomyelitis b) Hematoma c) Hemorrhage d) Infection

a) Osteomyelitis Explanation: Chronic osteomyelitis may occur after persistent infection in the late postoperative period. Hematoma, hemorrhage, and infection are potential complications in the immediate postoperative period. pg.1186

The client presents to the emergency department with fever, chills, restlessness, and limited movement of a fractured jaw. The nurse interprets these findings as indicating which of the following complications? a) Osteomyelitis b) Avascular necrosis c) Fat embolism d) Compartment syndrome

a) Osteomyelitis Explanation: Clinical manifestations of osteomyelitis include signs and symptoms of sepsis and localized infection. pg.1148

Treatment of metastatic bone cancer includes which of the following? a) Palliation b) Radiation c) Combination chemotherapy and radiation d) Chemotherapy

a) Palliation Explanation: The treatment of metastatic bone cancer is palliative. The therapeutic goal is to relieve the patient's pain and discomfort while promoting quality of life. pg.1152

The nurse recognizes that goal of treatment for metastatic bone cancer is to: a) Promote pain relief and quality of life b) Cure the diseased bone and cartilage c) Diagnose the extent of bone damage d) Reconstruct the bone with a prosthesis

a) Promote pain relief and quality of life Explanation: Treatment of metastatic bone cancer is palliative. pg.1152

Which of the following terms refers to disease of a nerve root? a) Radiculopathy b) Contracture c) Involucrum d) Sequestrum

a) Radiculopathy Explanation: When the patient reports radiating pain down the leg, he or she is describing radiculopathy. Involucrum refers to new bone growth around the sequestrum. Sequestrum refers to dead bone in an abscess cavity. Contracture refers to abnormal shortening of muscle or fibrosis of joint structures. pg.1133

Ms. Malcolm has come to your clinic complaining of jaw pain. This is also associated with muscle spasm and tenderness of the masseter and temporalis muscles. The physician has diagnosed a temporomandibular disorder (TMD). What would the treatment course for this client include? Select all that apply. a) Referral to a dentist who has experience managing clients with TMD b) Analgesics c) Custom-fitted mouth guard during sleep d) Corticosteroids

a) Referral to a dentist who has experience managing clients with TMD b) Analgesics c) Custom-fitted mouth guard during sleep Explanation: Referral to a dentist who has experience managing clients with TMD, analgesics, and custom-fitted mouth guard during sleep are all part of the treatment course. Corticosteroids are not part of the treatment regimen. pg.1241

A nurse is giving instructions to a client who's going home with a cast on his leg. Which teaching point is most critical? a) Reporting signs of impaired circulation b) Exercising joints above and below the cast, as ordered c) Using crutches properly d) Avoiding walking on a leg cast without the physician's permission

a) Reporting signs of impaired circulation Explanation: Although all of these points are important, reporting signs of impaired circulation is the most critical. Signs of impaired circulation must be reported to the physician immediately to prevent permanent damage. The other options reflect more long-term concerns. The client should learn to use his crutches properly to avoid nerve damage. The client may exercise above and below the cast, as the physician orders. The client should be told not to walk on the cast without the physician's permission. pg.1109

A client is brought to the emergency department by a softball team member who states the client and another player ran into each other, and the client is having severe pain in the right shoulder. What symptoms of a fractured clavicle does the nurse recognize? a) Right shoulder slopes downward and droops inward. b) Client complains of pain in the unaffected shoulder. c) Right shoulder is elevated above the left. d) Client complains of tingling and numbness in the right shoulder.

a) Right shoulder slopes downward and droops inward. Explanation: The client with a fractured clavicle has restricted motion, and the affected shoulder appears to slope downward and droop inward. The client will have pain, not typically tingling and numbness in the right shoulder. Pain is not felt in the unaffected shoulder. pg.1184

A client is diagnosed with osteomyelitis. This is most commonly caused by which of the following? a) Staphylococcus aureus b) Psuedomonas aeruginosa c) Escherichia coli d) Proteus vulgaris

a) Staphylococcus aureus Explanation: Staphylococcus aureus causes over 50% of bone infections. Other organisms include Proteus vulgaris and Pseudomonas aeruginosa, as well as E. coli. pg.1148

A patient with chronic osteomyelitis has undergone 6 weeks of antibiotic therapy. There is no improvement in the wound appearance. What action would the nurse anticipate to promote healing? a) Surgical debridement b) Vitamin supplements c) Wound irrigation d) Wound packing

a) Surgical debridement Explanation: In chronic osteomyelitis, surgical debridement is used when the wound fails to respond to antibiotic therapy. Wound packing, vitamin supplements, and wound irrigation are not the standard of care when treating chronic osteomyelitis. pg.1149

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

a) Take the supplement with meals or with orange juice. Explanation: Calcium supplements, such as Caltrate or Citracal, are over-the-counter medications. They should be taken with meals or with a beverage high in vitamin C. pg.1144

A client has been treated for migraine headaches for several months and comes to the clinic stating he is getting no better. The nurse is talking with the client and hears an audible click when the client is moving his jaw. What does the nurse suspect may be happening? a) Temporomandibular disorder b) Trigeminal neuralgia c) Loose teeth d) Dislocated jaw

a) Temporomandibular disorder Explanation: The disorder can be confused with trigeminal neuralgia and migraine headaches. The client experiences clicking of the jaw when moving the joint, or the jaw can lock, which interferes with opening the mouth. Loose teeth will not cause a clicking of the jaw. The client does not have a dislocated jaw. pg.1236

The nurse is educating a patient with lower back pain on proper lifting techniques. The nurse would document what behavior as evidence the education was effective? a) The patient placed the load close to the body. b) The patient reached over head with arms fully extended. c) The patient used a narrow base of support. d) The patient bent at the hips and tightened the abdominal muscles.

a) The patient placed the load close to the body. Explanation: Instructions for the patient with low back pain should include that when lifting, the patient should avoid overreaching. The patient should also keep the load close to the body, bend the knees and tighten the abdominal muscles, use a wide base of support, and use a back brace to protect the back. Bending at the hips increases the strain on the back muscles when lifting. pg.1134

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

a) Use the large muscles of the leg when lifting items. Explanation: The large muscles of the leg should be used when lifting. pg.1134

The nurse teaches the patient with a high risk for osteoporosis about risk-lowering strategies including which of the following actions? a) Walk or perform weight-bearing exercises b) Decrease the intake of vitamin A and D c) Reduce stress d) Increase fiber in the diet

a) Walk or perform weight-bearing exercises Explanation: Risk-lowering strategies for osteoporosis include walking or exercising outdoors, performing a regular weight-bearing exercise regimen, increasing dietary calcium and vitamin D intake, smoking cessation, and consuming alcohol and caffeine consumption in moderation. pg.1144

A nurse is planning discharge teaching regarding exercise for a client at risk for osteoporosis. Which of the following exercises would be appropriate? a) Walking b) Yoga c) Bicycling d) Swimming

a) Walking Explanation: Weight-bearing exercises should be incorporated into the client's lifestyle activities. pg.1141

During a routine physical examination on a 75-year-old female client, a nurse notes that the client is 5 feet, 3/8 inches (1.6 m) tall. The client states, "How is that possible? I was always 5 feet and 1/2? (1.7 m) tall." Which statement is the best response by the nurse? a) "After age 40, height may show a gradual decrease as a result of spinal compression" b) "After menopause, the body's bone density declines, resulting in a gradual loss of height." c) "The posture begins to stoop after middle age." d) "There may be some slight discrepancy between the measuring tools used."

b) "After menopause, the body's bone density declines, resulting in a gradual loss of height." Explanation: The nurse should tell the client that after menopause, the loss of estrogen leads to a loss in bone density, resulting in a loss of height. This client's history doesn't indicate spinal compression. Telling the client that measuring tools used to obtain the client's height may have a discrepancy or that the posture begins to stoop after middle age doesn't address the client's question. pg.1143

A nurse is teaching a client who was recently diagnosed with carpal tunnel syndrome. Which statement should the nurse include? a) "This condition is associated with various sports." b) "Ergonomic changes can be incorporated into your workday to reduce stress on your wrist." c) "Surgery is the only sure way to manage this condition." d) "Using arm splints will prevent hyperflexion of the wrist."

b) "Ergonomic changes can be incorporated into your workday to reduce stress on your wrist." Explanation: Ergonomic changes, such as adjusting keyboard height, can help clients with carpal tunnel syndrome avoid hyperextension of the wrist. This condition is associated with repetitive tasks such as clerical work, not sports. The condition may be managed with medications, yoga, acupuncture, and wrist (not arm) splints. pg.1136

A client with diabetes punctured his foot with a broken acorn in the yard. Within a week, the client developed osteomyelitis of the foot. The client was admitted for IV antibiotic therapy. How long does the nurse anticipate the client will receive IV antibiotics? a) 7 to 10 days b) 3 to 6 weeks c) 6 months d) 3 months

b) 3 to 6 weeks Explanation: Identification of the causative organism to initiate appropriate and ongoing antibiotic therapy for infection control. IV antibiotic therapy is administered for 3 to 6 weeks. Oral antibiotics then follow for as long as 3 months. pg.1148

The nurse is caring for a patient with a total hip replacement. How should the nurse allow the patient to turn? a) From the prone to the supine position only, and the patient must keep the affected hip extended and abducted b) 45 degrees onto the unoperated side if the affected hip is kept abducted c) To any comfortable position as long as the affected leg is extended d) To the operative side if the affected hip remains extended

b) 45 degrees onto the unoperated side if the affected hip is kept abducted Explanation: When the nurse turns the patient in bed to the unaffected side, it is important to keep the operative hip in abduction (movement away from the center or median line of the body). The patient should not be turned to the operative side, which could cause dislocation, unless specified by the surgeon. The patient's hip is never flexed more than 90 degrees. pg.1119

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) Instructing the client to ambulate twice daily b) Administering large doses of I.V. antibiotics as ordered c) Withholding all oral intake d) Administering large doses of oral antibiotics as ordered

b) Administering large doses of I.V. antibiotics as ordered 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. pg.1148

The nurse is taking care of a client who underwent a leg amputation. What teachings should the nurse offer such a client to prevent abduction deformity? Choose all correct options. a) Advise the client to place pillows between the legs. b) Advise the client to use a trochanter roll. c) Advise the client who is lying on the stomach to adduct the stump so it presses against the other leg. d) Advise the client to use antiembolism stockings on both legs.

b) Advise the client to use a trochanter roll. c) Advise the client who is lying on the stomach to adduct the stump so it presses against the other leg. Explanation: Use a trochanter roll to prevent external rotation of the hip and knee. Avoid placing pillows between the legs. These measures prevent abduction deformity. If the client is lying on the stomach, the nurse should advise the client to adduct the stump so it presses against the other leg. Adduction stretches flexor muscles and prevents abduction deformity. The client should only use an antiembolism stocking on the unaffected leg. pg.1189

What food can the nurse suggest to the client at risk for osteoporosis? a) Carrots b) Broccoli c) Bananas d) Chicken

b) Broccoli Explanation: Calcium is important for the prevention of osteoporosis. Broccoli is high in calcium. pg.1141

Which of the following inhibits bone resorption and promotes bone formation? a) Estrogen b) Calcitonin c) Corticosteroids d) Parathyroid hormone

b) Calcitonin Explanation: Calcitonin, which inhibits bone resorption and promotes bone formation, is decreased in osteoporosis. Estrogen, which inhibits bone breakdown, decreases with aging. On the other hand, parathyroid hormone (PTH) increases with aging, increasing bone turnover and resorption. The consequence of these changes is net loss of bone mass over time. Corticosteroids place patients as risk for developing osteoporosis. pg.1143

The nurse is assessing the feet of a patient and observes an overgrowth of the horny layer of the epidermis. What does the nurse recognize this condition as? a) Hammer Toe b) Corn c) Clawfoot d) Bunion

b) Corn Explanation: A corn is an area of hyperkeratosis (overgrowth of a horny layer of epidermis) produced by internal pressure (the underlying bone is prominent because of a congenital or acquired abnormality, commonly arthritis) or external pressure (ill-fitting shoes). The fifth toe is most frequently involved, but any toe may be involved. pg.1139

The nurse is caring for a client who sustained rib fractures in an automobile accident. What symptoms does the nurse recognize as a complication of rib fractures and should immediately be reported to the physician? a) Heart rate of 94 beats/minute b) Crackles in the lung bases c) Blood pressure of 140/90 mm Hg d) Client complains of pain in the affected rib area when taking a deep breath

b) Crackles in the lung bases Explanation: Crackles in the lung bases can be an indicator that the client has developed pneumonia from shallow respirations. The blood pressure is high but may be due to pain. It is expected that the client will have pain in the rib area when taking deep breaths. A heart rate of 94 beats/minuteis within normal range. pg.1182

A patient with a fractured ankle is having a fiberglass cast applied. The patient starts yelling, "My leg is burning, take it off." What action by the nurse is most appropriate? a) Remove the cast immediately, notifying the physician. b) Explain that the sensation being felt is normal and will not cause burns to the patient. c) Call for assistance to hold the patient is the required position until the cast has dried. d) Administer antianxiety and pain medication.

b) Explain that the sensation being felt is normal and will not cause burns to the patient. Explanation: A fiberglass cast when applied will give off heat. The reaction is a normal, temporary sensation. Heat given off during the application phase of the cast does not cause burns to the skin. By explaining these principles to the patient, the nurse can alleviate any anxiety associated with the application of the cast. Because this is a known reaction to the application of the fiberglass cast, it is not necessary to remove the cast. Holding the patient may cause more harm to the injury. Antianxiety medications are generally not needed when applying a cast. pg.1104

The nurse is very concerned about the potential debilitating complication of peroneal nerve injury. What symptom does the nurse recognize as a result of that complication? a) Permanent paresthesias b) Footdrop c) Deep vein thrombosis (DVT) d) Infection

b) Footdrop Explanation: Injury to the peroneal nerve as a result of pressure is a cause of footdrop (the inability to maintain the foot in a normally flexed position). Consequently, the patient drags the foot when ambulating. pg.1109

A client has a cast that extends from below the elbow to the palmar crease and is secured around the base of the thumb. The thumb is also casted. The nurse identifies this as which type of cast? a) Body cast b) Gauntlet cast c) Short arm cast d) Spica cast

b) Gauntlet cast Explanation: A gauntlet cast is a short arm cast that extends from below the elbow to the palmar crease and is secured around the base of the thumb, with the thumb also being casted. A short arm cast extends from below the elbow to the palmar crease and is secured around the base of the thumb. A body cast is a larger form of a cylinder cast that encircles the trunk from about the nipple line to the iliac crests. A hip spica cast surrounds one or both legs and the trunk. It may be strengthened by a bar that spans a casted area between the legs. pg.1104

The nurse notes that the patient's left great toe deviates laterally. This finding would be recognized as which of the following? a) Hammertoe b) Hallux valgus c) Pes cavus d) Flatfoot

b) Hallux valgus Explanation: Hallux valgus is commonly referred to as a bunion. Hammertoes are usually pulled upward. Pes cavus refers to a foot with an abnormally high arch and a fixed equinus deformity of the forefoot. In flatfoot, the patient demonstrates a diminished longitudinal arch of the foot. pg.1140

Which is a deformity in which the great toe deviates laterally? a) Hammertoe b) Hallux valgus c) Pes cavus d) Plantar fasciitis

b) Hallux valgus Explanation: Hallux valgus is a deformity in which the great toe deviates laterally. A hammertoe is a flexion deformity of the interphalangeal joint, which may involve several toes. Pes cavus refers to a foot with an abnormally high arch and a fixed equines deformity of the forefoot. Plantar fasciitis is an inflammation of the foot-supporting fascia. pg.1140

During a routine physical examination of a client, the nurse observes a flexion deformity of the promixal interphalangeal (PIP) joint of two toes on the right foot. The nurse documents this finding as which of the following? a) Mallet toe b) Hammer toe c) Bunion d) Hallux valgus

b) Hammer toe Explanation: Hammer toe is a flexion deformity of the proximal interphalangeal (PIP) joint and may involve several toes. Mallet toe is a flexion deformity of the distal interphalangeal joint (DIP), and also can affect several toes. Hallux valgus, also called a bunion, is a deformity of the great (large) toe at its metatarsophalangeal joint. pg.1139

A patient in pelvic traction needs circulatory status assessed. How should the nurse assess for a positive Homans' sign? a) Have the patient squeeze the nurse's hands with his or her hands to evaluate any difference in strength. b) Have the patient extend each leg and dorsiflex each foot to determine if pain or tenderness is present in the lower leg. c) Have the patient extend both hands while the nurse compares the volume of both radial pulses. d) Have the patient plantar flex both feet while the nurse performs the blanch test on all of the patient's toes.

b) Have the patient extend each leg and dorsiflex each foot to determine if pain or tenderness is present in the lower leg. Explanation: The nurse should assess for pain on passive flexion of each foot, which could indicate deep vein thrombosis. pg.1121

Which intervention should the nurse implement with the client who has undergone a hip replacement? a) Place the client in high Fowler's position for meals. b) Instruct the client to avoid internal rotation of the leg. c) Have the client bend forward to rise from the chair. d) Adduct the legs by placing a pillow between the legs.

b) Instruct the client to avoid internal rotation of the leg. Explanation: The client should avoid all activities that can result in dislocation of the hip. The affected leg should not cross midline or be turned inward. A pillow is used to keep the legs in abduction. The hip should not bend more than 90 degrees when seated. The head of bed should be kept at 60 degrees or less. pg.1119

The nurse is caring for a client with a spica cast. A priority nursing intervention is to: a) Keep the legs in abduction. b) Keep the cast clean and dry. c) Promote elimination with a regular bedpan. d) Position the client on the affected side.

b) Keep the cast clean and dry. Explanation: Keeping the cast clean and dry around the perineal opening is a priority. A spica cast has a built-in abduction bar. The client should be positioned on the unaffected side every 2 hours and prone twice a day. A fracture bedpan is easier to use for the client with a spica cast. pg.1110

Assessment of a client reveals signs and symptoms of Paget's disease. Which of the following would be most likely? a) Skull narrowing b) Long bone bowing c) Lordosis d) Waddling gait

b) Long bone bowing Explanation: Some clients with Paget's disease are asymptomatic with only some mild skeletal deformity. Other clients have marked skeletal deformities which may include enlargement of the skull, bowing of the long bones, and kyphosis. Waddling gait is associated with osteomalacia. pg.1146

A client is in Buck's traction after fracturing his right hip. The nurse should include which action in the care plan? a) Keeping the client in semi-Fowler's position b) Maintaining correct body alignment c) Maintaining the bed in the knee-Gatch position d) Removing the weights once every shift

b) Maintaining correct body alignment Explanation: Buck's traction produces realignment by exerting a pulling force on the fractured hip. Therefore, the nurse must maintain correct body alignment. Traction should be continuous; if the weights must be removed, the nurse should apply manual traction until the weights are replaced. The nurse shouldn't use the knee-Gatch position because it disrupts the constant pulling force needed for alignment. Using the semi-Fowler's position would cause the client to slide in the direction of the traction, defeating the purpose of traction. pg.1112

Which of the following should be included in the teaching plan for a patient diagnosed with plantar fasciitis? a) The pain of plantar fasciitis diminishes with warm water soaks. b) Management of plantar fasciitis includes stretching exercises. c) Plantar fasciitis presents as an acute onset of pain localized to the ball of the foot that occurs when pressure is placed upon it and diminishes when pressure is released. d) Complications of plantar fasciitis include neuromuscular damage and decreased ankle range of motion.

b) Management of plantar fasciitis includes stretching exercises. Explanation: Management also includes wearing shoes with support and cushioning to relieve pain, orthotic devices (eg, heel cups, arch supports), and the use of nonsteroidal anti-inflammatory drugs (NSAIDs). Plantar fasciitis, an inflammation of the foot-supporting fascia, presents as an acute onset of heel pain experienced with taking the first steps in the morning. The pain is localized to the anterior medial aspect of the heel and diminishes with gentle stretching of the foot and Achilles tendon. Unresolved plantar fasciitis may progress to fascial tears at the heel and eventual development of heel spurs. pg.1139

The nurse assesses a patient after total right hip arthroplasty and observes a shortening of the extremity, and the patient complains of severe pain in the right side of the groin. What is the priority action of the nurse? a) Apply Buck's traction. b) Notify the physician. c) Externally rotate the extremity. d) Bend the knee and rotate the knee internally.

b) Notify the physician. Explanation: If any clinical manifestations of dislocation of the prosthesis occur, including acute groin pain in the affected hip or shortening of the affected extremity, the nurse (or the patient, if at home) must immediately notify the surgeon, because the hip must be reduced and stabilized promptly so that the leg does not sustain circulatory and nerve damage. After closed reduction, the hip may be stabilized with Buck's traction or a brace to prevent recurrent dislocation. As the muscles and joint capsule heal, the chance of dislocation diminishes. Stresses to the new hip joint should be avoided for the first 8 to 12 weeks, when the risk of dislocation is greatest. pg.1123

A client's fracture was reduced by surgically exposing the bone and realigning it. The nurse identifies this as which of the following? a) Internal fixation b) Open reduction c) Buck's traction d) Skeletal traction

b) Open reduction Explanation: In an open reduction, the bone is surgically exposed and realigned. Buck's traction is a type of skin traction that provides pulling on the structures. Skeletal traction is applied directly to the bone using a wire, pin, or cranial tongs. Internal fixation involves the use of metal screws, plates, rods, nails or pins to stabilize a reduced fracture. pg.1116

A patient has a long leg cast applied. Where does the nurse understand a common pressure problem may occur? a) Dorsalis pedis b) Peroneal nerve c) Popliteal artery d) Posterior tibialis

b) Peroneal nerve Explanation: The nurse assesses circulation by observing the color, temperature, and capillary refill of the exposed toes. Nerve function is assessed by observing the patient's ability to move the toes and by asking about the sensations in the foot. Numbness, tingling, and burning may indicate peroneal nerve injury resulting from pressure at the head of the fibula. pg.1109

The nurse is educating the patient with low back pain about the proper way to lift objects. What muscle should the nurse encourage the patient to maximize? a) Gastrocnemius b) Quadriceps c) Rectus abdominis d) Latissimus dorsi

b) Quadriceps Explanation: The nurse instructs the patient in the safe and correct way to lift objects using the strong quadriceps muscles of the thighs, with minimal use of weak back muscles (Fig. 42-3). pg.1135

A patient is placed in traction for a femur facture. The nurse would document what as the expected outcomes of traction? Select all that apply. a) Full range of motion to extremity b) Reduction of deformity c) Minimization of muscle spasms d) Realignment of a fracture e) Increased ability to bear weight f) Decreased pedal pulse

b) Reduction of deformity c) Minimization of muscle spasms d) Realignment of a fracture Explanation: Traction is used to minimize muscle spasms, to reduce, align, and immobilize fractures, and to reduce deformity. Traction does not allow for full range of motion or an increased ability to bear weight. The patient is confined to the bed while in traction. A decreased pulse is a sign of circulatory compromise and should be investigated and reported. pg.1111

A client with Paget's disease comes to the hospital and complains of difficulty urinating. The emergency department physician consults urology. What should the nurse suspect is the most likely cause of the client's urination problem? a) Urinary tract infection (UTI) b) Renal calculi c) Benign prostatic hyperplasia d) Dehydration

b) Renal calculi Explanation: Renal calculi commonly occur with Paget's disease, causing pain and difficulty when urinating. A UTI commonly causes fever, urgency, burning, and hesitation with urination. Benign prostatic hyperplasia is common in men older than age 50; however, because the client has Paget's disease, the nurse should suspect renal calculi, not benign prostatic hyperplasia. Dehydration causes a decrease in urine production, not a problem with urination. pg.1142

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

b) Risk for falls Explanation: The client with Paget's disease is at risk for falls secondary to pathological fractures and impaired gait/mobility. pg.1147

Which of the following devices is designed specifically to support and immobilize a body part in a desired position? a) Trapeze b) Splint c) Continuous passive motion (CPM) device d) Brace

b) Splint Explanation: A splint may be applied to a fractured extremity initially until swelling subsides. A brace is an externally applied device to support a body part, control movement, and prevent injury. A CPM device is an instrument that moves a body part to promote healing and circulation. A trapeze is an overhead device to promote patient mobility in bed. pg.1105

A patient stepped on an acorn while walking barefoot in the backyard and developed an infection progressing to osteomyelitis. What microorganism does the nurse understand is most often the cause of the development of osteomyelitis? a) Proteus b) Staphylococcus aureus c) Salmonella d) Pseudomonas

b) Staphylococcus aureus Explanation: More than 50% of bone infections are caused by Staphylococcus aureus and increasingly of the variety that is methicillin resistant (i.e., methicillin-resistant Staphylococcus aureus [MRSA]) (Miller & Kaplan, 2009). Other pathogens include the gram-positive organisms streptococci and enterococci, followed by gram-negative bacteria, including pseudomonas. pg.1148

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

b) Supine, with the knees slightly flexed and the head of the bed elevated 30 degrees Explanation: A medium to firm, nonsagging mattress (a bed board may be used) is recommended; there is no evidence to support the use of a firm mattress (National Guideline Clearinghouse, 2010). Lumbar flexion is increased by elevating the head and thorax 30 degrees by using pillows or a foam wedge and slightly flexing the knees supported on a pillow. Alternatively, the patient can assume a lateral position with knees and hips flexed (curled position) with a pillow between the knees and legs and a pillow supporting the head (Fig. 42-1). A prone position should be avoided because it accentuates lordosis. pg.1134

A nurse is teaching a female client about preventing osteoporosis. Which teaching point is correct? a) Obtaining the recommended daily allowance of calcium requires taking a calcium supplement. b) The recommended daily allowance of calcium may be found in a wide variety of foods. c) Obtaining an X-ray of the bones every 3 years is recommended to detect bone loss. d) To prevent fractures, the client should avoid strenuous exercise

b) The recommended daily allowance of calcium may be found in a wide variety of foods. Explanation: Premenopausal women require 1,000 mg of calcium per day. Postmenopausal women require 1,500 mg per day. Clients usually can get the recommended daily requirement of calcium by eating a varied diet. Osteoporosis doesn't show up on ordinary X-rays until 30% of bone has been lost. Bone densitometry, however, can detect bone loss of 3% or less. This test is sometimes recommended routinely for women older than 35 who are at risk for osteoporosis. Strenuous exercise won't cause fractures. Although supplements are available, they aren't always necessary. pg.1143

Instructions for the patient with low back pain include that when lifting the patient should a) use a narrow base of support. b) avoid overreaching. c) bend the knees and loosen the abdominal muscles. d) place the load away from the body.

b) avoid overreaching. Explanation: Instructions for the patient with low back pain should include that when lifting, the patient should avoid overreaching. The patient should also keep the load close to the body, bend the knees and tighten the abdominal muscles, use a wide base of support, and use a back brace to protect the back. When lifting, the patient with low back pain should keep the load close to the body. When lifting, the patient with low back pain should bend the knees and tighten the abdominal muscles. pg.1134

A physician diagnoses primary osteoporosis in a client who has lost bone mass. In this metabolic disorder, the rate of bone resorption accelerates while bone formation slows. Primary osteoporosis is most common in: a) young menstruating women. b) elderly postmenopausal women. c) young children. d) elderly men.

b) elderly postmenopausal women. Explanation: Although the cause of primary osteoporosis is unknown, an important contributing factor may be faulty protein metabolism resulting from estrogen deficiency and a sedentary lifestyle. Typically, these conditions occur in elderly postmenopausal women. pg.1143

Meniscectomy refers to the a) replacement of one of the articular surfaces of a joint. b) excision of damaged joint fibrocartilage. c) incision and diversion of the muscle fascia. d) removal of a body part.

b) excision of damaged joint fibrocartilage. Explanation: The most common site for meniscectomy is the knee; the procedure refers to the excision of damaged joint fibrocartilage. Fasciotomy refers to the incision and diversion of the muscle fascia to relieve muscle constriction. Hemiarthroplasty refers to the replacement of one of the articular surfaces of a joint. Amputation refers to the removal of a body part. pg.1116

The client returns to the nursing unit following an open reduction with internal fixation of the right hip. Which intervention would be inappropriate for the prophylactic treatment of deep vein thrombosis? a) antiembolic stockings b) increased fiber intake c) enoxaparin (Lovenox) d) increased fluid intake

b) increased fiber intake Explanation: Increased fiber intake does not prevent deep vein thrombosis. pg.1118

The nurse is reviewing the medication administration record of the client. Which of the following medications would lead the nurse to suspect that the client is at risk for osteoporosis? a) penicillamine (Cuprimine) b) raloxifene (Evista) c) plicamycin (Mithracin) d) methotrexate (Rheumatrex)

b) raloxifene (Evista) Explanation: Raloxifene (Evista) is used for the prevention and treatment of osteoporosis. pg.1144

When discussing physical activities with the client who has just undergone a right total hip replacement, which instruction should the nurse provide? a) "Intermittently cross and uncross your legs several times each day." b) "Avoid weight bearing until the hip is completely healed." c) "Limit hip flexion to 90 degrees." d) "Perform rotation exercises each day."

c) "Limit hip flexion to 90 degrees." Explanation: The client should avoid all activities that can result in dislocation of the hip. The affected leg should not cross midline or be turned inward. The hip should not bend more than 90 degrees. Ambulation begins the day following surgery, and weight bearing ambulation may not be restricted, depending on the type of prosthesis. pg.1119

A nurse is performing discharge teaching for an elderly client diagnosed with osteoporosis. Which statement about home safety should the nurse include? a) "Most falls among the elderly occur outside the home. Clients should confine themselves to their homes as much as practical." b) "Because of the increase in home burglaries involving the elderly, these clients should have burglar bars on every window in the home." c) "Most falls among the elderly occur in the home. These clients should remove throw rugs and install bathroom grab bars." d) "Most accidental injuries among the elderly are automobile-related. Elderly clients should have vision testing every 6 months while they're still driving."

c) "Most falls among the elderly occur in the home. These clients should remove throw rugs and install bathroom grab bars." Explanation: Falls in the home cause most injuries among the elderly. Elderly clients should take measures to decrease the clutter that can contribute to falls, such as removing objects such as throw rugs from the floor. Elderly clients should also install grab bars in the shower and next to the toilet. The threat of fire makes burglar bars on every window impractical. pg.1144

Which statement by a staff nurse on the orthopedic floor indicates the need for further staff education? a) "Monitoring skin integrity is important while the continuous passive motion device is in place." b) "The continuous passive motion device can decrease the development of adhesions." c) "The client is receiving physical therapy twice per day, so he doesn't need a continuous passive motion device." d) "Bleeding is a complication associated with the continuous passive motion device."

c) "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. pg.1126

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

c) Alkaline phosphatase Explanation: Serum alkaline phosphatase levels are frequently elevated with osteogenic sarcoma or bone metastasis. Hypercalcemia is also present with bone metastases from breast, lung, or kidney cancer. Symptoms of hypercalcemia include muscle weakness, fatigue, anorexia, nausea, vomiting, polyuria, cardiac dysrhythmias, seizures, and coma. Hypercalcemia must be identified and treated promptly. pg.1152

Which medication classification is prescribed when allergy is a factor causing the skin disorder? a) Antibiotics b) Local anesthetics c) Antihistamines d) Corticosteroids

c) Antihistamines Explanation: Antihistamines are frequently prescribed when an allergy is a factor in causing the skin disorder. They relieve itching and shorten the duration of allergic reaction. Corticosteroids are used to relieve inflammatory or allergic symptoms. Antibiotics are used to treat infectious disorders. Local anesthetics are used to relieve minor skin pain and itching. pg.1040

Which of the following nursing actions would help prevent deep vein thrombosis in a patient who has had an orthopedic surgery? a) Apply cold packs b) Instruct about exercise, as prescribed c) Apply antiembolism stockings d) Instruct about using patient-controlled analgesia, if prescribed

c) Apply antiembolism stockings Explanation: Applying antiembolism stockings helps prevent deep vein thrombosis (DVT) in a patient who is immobilized due to orthopedic surgery. Regular administration of analgesics controls and prevents escalation of pain while ROM exercises help in maintaining muscle strength and tone and prevent contractions. On the other hand, cold packs are applied to help reduce swelling and it does not prevent deep vein thrombosis. pg.1128

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

c) Bone fracture Explanation: Bone fracture is a major complication of osteoporosis; it results when loss of calcium and phosphate increases the fragility of bones. Estrogen deficiencies result from menopause — not osteoporosis. Calcium and vitamin D supplements may be used to support normal bone metabolism, but a negative calcium balance isn't a complication of osteoporosis. Dowager's hump results from bone fractures. It develops when repeated vertebral fractures increase spinal curvature. pg.1144

Which medication directly inhibits osteoclasts thereby reducing bone loss and increasing BMD? a) Teriparatide (Forteo) b) Vitamin D c) Calcitonin (Miacalcin) d) Raloxifene (Evista)

c) Calcitonin (Miacalcin) Explanation: Miacalcin directly inhibits osteoclasts, thereby reducing bone loss and increased BMD. Evista reduces the risk of osteoporosis by preserving BMD without estrogenic effects on the uterus. Forteo has been recently approved by the FDA for the treatment of osteoporosis. pg.1143

When describing malignant bone tumors to a group of students, which of the following would the instructor cite as the usual location? a) Wrist-hand junction b) Femur-hip area c) Distal femur around the knee d) Proximal humerus

c) Distal femur around the knee Explanation: Malignant bone tumors usually are located around the knee in the distal femur or proximal fibula; a few are found in the proximal humerus. The wrist-hand junction and femur-hip area are not common sites. pg.1151

The client diagnosed with osteosarcoma is scheduled for a surgical amputation. Which nursing diagnosis would be a priority for this client compared with other surgical clients? a) Impaired physical mobility b) Risk for infection c) Disturbed body image d) Inadequate nutrition

c) Disturbed body image Explanation: Amputation of a body part can result in disturbances in body image. pg.1153

A patient comes to the clinic complaining of low back pain radiating down the left leg. After diagnostic studies rule out any pathology, the physician orders a serotonin-norepinephrine reuptake inhibitor (SNRI). Which medication does the nurse anticipate educating the patient about? a) Cyclobenzaprine (Flexeril) b) Amitriptyline (Elavil) c) Duloxetine (Cymbalta) d) Gabapentin (Neurontin)

c) Duloxetine (Cymbalta) Explanation: Nonprescription analgesics such as acetaminophen (Tylenol) and nonsteroidal anti-inflammatory drugs (NSAIDs) and short-term prescription muscle relaxants (e.g., cyclobenzaprine [Flexeril]) are effective in relieving acute low back pain. Tricyclic antidepressants (e.g., amitriptyline [Elavil) and the newer dual-action serotonin-norepinephrine reuptake inhibitors (e.g., duloxetine [Cymbalta]) (Karp et al., 2010) or atypical seizure medications (e.g., gabapentin [Neurontin], which is prescribed for pain from radiculopathy) are used effectively in chronic low back pain. pg.1133

A nurse is caring for a client with a cast on his left arm after sustaining a fracture. Which assessment finding is most significant for this client? a) Minimal pain in the left arm b) Cast edges are rough, with skin irritation present c) Fingers on the left hand are swollen and cool d) Presence of a normal popliteal pulse

c) Fingers on the left hand are swollen and cool Explanation: Swollen and cool fingers on the left hand are the most significant assessment findings. They represent altered circulation to the hand caused by the cast. A normal radial, not popliteal, pulse should be present in the left arm; the popliteal pulse is found on the leg. Skin irritation is an abnormal assessment finding but it isn't as significant as altered circulation. Minimal pain in the left arm is expected. pg.1109

Which type of cast encloses the trunk and a lower extremity? a) Short-leg b) Body cast c) Hip spica d) Long-leg

c) Hip spica Explanation: A hip spica cast encloses the trunk and a lower extremity. A body cast encloses the trunk. A long-leg cast extends from the junction of the upper and middle third of the thigh to the base of the toes. A short-leg cast extends from below the knee to the base of the toes. pg.1109

Which of the following is a benefit of a continuous passive motion (CPM) device when applied after knee surgery? a) It prevents infection and controls edema and bleeding. b) It promotes healing by immobilizing the knee joint. c) It promotes healing by increasing circulation and movement of the knee joint. d) It provides active range of motion.

c) It promotes healing by increasing circulation and movement of the knee joint. Explanation: A CPM device applied after knee surgery promotes healing by increasing circulation and movement of the knee joint. pg.1113

A nurse would most likely expect the need for open reduction for a client with which of the following? a) Little bone separation b) Soft tissue free of bone ends c) Joint fracture d) Closed fracture

c) Joint fracture Explanation: An open reduction is required when soft tissue is caught between the ends of the broken pieces of bone, the bone has a wide separation, open fractures are evident, comminuted fractures are present, and the patella or other joints are fractured. It is also done when wound debridement or internal fixation is needed. pg.1116

Which assessment findings would the nurse expect in a client diagnosed with osteomyelitis? a) Pruritus and uremic frost b) Petechiae over the chest and abnormal ABGs c) Leukocytosis and localized bone pain d) Thrombocytopenia and ecchymosis

c) Leukocytosis and localized bone pain Explanation: Clinical manifestations of osteomyelitis include signs and symptoms of sepsis and localized infection. pg.1148

A client is having traction applied to a fractured left lower extremity prior to surgery. What outcomes does the nurse expect from the application of the traction for the client? Select all that apply. a) Surgery will not be required. b) The bones of the left leg will be aligned. c) Muscle spasms will be relieved. d) Less pain medication will be required. e) Immobilization of the left leg will be maintained.

c) Muscle spasms will be relieved. b) The bones of the left leg will be aligned. e) Immobilization of the left leg will be maintained. Explanation: Traction is used to relieve muscle spasm, align bones, and maintain immobilization when used properly. It will not replace surgery to correct the fracture. The client will still require pain medication prior to surgical correction. pg.1111

Which of the following would the nurse use to determine that a client is exhibiting signs and symptoms of chronic osteomyelitis? a) Rapid pulse b) Tenderness over the affected area c) Persistent draining sinus d) High fever

c) Persistent draining sinus Explanation: Persistent draining sinus indicates a chronic infection in a client with osteomyelitis. High fever, rapid pulse, and tenderness or pain over the affected area is evidence of an acute infection. pg.1148

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

c) Plantar fasciitis Explanation: Plantar fasciitis, an inflammation of the foot-supporting fascia, present as an acute onset of heal pain experienced with the first steps in the morning. Hallux valgus (commonly called a bunion) is a deformity in which the great toe deviates laterally. Morton's neuroma is a swelling of the third (lateral) branch of the median plantar nerve. A ganglion, a collection of gelatinous material near the tendon sheaths and joints, appears as a round, firm compressible cystic swelling, usually on the dorsum of the wrist. pg.1139

The nurse is caring for a patient who had a total hip replacement. What lethal postoperative complication should the nurse closely monitor for? a) Hypovolemia b) Atelectasis c) Pulmonary embolism d) Urinary tract infection

c) Pulmonary embolism Explanation: Patients having orthopedic surgery are particularly at risk for venous thromboembolism, including deep vein thrombosis and pulmonary embolism. pg.1118

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

c) Raloxifene Explanation: Raloxifene is the only selective estrogen receptor modulator (SERM) approved for osteoporosis in post menopausal women as it does not increase the risk of breast or uterine cancer, but it does come with an increased risk of thromboembolism. Fosamax is a bisphosphonate. Forteo is a subcutaneously administered medication that is given one daily for the treatment of osteoporosis. Denosumab has recently been approved for treatment of postmenopausal women with osteoporosis who are at risk for fractures. pg.1144

A client is having a cast applied for a fractured leg that extends from below the knee to the base of the toes. The foot is flexed at a right angle in a neutral position. What type of cast is the client having applied? a) Long leg cast b) Hip spica cast c) Short leg cast d) Walking cast

c) Short leg cast Explanation: A short leg cast extends from below the knee to the base of the toes. The foot is flexed at a right angle in a neutral position. A long leg cast extends from the junction of the upper and middle third of the thigh to the base of the toes. The knee may be slightly flexed. A walking cast is a short or long leg cast reinforced for strength. A hip spica cast encloses the trunk and a lower extremity. pg.1104

Which of the following is an inaccurate principle of traction? a) The weights are not removed unless intermittent treatment is prescribed. b) The patient must be in good alignment in the center of the bed. c) Skeletal traction is interrupted to turn and reposition the patient. d) The weights must hang freely.

c) Skeletal traction is interrupted to turn and reposition the patient. Explanation: Skeletal traction is never interrupted. The weights are not removed unless intermittent treatment is prescribed. The weights must hang freely with the patient in good alignment in the center of the bed. pg.1114

Which is a risk-lowering strategy for osteoporosis? a) Diet low in calcium and vitamin D b) Increased age c) Smoking cessation d) Low initial bone mass

c) Smoking cessation Explanation: Risk-lowering strategies include increased dietary calcium and vitamin D intake, smoking cessation, alcohol and caffeine consumption in moderation, and outdoor activity. Individual risk factors include low initial bone mass and increased age. A lifestyle risk factor is a diet low in calcium and vitamin D. pg.1141

A nurse is caring for a client who's experiencing septic arthritis. This client has a history of immunosuppressive therapy and his immune system is currently depressed. Which assignment is the most appropriate for the nurse caring for this client? a) The nurse caring for this client is also caring for four clients receiving chemotherapy for cancer treatment on the oncology floor. b) The nurse caring for this client is also caring for two other immunosuppressed clients on the medical intensive care unit. c) The nurse is caring for this client on the intensive care unit. d) The nurse caring for this client is also caring for four other immunosuppressed clients on the medical floor.

c) The nurse is caring for this client on the intensive care unit. Explanation: This client is critically ill; his diagnosis and immunosuppression place him at a high risk for infection. The most appropriate place for this client is in an intensive care unit, where the nurse can focus exclusively on his health promotion. This client shouldn't be on the oncology floor. This client requires close monitoring. The nurse caring for this client shouldn't also be caring for other clients who may require frequent interventions. pg.1151

Which sign may be helpful in identifying carpal tunnel syndrome? a) Brudzinski's b) Babinski's c) Tinel's d) Kernig's

c) Tinel's Explanation: Tinel's sign may be used to help identify carpal tunnel syndrome. The presence of the Babinski's sign can identify disease of the brain and spinal cord in adults and also exists as a primitive reflex in infants. The Brudzinski's and Kernig's sign are indicative of meningeal irritation. pg.1136

The nurse teaches the patient with a high risk for osteoporosis about risk-lowering strategies including which of the following actions? a) Decrease the intake of vitamin A and D b) Reduce stress c) Walk or perform weight-bearing exercises outdoors d) Increase fiber in the diet

c) Walk or perform weight-bearing exercises outdoors Explanation: Risk-lowering strategies for osteoporosis include walking or exercising outdoors, performing a regular weight-bearing exercise regimen, increasing dietary calcium and vitamin D intake, smoking cessation, and consuming alcohol and caffeine consumption in moderation. pg.1145

A patient in the emergency department is being treated for a wrist fracture. The patient asks why a splint is being applied instead of a cast. What is the best response by the nurse? a) "It is best if an orthopedic doctor applies the cast." b) "Not all fractures require a cast." c) "You would have to stay here much longer because it takes a cast longer to dry." d) "A splint is applied when more swelling is expected at the site of injury."

d) "A splint is applied when more swelling is expected at the site of injury." Explanation: Splints are noncircumferential and will not compromise circulation when swelling is expected. A splint is applied to support and immobilize the injured joint. A fracture will experience swelling as part of the inflammation process. The patient would not have to stay longer if a fiberglass cast is applied. Fiberglass cast dry in approximately 30 minutes. An orthopedic doctor is not needed to apply the cast. Many nurses and technicians are trained in proper application of a cast. Some fractures may not be treated with a cast but it would not be appropriate to answer with this response because it does not reflect the actual reason for a splint being applied. pg.1105

The nurse has educated a patient with low back pain about techniques to relieve the back pain and prevent further complications. What statement by the patient shows understanding of the education the nurse provided? a) "I will bend at the waist when I am lifting objects from the floor." b) "Instead of turning around to grasp an object, I will twist at the waist." c) "I will lie prone with my legs slightly elevated." d) "I will avoid prolonged sitting or walking."

d) "I will avoid prolonged sitting or walking." Explanation: The nurse encourages the patient to alternate lying, sitting, and walking activities frequently, and advises the patient to avoid sitting, standing, or walking for long periods. pg.1133

A client with suspected osteomalacia has a fractured tibia and fibula. What test would give a definitive diagnosis of osteomalacia? a) Elevated levels of alkaline phosphatase b) Increased and decreased areas of bone metabolism c) Demineralization of the bone d) A bone biopsy

d) A bone biopsy Explanation: A definitive diagnosis is obtained by bone biopsy. Radiographic studies demonstrate demineralization of the bone. A bone scan detects increased and decreased areas of bone metabolism. Alkaline phosphatase levels are detected from a blood sample. pg.1146

The nurse is caring for patient with a hip fracture. The physician orders the patient to start on a bisphosphonate. Which medication would the nurse document as given? a) Raloxifene (Evista) b) Teriparatide (Forteo) c) Denosumab (Prolia) d) Alendronate (Fosamax)

d) Alendronate (Fosamax) Explanation: Alendronate (Fosamax) is a bisphosphonate medication. Raloxifene (Evista) is a selective estrogen receptor modulator. Terparatide (Forteo) is an anabolic agent, and denosumab (Prolia) is a monoclonal antibody agent. pg.1144

The nurse is preparing a client for a surgical procedure that will allow visualization of the extent of joint damage of the knee for a client with rheumatoid arthritis and also obtain a sample of synovial fluid. What procedure will the nurse prepare the client for? a) Arthroplasty b) Open reduction c) Needle aspiration d) Arthroscopy

d) Arthroscopy Explanation: Arthroscopic examination may be carried out to visualize the extent of joint damage as well as to obtain a sample of synovial fluid. An open reduction would be used for the treatment of a fracture. Needle aspiration will not allow visualization of the joint damage but will allow obtaining the sample of synovial fluid. Arthroplasty is the restructure of the joint surface after diagnosis is made. pg.1100

A group of students are reviewing information about cast composition in preparation for a discussion on the advantages and disadvantages of each. The students demonstrate understanding of the topic when they cite which of the following as an advantage of a plaster cast? a) Longer-lasting b) More breathable c) Quicker drying d) Better molding to the client

d) Better molding to the client Explanation: Plaster casts require a longer time for drying, but mold better to the client, and are initially used until the swelling subsides. Fiberglass casts dry more quickly, are lighter in weight, longer-lasting, and breathable. pg.1104

Which group is at the greatest risk for osteoporosis? a) Asian women b) Men c) African American women d) Caucasian women

d) Caucasian women Explanation: Small-framed, nonobese Caucasian women are at greatest risk for osteoporosis. Asian women of slight build are at risk for low peak BMD. African American women, who have a greater bone mass that Caucasian women, are less susceptible to osteoporosis. Men have a greater peak bone mass and do not experience sudden estrogen reduction. pg.1141

A client has a cast applied to the leg for treatment of a tibia fracture and also has a wound on the leg that requires dressing changes due to drainage. For what should the nurse prepare the client? a) Insertion of an external fixator b) Removal of the cast c) Cutting of a bivalve cast d) Cutting a cast window

d) Cutting a cast window Explanation: After the cast dries, a cast window, or opening, may be cut. This usually is done when the client reports discomfort under the cast or has a wound that requires a dressing change. The window permits direct inspection of the skin, a means to check the pulse in a casted arm or leg, or a way to change a dressing. A bivalve cast is when the cast is cut in two if the leg swells or if the client is being weaned from a cast, when a sharp x-ray is needed, or as a splint for immobilizing painful joints when a client has arthritis. The cast should not be removed due to the instability of a fracture. The client's condition does not indicate an external fixator is required. pg.1108

A patient with a tibia fracture was placed in an external fixator 24 hours ago. The nurse is completing pin care and notices redness at the pin site and a small amount of serous drainage. What action by the nurse is appropriate? a) Notify the physician. b) Assess patient's hemoglobin and hematocrit. c) Prepare for surgical removal of the fixator. d) Document the findings.

d) Document the findings. Explanation: Serous drainage and redness at the pin site is an expected finding for 24-48 hours postinsertion. The nurse should document the findings and continue to monitor the site. The physician does not need to be notified unless other signs and symptoms are present. The fixator does not need to be removed at this time. The greatest concern is for infection; assessing the hemoglobin and hematocrit are not relevant to assessing for infection. pg.1111

Which term describes a surgical procedure to release constricting muscle fascia so as to relieve muscle tissue pressure? a) Osteotomy b) Arthroplasty c) Arthrodesis d) Fasciotomy

d) Fasciotomy Explanation: A fasciotomy is a surgical procedure to release constricting muscle fascia so as to relieve muscle tissue pressure. An osteotomy is a surgical cutting of bone. An arthroplasty is a surgical repair of a joint. Arthrodesis is a surgical fusion of a joint. pg.1107

Ms. Simpson has come to the clinic with foot pain. The physician has described her problem as a flexion deformity of the proximal interphalangeal joint. What is the name of this disorder? a) Mallet toe b) Hallux valgus (bunion) c) Heberden's nodes d) Hammer toe

d) Hammer toe Explanation: Hammer toe is a flexion deformity of the proximal interphalangeal joint. Mallet toe is a flexion deformity of the distal interphalangeal joint. Bunion is a deformity of the great toe at its metatarsophalangeal joint. Heberden's nodes are bony enlargements of the distal interphalangeal joints. This is a finding in degenerative joint disease. pg.1139

A client has just undergone a leg amputation. The nurse would closely monitor the client for which of the following during the immediate postoperative period? a) Chronic osteomyelitis b) Neuroma c) Unexplainable burning pain (causalgia) d) Hematoma

d) Hematoma Explanation: Hematoma, hemorrhage, and infection are potential complications in the immediate postoperative period. Sleeplessness, nausea, and vomiting may occur but are adverse reactions, not complications. Chronic osteomyelitis and causalgia are potential complications that are likely to arise in the late postoperative period. A neuroma occurs when the cut ends of the nerves become entangled in the healing scar. This would occur later in the postoperative course. pg.1187

The client returns to the nursing unit following an open reduction with internal fixation of the right hip. Nursing assessment findings include temperature 100.8 degrees Farenheit, heart rate 112 beats per minute, respiratory rate 28 breaths per minute, and blood pressure 86/58. There is no urine in the Foley catheter collection bag. The nurse interprets these findings as indicating which of the following complications? a) Osteomyelitis b) Atelectasis c) Urinary retention d) Hypovolemic shock

d) Hypovolemic shock Explanation: Indicators of hypovolemic shock include a heart rate greater than 100 beats per minute, a blood pressure less than 90/60 mm Hg, and urine output less than 30 ml per hour. pg.1128

The nurse is preparing a client for a hip replacement with the use of porous-coated cementless joint components. What does the nurse know is the benefit of this type of component? a) The component is less expensive because there is no cement used. b) It prevents the client from developing infection related to the application of cement in the joint spaces. c) The client will not reject the prosthesis because there is no cement on the prosthetics. d) It allows the bone to grow into the prosthesis and securely fix the joint replacement in place.

d) It allows the bone to grow into the prosthesis and securely fix the joint replacement in place. Explanation: Porous-coated cementless joint components are used to allow the bone to grow into the prosthesis and thus securely fix the joint replacement in place. The prosthesis is not less expensive and cost is not a factor in reconstruction. The client may still have a local or systemic reaction to the prostheses even if it does not have cement. pg.1117

Which area of the spinal column is subject to the greatest mechanical stress and degenerative changes? a) Cervical b) Thoracic c) Upper lumbar d) Lower lumbar

d) Lower lumbar Explanation: The lower lumbar disks, L4 to L5 and L5 to S1, are subject to the greatest mechanical stress and greatest degenerative changes. pg.1133

A client has undergone an external fixation. Which actions would be the priority for this client? a) Monitoring the client's blood pressure. b) Monitoring the client's urine output. c) Planning the client's diet. d) Maintaining pin care.

d) Maintaining pin care. Explanation: Pin care is a priority for a client with external fixation, because pin sites are entry points for infection. The nurse should also monitor redness, drainage, and tenderness at the site. Planning the client's diet and monitoring the client's urine output and blood pressure, although necessary, are not as important as maintaining pin care. pg.1110

After a traumatic back injury, a client requires skeletal traction. Which intervention takes priority? a) Monitoring the client for skin breakdown b) Supporting the traction weights with a chair or table to prevent accidental slippage c) Restricting the client's fluid and fiber intake to reduce the movement required for bedpan use d) Maintaining traction continuously to ensure its effectiveness

d) Maintaining traction continuously to ensure its effectiveness Explanation: The nurse must maintain skeletal traction continuously to ensure its effectiveness. The nurse should assess skin for breakdown; however, maintaining skeletal traction takes priority. Traction weights must hang freely to be effective; they should never be supported. The nurse should increase, not restrict, the client's fluid and fiber intake (unless contraindicated by a concurrent illness) to prevent constipation associated with complete bed rest. pg.1114

The nurse is caring for a client following foot surgery. Which nursing intervention is most important for the nurse to include in the nursing care plan? a) Monitor vital signs every 4 hours. b) Administer pain medication per client request. c) Examine surgical dressing every hour. d) Perform neuromuscular assessment every hour.

d) Perform neuromuscular assessment every hour. Explanation: The priority nursing intervention is to perform a neuromuscular assessment every hour. Early detection of neurological and perfusion problems is critical. pg.2061

A patient had hand surgery to correct a Dupuytren's contracture. What nursing intervention is a priority postoperatively? a) Applying a cock-up splint and immobilization b) Changing the dressing c) Having the patient exercise the fingers to avoid future contractures d) Performing hourly neurovascular assessments for the first 24 hours

d) Performing hourly neurovascular assessments for the first 24 hours Explanation: Hourly neurovascular assessment of the exposed fingers for the first 24 hours following surgery is essential for monitoring function of the nerves and perfusion. pg.1137

Which instruction should the nurse include when teaching the client following hip replacement surgery? (Select all that apply.) a) "Avoid bending forward when sitting in a chair." b) "Use a raised toilet seat and high-seated chair." c) "You may cross your legs at the ankles only." d) "Place pillows between your legs when you lay on your side." e) "It is okay to briefly flex the hip to put on your clothes."

d) Place pillows between your legs when you lay on your side." a) "Avoid bending forward when sitting in a chair." b) "Use a raised toilet seat and high-seated chair." Explanation: The client following post hip replacement should not cross the legs, even at the ankle. He or she should avoid bending forward when sitting in a chair, avoid flexing the hip when dressing, and use a raised toilet seat. A pillow should be placed between the legs when side-lying. pg.1119

A 70-year-old client with a diagnosis of left-sided stroke is admitted to the facility. To prevent the development of disuse osteoporosis, which objective is most appropriate? a) Maintaining vitamin levels b) Maintaining protein levels c) Promoting range-of-motion (ROM) exercises d) Promoting weight-bearing exercises

d) Promoting weight-bearing exercises Explanation: When the mechanical stressors of weight bearing are absent, disuse osteoporosis can occur. Therefore, if the client does weight-bearing exercises, disuse complications can be prevented. Maintaining protein and vitamins levels is important, but neither will prevent osteoporosis. ROM exercises will help prevent muscle atrophy and contractures. pg.1141

A client with osteoporosis is prescribed a selective estrogen receptor modifier (SERM) as treatment. The nurse would identify which drug as belonging to this class? a) Alendronate (Fosamax) b) Calcium gluconate c) Tamoxifen (Nolvadex) d) Raloxifene (Evista)

d) Raloxifene (Evista) Explanation: An example of a selective estrogen receptor modifier (SERM) is raloxifene (Evista). Alendronate is a biphosphonate; calcium gluconate is an oral calcium preparation; tamoxifen is an antiestrogen agent. pg.1144

A patient diagnosed with osteoporosis is being discharged home. Which of the following is the priority education the nurse should provide? a) Classifying medications b) Increasing calcium and vitamin D in the diet c) Participating in weight-bearing exercises d) Removing all small rugs from the home

d) Removing all small rugs from the home Explanation: A patient with osteoporosis is at risk for fractures related to falls. The home environment needs to be evaluated for safety issues, such as rugs and other objects that could cause a fall. All other education is important in educating the patient, but the risk for injury with a fall and potential for a fracture makes safety in the home environment a priority. pg.1143

Which nursing assessment finding indicates the client with traction has not met expected outcomes? a) Capillary refill < 3 seconds b) Peripheral pulses +2 bilaterally c) Repositions self with trapeze d) Right calf warm and swollen

d) Right calf warm and swollen Explanation: Deep vein thrombosis is a potential complication of the client immobilized by traction. Clinical manifestations of deep vein thrombosis include calf tenderness, warmth, redness, and swelling of the affected extremity. pg.1118

A patient arrives in the emergency department with a suspected bone fracture of the right arm. How does the nurse expect the patient to describe the pain? a) Similar to "muscle cramps" b) A dull, deep, boring ache c) Sore and aching d) Sharp and piercing

d) Sharp and piercing Explanation: The nurse must carefully evaluate pain associated with the musculoskeletal condition, asking the patient to indicate the exact site and to describe the character and intensity of the pain using a pain rating scale. Most pain can be relieved by elevating the involved part, applying ice or cold packs, and administering analgesic agents as prescribed. Pain associated with the underlying condition (e.g., fracture, which is sharp and piercing) is frequently controlled by immobilization. Pain due to edema that is associated with trauma, surgery, or bleeding into the tissues can frequently be controlled by elevation and, if prescribed, intermittent application of ice or cold packs. Ice bags (one third to one half full) or cold application devices are placed on each side of the cast, if prescribed, making sure not to indent or wet the cast. Unrelieved or disproportionate pain may indicate complications. Pain associated with compartment syndrome is relentless and is not controlled by modalities such as elevation, application of ice or cold, and usual dosages of analgesic agents. Severe burning pain over bony prominences, especially the heels, anterior ankles, and elbows, warns of an impending pressure ulcer. This may also occur from too-tight elastic wraps used to hold splints in place. pg.1106

In chronic osteomyelitis, antibiotics are adjunctive therapy in which of the following situations? a) Wound irrigation b) Vitamin supplements c) Wound packing d) Surgical debridement

d) Surgical debridement Explanation: In chronic osteomyelitis, antibiotics are adjunctive therapy to surgical debridement. pg.1148

Morton's neuroma is exhibited by which of the following clinical manifestations? a) Inflammation of the foot-supporting fascia b) Longitudinal arch of the foot is diminished c) High arm and a fixed equinus deformity d) Swelling of the third (lateral) branch of the median plantar nerve

d) Swelling of the third (lateral) branch of the median plantar nerve Explanation: Morton's neuroma is swelling of the third branch of the median plantar nerve. Pes cavus refers to a foot with an abnormally high arch and a fixed equinus deformity of the forefoot. Flatfoot is a common disorder in which the longitudinal arch of the foot is diminished. Plantar fasciitis is an inflammation of the foot-supporting fascia. pg.1139

Which of the following statements is accurate regarding care of a plaster cast? a) The cast must be covered with a blanket to keep it moist during the first 24 hours. b) The cast will dry in about 12 hours. c) A dry plaster cast is dull and gray. d) The cast can be dented while it is damp.

d) The cast can be dented while it is damp. Explanation: The cast can be dented while it is damp. A dry plaster case is white and shiny. The cast will dry in 24 to 72 hours. A freshly applied cast should be exposed to circulating air to dry and should not be covered with clothing or bed linens or placed on plastic-coated mats or bedding. pg.1104

The nurse is preparing a client to have his cast cut off after having it for 6 weeks to treat a fracture tibia. What should the nurse inform the client prior to the cast being removed? a) The leg will look as it did prior to the cast being applied. b) The leg strength is enforced by the wearing of the cast. c) The leg will look moist and will have small bumps that will go away in a few days. d) The skin may be covered with a yellowish crust that will shed in a few days.

d) The skin may be covered with a yellowish crust that will shed in a few days. Explanation: Once the cast is off, the skin appears mottled and may be covered with a yellowish crust composed of accumulated body oil and dead skin. The client usually sheds this residue in a few days. The leg will not look as it did prior to the cast but will regain the same shape and status as the other leg. There should be no bumps underneath the cast. The leg may be weak and stiff for some time after the cast is removed, not stronger. pg.1108

The nurse is checking the traction apparatus for a client in skin traction. Which finding would require the nurse to intervene? a) Pulleys without evidence of the obstruction b) Body aligned opposite to line of traction pull c) Ropes freely moving over pulleys d) Weights hanging and touching the floor

d) Weights hanging and touching the floor Explanation: When checking traction equipment, the weights should be freely hanging. Weights that touch the floor require the nurse to intervene. The body should be aligned in an opposite line to the pull of the traction. The ropes should be freely moving over unobstructed pulleys. pg.1112

A client with a fracture develops compartment syndrome. Which of the following signs should alert the nurse to impending organ failure?

dark scanty urine (compartment syn may release myoglobin - obstruction of kidneys - renal failure)

A patient with an arm cast complains of pain. What nursing interventions should the nurse provide in order to reduce the incidence of complications? (Select all that apply.) a) Cut the cast with a cast saw b) Assess for a pressure sore c) Administer a prescribed analgesic to promote comfort and allay anxiety. d) Determine the exact site of the pain. e) Assess the fingers for color and temperature.

e) Assess the fingers for color and temperature. b) Assess for a pressure sore d) Determine the exact site of the pain. Explanation: Neurovascular assessment includes the assessment of peripheral circulation, motion, and sensation of the affected extremity, assessing the fingers or toes of the affected extremity, and comparing them with those of the opposite extremity. When assessing peripheral circulation, the nurse must check peripheral pulses as well as capillary refill response (within 3 seconds), edema, and the color and temperature of the skin. The nurse must carefully evaluate pain associated with the musculoskeletal condition, asking the patient to indicate the exact site and to describe the character and intensity of the pain using a pain rating scale (see Chapter 12). Severe burning pain over bony prominences, especially the heels, anterior ankles, and elbows, warns of an impending pressure ulcer. pg.1105

A nurse is caring for a female client following a motor vehicle accident resulting in paraplegia. The client is ready for discharge to home with her husband, who states, "I'm scared to carry her because I'm afraid I'll either hurt my back or drop her." A nurse identifies a need for discharge teaching of the husband in regard to: a) ergonomic principles and body mechanics. b) the importance of monitoring urinary elimination. c) signs and symptoms of chronic back pain that he should report to his physician. d) nutritional changes for the client with paraplegia.

ergonomic principles and body mechanics.

A client who has been diagnosed with osteoarthritis asks if he'll eventually begin to notice deformities in his hands and fingers as the condition progresses. Which concept should the nurse include in her response?

hand deformities are associated with RA (RA: morning stiffness OA: pain with activity RA: joint deformity OA: Heberden's/bouchard nodes)

A 30-year-old client, hospitalized with a fractured femur being treated with skeletal traction, has not had a bowel movement for 2 days. Which of the following interventions is most appropriate at this time?

increase fluid intake to 3000 mL/day

A fracture is termed pathologic when the fracture a) occurs through an area of diseased bone. b) presents as one side of the bone being broken and the other side being bent. c) involves damage to the skin or mucous membranes. d) results in a pulling away of a fragment of bone by a ligament or tendon and its attachment.

occurs through an area of diseased bone.

Primary prevention of osteoporosis includes: a) using a professional alert system in the home in case a client falls when she's alone. b) installing grab bars in the bathroom to prevent falls. c) optimal calcium intake and estrogen replacement therapy. d) placing items within the client's reach.

optimal calcium intake and estrogen replacement therapy.

A client with osteoarthritis tells the nurse she is concerned that the disease will prevent her from doing her chores. Which suggestion should the nurse offer?

pace yourself and rest frequently (OA: pain with activity RA: pain in morning - passive range of motion)

An example of a flat bone is the a) sternum. b) vertebra. c) metacarpals. d) femur.

sternum

A client is being discharged to a transitional rehabilitation care facility following a hip replacement due to degenerative arthritis. When reporting to the LPN, which nursing actions would the orthopedic nurse stress as essential? Select all that apply.

• Avoid any hip flexion exercises. • Place two pillows between the client's knees. • Place a raised toilet seat in the bathroom.

Following a total hip replacement, the nurse should do which of the following? Select all that apply.

• Encourage the client to use the overhead trapeze to assist with position changes. • Use a fracture bedpan when needed by the client. • When the client is in bed, prevent thromboembolism by encouraging the client to do toe-pointing exercises.

A client has had a total hip replacement. Which of the following signs most likely indicates that the hip has dislocated?

shortening of affected leg (also increasing pain, loss of function to the extremity, and deformity. Abduction of the leg after total hip replacement - prevent dislocation)

A client with a fractured leg has been instructed to ambulate without weight bearing on the affected leg. The nurse evaluates that the client is ambulating correctly if the client uses which of the following crutch-walking gaits?

3 point gait (client advances the crutches and the affected leg at the same time while weight is supported on the unaffected extremity

Which of the following exercises should the nurse advise the client to avoid after a lumbar laminectomy?

sit ups (stress on back)

Which of the following activities should the nurse plan to teach the client to strengthen the hand muscles in preparation for using crutches?

squeeze rubber ball (strengthen the hands in preparation for weight bearing with the hands)

A client has a Pearson attachment on the traction setup. Which of the following is the purpose of this attachment?

supports lower portion of leg

What is the most important assessment for the nurse to make when assessing peripheral pulses on a client who is post limb fracture?

Amplitude and symmetry of both extremities

A nurse is teaching a client with osteomalacia how to take ordered vitamin D supplements. Which adverse effects should the nurse instruct the client to report?

Gi up set/metallic taste (early s/s of vit d toxicity)

A nurse is caring for a client with lower back pain who is scheduled for myelography using metrizamide (a water-soluble contrast dye). After the test, the nurse should place the client in which position?

HOB elevated 45 degrees (water soluble dye - slows upward dispersion. Air contrast: supine with feet above level of head "trendelenberg")

The nurse advises the client who has had a femoral head prosthesis placement on the type of chair to sit in during the first 6 to 8 weeks after surgery. Which would be the correct type to recommend?

High backed chair w/ armrest (high-backed straight chair with armrests is recommended to help keep the client in the best possible alignment after surgery for a femoral head prosthesis placement. Use of this type of chair helps to prevent dislocation of the prothesis from the socket.)

A client's left leg is in skeletal traction with a Thomas leg splint and Pearson attachment. Which intervention should the nurse include in this client's care plan? a) Apply the traction straps snugly. b) Teach the client how to prevent problems caused by immobility. c) Assess the client's level of consciousness. d) Remove the traction at least every 8 hours.

Teach the client how to prevent problems caused by immobility. Explanation: By teaching the client about prevention measures, the nurse can help prevent problems caused by immobility, such as hypostatic pneumonia, muscle contracture, and atrophy. The nurse applies traction straps for skin traction — not skeletal traction. For a client in skeletal traction, the nurse should assess the affected limb, rather than assess the level of consciousness. Removing skeletal traction is the physician's responsibility — not the nurse's. pg.1116

A client is scheduled to undergo an open reduction internal fixation of the right femur. The night before surgery, the nurse administers zolpidem as ordered. Which statement about zolpidem is correct?

The nurse should administer the drug immediately before bedtime. (rapid onset)

The nurse is evaluating a client in skin traction. Which of the following indicate the traction is applied for maximum effectiveness?

The ropes are in the wheel grooves of the pulleys.

A client, age 50, visits the physician for a routine checkup. The history reveals that the client was diagnosed with a spinal curvature at age 45. The nurse knows that life-threatening complications can occur if the progressive spinal curvature exceeds 65 degrees. Which region of the spine should the nurse assess for complications?

Thoracic (The nurse should assess the thoracic region of the spine because a progressive curvature of more than 65 degrees in this region may lead to cardiopulmonary failure as well as less serious signs and symptoms, such as fatigue, back pain, decreased height, and cosmetic deformity)

A client has a plaster cast applied to the left leg. Which of the following comments by the client following the procedure should the nurse address first? a) "My toes are stiff." b) "My pain is a 3." c) "My toes are pink." d) "My cast is still wet."

a) "My toes are stiff." Explanation: Compartment syndrome is characterized by neurovascular compromise. Stiffness of the toes may be a preliminary finding that the client is having trouble with motor function. pg.1107

The nurse is caring for a client who lives alone and had a total knee replacement. An appropriate nursing diagnosis for the client is: a) Risk for ineffective therapeutic regimen management b) Risk for avascular necrosis of the joint c) Disturbed body image d) Situational low self-esteem

a) Risk for ineffective therapeutic regimen management Explanation: The client without adequate support and resources is at risk for ineffective therapeutic regimen management. A total knee replacement may be used to treat avascular necrosis. While an orthopedic client is at risk for disturbed body image and situational low self-esteem, there is no evidence that these exist for this client. pg.1128

A client is about to have a cast applied to his left arm. The nurse would alert the client to which of the following as the cast is applied? a) Sensation of warmth or heat with application b) Sensation of weakness c) Arm being moved to various positions d) Increased in pain in left arm

a) Sensation of warmth or heat with application Explanation: When a cast is applied, the client needs to be aware that he may feel a sensation of warmth or heat due to the material being mixed with water. The client should not feel an increase in pain during the application. The arm will be held in place to ensure proper alignment during the application. The client should not feel weakness in the extremity. This is more commonly experiences after a cast is removed. pg.1104

Which of the following principles apply to the patient in traction? a) Skeletal traction is never interrupted b) Weights are removed routinely c) Weights should rest on the bed d) Knots in the ropes should touch the pulley

a) Skeletal traction is never interrupted Explanation: Skeletal traction is applied directly to the bone and is never interrupted. In order to be effective, the weights must hang freely and not rest on the bed or floor. Knots in the rope or the footplate must not touch the pulley or the foot of the bed. Traction must be continuous to be effective in reducing and immobilizing fractures. pg.1114

The nurse is instructing a nursing assistant on how to correctly position a client who has had a recent total hip replacement. In which position should the nurse tell the assistant to place the operated leg when the client is lying on the nonoperative side?

abduction extension

A nurse is assessing a client with possible osteoarthritis. The most significant risk factor for primary osteoarthritis is:

age (more signif than obesity)

On the evening of surgery for total knee replacement, a client wants to get out of bed. To safely assist the client the nurse should do which of the following?

apply a knee immobilizer. (The knee is usually protected with a knee immobilizer -splint, cast, or brace- and is elevated when the client sits in a chair. Pre- and post-surgery, the physician prescribes weight-bearing limits and use of assistive devices for progressive ambulation. Positioning a straight-backed chair at the foot of the bed is not an action conducive for getting the client out of bed on the evening of surgery for a total knee replacement. )

After total hip replacement, a client is receiving epidural analgesia to relieve pain. Which action is a nursing priority for this client?

assess for sensation in legs

Upon reporting to work and receiving report, a nurse has been assigned to provide care for three clients. Each of the clients has called out to the nurses' station requesting assistance. Which client should the nurse see first? a) A 60-year-old female, who is in traction to manage chronic muscle spasms, who is requesting assistance to order her evening meal b) A 32-year-old male, who had a plaster cast applied to his leg 2 hours ago, who complains that the cast feels as if it's getting tighter c) The order doesn't matter; all clients are of equal priority d) A 56-year-old male, who had an arthroscopy of his left knee 3 hours ago, who is asking to be discharged

b) A 32-year-old male, who had a plaster cast applied to his leg 2 hours ago, who complains that the cast feels as if it's getting tighter Explanation: The male who reports his cast feels tighter requires a complete assessment that focuses on his neurovascular status. The nurse should respond to him first. The older male and female are stable and aren't priorities at this time. pg.1105

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

b) limit hip flexion of the client's hip when he sits. Explanation: The nurse should instruct the client to limit hip flexion to 90 degrees when he sits. The nurse should supply an elevated toilet seat so that the client can sit without having to flex his hip more than 90 degrees. The nurse should instruct the client not to cross his legs to avoid dislodging or dislocating the prosthesis. The nurse should caution the client against sitting in chairs that are too low or too soft; these chairs increase flexion, which is undesirable. pg.1119

Which action by the nurse would be inappropriate for the client following casting? a) Circulate room air with a portable fan. b) Petal and smooth the edges of the cast. c) Protect the cast by covering with a sheet. d) Handle the cast with the palms of hands.

c) Protect the cast by covering with a sheet. Explanation: The nurse performs actions to facilitate drying of the cast. The cast should be exposed to air. Portable fans can be used to dry the cast. Pressure on the cast should be avoided. pg.1104

Which of the following statements describes external fixation? a) The bone is surgically exposed and realigned. b) The surgeon secures the bone with metal screws, plates, rods, nails, or pins. A cast or other mode of immobilization is applied. c) The surgeon inserts metal pins into the bone or bones from outside the skin surface and then attaches a compression device to the pins. d) The bone is restored to its normal position by external manipulation.

c) The surgeon inserts metal pins into the bone or bones from outside the skin surface and then attaches a compression device to the pins. Explanation: In external fixation, the surgeon inserts metal pins into the bone or bones from outside the skin surface and then attaches a compression device to the pins. In internal fixation, the surgeon secures the bone with metal screws, plates, rods, nails, or pins. A cast or other mode of immobilization is applied. In closed reduction, the bone is restored to its normal position by external manipulation. In open reduction, the bone is surgically exposed and realigned. pg.1110

A client has severe osteoarthritis in the left hip and is having surgery to replace both articular surfaces of the hip. What type of surgical procedure will the nurse prepare the client for? a) Arthrodesis b) Hemiarthroplasty c) Total arthroplasty d) Osteotomy

c) Total arthroplasty Explanation: A total arthroplasty is a replacement of both articular surfaces within one joint. An arthrodesis is a fusion of a joint for stabilization and pain relief and is usually done on a wrist or knee. A hemiarthroplastyis the replacement of one of the articular surfaces in a joint, such as the femoral head but not the acetabulum. An osteotomy is the cutting and removal of a wedge of bone to change the bone's alignment, thereby improving function and relieving pain. pg.1116

A patient is being discharged home with a long arm cast. What education should the nurse include to prevent disuse syndrome in the arm? a) Proper use of a sling b) Abduction and adduction of the shoulder c) Use of isometric exercises d) Repositioning the arm in the cast

c) Use of isometric exercises Explanation: Isometric exercises allow for use of the muscle without moving the bone. Doing isometric exercises every hour while the patient is awake will help prevent disuse syndrome. Proper use of a sling does not prevent disuse syndrome. The patient should not attempt to reposition the arm in the cast. Abduction and adduction of the shoulder will help the shoulder joint but does not require the use of muscles in the lower arm. pg.1108

All of the following are guidelines for avoiding hip dislocation after replacement surgery. Select the answer that is not. a) Put a pillow between the legs when sleeping. b) Keep the knees apart at all times. c) You may flex at the hip to put on clothing such as pants, stockings, socks, or shoes. d) Never cross the legs when seated.

c) You may flex at the hip to put on clothing such as pants, stockings, socks, or shoes. Explanation: "Do not flex at the hip to put on clothing such as pants, stockings, socks, or shoes" is the correct guideline. Keep the knees apart at all times. Put a pillow between the legs when sleeping. Never cross the legs when seated. pg.1124

To protect a client's skin under a back brace, the nurse should:

wear thin cotton shirt

The client displays manifestations of compartment syndrome. The nurse expects the client to be scheduled for: a) A total hip replacement b) A total knee replacement c) An open reduction d) A fasciotomy

d) A fasciotomy Explanation: A treatment option for compartment is fasciotomy. pg.1107

A client is diagnosed with osteoporosis. Which statements should the nurse include when teaching the client about the disease? Select all that apply.

• "It's common in females after menopause." • "It's a degenerative disease characterized by a decrease in bone density." • "It can cause pain and injury."

Which of the following goals is a priority for a client with rheumatoid arthritis? The client will:

demonstrate use of adaptive equipment (hand deformities)

A client was undergoing conservative treatment for a herniated nucleus pulposus, at L5 - S1, which was diagnosed by magnetic resonance imaging. Because of increasing neurological symptoms, the client undergoes lumbar laminectomy. The nurse should take which step during the immediate postoperative period?

logroll client from side to side

The nurse teaches a client about heat and cold treatments to manage arthritis pain. Which of the following client statements indicates that the client still has a knowledge deficit?

"Heat-producing liniments can be used with other heat devices." (Heat-producing liniment can produce a burn if used with other heat devices that could intensify the heat reaction. Heat and cold can be used as often as the client desires. However, each application of heat should not exceed 20 minutes, and each application of cold should not exceed 10 to 15 minutes.)

Which statement by the client with rheumatoid arthritis would indicate the need for additional teaching to safely receive the maximum benefit of aspirin therapy?

"I try to take aspirin only on days when the pain seems particularly bad." (should be used continuously for therapeutic effect)

A client has bursitis in the subacromial bursa. A nurse determines that the client understands teaching when the client says which of the following?

"I will apply moist heat to my shoulder for 20 minutes three times each day." (non pharmacologic measure

The client who had a total hip replacement was discharged home and developed acute groin pain in the affected leg, shortening of the leg, and limited movement of the fractured leg. The nurse interprets these findings as indicating which of the following complications? a) Dislocation of the hip b) Avascular necrosis of the hip c) Re-fracture of the hip d) Contracture of the hip

a) Dislocation of the hip Explanation: Manifestations of a dislocated hip prosthesis are increased pain at the surgical site, acute groin pain in the affected leg, shortening of the leg, abnormal external or internal rotation, and limited movement of the fractured leg. The client may report a "popping" sensation in the hip. pg.1119

A client is seen in the emergency department for an injury acquired from falling off of a bicycle and fracturing the arm. The client also has a long laceration that has been sutured in the same area. The client asks the nurse why a splint is applied and not a cast. What is the best explanation by the nurse? a) "We will need to monitor the status of the laceration to be sure it does not get infected." b) "You will be able to wear the splint longer than you would a cast." c) "The splint is less expensive than the cast." d) "The arm does not require the same immobilization that a leg fracture would."

a) "We will need to monitor the status of the laceration to be sure it does not get infected." Explanation: A splint would be used when there is special skin treatment or observation that is required. The arm fracture would require the same form of immobilization that a leg fracture does. The length of time the splint can be worn is equal to that of a cast to immobilize the fracture. The cost of the splint and cast would be similar. pg.1105

A patient had a total hip replacement. What recommended leg position should the nurse ensure is maintained to prevent prosthesis dislocation? a) Abduction b) Adduction c) Internal rotation d) Flexion

a) Abduction Explanation: The nurse educates the patient about protective positioning, which includes maintaining abduction and avoiding internal and external rotation, hyperextension, and acute flexion. pg.1123

Which of the following would be an inconsistent initial pain relief measure for the patient with a cast? a) Application of cold packs b) Application of a new cast c) Administration of analgesics d) Elevation of the involved part

b) Application of a new cast Explanation: Most pain can be relieved by elevating the casted part of the body, and by applying cold packs as prescribed and administering analgesics. Application of a new cast is usually not necessary. pg.1106

Which action would be most important postoperatively for a client who has had a knee or hip replacement? a) Encouraging expressions of anxiety. b) Assisting in early ambulation. c) Using a continuous passive motion (CPM) machine. d) Providing crutches to the client.

b) Assisting in early ambulation. Explanation: An anticoagulant therapy and early ambulation are important for clients who undergo a knee or hip replacement. A CPM machine or crutches may be provided when prescribed. It is important to encourage clients to express their feelings of anxiety or depression. This is more crucial for clients who undergo an amputation rather than for clients who undergo a replacement surgery. pg.1128

Which nursing assessment finding would be indicative of compartment syndrome in the client with a cast applied to the left forearm 3 hours earlier? a) Absence of numbness and tingling b) Capillary refill of left fingers greater than 3 seconds c) Radial pulses palpable and +2 bilaterally d) Fingers pink and warm and move freely

b) Capillary refill of left fingers greater than 3 seconds Explanation: Compartment syndrome is characterized by neurovascular compromise. Capillary refill should be less than 3 seconds. pg.1107

Following a total knee replacement, the surgeon orders a continuous passive motion (CPM) device. The client asks about the purpose of this treatment. The best response by the nurse is: a) "CPM delivers analgesic agents directly into the joint." b) "CPM strengthens the muscles of the leg." c) "CPM increases range of motion of the joint." d) "CPM prevents injury by limiting flexion of the knee."

c) "CPM increases range of motion of the joint." Explanation: CPM increases circulation and range of motion of the knee joint. pg.1126

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

c) "Metal pins will go through my skin to the bone." Explanation: In skeletal traction, metal rods or pins are used to apply continuous traction directly to the bone. Weights are used to apply the traction. Casts, external fixators, or splints are used when the traction is discontinued. pg.1114

A client has a Fiberglas cast on the right arm. Which action should the nurse include in the care plan? a) Evaluating pedal and posterior tibial pulses every 2 hours b) Avoiding handling the cast for 24 hours or until it is dry c) Assessing movement and sensation in the fingers of the right hand d) Keeping the casted arm warm by covering it with a light blanket

c) Assessing movement and sensation in the fingers of the right hand Explanation: The nurse should assess a casted arm every 2 hours for finger movement and sensation to make sure the cast isn't restricting circulation. To reduce the risk of skin breakdown, the nurse should leave a casted arm uncovered, which allows air to circulate through the cast pores to the skin below. Unlike a plaster cast, a Fiberglas cast dries quickly and can be handled without damage soon after application. The nurse should assess the brachial and radial pulses distal to the cast — not the pedal and posterior tibial pulses, which are found in the legs. pg.1109

Which of the following would the nurse expect a physician to use on a short-term basis for a client with an injured body part that does not require rigid immobilization? a) Cast b) Brace c) Splint d) Skin traction

c) Splint Explanation: A splint immobilizes and supports an injured body part in a functional position and is used when the condition does not require rigid immobilization, causes a large degree of swelling, or requires special skin treatment. Casts and traction provide rigid immobilization. A brace provides support, controls movement, and prevents additional injury for more long-term use. pg.1105

A patient had a total left hip arthroplasty. What clinical manifestation would indicate to the nurse that the prosthesis is dislocated? a) Diminished peripheral pulses on the affected extremity b) The leg length is the same as the right leg. c) The left leg is internally rotated. d) The patient has discomfort when moving in the bed.

c) The left leg is internally rotated. Explanation: The nurse must monitor for signs and symptoms of dislocation of the prosthesis, which include abnormal external or internal rotation of the affected extremity. pg.1123

When developing a teaching plan for a client who is prescribed acetaminophen for muscle pain, which information should the nurse expect to include? Select all that apply.

can be used in those allergic to aspirin doesn't cause platelet aggregation causes little to no GI aggrivation

A patient diagnosed with a right ulnar fracture asks why the cast needs to go all the way up the arm. What is the best response by the nurse? a) "When a spica cast is ordered, the arm must be immobilized." b) "This will allow for the strength in the arm to remain consistent." c) "The method will allow for the fastest healing time and the greatest mobility." d) "The joint above the fracture and below the fracture must be immobilized."

d) "The joint above the fracture and below the fracture must be immobilized." Explanation: Generally, the joints proximal and distal to the fracture are immobilized to promote healing. The purpose is not for the strength to remain consistent, most patients will lose strength. A spica cast would not be ordered for an ulnar fracture. Although immobilizing the joints above and below fractures may aide in healing time, it does not allow for increased mobility. pg.1103

A nurse is caring for a client placed in traction to treat a fractured femur. Which nursing intervention has the highest priority? a) Ensuring that the weights hang free at all times b) Keeping the client from sliding to the foot of the bed c) Keeping the ropes over the center of the pulley d) Assessing the extremity for neurovascular integrity

d) Assessing the extremity for neurovascular integrity Explanation: Although all measures are correct, assessing neurovascular integrity takes priority because a decrease in neurovascular integrity could compromise the limb. The pull of the traction must be continuous to keep the client from sliding. Sufficient countertraction must be maintained at all times by keeping the ropes over the center of the pulley. The line of pull is maintained by allowing the weights to hang free. pg.1114

A group of students is studying for a test on traction. The students demonstrate understanding of the types of traction when they identify which of the following as an example of skin traction? a) Thomas splint b) Balanced suspension c) Crutchfield tongs d) Buck's

d) Buck's Explanation: An example of skin traction is Buck's traction. Crutchfield tongs, a Thomas splint, or balanced suspension traction are types of skeletal traction. pg.1113

A physician orders chlorzoxazone, 500 mg P.O. t.i.d for a client. The nurse knows that chlorzoxazone, a centrally acting skeletal muscle relaxant, is commonly used to treat:

severe muscle spasm (Centrally acting skeletal muscle relaxants such as chlorzoxazone are ineffective in treating spasticity associated with chronic neurologic disease, such as cerebral palsy, and they treat acute musculoskeletal disorders, not chronic ones. Chlorzoxazone and the other relaxants are used to treat spasticity of any extremity, not just lower extremity spasiticity.)

The client with an above-the-knee amputation is to use crutches while the prosthesis is being adjusted. Which of the following exercises will best prepare the client for using crutches?

triceps stretching exercises (Use of crutches requires significant strength from the triceps muscles)