Muscloskeletal Nclex

A client with osteoarthritis will undergo an arthrocentesis on his painful edematous knee. What should be included in the nursing plan of care? Select all that apply. 1. Explain the procedure. 2. Administer preoperative medication 1 hour before surgery. 3. Instruct the client to immobilize the knee for 2 days after the surgery. 4. Assess the site for bleeding. 5. Offer pain medication.

1, 4, 5. To prepare a client for an arthrocentesis, the nurse should tell the client that a local anesthetic administered by the physician will decrease discomfort. There may be bleeding after the procedure, so the nurse should check the dressing. The client may experience pain. The nurse should offer pain medication and evaluate outcomes for pain relief. Because a local anesthetic is used, the client will not require preoperative medication. The client will rest the knee for 24 hours and then should begin range-of-motion and muscle strengthening exercises.

Which of the following statements indicates that the client with osteoarthritis understands the effects of capsaicin (Zostrix) cream? 1. "I always wash my hands right after I apply the cream." 2. "After I apply the cream, I wrap my knee with an elastic bandage." 3. "I keep the cream in the cabinet above the stove in the kitchen." 4. "I also use the same cream when I get a cut or a burn."

1. Capsaicin cream, which produces analgesia by preventing the reaccumulation of substance P in the peripheral sensory neurons, is made from the active ingredients of hot peppers. Therefore, clients should wash their hands immediately after applying capsaicin cream if they do not wear gloves, to avoid possible contact between the cream and mucous membranes. Clients are instructed to avoid wearing tight bandages over areas where capsaicin cream has been applied because swelling may occur from inflammation of the arthritis in the joint and lead to constriction on the peripheral neurovascular system. Capsaicin cream should be stored in areas between 59 ° F and 86 ° F (15 ° C and 30 ° C). The cabinet over the stove in the kitchen would be too warm. Capsaicin cream should not come in contact with irritated and broken skin, mucous membranes, or eyes. Therefore it should not be used on cuts or burns.

A postmenopausal client is scheduled for a bone-density scan. To plan for the client's test, what should the nurse communicate to the client? 1. Request that the client remove all metal objects on the day of the scan. 2. Instruct the client to consume foods and beverages with a high content of calcium for 2 days before the test. 3. Inform the client that she will need to ingest 600 mg of calcium gluconate by mouth for 2 weeks before the test. 4. Tell the client that she should report any significant pain to her physician at least 2 days before the test.

1. Metal will interfere with the test. Metallic objects within the examination field, such as jewelry, earrings, and dental amalgams, may inhibit organ visualization and can produce unclear images. Ingesting foods and beverages days before the test will not affect bone mineral status. Short-term calcium gluconate intake will also not influence bone mineral status. The client may already have had chronic pain as a result of a bone fracture or from osteoporosis.

A client with osteoporosis needs education about diet and ways to increase bone density. Which of the following should be included in the teaching plan? Select all that apply. 1. Maintain a diet with adequate amounts of vitamin D, as found in fortified milk and cereals. 2. Choose good calcium sources, such as figs, broccoli, and almonds. 3. Use alcohol in moderation because a moderate intake has no known negative effects. 4. Try swimming as a good exercise to maintain bone mass. 5. Avoid the use of high-fat foods, such as avocados, salad dressings, and fried foods.

1, 2, 3. A diet with adequate amounts of vitamin D aids in the regulation, absorption, and subsequent utilization of calcium and phosphorus, which are necessary for the normal calcification of bone. Figs, broccoli, and almonds are very good sources of calcium. Moderate intake of alcohol has no known negative effects on bone density but excessive alcohol intake does reduce bone density. Swimming, biking, and other non- weight-bearing exercises do not maintain bone mass. Walking and running, which are weight-bearing exercises, do maintain bone mass. The client should eat a balanced diet but does not need to avoid the use of high-fat foods.

Which of the following statements should the nurse include in the teaching session when preparing a client for arthrocentesis? Select all that apply. 1. "A local anesthetic agent may be injected into the joint site for your comfort." 2. "A syringe and needle will be used to withdraw fluid from your joint." 3. "The procedure, although not painful, will provide immediate relief." 4. "We'll want you to keep your joint active after the procedure to increase blood flow." 5. "You will need to wear a compression bandage for several days after the procedure."

1, 2, 5. An arthrocentesis is performed to aspirate excess synovial fluid, pus, or blood from a joint cavity to relieve pain or to diagnosis inflammatory diseases such as rheumatoid arthritis. A local agent may be used to decrease the pain of the needle insertion through the skin and into the joint cavity. Aspiration of the fluid into the syringe can be very painful because of the size and inflammation of the joint. Usually a steroid medication is injected locally to alleviate the inflammation; a compression bandage is applied to help decrease swelling; and the client is asked to rest the joint for up to 24 hours afterwards to help relieve the pain and promote rest to the inflamed joint. The client may experience pain during this time until the inflammation begins to resolve and swelling decreases.

The teaching plan for the client with rheumatoid arthritis includes rest promotion. Which of the following would the nurse expect to instruct the client to avoid during rest periods? 1. Proper body alignment. 2. Elevating the part. 3. Prone lying positions. 4. Positions of flexion.

4. Positions of flexion should be avoided to prevent loss of functional ability of affected joints. Proper body alignment during rest periods is encouraged to maintain correct muscle and joint placement. Lying in the prone position is encouraged to avoid further curvature of the spine and internal rotation of the shoulders.

A client with rheumatoid arthritis tells the nurse, "I know it is important to exercise my joints so that I won't lose mobility, but my joints are so stiff and painful that exercising is difficult." Which of the following responses by the nurse would be most appropriate? 1. "You are probably exercising too much. Decrease your exercise to every other day." 2. "Tell the physician about your symptoms. Maybe your analgesic medication can be increased." 3. "Stiffness and pain are part of the disease. Learn to cope by focusing on activities you enjoy." 4. "Take a warm tub bath or shower before exercising. This may help with your discomfort."

4. Superficial heat applications, such as tub baths, showers, and warm compresses, can be helpful in relieving pain and stiffness. Exercises can be performed more comfortably and more effectively after heat applications. The client with rheumatoid arthritis must balance rest with exercise every day, not every other day. Typically, large doses of analgesics, which can lead to hepatotoxic effects, are not necessary. Learning to cope with the pain by refocusing is inappropriate.

After a computer tomography scan with intravenous contrast medium, a client returns to the unit complaining of shortness of breath and itching. The nurse should be prepared to treat the client for: A. An anaphylactic reaction to the dye B. Inflammation from the extravasation of fluid during injection. C. Fluid overload from the volume of the infusions D. A normal reaction to the stress of the diagnostic procedure

A

Which of the following would lead the nurse to suspect that a client with a fracture of the right femur may be developing a fat embolus? A. Acute respiratory distress syndrome B. Migraine like headaches C. Numbness in the right leg D. Muscle spasms in the right thigh

A

Which of the following would the nurse use as the best method to assess for the development of deep vein thrombosis in a client with a spinal cord injury? A. Homan's sign B. Pain C. Tenderness D. Leg girth

A

Which nursing intervention is most effective in preventing transfer of an organism from the wound of a client with osteomyelitis to other clients? a. Contact Precautions b. Restriction of visitors c. Irrigating the wound as needed d. Leaving the wound open to air

ANS: A In the presence of wound drainage, Contact Precautions may be used to prevent the spread of the offending organism to other clients and health care personnel. Restricting visitors does not prevent transfer. One visitor could possibly transfer the bacteria to another surface. Irrigating the wound would not destroy the organism. The wound should be covered to prevent transfer of the organism.

A client for whom skeletal traction is planned asks for an explanation regarding the purpose of this type of traction. Which is the nurse's best response? a. "It aids in realigning the bone." b. "It prevents low back pain." c. "It decreases muscle spasms that occur with a fracture." d. "It prevents injury to the skin as a result of the fracture."

ANS: A Skeletal traction pins or screws are surgically inserted into the bone to aid in bone alignment. The other choices are not primary purposes of skeletal traction.

While assessing an older adult client admitted 2 days ago with a fractured hip, the nurse notes that the client is confused, tachypneic, and restless. Which is the nurse's first action? a. Administer oxygen via nasal cannula. b. Apply restraints and ask for a sitter. c. Slow the IV flow rate. d. Discontinue the pain medication

ANS: A The client is at high risk for a fat embolism and has some of the clinical manifestations of altered mental status and dyspnea. Although this is a life-threatening emergency, the nurse should take the time to administer oxygen first and then notify the health care provider. Oxygen administration can reduce the risk for cerebral damage from hypoxia. The nurse would not restrain a client who is confused without further assessment and orders. Pain medication most likely would not cause the client to be restless. The IV rate is not related.

While assessing an older adult client admitted 2 days ago with a fractured hip, the nurse notes that the client is confused, tachypneic, and restless. What is the nurse's first action? A. Administer oxygen. B. Notify the physician. C. Slow the IV flow rate. D. Discontinue the pain medication.

ANS: A The client is at high risk for a fat embolism and has some of the clinical manifestations. Although this is a life-threatening emergency, the nurse should take the time to administer oxygen first and then notify the physician. Oxygen administration can reduce the risk for cerebral damage from hypoxia.

The nurse is caring for a client 3 days after a below-knee amputation. Which is a priority intervention? a. Muscle-strengthening exercises b. Use of a very soft bed mattress c. Placing a pillow between the client's knees d. Placing the client in high Fowler's position

ANS: A To prepare for a prosthesis, the nurse instructs the client in muscle-strengthening exercises, provides the client with a firm mattress, and places the client in a prone position every 3 to 4 hours for 20 to 30 minutes to prevent flexion contractures. A pillow should not be placed between the client's knees.

A client with a new fracture reports pain in the site of the fracture. An opioid pain medication was administered 20 minutes ago. Which is the nurse's best intervention? (Select all that apply.) a. Administration of additional opioids b. Elevation of the extremity c. Application of ice d. Application of heat e. Keeping the extremity in a dependent position

ANS: A, B, C The client with a new fracture likely has edema; elevating the extremity and applying ice probably will help in decreasing pain. Heat will increase edema and may increase pain. Dependent positioning will also increase edema. Administration of an additional opioid within the dosage guidelines may be ordered.

The nurse is performing a medical history and physical assessment for a client. Which assessment findings lead the nurse to conclude that the client is at risk for development of osteoporosis? (Select all that apply.) a. Client is a white woman with a body mass index (BMI) of 19.4. b. Client fractured her wrist badly in a fall last year. c. Client drinks at least four cans of diet cola every day. d. Client does tai chi exercises for 45 minutes every morning. e. Client has smoked two packs of cigarettes a day for 40 years. f. Client has taken estrogen (Premarin) 0.625 mg daily since menopause

ANS: A, B, C, E Risk factors for osteoporosis include white race, female gender, small body frame, large intake of caffeinated carbonated drinks, and smoking cigarettes. Recent fracture after a fall indicates that the client's bones may be soft and/or thin. Hormone replacement therapy, late onset of menopause, and regular exercise help reduce the risk of osteoporosis.

A client has a fractured tibia and is asking the nurse about external fixation. What are some advantages for the use of external fixation for the immobilization of fractures? (Select all that apply.) a. Leads to minimal blood loss b. Allows for early ambulation c. Decreases the risk of infection d. Increases blood supply to tissues e. Provides visualization of bone ends f. Promotes healing

ANS: A, B, F Blood loss is less. The device allows early ambulation and exercise, maintains alignment, stabilizes the fracture site, and promotes healing. The device does place the client at risk for infection and does not increase the blood supply to tissues, nor does it provide visualization of the ends of the bone.

The nurse is teaching a client who has left leg weakness to walk with a cane. Which gait training technique is correct? a. Place the cane in the client's left hand and move the cane forward, followed by moving the left leg one step forward. b. Place the cane in the client's left hand and move the cane forward, followed by moving the right leg one step forward. c. Place the cane in the client's right hand and move the cane forward, followed by moving the left leg one step forward. d. Place the cane in the client's right hand and move the cane forward, followed by moving the right leg one step forward.

ANS: C Placing the cane in the client's left hand does not provide sufficient stability. After the cane in the right hand (stronger side) is moved ahead, the cane and the stronger leg provide a stable base for movement of the weaker leg. The other techniques are not correct.

The nurse is caring for a client after arthroscopy surgery. Which intervention is a postoperative priority for this client? a. Passive range of motion on the involved knee b. Active range of motion on the involved knee c. Straight leg raises with the involved leg d. Immobilization of the leg

ANS: C Straight leg raises and quadriceps setting are started immediately after the client awakens from the anesthesia. These exercises are performed to strengthen the leg, prevent venous thromboembolism, and decrease swelling. Bending the affected knee and range of motion should not be done for several days. Immobilization will lead to additional complications.

The nurse is caring for an older adult client who had leg amputation surgery the previous day. During the admission assessment, the client tells the nurse, "I don't want to live with only one leg, so I should have died during the surgery." Which is the nurse's best response? a. "Your vital signs are good, and you are doing just fine right now." b. "Your children are waiting outside and do not want to lose their parent." c. "Remember that you are still the same person inside, with a missing body part." d. "You will be able to do some of the same things as before you became disabled."

ANS: C The client feels like less of a person following the amputation, so the nurse should remind the client that he is still the same person inside. The nurse should not try to make the client feel guilty by saying that his children do not want to lose their parent. The nurse should not ignore the client's feelings by focusing on vital signs. The nurse should not refer to the client as being "disabled."

A client who has had an above-knee amputation of the right leg reports pain in the right foot. Which priority medication does the nurse administer? a. IV morphine b. 650 mg of acetaminophen c. IV calcitonin d. 600 mg of ibuprofen

ANS: C The client is experiencing phantom limb pain. IV infusions of calcitonin during the week after amputation can reduce phantom limb pain. The other medications will not assist in decreasing the client's pain.

A client who had a long-leg cast applied last week reports to the clinic nurse, "I can't seem to catch my breath and I feel a bit lightheaded." Which is the priority action of the nurse? a. Listen to the client's lungs and check the client's blood glucose level. b. Give the client 2 L of oxygen via nasal cannula and check vital signs. c. Check the client's pulse oximetry and arrange emergency transfer to the hospital. d. Reassure the client that it takes much more effort to move with a long-leg cast

ANS: C The client's symptoms are consistent with the development of pulmonary embolism (PE) caused by leg immobility in the long cast. The nurse should check the client's pulse oximetry reading and arrange for transfer to the hospital for further testing and treatment. The client should not be reassured that the symptoms are caused by exertion. The nurse can check vital signs, administer oxygen, and check the client's blood glucose level while waiting for transport to the emergency department.

What assessment should be performed hourly for a client who had an arthroscopy of the right knee 1 hour ago? A. Pain B. Bowel sounds C. Right pedal pulse D. Respiratory rate and rhythm

ANS: C The most important assessments to perform hourly after arthroscopy are neurovascular assessments. The nurse monitors the distal pulses, skin warmth and color, and capillary refill of the affected extremity.

The nurse is caring for a client with a pelvic fracture. Which is the nurse's priority action to prevent complications? a. Monitor temperature daily. b. Insert a urethral catheter. c. Monitor blood pressure frequently. d. Turn the client every 2 hours

ANS: C With a pelvic fracture, internal organ damage may result in bleeding and hypovolemic shock. The nurse monitors the client's vital signs, skin color, and level of consciousness frequently to determine whether shock is occurring. The client may need a urethral catheter inserted at some point in time if voiding is a problem. It is important to monitor the urine for blood to assess whether the urinary system has been damaged with the pelvic fracture. The client should not be turned on his or her side unless the fracture is stabilized.

The most serious complication of a pelvic fracture is which of the following? A. Infection B. Delayed union C. Hypovolemic shock D. Impaired skin integrity

ANS: C With a pelvic fracture, there can be internal organ damage, resulting in bleeding and hypovolemic shock. The nurse monitors the client's vital signs, skin color, and level of consciousness.

A client who has been diagnosed with osteomyelitis is beginning antibiotic therapy. Which information does the nurse include in the client's teaching plan? a. Needing a consultation with a surgeon b. Continuing on Contact Isolation at home c. Remaining in the hospital for the rest of the treatment d. Receiving antibiotic treatment at home from the home health nurse

ANS: D Typically, osteomyelitis requires treatment with IV antibiotics for several weeks. The client will leave the hospital with a central IV catheter (PICC) for home infusion of the medication. Oral antibiotics usually follow the IV regimen for several more weeks. Surgical intervention is reserved for clients with chronic osteomyelitis if medication therapy is ineffective. Contact Isolation is needed only if the infection can be transmitted to another person when copious drainage is present.

After the administration of each dose of zoledronic acid (Zometa), it is most important for the nurse to determine which finding? a. Capillary refill b. Pain relief c. Level of consciousness d. Urine output

ANS: D Zoledronic acid is a bisphosphonate that helps protect bones and prevent fractures. Urine output and serum creatinine should be monitored because this drug can be toxic to the kidneys. Zometa does not relieve pain or affect capillary refill or level of consciousness.

A patient whose work involves loading and unloading boxes has a history of chronic back pain. Which statement after the nurse has taught the patient about correct body mechanics indicates that the teaching has been effective? a. "I plan to start doing sit-ups and leg lifts to strengthen the muscles of my back." b. "I will try to sleep with my hips and knees extended to prevent back strain." c. "I can tell my boss that I need to change to a job where I can work at a desk." d. "I will keep my back straight when I need to lift anything higher than my waist."

Answer: A Rationale: Sit-ups and leg lifts will help to strengthen the muscles that support the back. Flexion of the hips and knees places less strain on the back. Modifications in the way the patient lifts boxes are needed, but sitting for prolonged periods can aggravate back pain. The patient should not lift above the level of the elbows.

A patient is seen at the urgent care center following a blunt injury to the left knee. The knee is grossly swollen and very painful, but the skin is intact. During an arthrocentesis on the patient's knee, the nurse would expect the aspirated fluid to appear a. sanguineous. b. purulent and thick. c. straw colored. d. white, thick, and ropelike.

Answer: A Rationale: The patient's clinical manifestations suggest hemarthrosis, and the appearance of blood in the synovial fluid is expected. Purulent fluid occurs when there is a joint infection. Straw-colored fluid is normal and will not be expected when the knee is swollen and painful. Thick fluid suggests infection.

Which information obtained during the nurse's assessment of the patient's nutritional-metabolic pattern may indicate the risk for musculoskeletal problems? a. The patient is 5 ft 2 in and weighs 180 lb. b. The patient prefers whole milk to nonfat milk. c. The patient dislikes fruits and vegetables. d. The patient takes a multivitamin daily.

Answer: A Rationale: The patient's height and weight indicate obesity, which places stress on weight-bearing joints. The use of whole milk, avoiding fruits and vegetables, and use of a daily multivitamin are not risk factors for musculoskeletal problems.

After teaching a patient with a bunion about how to prevent further problems, the nurse will determine that more teaching is needed if the patient says, a. "I will wear soft slippers whenever possible." b. "I will throw away my high heel shoes." c. "I will use the bunion pad to relieve the pain." d. "I will take ibuprofen (Motrin) when I need it."

Answer: A Rationale: The shank of the shoe should be rigid enough to support the foot. The other patient statements indicate that the teaching has been effective.

When evaluating the effectiveness of treatment for a patient who is being treated for Paget's disease with calcitonin (Cibacalcin) and ibandronate (Boniva), the nurse will ask the patient about a. weight loss. b. skeletal pain. c. decreased appetite. d. frequent cough.

Answer: B Rationale: Bone pain is one of the common early manifestations of Paget's disease, and the nurse should ask about improvement in pain levels to determine whether the treatment is effective. Weight loss, anorexia, and frequent cough are not symptoms of Paget's disease.

When the health care provider tells a patient that the pain in the patient's knee is caused by bursitis, the patient asks the nurse to explain just what bursitis is. The nurse's best response would be to tell the patient bursitis is an inflammation of a. the fibrocartilage that acts as a shock absorber in the knee joint. b. a small, fluid-filled sac found at many joints. c. any connective tissue that is found supporting the joints of the body. d. the synovial membrane that lines the area between two bones of a joint.

Answer: B Rationale: Bursae are fluid-filled sacs that cushion joints and bony prominences. Fibrocartilage is a solid tissue that cushions some joints. Bursae are a specific type of connective tissue. The synovial membrane lines many joints but is not a bursa.

A patient is receiving gentamicin (Garamycin) 80 mg IV twice daily for acute osteomyelitis. Which action should the nurse take before administering the gentamicin? a. Obtain the patient's oral temperature. b. Review the patient's BUN and creatinine levels. c. Ask the patient about any nausea. d. Change the wet-to-dry dressing.

Answer: B Rationale: Gentamicin is nephrotoxic and can cause renal failure. Monitoring the patient's temperature before gentamicin administration is not necessary. Nausea is not a common side effect of IV gentamicin. There is no need to change the dressing before gentamicin administration.

A patient is hospitalized for initiation of regional antibiotic perfusion for acute osteomyelitis of the right femur. Which intervention will be included in the plan of care? a. Frequent weight-bearing exercise b. Immobilization of the right leg c. Avoid administration of NSAIDs d. Support right leg in a flexed position

Answer: B Rationale: Immobilization of the affected leg helps to decrease pain and reduce the risk for pathologic fractures. Weight-bearing exercise increases the risk for pathologic fractures. NSAIDs are frequently prescribed to treat pain. Flexion of the affected limb is avoided to prevent contractures.

Which statement by a patient who is scheduled for an above-the-knee amputation for treatment of an osteogenic sarcoma of the right tibia indicates that patient teaching is needed? a. "I wish that I did not have to have chemotherapy after this surgery." b. "I do not mind the surgery because it will finally cure the cancer." c. "I know that I will need lots of physical therapy after surgery." d. "I will use the patient-controlled analgesia to help control my pain level after surgery."

Answer: B Rationale: Osteogenic sarcoma is an aggressive cancer with early metastasis and is not considered cured by surgery alone. Postoperative chemotherapy will also be required. The other patient statements indicate that patient teaching has been effective.

An assessment finding that alerts the nurse to the presence of osteoporosis in a middle-aged patient is a. the presence of bowed legs. b. measurable loss of height. c. an aversion to dairy products. d. statements about frequent falls.

Answer: B Rationale: Osteoporosis occurring in the vertebrae produces a gradual loss of height. Bowed legs are associated with osteomalacia. Low intake of dairy products is a risk factor for osteoporosis, but it does not indicate that osteoporosis is present. Frequent falls increase the risk for fractures but are not an indicator of osteoporosis.

The nurse is assessing the passive range of motion of a patient's shoulder. The patient complains of pain during circumduction when the nurse moves the arm behind the patient. Which question should the nurse ask? a. "Do you ever have trouble making it to the toilet?" b. "Do you have difficulty in putting on a jacket?" c. "Are you able to feed yourself without difficulty?" d. "How well are you able to sleep at night?"

Answer: B Rationale: The patient's pain will make it more difficult to accomplish tasks like putting on a shirt or jacket. This pain should not impact the patient's ability to feed himself or herself or use the toilet because these tasks do not involve moving the arm behind the patient. The arm will not usually be positioned behind the patient during sleeping.

While testing the patient's muscle strength, the nurse finds that the patient can flex the arms when no resistance is applied but is unable to flex when the nurse applies light resistance. The nurse should documents the patient's muscle strength as level a. 1. b. 2. c. 3. d. 4.

Answer: C Rationale: A level 3 indicates that the patient is unable to move against resistance but can move against gravity. Level 1 indicates minimal muscle contraction, level 2 indicates that the arm can move when gravity is eliminated, and level 4 indicates active movement with some resistance.

When the nurse is assessing a new patient in the clinic, which information about the patient's medications will be of most concern? a. The patient takes hormone replacement therapy (HRT) to prevent "hot flashes." b. The patient takes a daily multivitamin and calcium supplement. c. The patient has severe asthma and requires frequent therapy with steroids. d. The patient has migraine headaches which are treated with NSAIDs.

Answer: C Rationale: Corticosteroid use may lead to skeletal problems such as avascular necrosis and osteoporosis. The use of HRT and calcium supplements will help prevent osteoporosis. NSAID use does not increase the risk for musculoskeletal problems.

patient with kyphosis is scheduled for dual-energy x-ray absorptiometry (DEXA) testing. The nurse will plan to a. start an intravenous line. b. screen the patient for shellfish allergies. c. teach the patient that DEXA is noninvasive. d. give an oral sedative.

Answer: C Rationale: DEXA testing is painless and noninvasive. No IV access is necessary. Contrast medium is not used. Because the procedure is painless, no antianxiety medications are required.

A 58-year-old woman who has been menopausal for 5 years is diagnosed with osteoporosis following densitometry testing. The woman has been concerned about her risk for osteoporosis because her mother has the condition. In teaching the woman about her osteoporosis, the nurse explains that a. with a family history of osteoporosis, there is no way to prevent or slow gradual bone resorption. b. estrogen replacement therapy must be started to prevent rapid progression of her osteoporosis. c. even with a family history of osteoporosis, the calcium loss from bones can be slowed by increased calcium intake and exercise. d. continuous, low-dose corticosteroid treatment is effective in stopping the course of osteoporosis.

Answer: C Rationale: Progression of osteoporosis can be slowed by increasing calcium intake and weight-bearing exercise. Estrogen replacement therapy does help to prevent osteoporosis, but it is not the only treatment and is not appropriate for some patients. Corticosteroid therapy increases the risk for osteoporosis.

Which of these nursing actions included in the care of a patient after laminectomy can the nurse delegate to an experienced nursing assistant? a. Evaluation of the effectiveness of the PCA b. Monitoring plantar and dorsiflexion of the feet c. Logrolling the patient from side to side every 2 hours d. Determining the patient's readiness to ambulate

Answer: C Rationale: Repositioning a patient is included in the education and scope of practice of nursing assistants, and an experienced nursing assistant would be familiar with logrolling. Evaluation of the effectiveness of pain medications, assessment of neurologic function, and evaluation of a patient's readiness to ambulate after surgery require higher-level nursing education and scope of practice.

The nurse identifies a nursing diagnosis of pain related to muscle spasms for a patient with acute low back pain associated with acute lumbosacral strain. An appropriate nursing intervention for this problem is to teach the patient to a. twist gently from side to side to maintain range-of-motion in the spine. b. place a small pillow under the upper back to flex the lumbar spine gently. c. keep the head elevated slightly and flex the knees when resting in bed. d. avoid the use of cold because it will exacerbate the muscle spasms.

Answer: C Rationale: Resting with the head elevated and knees flexed will reduce the strain on the back and decrease muscle spasms. Twisting from side to side will increase tension on the lumbar area. A pillow placed under the upper back will cause strain on the lumbar spine. Alternate application of cold and heat should be used to decrease pain.

During assessment of the musculoskeletal system of a 74-year-old woman, the nurse notes that the patient has lost 1 inch in height since the previous visit two years ago. The nurse will plan to teach the patient about a. diskography studies. b. magnetic resonance imaging (MRI). c. dual-energy x-ray absorptiometry (DEXA). d. myelographic testing.

Answer: C Rationale: The decreased height and the patient's age suggest that the patient may have osteoporosis and that bone density testing is needed. Diskography, MRI, and myelography are typically done for patients with current symptoms caused by musculoskeletal dysfunction and are not the initial diagnostic test for osteoporosis.

A patient has a new order for open magnetic resonance imaging (MRI) to evaluate for right femur osteomyelitis. Which information obtained by the nurse indicates that the nurse should consult with the health care provider before scheduling an MRI? a. The patient is claustrophobic. b. The patient wears a hearing aid. c. The patient is allergic to shellfish. d. The patient has a pacemaker.

Answer: D Rationale: Patients with permanent pacemakers cannot have MRI. An open MRI will not cause claustrophobia. The patient will need to be instructed to remove the hearing aid before the MRI, but this does not require consultation with the health care provider. Contrast medium will not be used, so shellfish allergy is not a contraindication to MRI.

The nurse is teaching a client who is preparing for discharge from the hospital after a total hip replacement. Which statement by the client would indicate the need for further instructions? a) I cannot drive a car for probably 6 weeks b) I should not sit in one position for more than 4 hours c) I need to wear a support stocking on an unaffected leg d) I need to place a pillow between my knees when I lie down

B - The client needs to be instructed to not sit continuously for more than 1 hour. The client should be instructed to stand, stretch, and take a few steps periodically. The client cannot drive a car for 6 weeks after surgery unless allowed to do so by a physician. A support stocking should be worn on the unaffected leg, and an Ace bandage usually is prescribed to be placed on the affected leg until there is no swelling in the legs and feet and until full activities are resumed. The legs are abducted by placing a pillow between them when the client lies down.

Which of the following clinical manifestations should the healthcare provider anticipate observing in a patient diagnosed with rheumatoid arthritis (RA)? Select all that apply. Select all that apply. A. Bone spurs noted on X-ray B. Ulnar deviation C. Decreased synovial fluid D. Low-grade fever E. Increased C-reactive protein (CRP)

B, D, E Clinical manifestations expected in RA include increased CRP (a general indication of inflammation), low-grade fever (a systemic manifestation), and ulnar deviation (caused by chronic synovial inflammation, weakened ligaments, and subsequent deformities).

A client seeks treatment in the emergency department for a lower leg injury. There is visible deformity to the lower aspect of the leg, and the injured leg appears shorter than the other leg. The area is painful, swollen, and beginning to become ecchymotic. The nurse interprets that this client has experienced a: a) strain b) sprain c) fracture d) contusion

C - Typical signs and symptoms of fracture include pain, loss of function in the area, deformity, shortening of the extremity, crepitus, swelling, and ecchymosis. Not all fractures lead to the development of every sign. A strain results from a pulling force on the muscle. Symptoms include soreness and pain with muscle use. A sprain is an injury to a ligament caused by a wrenching or twisting motion. Symptoms include pain, swelling, and inability to use the joint or bear weight normally. A contusion results from a blow to soft tissue and causes pain, swelling, and ecchymosis.

On the first postoperative day, a patient with a below-the-knee amputation complains of pain in the amputated limb. An appropriate action by the nurse is to a. administer prescribed opioids to relieve the pain. b. explain the reasons for phantom limb pain. c. loosen the compression bandage to decrease incisional pressure. d. remind the patient that this phantom pain will diminish over time.

Correct Answer: A Rationale: Phantom limb pain is treated like any other type of postoperative pain would be treated. Explanations of the reason for the pain may be given, but the nurse should still medicate the patient. The compression bandage is left in place except during physical therapy or bathing. Although the pain may decrease over time, it still requires treatment now.

A patient with a fractured radius asks when the cast can be removed. The nurse will instruct the patient that the cast can be removed only after the bone a. is strong enough to stand mild stress. b. union is complete on the x-ray. c. fragments are fully fused. d. healing has started.

Correct Answer: A Rationale: The cast may be removed when callus ossification has occurred. It is not necessary to wait until radiologic union or complete bone fusion occurs. Bone healing starts immediately after the injury, but the cast will need to be worn at least 3 weeks

A patient with severe ulnar drift caused by rheumatoid arthritis (RA) is scheduled for an arthroplasty of the right hand and fingers. The nurse determines that the patient has realistic expectations of the outcome of surgery when the patient says, a. "I will be able to use my fingers to grasp objects better." b. "My fingers will appear normal in size and shape after this surgery." c. "This procedure will prevent further deformity in my hands and fingers." d. "I will not have to do as many hand exercises after the surgery."

Correct Answer: A Rationale: The goal of hand surgery in RA is to restore function, not to correct for cosmetic deformity or treat the underlying process.

All these medications are ordered at 9:00 AM for a patient who has had a right-hip replacement the previous day and is scheduled to ambulate with the physical therapist for the first time at 9:45. Which medication should be given first? a. Oxycodone (Roxicodone) 5 mg PO b. Ceftriaxone (Rocephin) 500 mg IV c. Enoxaparin (Lovenox) 30 mg SC d. Psyllium (Metamucil) 1 tsp PO

Correct Answer: A Rationale: The pain medication should be given so that it has time to take effect before the patient is ambulated. The other medications will not affect whether the patient can ambulate or not, although the antibiotic and anticoagulant medications should be given as soon as possible in order to maintain therapeutic blood levels

When preparing a patient to ambulate the day after an ORIF for a hip fracture, which action is most important for the nurse to take? a. Administering the ordered oral opioid pain medication b. Instructing the patient about the benefits of ambulation c. Ensuring that the incisional drain has been discontinued d. Changing the hip dressing and document the appearance of the site

Correct Answer: A Rationale: The patient should be adequately medicated for pain before any attempt to ambulate. Instructions about the benefits of ambulation may increase the patient's willingness to ambulate, but decreasing pain with ambulation is more important. The presence of an incisional drain or timing of dressing change will not impact on ambulation.

A 22-year-old patient started an exercise regimen 2 months ago that includes running 3 to 4 miles a day. The patient tells the nurse, "I enjoy my daily runs, but now I have shin splints." Which response by the nurse is appropriate? a. "You may be increasing your running time too quickly and need to cut back a little bit." b. "You need to have x-rays of your lower legs to be sure you do not have stress fractures." c. "You should expect some leg pain while running." d. "You should try speed-walking rather than running."

Correct Answer: A Rationale: The patient's information about running 3 to 4 miles daily after starting an exercise program only 2 months previously suggests that the shin splints are caused by overuse. Radiographs are not indicated for the type of injury described by the patient. Shin splints are not a normal or expected response to running. Because the patient expresses enjoyment of running, it would not be appropriate for the nurse to suggest a different sport.

A patient arrives in the emergency department with ankle swelling and severe pain after twisting the ankle playing soccer. All of the following orders are written by the health care provider. Which one will the nurse act on first? a. Administer naproxen (Naprosyn) 500 mg PO. b. Wrap the ankle and apply an ice pack. c. Give acetaminophen with codeine (Tylenol #3). d. Take the patient to the radiology department for x-rays.

Correct Answer: B Rationale: Immediate care after a sprain or strain injury includes the application of cold and compression to the injury to minimize swelling. The other actions should be taken after the ankle is wrapped with a compression bandage and ice is applied.

When giving home-care instructions to a patient who has multiple forearm fractures and a long-arm cast on the right arm, which information should the nurse include? a. Keep the hand immobile to prevent soft tissue swelling. b. Call the health care provider for increased swelling or numbness. c. Keep the right shoulder elevated on a pillow or cushion. d. Avoid the use of NSAIDs for the first 48 hours after the injury.

Correct Answer: B Rationale: Increased swelling or numbness may indicate increased pressure at the injury, and the health care provider should be notified immediately to avoid damage to nerves and other tissues. The patient should be encouraged to move the joints above and below the cast to avoid stiffness. There is no need to elevate the shoulder, although the forearm should be elevated to reduce swelling. NSAIDs are appropriate to treat pain after a fracture.

The nurse observes a patient doing all these activities after having a hip-replacement surgery. Which patient action requires that the nurse intervene immediately? a. The patient sits straight up on the edge of the bed. b. The patient leans over to pull shoes and socks on. c. The patient bends over the sink while brushing the teeth. d. The patient uses crutches with a swing-to gait.

Correct Answer: B Rationale: Leaning over would flex the hip at greater than 90 degrees and predispose the patient to hip dislocation. The other patient actions are appropriate and do not require any immediate action by the nurse to protect the patient.

When getting a patient from the bed into the chair for the first time since having an ORIF of a hip fracture, the nurse should a. use a mechanical lift to transfer the patient from the bed to the chair. b. assist the patient to use a walker with partial weight bearing to assist in transfer to the chair. c. have the patient use crutches with a swing-through gait to transfer. d. ask a nursing assistant to help the patient to stand at the bedside and pivot to the chair.

Correct Answer: B Rationale: The patient will use an assistive device such as a walker to help with the initial transfers and ambulation. A mechanical lift is not needed. Crutch walking is taught before discharge but would not be used for the initial transfer. The RN, not a nursing assistant, should supervise the patient during the initial transfer to evaluate how well the patient is able to accomplish this skill.

A patient who has been hospitalized for 3 days with a hip fracture and Buck's traction has sudden onset shortness of breath and tachypnea. The patient tells the nurse, "I feel like I am going to die!" Which action should the nurse take first? a. Stay with the patient and offer reassurance. b. Administer oxygen at 4 L/min by a nasal cannula. c. Notify the health care provider about the patient's symptoms. d. Check the patient's legs for swelling or tenderness.

Correct Answer: B Rationale: The patient's clinical manifestations and history are consistent with a pulmonary embolus, and the nurse's first action should be to ensure adequate oxygenation. The nurse should offer reassurance to the patient, but meeting the physiologic need for oxygen is a higher priority. The health care provider should be notified after the oxygen is started and pulse oximetry and assessment for deep vein thrombosis (DVT) are obtained.

A patient undergoes a right below-the-knee amputation with an immediate prosthetic fitting. When the patient is returned to the nursing unit, the nurse should a. check the surgical site for hemorrhage. b. take the patient's vital signs frequently. c. keep the residual leg elevated on a pillow. d. place the patient in a prone position.

Correct Answer: B Rationale: The vital signs should be monitored frequently to assess for hemorrhage because the nurse will not be able to visualize the surgical site. Flexion contracture of the hip would be encouraged by elevating the residual limb on a pillow. The patient is placed in a prone position after amputation to prevent hip flexion, but this would not be done during the immediate postoperative period.

A patient hospitalized with multiple fractures has a long-arm plaster cast applied for immobilization of a fractured left radius. Until the cast has completely dried, the nurse should a. keep the left arm in a dependent position. b. handle the cast with the palms of the hands. c. place gauze around the cast edge to pad any roughness. d. cover the cast with a small blanket to absorb the dampness.

Correct Answer: B Rationale: Until a plaster cast has dried, placing pressure on the cast should be avoided to prevent creating areas inside the cast that could place pressure on the arm. The left arm should be elevated to prevent swelling. The edges of the cast may be petaled once the cast is dry, but padding the edges before that may cause the cast to be misshapen. The cast should not be covered until it is dry because heat builds up during drying.

in developing a care plan for a patient with an open reduction and internal fixation (ORIF) of an open, displaced fracture of the tibia, the priority nursing diagnosis is a. risk for constipation related to prolonged bed rest. b. activity intolerance related to deconditioning. c. risk for infection related to disruption of skin integrity. d. risk for impaired skin integrity related to immobility.

Correct Answer: C Rationale: A patient having an ORIF is at risk for problems such as wound infection and osteomyelitis. After an ORIF, patients typically are mobilized starting the first postoperative day, so problems caused by immobility are not as likely.

A patient with severe osteoarthritis of the left knee has undergone left-knee arthroplasty with replacement of the total knee joint with a plastic prosthesis. Postoperatively, the nurse expects care of the leg to include a. bed rest for 3 days with the left leg immobilized in an extended position. b. use of a compression bandage to hold the left knee in a flexed position. c. progressive leg exercises to obtain 90-degree flexion. d. early ambulation with full weight bearing on the left leg.

Correct Answer: C Rationale: After knee arthroplasty, active or passive flexion exercises are used to obtain a 90-degree flexion of the knee. The patient is ambulated the first postoperative day. A compression bandage is used to hold the knee in an extended position after surgery. Full weight bearing is expected before discharge, but it is not started early after surgery.

A patient with an intracapsular fracture of the left femur is placed in Buck's traction before surgery for a hip replacement. The patient asks why traction is necessary when surgery is planned. The nurse's response to the patient is based on the knowledge that traction a. will help prevent flexion contractures of the affected hip. b. is necessary to prevent displacement of the fracture. c. will decrease the incidence of painful muscle spasms d. is used to maintain the leg in the external rotation position.

Correct Answer: C Rationale: Buck's traction keeps the leg immobilized and reduces muscle spasm. Flexion contractures are not likely to occur during the short time before surgery. Displacement of the hip is prevented by keeping the patient on bed rest before surgery. The leg is externally rotated because of the hip fracture, not because of traction.

Following x-rays of an injured wrist, the patient is informed that it is badly sprained. In teaching the patient to care for the injury, the nurse tells the patient to a. apply a heating pad to reduce muscle spasms. b. wear an elastic compression bandage continuously. c. use pillows to keep the arm elevated above the heart. d. gently exercise the joint to prevent muscle shortening.

Correct Answer: C Rationale: Elevation of the arm will reduce the amount of swelling and pain. For the first 24 to 48 hours, cold packs are used to reduce swelling. Compression bandages are not left on continuously. The wrist should be rested and kept immobile to prevent further swelling or injury.

After falling at home, a patient is admitted to the emergency department, where x-rays confirm the presence of an extracapsular fracture of the femur. When assessing the patient, the nurse would expect to find a. bruising of the left hip and thigh. b. numbness in the left leg and hip. c. outward pointing toes on the left leg. d. weak or nonpalpable left leg pulses

Correct Answer: C Rationale: External rotation of the leg is a classic sign associated with a hip fracture. Bruising does not always appear rapidly, and bruising extending to the thigh might indicate hemorrhage. Numbness and decreased pulses are not typical of a hip fracture unless there is associated tissue swelling and trauma to blood vessels.

A patient has a short-arm plaster cast applied at the outpatient center for a wrist fracture. An understanding of discharge teaching is apparent when the patient says, a. "I can get the cast wet as long as I dry it right away with a hair dryer." b. "I should avoid moving my fingers and elbow until the cast is removed." c. "I will apply an ice pack to the cast over the fracture site for the next 24 hours." d. "I can rub lotion on any itching areas under the cast with a cotton-tipped applicator."

Correct Answer: C Rationale: Ice application for the first 24 hours after a fracture will help to reduce swelling and can be placed over the cast. Plaster casts should not get wet. The patient should be encouraged to move the joints above and below the cast. Patients should not insert objects inside the cast.

A patient who has a proximal humerus fracture that is immobilized with a left-sided long-arm cast, and a sling is admitted to the medical-surgical unit. Which nursing intervention will be included in the plan of care? a. Use surgical net dressing to hang the arm from an IV pole. b. Immobilize the fingers on the left hand with gauze dressings. c. Assess the left axilla and change absorbent dressings as needed. d. Assist the patient in passive range of motion (ROM) for the right arm.

Correct Answer: C Rationale: The axilla can become excoriated when a sling is used to support the arm, and the nurse should check the axilla and apply absorbent dressings to prevent this. A patient with a sling would not have traction applied by hanging. The patient will be encouraged to move the fingers on the injured arm to maintain function and to help decrease swelling. The patient will do active ROM on the uninjured side.

When evaluating the crutch-walking technique of a patient with a right-leg long-leg cast and no weight bearing on the right leg, the nurse determines that the patient is prepared to ambulate independently with the crutches on observing that the patient a.uses the bedside chair to assist in balance as needed when ambulating in the room. b. keeps the padded area of the crutch firmly in the axillary area when ambulating. c. advances the right leg and both crutches together and then advances the left leg. d. moves the left crutch with the left leg and then the right crutch with the right leg.

Correct Answer: C Rationale: When using crutches, patients are usually taught to move the assistive device and the injured leg forward at the same time and then to move the unaffected leg. Patients are discouraged from using furniture to assist with ambulation. The patient is taught to place weight on the hands, not in the axilla, to avoid nerve damage. If the 2- or 4-point gaits are to be used, the crutch and leg on opposite sides move forward, not the crutch and same-side leg.

The nurse provides discharge instructions to a patient with an above-the-knee amputation who will be fitted with a prosthesis when healing is complete and the residual limb is well molded. The nurse determines that teaching has been effective when the patient says, a. "I should change the limb sock when it becomes soiled or stretched out." b. "I should use lotion on the stump to prevent drying and cracking of the skin." c. "I should elevate my residual limb on a pillow 2 or 3 times a day." d. "I should lay on my abdomen for 30 minutes 3 or 4 times a day."

Correct Answer: D Rationale: The patient lies in the prone position several times daily to prevent flexion contractures of the hip. The limp sock should be changed daily. Lotion should not be used on the stump. The residual limb should not be elevated because this would encourage flexion contracture.

A patient with a fractured pelvis is initially treated with bed rest with no turning from side to side permitted. The second day after admission, the patient develops chest pain, tachypnea, and tachycardia. The nurse determines that the patient's symptoms are most likely related to fat embolism when assessment of the patient reveals a. a blood pressure of 100/65 mm Hg. b. anxiety, restlessness, and confusion. c. warm, reddened areas in the calf. d. pinpoint red areas on the upper chest.

Correct Answer: D Rationale: The presence of petechiae helps distinguish fat embolism from other problems. The other symptoms might occur with fat embolism but could also occur with other postoperative complications such as bleeding, myocardial infarction, venous thrombosis, or hypoxemi

The client with an above the knee amputation is to use crutches until the prosthesis is properly lifted. When teaching the client about using the crutches, the nurse instructs the client to support her weight primarily on which of the following body areas? A. Axillae B. Elbows C. Upper arms D. Hands

D

When evaluating all forms of traction, the nurse knows the direction of pull is controlled by the: A. Client's position B. Rope/pulley system C. Amount of weight D. Point of friction

B

A client is 1 day postoperative after a total hip replacement. The client should be placed in which of the following position? A. Supine B. Semi Fowler's C. Orthopneic D. Trendelenburg

B

A female client with rheumatoid arthritis has been on aspirin grain TID and prednisone 10mg BID for the last two years. The most important assessment question for the nurse to ask related to the client's drug therapy is whether she has A. Headaches B. Tarry stools C. Blurred vision D. Decreased appetite

B

A young client is in the hospital with his left leg in Buck's traction. The team leader asks the nurse to place a footplate on the affected side at the bottom of the bed. The purpose of this action is to: A. Anchor the traction B. Prevent footdrop C. Keep the client from sliding down in bed D. Prevent pressure areas on the foot

B

The client who had an open femoral fracture was discharged to her home, where she developed, fever, night sweats, chills, restlessness and restrictive movement of the fractured leg. The nurse interprets these finding as indicating which of the following? A. Pulmonary emboli B. Osteomyelitis C. Fat emboli D. Urinary tract infection

B

The major rationale for the use of acetylsalicylic acid (aspirin) in the treatment of rheumatoid arthritis is to: A. Reduce fever B. Reduce the inflammation of the joints C. Assist the client's range of motion activities without pain D. Prevent extension of the disease process

B

The nurse is caring for the client who is going to have an arthrogram using a contrast medium. Which of the following assessments by the nurse are of highest priority? A. Allergy to iodine or shellfish B. Ability of the client to remain still during the procedure C. Whether the client has any remaining questions about the procedure D. Whether the client wishes to void before the procedure

A

Following an amputation, the advantage to the client for an immediate prosthesis fitting is: A. Ability to ambulate sooner B. Less change of phantom limb sensation C. Dressing changes are not necessary D. Better fit of the prosthesis

A

In order for Buck's traction applied to the right leg to be effective, the client should be placed in which position? A. Supine B. Prone C. Sim's D. Lithotomy

A

The client immobilized skeletal leg traction complains of being bored and restless. Based on these complaints, the nurse formulates which of the following nursing diagnoses for this client? A. Diversional activity deficit B. Powerlessness C. Self care deficit D. Impaired physical mobility

A

The nurse is assessing the casted extremity of a client. The nurse assesses for which of the following signs and symptoms indicative of infection? A. Coolness and pallor of the extremity B. Presence of a "hot spot" on the cast C. Diminished distal pulse D. Dependent edema

B

The nurse is repositioning the client who has returned to the nursing unit following internal fixation of a fractured right hip. The nurse uses a: A. Pillow to keep the right leg abducted during turning B. Pillow to keep the right leg adducted during turning C. Trochanter roll to prevent external rotation while turning D. Trochanter roll to prevent abduction while turning

A

Three hours ago a client was thrown from a car into a ditch, and he is now admitted to the ED in a stable condition with vital signs within normal limits, alert and oriented with good coloring and an open fracture of the right tibia. When assessing the client, the nurse would be especially alert for signs and symptoms of which of the following? A. Hemorrhage B. Infection C. Deformity D. Shock

A

Which nursing intervention is appropriate for a client with skeletal traction? A. Pin care B. Prone positioning C. Intermittent weights D. 5lb weight limit

A

The nurse has an order to get the client out of bed to a chair on the first postoperative day after a total knee replacement. The nurse plans to do which of the following to protect the knee joint: A. Apply a knee immobilizer before getting the client up and elevate the client's surgical leg while sitting B. Apply an Ace wrap around the dressing and put ice on the knee while sitting C. Lift the client to the bedside change leaving the CPM machine in place D. Obtain a walker to minimize weight bearing by the client on the affected leg

A

A client who has been taking carisoprodol (Soma) at home for a fractured arm is admitted with a blood pressure of 80/50 mmHg, a pulse rate of 115 bpm, and respirations of 8 breaths/minute and shallow, the nurse interprets these finding as indicating which of the following? A. Expected common side effects B. Hypersensitivity reactions C. Possible habituating effects D. Hemorrhage from GI irritation

A

The rehabilitation nurse is providing home care instruction for a client being discharged after above-the-knee amputation of the right lower limb with a fitted prosthesis. The nurse determines the client requires further teaching if the client makes which of the following statements? a) I will elevate the residual limb on a pillow b) I will change the residual limb sock everyday c) I will check the residual limb for skin irritation daily d) I will notify my prosthesis if my residual limb sock becomes stretched or ill-fitting

A - Clients must avoid elevation of the residual limb to prevent flexion contractures of the right hip. Additionally, sitting in a chair should be limited to 1-hour intervals to avoid the same. If there is no contraindication, clients should lie in the prone position three to four times a day to promote hip extension. Limb socks should be removed daily, laundered in mild soap, and replaced with a clean sock. When the sock is removed, the residual limb should be inspected for erythema and excoriation. As the edema resolves, the residual limb shrinks and the sock may not fit properly, leading to skin irritation. The prosthetist should be notified of the ill-fitting sock.

When taking a patient history during assessment of the musculoskeletal system, the nurse identifies an increased risk for the patient who reports a. that a parent became much shorter with aging. b. a sprained ankle 2 years previously. c. a family history of tuberculosis. d. taking over-the-counter (OTC) ibuprofen (Advil) for occasional aches.

Answer: A Rationale: A family history of height loss with aging may indicate osteoporosis, and the patient may need to consider preventative actions, such as calcium supplements. A sprained ankle 2 years previously will not cause any current or future musculoskeletal problems. A family history of tuberculosis is not a risk factor. Occasional nonsteroidal antiinflammatory drug (NSAID) use does not indicate any increased musculoskeletal risk.

A patient with an open fracture of the left tibia and soft tissue damage underwent a surgical reduction and fixation of the tibia with debridement of nonviable tissue and drain placement. When assessing the patient during the postoperative period, the nurse will be most concerned about a. fever with chills and night sweats. b. light yellow drainage from the wound. c. pain on movement of the affected limb. d. muscle spasms around the affected bone.

Answer: A Rationale: Fever, chills, and night sweats are suggestive of osteomyelitis. The other clinical manifestations are typical after a fracture repair.

The nurse is caring for the client who had an above the knee amputation two (2) days ago. The residual limb was wrapped with an elastic compression bandage which has come off. The nurse immediately: A. Calls the physician B. Rewrap the stump with an elastic compression bandage C. Applies ice to the site D. Applies a dry sterile dressing and elevates it on a pillow

B

When antibiotics are not producing the desired outcome for a client with osteomyelitis, the nurse interprets this as suggesting the occurrence of which of the following as most likely? A. Formation of scar tissue interfering with absorption B. Development of pus leading to ischemia C. Production of bacterial growth by avascular tissue D. Antibiotics not being instilled directly into the bone

C

When preparing a teaching plan for the client with osteoarthritis who is taking celecoxib (Celebrex), the nurse expects to explain that the major advantage of celecoxib over diclofenac (Voltaren), is that the celecoxib is likely to produce which of the following? A. Hepatotoxicity B. Renal toxicity C. Gastrointestinal bleeding D. Nausea and vomiting

C

When the client is lying supine, the nurse will prevent external rotation of the lower extremity by using a: A. Trochanter roll by the knee B. Sandbag to the lateral calf C. Trochanter roll to the thigh D. Footboard

C

Which of the following would the nurse assess in a client with an intracapsular hip fracture? A. Internal rotation B. Muscle flaccidity C. Shortening of the affected leg D. Absence of pain the fracture area

C

A client in the PACU with a left below the knee amputation complains of pain in her left big toe. Which of the following would the nurse do first? A. Tell the client it is impossible to feel the pain B. Show the client that the toes are not there C. Explain to the client that the pain is real D. Give the client the prescribed narcotic analgesic

D

A client who has had a plaster of Paris cast applied to his forearm is receiving pain medication. To detect early manifestations of compartment syndrome, which of these assessments should the nurse make? A. Observe the color of the fingers B. Palpate the radial pulse under the cast C. Check the cast for odor and drainage D. Evaluate the response to analgesics

D

A client with fracture develops compartment syndrome. When caring for the client, the nurse would be alert for which of the following signs of possible organ failure? A. Rales B. Jaundice C. Generalized edema D. Dark, scanty urine

D

One method of assessing for sign of circulatory impairment in a client with a fractured femur is to ask the client to: A. Cough and deep breathe B. Turn himself in bed C. Perform biceps exercise D. Wiggle his toes

D

Of the clients listed below, who is at risk for developing rheumatoid arthritis (RA)? Select all that apply. 1. Adults between the ages of 20 and 50 years. 2. Adults who have had an infectious disease with the Epstein-Barr virus. 3. Adults that are of the male gender. 4. Adults who possess the genetic link, specifically HLA-DR4. 5. Adults who also have osteoarthritis.

1, 2, 4. Rheumatoid arthritis (RA) affects women three times more often than men, between the ages of 20 and 55 years. Research has determined that RA occurs in clients who have had infectious disease, such as the Epstein-Barr virus. The genetic link, specifically HLA-DR4, has been found in 65% of clients with RA. People with osteoarthritis are not necessarily at risk for developing rheumatoid arthritis.

A 25-year-old client taking hydroxychloroquine (Plaquenil) for rheumatoid arthritis reports difficulty seeing out of her left eye. Correct interpretation of this assessment finding indicates which of the following? 1. Development of a cataract. 2. Possible retinal degeneration. 3. Part of the disease process. 4. A coincidental occurrence.

2. Difficulty seeing out of one eye, when evaluated in conjunction with the client's medication therapy regimen, leads to the suspicion of possible retinal degeneration. The possibility of an irreversible retinal degeneration caused by deposits of hydroxychloroquine (Plaquenil) in the layers of the retina requires an ophthalmologic examination before therapy is begun and at 6-month intervals. Although cataracts may develop in young adults, they are less likely, and damage from the hydroxychloroquine is the most obvious at-risk factor. Eyesight is not affected by the disease process of rheumatoid arthritis.

A client is in the acute phase of rheumatoid arthritis. Which of the following should the nurse identify as lowest priority in the plan of care? 1. Relieving pain. 2. Preserving joint function. 3. Maintaining usual ways of accomplishing tasks. 4. Preventing joint deformity.

3. Maintaining usual ways of accomplishing tasks would be the lowest priority during the acute phase. Rather, the focus is on developing less stressful ways of accomplishing routine tasks. Pain relief is a high priority during the acute phase because pain is typically severe and interferes with the client's ability to function. Preserving joint function and preventing joint deformity are high priorities during the acute phase to promote an optimal level of functioning and reduce the risk of contractures.

A client with a compound (open) fracture of the radius has a plaster cast applied in the emergency department. The nurse provides home-care instructions and tells the client to seek medical attention if which of the following occurs? a) numbness and tingling are felt in the fingers b) the cast feels heavy and damp after 24 hours of application c) the entire cast feels warm during the first 24 hours after application d) bloody drainage is noted in the cast during the first 6 hours after application

A - A limb encased in a cast is at risk for nerve damage and diminished circulation from increased pressure caused by edema. Signs of increased pressure from the cast include numbness, tingling, and increased pain. A cast can take up to 48 hours to dry and generates heat while drying. Some drainage may occur initially with a compound (open) fracture.

Which instruction is most important for the RN to provide to the nursing assistant assigned to care for a client with primary osteoporosis? a. "Clean up clutter in the room." b. "Encourage the client to bathe herself or himself." c. "Monitor urinary output." d. "Perform passive range-of-motion exercises."

ANS: A Clients with osteoporosis are at risk for fracture when they fall. Clutter in the room is a risk factor for falls. The other choices have nothing to do with prevention of bone fracture in a client with primary osteoporosis.

A client is prescribed alendronate (Fosamax). Which statement indicates that the client understands teaching about this drug? a. "I should take this drug with a full glass of water." b. "I need to lie down for 30 minutes after taking it." c. "This drug should be taken after a meal." d. "This drug needs to be taken at the same time as calcium."

ANS: A Fosamax needs to be taken on an empty stomach with a full glass of water for best absorption and to prevent esophagitis. After taking the drug, the client needs to stay upright for 30 minutes. Calcium can be taken, but not at the same time as Fosamax.

While caring for a client who has chronic osteomyelitis and wound drainage, which intervention is most important for the nurse to implement? a. Cover the wound with a dressing. b. Teach about the cause of the infection. c. Monitor the erythrocyte sedimentation rate (ESR). d. Prepare the client for hyperbaric oxygenation.

ANS: A If an open wound is present in the hospital or long-term care setting, the client's treatment usually includes Standard Precautions for limiting infection by covering the wound. Teaching about the cause of the infection could prevent further episodes of infection, but does not take care of the current problem. The ESR just tells the health care provider that an inflammatory process is going on. Hyperbaric oxygenation is used only for clients with chronic, unremitting osteomyelitis. Covering the wound would be the most important step for the nurse to take first.

The nurse is performing an assessment on a client admitted with a fractured left humerus. When the client moves the extremity, the nurse notes the presence of a grating sound. Which is the nurse's best intervention? a. Immobilize the arm. b. Perform range of motion. c. Monitor for other signs of infection. d. Administer steroids.

ANS: A The grating sound heard when the affected part is moved is known as crepitation. This sound is created by bone fragments. Because bone fragments may be present, the nurse should immobilize the client's arm and tell him or her not to move the arm. The nurse should not move the extremity for range of motion. The grating sound does not indicate infection. Steroids would not be indicated.

A client who has sustained a crush injury to the right lower leg reports numbness and tingling of the affected extremity. The skin of the right leg appears pale. Which is the nurse's first intervention? a. Assess pedal pulses. b. Apply oxygen by nasal cannula. c. Increase the IV flow rate. d. Document the finding.

ANS: A The symptoms represent early warning of acute compartment syndrome. In acute compartment syndrome, sensory deficits such as paresthesias precede changes in vascular or motor signs. If the nurse finds a decrease in pedal pulses, the health care provider should be notified as soon as possible.

Which instruction does the nurse include in the discharge teaching plan of a client who has osteoporosis? a. "Avoid using scatter rugs." b. "Avoid weight-bearing exercises." c. "Use a cane when walking outside." d. "Reduce the amount of protein in your diet."

ANS: A To avoid falls, the client should keep a hazard-free environment, including avoiding scatter rugs, cluttered rooms, and wet floor areas. Weight-bearing exercises help prevent bone resorption. A cane is not needed unless the client has a physical disability. A protein deficiency should be avoided because it might cause a reduction in bone density.

An adult client's susceptibility to osteoporosis is caused by which aspect of his or her history? a. Fractured arm at age 16 b. Active smoking c. Vitamin D supplements d. Weight lifting

ANS: B A history of smoking has been identified as a risk factor for osteoporosis. A history of low-trauma fracture after the age of 50 has been identified as a risk factor. Vitamin D and weight lifting are measures that can be used to prevent this disease.

The nurse is caring for a client with a lesion in the area of the tibia that is swollen and tender. Which client problem is the highest priority for nursing care? a. Need for increased calories related to increased metabolism b. Pain management related to physical injury c. Compromised self-care related to weakness d. Safety risk related to skeletal impairment

ANS: B A palpable mass and swelling in the area of the tibia are symptoms of osteochondroma, which is a common, benign bone tumor. Pain is the most common manifestation of a benign bone tumor. The other distractors are important, but pain management is the highest priority.

When providing care for a client who has had a débridement for osteomyelitis, which intervention is most important for the nurse to implement? a. Assess the white blood cell count. b. Assess circulation in the distal extremities. c. Administer pain medication. d. Monitor temperature.

ANS: B All the interventions would be completed during care of this client. However, after resection of infected bone, neurovascular assessments must be done frequently because the client experiences increased swelling, which could cause neurovascular compromise.

A client with a fractured clavicle is placed in a muslin brace to immobilize the area. The client asks why a plaster cast is not applied to this fracture. What is the nurse's best response? A. "Plaster is not used on the upper body because it will make the area too heavy for movement." B. "Because the clavicle does not bear weight, a splint or bandage is sufficient to keep the bones in alignment." C. "Upper extremities are more vascular than lower extremities; cloth braces are less likely to disrupt circulation." D. "Plaster is not needed because fractures to the upper body always heal more quickly than fractures of the lower body."

ANS: B Because upper extremities do not bear weight, cloth splints are usually sufficient to immobilize the fracture.

A client asks why a plaster cast is not applied to the fractured clavicle. Which is the nurse's best response? a. "Plaster will make the area too heavy for movement." b. "A splint or a bandage is sufficient to keep the bones in alignment." c. "Cloth braces are less likely to disrupt circulation." d. "Fractures to the upper body always heal more quickly."

ANS: B Because upper extremities do not bear weight, cloth splints are usually sufficient to immobilize the fracture. The other responses are not accurate for this type of fracture.

The nurse is rounding on assigned orthopedic clients. The client with which type of fracture requires immediate interventions to prevent infection? a. Fractured clavicle b. Open fracture of the tibia c. Simple fracture of the wrist d. Compression fracture of a vertebra

ANS: B Bone infection or osteomyelitis is most common in clients with an open fracture because skin integrity is lost and organisms gain access easily. The nurse will remind all those who come into contact with the client to use good handwashing and will observe the wound daily for signs of infection. The other clients do not have extra risk factors for infection.

Which of the following clients is most at risk for secondary osteoporosis? A. 33-year-old man recovering from a fractured wrist B. 55-year-old woman taking prednisone for asthma C. 72-year-old man who resides in a nursing home D. 25-year-old woman taking oral contraceptives

ANS: B Osteoporosis is more prevalent in postmenopausal women, and certain medications, such as corticosteroids, increase the risk of secondary osteoporosis

Which exercise does the nurse recommend to a client at risk for osteoporosis? a. High-impact aerobics 45 minutes once weekly b. Walking 30 minutes three times weekly c. Jogging 30 minutes four times weekly d. Bowling for 1 hour twice weekly

ANS: B Weight-bearing, nonjarring exercises have been proved to reduce or slow bone loss without causing vertebral compression. High-impact aerobics, jogging, and bowling are activities that actually could cause fracture in a client with osteoporosis. Walking would be the best choice as an exercise.

To prevent bone density loss, which exercise should the nurse recommend to a client at risk for osteoporosis? A. High-impact aerobics 45 minutes once weekly B. Walking 30 minutes three times weekly C. Jogging 30 minutes four times weekly D. Bowling for 1 hour twice weekly

ANS: B Weight-bearing, nonjarring exercises have been proven to reduce or slow bone loss without causing vertebral compression.

The nurse reviews the health history of a client with acute osteomyelitis. Which findings might have contributed to the diagnosis? (Select all that apply.) a. Recent dental work b. Urinary tract infection c. Pregnancy d. Age e. Hemodialysis f. Gastrointestinal infection

ANS: B, E, F Poor dental hygiene and gum infection (not necessarily recent dental work), urinary tract infection, hemodialysis, and Salmonella infection of the gastrointestinal tract can be sources of infection and, consequently, osteomyelitis. Pregnancy and advancing age are not necessarily precursors to osteomyelitis, even though urinary tract infection leading to osteomyelitis is common in older men.

A client who had a plaster cast applied to the right arm 3 weeks ago presents to the clinic with an erythrocyte sedimentation rate (ESR) that has increased from 15 to 25 mm/hr. Which is the nurse's best action? a. Repeat this laboratory assessment in 4 hours. b. Have the cast reapplied. c. Evaluate temperature and vital signs. d. Obtain blood for a platelet count

ANS: C A rise in the ESR during fracture healing suggests a bone infection or a fat embolism. The nurse should collect all other assessment data that can assist in confirming this diagnosis and then should notify the health care provider. Repeating the laboratory assessment, reapplying the cast, and assessing a platelet count would not be indicated.

Which of the following best explains the development of a fat embolism as a complication of a bone fracture? A. The bone is rich in blood and platelet activity is easily activated. B. Flat bones contain additional amounts of lipoprotein that initiate the lipid cascade. C. The marrow contains fat cells that can be dislodged during injury D. Open fractures tear tissue as the bone exits the skin and this tissue enters the bloodstream as an embolism.

ANS: C Yellow marrow contains fat cells that can be dislodged and enter the bloodstream, causing fat embolism.

The nurse is caring for a client with an external fixator in place on the leg. What does the nurse assess for first? a. Alteration in skin integrity b. Impaired motor action c. Acute pain d. Signs of infection

ANS: D As long as the external fixator is in place, a direct connection is present between the external environment and the bone. The risk for infection is high. An expected alteration in skin integrity and a decrease in movement are noted. Acute pain would not be expected, but the client should be medicated for pain if necessary.

The most significant complication of the use of an external fixator on the lower leg for a fractured tibia reduction is which of the following? A. Skin impairment B. Muscle atrophy C. Acute pain D. Infection

ANS: D As long as the external fixator is in place, there is a direct connection between the external environment and the bone. The risk for infection is high.

Which client does the nurse assess more carefully for risk of developing primary osteoporosis? a. African-American client b. Resident of a nursing home c. Client who eats meat with every meal d. Client who drinks 6 cups of coffee daily

ANS: D Excessive consumption of caffeine and alcohol has been shown to be a risk factor for primary osteoporosis because of loss of calcium in the urine. Being white or Asian has been identified as causing a higher risk for developing osteoporosis at an earlier age compared with African-American ethnicity. Being a resident of a nursing home who is not exposed to sunlight could be a risk factor, but just being a resident does not predispose to osteoporosis. Meat is high in protein. Protein deficiency has been identified as a risk factor.

Which assessment finding relates most directly to a diagnosis of chronic osteomyelitis? a. Erythema of the affected area b. Swelling around the affected area c. Temperature higher than 101° F (38° C) d. Ulceration of the skin

ANS: D Fever, swelling, and erythema are far less common in chronic osteomyelitis, whereas ulceration, sinus tract formation, and localized pain are more characteristic.

A client has an arm cast and reports that it feels really tight and the fingers are puffy. What is the nurse's best response? a. "Elevate your arm on two pillows and apply ice to the cast." b. "Continue to take ibuprofen (Motrin) until the swelling subsides." c. "It is normal for a new cast to feel a little tight for the first few days." d. "Please come to the clinic today to have your arm checked by the health care provider."

ANS: D Puffy fingers and a feeling of tightness from the cast may indicate the development of compartment syndrome. The client should come to the clinic that day to be evaluated by the provider because delay of treatment can cause permanent damage to the extremity. Ice and Motrin are acceptable actions, but checking the cast is the priority because it ensures client safety. The nurse should not just reassure the client that this is normal.

A client has a fractured humerus. Which dietary choice indicates that the client understands the nutrition needed to assist in healing the fracture? a. Skim milk, vitamin D supplements, and fish b. Soy milk, vitamin B supplements, and bacon, lettuce, and tomato sandwich c. Whole milk, vitamin A supplements, and vegetable lasagna d. Low-fat milk, vitamin C supplements, and roast beef

ANS: D The client with a healing fracture needs supplements of vitamins B and C and a high-protein, high-calorie diet. Milk for calcium supplementation and vitamin C supplementation are appropriate. Meat would increase protein in the diet that is necessary for bone healing. Fish, a sandwich, and vegetable lasagna would provide less protein.

The nurse notes that the skin around the client's skeletal traction pin site is swollen, red, and crusty, with dried drainage. Which is the nurse's priority intervention? a. Decrease the traction weight. b. Apply a new dressing. c. Cleanse the area, scrubbing off the crusty areas. d. Culture the drainage.

ANS: D These clinical manifestations indicate inflammation and possible infection. Infected pin sites can lead to osteomyelitis and should be treated immediately. The nurse should obtain a culture and assess vital signs. The provider should be notified. By decreasing the traction weight, applying a new dressing, or cleansing the area, the infection cannot be significantly treated.

A patient has chronic osteomyelitis of the left femur, which is being managed at home with self-administration of IV antibiotics. On a home visit, the nurse identifies the nursing diagnosis of ineffective therapeutic regimen management when the nurse finds that the patient a. is unable to plantar-flex the foot on the affected side. b. uses crutches to avoid weight bearing on the affected leg. c. takes and records the oral temperature twice a day. d. is irritable and frustrated with the length of treatment required.

Answer: A Rationale: Footdrop is an indication that the foot is not being supported in a neutral position by a splint. Using crutches and monitoring the oral temperature are appropriate self-care activities. Frustration with the length of treatment is not an indicator of ineffective management of the osteomyelitis.

A nurse is caring for a patient who has had hip replacement. The nurse should be most concerned about which of the following findings? A. Complaints of pain during repositioning. B. Scant bloody discharge on the surgical dressing. C. Complaints of pain following physical therapy. D. Temperature of 101.8 F (38.7 C).

Answer: D Post-surgical nursing assessment after hip replacement should be principally concerned with the risk of neurovascular complications and the development of infection. A temperature of 101.8 F (38.7 C) postoperatively is higher than the low grade that is to be expected and should raise concern. Some pain during repositioning and following physical therapy is to be expected and can be managed with analgesics. A small amount of bloody drainage on the surgical dressing is a result of normal healing.

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

Ask the client to plantar flex the toes. Explanation: A neurological assessment evaluates sensation and motion. Assessing plantar flexion of the toes would be included in a neurological assessment. Capillary refill, palpation of pulses, and inspecting for edema would be included in a vascular assessment.

A 23 year old female client was in an automobile accident and is now a paraplegic. She is on an intermittent urinary catheterization program and diet as tolerated. The nurse's priority assessment should be to observe for: A. Urinary retention B. Bladder distention C. Weight gain D. Bower evacuation

B

A client has just returned from surgery after having his left leg amputated below the knee. Physician's orders include elevation of the foot of the bed for 24 hours. The nurse observes that the nursing assistant has placed a pillow under the client's amputated limb. The nursing action is to: A. Leave the pillow as his stump is elevated B. Remove the pillow and elevate the foot of the bed C. Leave the pillow and elevate the foot of the bed D. Check with the physician and clarify the orders

B

After falling down the basement steps in his house, a client is brought to the emergency room. His physician confirms that his leg is fractured. Following application of a leg cast, the nurse will first check the client's toes for: A. Increase in the temperature B. Change in color C. Edema D. Movement

B

After a car accident, a client is admitted to an acute care facility with multiple traumatic injuries, including a fractured pelvis. For 24 to 48 hours after the accident, the nurse must monitor the client closely for which potential complication of a fractured pelvis? a. Compartment syndrome b. Fat embolism c. Infection d. Volkmann's ischemic contracture

B - Fat embolism is a relatively rare but life-threatening complication of pelvis and long-bone fractures, arising 24 to 48 hours after the injury. It occurs when fat droplets released at the fracture site enter the circulation, become lodged in pulmonary capillaries, and break down into fatty acids. Because these acids are toxic to the lung parenchyma, capillary endothelium, and surfactant, the client may develop pulmonary hypertension. Signs and symptoms of fat embolism include an altered mental status, fever, tachypnea, tachycardia, hypoxemia, and petechiae. Compartment syndrome and infection may complicate any fracture and aren't specific to a pelvis fracture. Volkmann's ischemic contracture is a potential complication of a hand or forearm fracture.

The nurse is planning to teach a client with a below-the-knee amputation about skin care to prevent breakdown. Which of the following points should the nurse include in the teaching plan? a) a stump sock must be worn at all times and changed twice a week b) the socket of the prosthesis must be dried carefully before it is used c) the residual limb (stump) is washed gently and dried every other day d) the socket of the prosthesis needs to be washed with a strong bactericidal agent daily

B - The socket of the prosthesis is cleansed with a mild detergent, rinsed, and dried carefully each day. A strong bactericidal agent would not be used. A stump sock must be worn at all times to absorb perspiration, and it is changed daily. The residual limb (stump) is washed, dried, and inspected for breakdown twice each day.

A 7 year old boy with a fractured leg tells the nurse that he is bored. An appropriate intervention would be to A. Read a story and act out the part B. Watch a puppet show C. Watch television D. Listen to the radio

C

A client has sustained a fracture of the femur and balanced skeletal traction with a Thomas splint has been applied. To prevent pressure points from occurring around the top of the splint, the most important intervention is to: A. Protect the skin with lotion B. Keep the client pulled up in bed C. Pad the top of the splint with washcloths D. Provide a footplate in the bed

C

A patient is seen at the urgent care center after falling on the right arm and shoulder. It will be most important for the nurse to determine a. whether there is bruising at the shoulder area. b. whether the right arm is shorter than the left. c. the amount of pain the patient is experiencing. d. how much range of motion (ROM) is present.

Correct Answer: B Rationale: A shorter limb after a fall indicates a possible dislocation, which is an orthopedic emergency. The nurse will expect bruising and pain at the area, even without an injury that requires surgery. The shoulder should be immobilized until it is evaluated by the health care provider.

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

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

The health care provider initially orders bed rest for a patient with an open-book pelvic fracture. Which assessment data obtained by the nurse are most important to report to the health care provider? a. The bowel tones are absent. b. There is an unusual amount of pelvic movement. c. The patient complains of level 4 abdominal pain on a 10-point pain scale. d. There is bruising of the abdomen

Correct Answer: A Rationale: Absent bowel tones may be due to complications of pelvic fractures such as paralytic ileus, hemorrhage, or trauma to the bladder, urethra, or colon. Unusual pelvic movement, abdominal pain, and abdominal bruising would be expected with this type of injury.

The nurse has given the client with a nonplaster (fiberglass) leg cast instructions regarding cast care at home. The nurse determines that the client needs further instructions if the client makes which statement? a) I should avoid walking on wet, slippery floors b) I'm not supposed to scratch the skin underneath the cast c) It's all right to wipe dirt off of the top of the cast with a damp cloth d) if the cast gets wet, I can dry it with a dryer turned to the hot setting

D - If the cast gets wet, it can be dried with a hair dryer set to a cool setting. The client is instructed to avoid walking on wet, slippery floors to prevent falls. If the skin under the cast itches, cool air from a hair dryer may be used to relieve it. The client should never scratch under the cast because of the risk of skin breakdown and infection. Surface soil on a cast may be removed with a damp cloth.

A client in the emergency department has a cast applied. The client arrives at the nursing unit, and the nurse prepares to transfer the client into the bed by: a) placing ice on top of the cast b) supporting the cast with the fingertips only c) asking the client to support the cast during transfer d) using the palms of the hands and soft pillows to support the cast

D - The palms or the flat surface of the extended fingers should be used when moving a wet cast to prevent indentations. Pillows are used to support the curves of the cast to prevent cracking or flattening of the cast from the weight of the body. Half-full bags of ice may be placed next to the cast to prevent swelling, but this action would be performed after the client is placed in bed. Asking the client to support the cast during transfer is inappropriate.

A patient is prescribed ibuprofen 800 mg every 4 hours for the treatment of rheumatoid arthritis (RA). Which of these clinical manifestations should the healthcare provider anticipate observing if the patient is developing an adverse effect from the medication? Select all that apply. Patient report of epigastric pain Positive fecal occult blood test Decreased serum albumin Increased blood urea nitrogen (BUN) Increased serum hematocrit

Patient report of epigastric pain Positive fecal occult blood test Increased blood urea nitrogen (BUN)

The client with RA has nontender movable nodules in subcutaneous tissue over the elbows and shoulders. Which statement is the best explanation for the nodules? a. The nodules indicate a rapidly progressive destruction of the affected tissue b. The nodules are small amounts of synovial fluid that have become crystallized c. The nodules are lymph nodes that have proliferated to try to fight the disease d. The nodules present a favorable prognosis and mean the client is better

a. The nodules indicate a rapidly progressive destruction of the affected tissue

The client diagnosed with RA who has been prescribed Plaquenil, shows marked improvement. Which instruction regarding the use of this medication should the nurse teach? a. Explain that the less medication loses its efficacy after a few months b. Continue to have regular eye exams while taking the medication c. Have yearly MRIs to follow the progress d. Discuss that the drug is taken for 3 weeks and then stopped for a week

b. Continue to have regular eye exams while taking the medication

The client diagnosed with RA has developed swan-neck fingers. Which referral would be the most appropriate for the client? a. Physical therapy b. Occupational therapy c. Psychiatric counselor d. Home health nurse

b. Occupational therapy

Which client problem is priority for a client diagnosed with RA? a. Activity intolerance b. Fluid and Electrolyte balance c. Alteration in comfort d. Excessive nutritional intake

c. Alteration in comfort

The client diagnosed with RA is receiving care through a nurse practitioner clinic. Which preventive care should the nurse include in the regularly scheduled clinic visits? a. Perform joint x-rays to determine progression of the disease b. Send blood to the lab for an erythrocyte sedimentation rate (ESR) c. Recommend the flu and pneumonia vaccines d. Assess the client for increasing joint involvement

c. Recommend the flu and pneumonia vaccines

Which psychosocial problem would be priority for a client diagnosed with RA? a. Alteration in comfort b. Ineffective coping c. Anxiety d. Altered body image

d. Altered body image

Which intervention has the highest priority when caring for a client diagnosed with RA? a. Encourage the client to ventilate feelings about the disease process b. Discuss the effects of disease on the client's career and other life roles c. Instruct the client to perform most important activities in the morning d. Teach the client the proper use of hot and cold therapy to provide pain relief

d. Teach the client the proper use of hot and cold therapy to provide pain relief

The nurse is assessing a client diagnosed with RA. Which assessment findings warrant immediate intervention? a. The client complains of joint stiffness and the knees feel warm to the touch b. The client has experienced one kg weight loss and is very tired c. The client requires a heating pad applied to the hips and back to sleep d. The client is crying, has a flat facial affect, and refuses to speak to the nurse

d. The client is crying, has a flat facial affect, and refuses to speak to the nurse

When planning care for a patient who will be treated with 2 days of bed rest for low back pain, which intervention will the nurse include? a. Telling the patient about the importance of a high fiber and fluid intake b. Instructing the patient to avoid positioning the knee in the flexed position c. Educating the patient that continuous heat application will reduce pain d. Teaching the patient that the prone position will help relieve back pain

Answer: A Rationale: Prevention of constipation caused by immobility is a goal for the patient with low back pain. The knee should be flexed to prevent pressure on the muscles and support structures of the spine. Heat and cold should be alternated. The prone position places more strain on the back and should be avoided.

The nurse determines that teaching regarding diet for a patient with osteoporosis has been successful when the patient selects which of these meals as having the highest amount of calcium? a. Sardine sandwich on whole wheat bread, one cup of fruit yogurt, and one cup of skim milk b. Two-egg omelet with American cheese, one slice of whole-wheat toast, and a half grapefruit c. Ham and Swiss cheese sandwich on whole-wheat bread, steamed broccoli, and an apple d. Chicken stir-fry with bok choy, onions, and snap peas and one cup of steamed brown rice

Answer: A Rationale: Sardines, yogurt, and milk are all high in calcium. The other choices have some foods that are high in calcium but also include foods that are low in calcium, such as eggs, apples, and grapefruit.

When administering alendronate (Fosamax) to a patient, the nurse will first a. administer the ordered calcium carbonate. b. be sure the patient has recently eaten. c. assist the patient to sit up at the bedside. d. ask about any leg cramps or hot flashes.

Answer: C Rationale: To avoid esophageal erosions, the patient taking bisphosphonates should be upright for at least 30 minutes after taking the medication. Fosamax should be taken on an empty stomach, not after taking other medications or eating. Leg cramps and hot flashes are not side effects of bisphosphonates.

A 20-year-old patient with a 6-year history of muscular dystrophy is hospitalized with a respiratory tract infection. Which nursing action will be included in the plan of care? a. Logroll the patient every 1 to 2 hours. b. Teach the patient about the muscle biopsy procedure. c. Provide the patient with a pureed diet. d. Assist the patient with active range-of-motion (ROM) exercises.

Answer: D Rationale: The goal for the patient with muscular dystrophy is to keep the patient active for as long as possible. The patient would not be confined to bed rest and would not require logrolling. Muscle biopsies are necessary to confirm the diagnosis but would not be ordered for a patient who already had a diagnosis. There is no indication that the patient requires a pureed diet.

Following a laminectomy with a spinal fusion, a patient reports numbness and tingling of the right lower leg. The first action indicated by the nurse is to a. report the patient's complaint to the surgeon. b. check the vital signs for indications of hemorrhage. c. turn the patient to the side to relieve pressure on the operative area. d. check the chart for preoperative neuromuscular assessment data.

Answer: D Rationale: The postoperative movement and sensation of the extremities should be unchanged (or improved) from the preoperative assessment. If the numbness and tingling are new, this information should be immediately reported to the surgeon. Numbness and tingling are not symptoms associated with hemorrhage at the site. Turning the patient will not relieve the numbness.

When a client has cervical halter traction to immobilize the cervical spine counteraction is provided by: A. Elevating the foot of the bed B. Elevating the head of the bed C. Application of the pelvic girdle D. Lowering the head of the bed

B

Which of these nursing actions will best promote independence for the client in skeletal traction? A. Instruct the client to call for an analgesic before pain becomes severe. B. Provide an overhead trapeze for client use C. Encourage leg exercise within the limits of traction D. Provide skin care to prevent skin breakdown

B

A nurse is performing pin site care on a client in skeletal traction. Which finding would the nurse expect to note when assessing the pin sites? a) loose pin sites b) clear drainage from the pin sites c) purulent drainage from the pin sites d) redness and swelling around the pin sites

B - A small amount of clear drainage ("weeping") may be expected after cleaning and removing crusting around the pin sites. Redness and swelling around the pin sites and purulent drainage may be indicative of an infection. Pins should not be loose, and, if this is noted, the physician should be notified.

After teaching the client about risk factors for rheumatoid arthritis, which of the following, if stated by the client as a risk factor, would indicate to the nurse that the client needs additional teaching? A. History of Epstein-Barr virus infection B. Female gender C. Adults between the ages 60 to 75 years D. Positive testing for human leukocyte antigen (HLA) DR4 allele

C

An elderly client has sustained intertrochanteric fracture of the hip and has just returned from surgery where a nail plate was inserted for internal fixation. The client has been instructed that she should not flex her hip. The best explanation of why this movement would be harmful is: A. It will be very painful for the client B. The soft tissue around the site will be damaged C. Displacement can occur with flexion D. It will pull the hip out of alignment

C

At which of the following times would the nurse instruct the client to take ibuprofen (Motrin), prescribed for left hip pain secondary to osteoarthritis, to minimize gastric mucosal irritation? A. At bedtime B. On arising C. Immediately after meal D. On an empty stomach

C

On a visit to the clinic, a client reports the onset of early symptoms of rheumatoid arthritis. Which of the following would be the nurse most likely to asses: A. Limited motion of joints B. Deformed joints of the hands C. Early morning stiffness D. Rheumatoid noduleS

C

The client has Buck's extension applied to the right leg. The nurse plans which of the following interventions to prevent complications of the device? A. Massage the skin of the right leg with lotion every 8 hours B. Give pin care once a shift C. Inspect the skin on the right leg at least once every 8 hours D. Release the weights on the right leg for range of motion exercises daily

C

The client with a fractured tibia has been taking methocarbamol (Robaxin), when teaching the client about this drug, which of the following would the nurse include as the drug's primary effect? A. Killing of microorganisms B. Reduction in itching C. Relief of muscle spasms D. Decrease in nervousness

C

The client with right sided weakness needs to learn how to use a cane. The nurse plans to teach the client to position the cane by holding it with the: A. Left hand and placing the cane in front of the left foot B. Right hand and placing the cane in front of the right foot C. Left hand and 6 inches lateral to the left foot D. Right hand and 6 inches lateral to the left foot

C

The nurse is caring for a client who develops compartment syndrome from a severely fractured arm. The client asks the nurse how this can happen. The nurse's response is based on the understanding that: a) A bone fragment has injured the nerve supply in the area b) an injured artery causes impaired arterial perfusion through the compartment c) bleeding and swelling cause increased pressure in an area that cannot expand d) the fascia expands with injury, causing pressure on underlying nerves and muscles

C - Compartment syndrome is caused by bleeding and swelling within a compartment, which is lined by fascia that does not expand. The bleeding and swelling place pressure on the nerves, muscles, and blood vessels in the compartment, triggering the symptoms.

A nurse is caring for a client who has been placed in Buck's extension traction. The nurse provides for countertraction to reduce shear and friction by: a) using a footboard b) providing an overhead trapeze c) slightly elevating the foot of the bed d) slightly elevating the head of the bed

C - The part of the bed under an area in traction is usually elevated to aid in countertraction. For the client in Buck's extension traction (which is applied to a leg), the foot of the bed is elevated. An overhead trapeze or footboard is not used to provide countertraction. Option C provides a force that opposes the traction force effectively without harming the client.

The morning of the second postoperative day following hip surgery for a fractured right hip, the nurse will ambulate the client. The first intervention is to: A. Get the client up in a chair after dangling at the bedside. B. Use a walker for balance when getting the client out of bed C. Have the client put minimal weight on the affected side when getting up D. Practice getting the client out of bed by having her slightly flex her hips

D

To prevent foot drop in a client with Buck's traction, the nurse should: A. Place pillows under the client's heels. B. Tuck the sheets into the foot of the bed C. Teach the client isometric exercises D. Ensure proper body positioning

D

A patient is being discharged after 2 weeks of IV antibiotic therapy for acute osteomyelitis in the left leg. Which information will be included in the discharge teaching? a. The reason for taking oral antibiotics for 7 to 10 days after discharge b. The need for daily aerobic exercise to help maintain muscle strength c. How to monitor and care for the long-term IV catheter site d. How to apply warm packs safely to the leg to reduce pain

Answer: C Rationale: The patient will be on IV antibiotics for several months, and the patient will need to recognize signs of infection at the IV site and how to care for the catheter during daily activities such as bathing. IV antibiotics rather than oral antibiotics are used for acute osteomyelitis. Patients are instructed to avoid exercise and heat application because these will increase swelling and the risk for spreading infection

When assessing the musculoskeletal system, the nurse's initial action will usually be to a. have the patient move the extremities against resistance. b. feel for the presence of crepitus during joint movement. c. observe the patient's body build and muscle configuration. d. check active and passive range of motion for the extremities.

Answer: C Rationale: The usual technique in the physical assessment is to begin with inspection. Abnormalities in muscle mass or configuration will allow the nurse to perform a more focused assessment of abnormal areas. The other assessments are also included in the assessment but are usually done after inspection.

A patient with a herniated intravertebral disk undergoes a laminectomy and diskectomy. Following the surgery, the nurse should position the patient on the side by a. elevating the head of the bed 30 degrees and having the patient extend the legs while turning to the side. b. turning the patient's head and shoulders and then the hips, keeping the patient centered in the bed. c. having the patient turn by grasping the side rails and pulling the shoulders over. d. placing a pillow between the patient's legs and turning the entire body as a unit.

Answer: D Rationale: Logrolling is used to maintain correct body alignment after laminectomy. The other positions will create misalignment of the spine.

A patient suffers an injury to the shoulder while playing football. To identify abnormalities of cartilage and soft tissue surrounding the joint, the nurse would expect the patient to be evaluated with a. radioisotope bone scanning. b. arthroscopy. c. standard x-rays. d. magnetic resonance imaging (MRI)

Answer: D Rationale: MRI is most useful in assessing for soft tissue injuries. Bone scanning and standard radiographs are used to assess for injures or lesions of bone. Arthroscopy is used for visualizing the joints.

A client presents in the emergency department after falling from a roof. A fracture of the femoral neck is suspected. Which of these assessments best support this diagnosis. A. The client reports pain in the affected leg B. A large hematoma is visible in the affected extremity C. The affected extremity is shortened, adducted, and extremely rotated D. The affected extremity is edematous

C

After surgery and insertion of a total joint prosthesis, a client develops severe sudden pain and an inability to move the extremity. The nurse interprets these findings as indicating which of the following? A. A developing infection B. Bleeding in the operative site C. Joint dislocation D. Glue seepage into soft tissue

C

The nurse is caring for a client with compound fracture of the tibia and fibula. Skeletal traction is applied. Which of these priorities should the nurse include in the care plan? A. Order a trapeze to increase the client's ambulation B. Maintain the client in a flat, supine position at all times. C. Provide pin care at least every hour D. Remove traction weights for 20 minutes every two hours

C

When admitting a client with a fractured extremity, the nurse would focus the assessment on which of the following first? A. The area proximal to the fracture B. The actual fracture site C. The area distal to the fracture D. The opposite extremity for baseline comparison

C

A client has sustained a closed fracture and has just has a cast applied to the affected arm. The client is complaining of intense pain. The nurse has elevated the limb, applied an ice bag, and administered an analgesic, which has provided very little pain relief. The nurse interprets that this pain may be caused by: a) infection under the cast b) the anxiety of the client c) impaired tissue perfusion d) the newness of the fracture

C - Most pain associated with fractures can be minimized with rest, elevation, application of cold, and administration of analgesics. Pain that is not relieved from these measures should be reported to the physician, because it may be caused by impaired tissue perfusion, tissue breakdown, or necrosis. Because this is a new closed fracture and cast, infection would not have had time to set in.

Which of the following would be inappropriate to include when preparing a client for magnetic resonance imaging (MRI) to evaluate a rupture disc? A. Informing the client that the procedure is painless B. Taking a thorough history of past surgeries C. Checking for previous complaints of claustrophobia D. Starting an intravenous line at keep-open rate

D

After teaching the client with severe rheumatoid arthritis about the newly prescribed medication methotrexate (Rheumatrex O), which of the following statements indicates the need for further teaching? A. "I will take my vitamins while I am on this drug" B. "I must not drink any alcohol while I'm taking this drug" C. "I should brush my teeth after every meal" D. "I will continue taking my birth control pills"

D

The client with an above the knee amputation is to use crutches until the prosthesis is being adjusted. In which of the following exercises would the nurse instruct the client to best prepare him for using crutches? A. Abdominal exercises B. Isometric shoulder exercises C. Quadriceps setting exercises D. Triceps stretching exercises

D

The nurse has taught the client with a below the knee amputation about prosthesis and stump care. The nurse evaluates that the client states to: A. Wear a clean nylon stump sock daily B. Toughen the skin of the stump by rubbing it with alcohol C. Prevent cracking of the skin of the stump by applying lotion daily D. Using a mirror to inspect all areas of the stump each daY

D

The nurse is giving the client with a left cast crutch walking instructions using the three point gait. The client is allowed touchdown of the affected leg. The nurse tells the client to advance the: A. Left leg and right crutch then right leg and left crutch B. Crutches and then both legs simultaneously C. Crutches and the right leg then advance the left leg D. Crutches and the left leg then advance the right leg

D

When completing the history and physical examination of a client diagnosed with osteoarthritis, which of the following would the nurse assess? A. Anemia B. Osteoporosis C. Weight loss D. Local joint pain

D

When developing the teaching plan for the client with rheumatoid arthritis to promote rest, which of the following would the nurse expect to instruct the client to avoid during the rest periods? A. Proper body alignment B. Elevating the part C. Prone lying positions D. Positions of flexion

D

Which of the following actions would be a priority for a client who has been in the postanesthesia care unit (PACU) for 45 minutes after an above the knee amputation and develops a dime size bright red spot on the ace bandage above the amputation site? A. Elevate the stump B. Reinforcing the dressing C. Calling the surgeon D. Drawing a mark around the site

D

While caring for a client with a newly applied plaster of Paris cast, the nurse makes note of all the following conditions. Which assessment finding requires immediate notification of the physician? A. Moderate pain, as reported by the client B. Report, by client, the heat is being felt under the cast C. Presence of slight edema of the toes of the casted foot D. Onset of paralysis in the toes of the casted fooT

D

A nurse is caring for a client who has been placed in Buck's extension traction while awaiting surgical repair of a fractured femur. The nurse prepares to perform a complete neurovascular assessment of the affected extremity and plans to assess: a) vital signs and bilateral lung sounds b) warmth of the skin and the temperature in the affected extremity c) pain level and for the presence of edema in the affected extremity d) color, sensation, movement, capillary refill, and pulse of the affected extremity

D - A complete neurovascular assessment of an extremity includes color, sensation, movement, capillary refill, and pulse of the affected extremity.

A client is hospitalized for open reduction of a fractured femur. During postoperative assessment, the nurse monitors for signs and symptoms of fat embolism, which include: a. pallor and coolness of the affected leg. b. nausea and vomiting after eating. c. hypothermia and bradycardia. d. restlessness and petechiae.

D - Signs and symptoms of fat embolism include restlessness, petechiae, and an altered mental status. Pallor and coolness of the affected leg are associated with a clot in the leg, not fat embolism. Nausea and vomiting after eating may be related to gastric obstruction. Hypothermia isn't an expected result of an open reduction of a fracture. Bradycardia has no relation to fat emboli but may indicate a cardiac problem.

The nurse has an order to get the client out of bed to a chair on the first postoperative day following total knee replacement. The nurse plans to do which of the following to protect the knee joint? a) apply a compression dressing and put ice on the knee while sitting b) obtain a walker to minimize weigh-bearing by the client on the affected leg c) lift the client to the bedside chair, leaving the continuous passive motion (CPM) machine d) apply a knee immobilizer before getting the client up and elevate the client's surgical leg while sitting

D - The nurse assists the client to get out of bed on the first postoperative day after putting a knee immobilizer on the affected joint to provide stability. The surgeon orders the weight-bearing limits on the affected leg. The leg is elevated while the client is sitting in the chair to minimize edema. Ice is not used unless prescribed. A compression dressing should already be in place on the wound. A CPM machine is used only while the client is in bed.