Musculoskeletal

What is the treatment for malignant hyperthermia?

-Antidote Dantrolene -100% O2 -Cooling measures (cold IV fluids, ice packs) -Sodium bicarb if metabolic acidosis

What symptoms need to be reported to the provider in a patient with a cast?

-Hot spots -Increased drainage -Malodor -Increased pain

For pins in immobilization devices, what is the pin site care?

-Monitor for loosening -Monitor for s/s infection (increased drainage, erythema, skin tenting at pin site) -Clean pins using NEW cotton tip swab for each pin -Do NOT remove crusting at pin site

What is the nursing care for halo traction (used for cervical fx)?

-Move patient AS A UNIT and do not apply pressure to rods -Make sure wrench/screwdriver are attached to vest to release patient in the event of an emergency

What are the s/s of malignant hyperthermia?

-Muscle rigidity -Tachycardia -FEVER -Dysrhythmias -Tachypnea -Hypotension -Cyanosis -Metabolic acidosis

What is the patient teaching to prevent hip flexion contractures after amputation of a limb?

-Perform ROM exercises -Avoid elevating the stump -Avoid sitting in a chair for >1hr -LIE PRONE for 20-30min every 3-4hr

How should weights (immobilization devices) be cared for?

-Should always be hanging freely -DO NOT let weights rest on the floor -Do NOT remove/lift weights

How should plaster casts be handled?

-Using PALMS (NOT fingertips- to avoid denting) until cast is dry -Elevate cast above level of the heart to decrease swelling

How can a patient with a cast relieve itching?

Blow cool air from a hair dryer under the cast

What causes malignant hyperthermia?

Certain drugs used in general anesthesia

When is Halo Traction used?

For cervical bone fx's

When is Bryant traction used?

For hip dysplasia in children (Ants are small like children)

When is Buck's traction used?

For hip fracture in adults (Adults have money- "Bucks")

What is an expected symptom for patients using immobilization devices?

Muscle spasms; treat with analgesics/muscle relaxants

When is skeletal traction used?

Screws inserted into the bone for long bone fx's

What should you always look out for in a patient with a spiral fracture?

Signs of abuse (fx caused by twisting motion)

What are good physical activities you can recommend someone with OA?

-PT -Strength training -Yoga -Tai Chi

A nurse is determining the client's risk of developing osteoporosis. The nurse should identify which of the following as risk factors for bone loss? SATA A. Small body frame B. Hypertension C. African-American ethnicity D. Low vitamin D intake E. Smoking

A. Small body frame D. Low vitamin D intake E. Smoking RATIONALE: C- Caucasian & Asian have higher risk

Where does a transverse fracture occur?

Along the long axis of a bone

A nurse is preparing an in-service presentation about the basics of none injuries. Which of the following types of fractures results when a client's bone breaks into multiple pieces? A. Avulsion B. Comminuted C. Compression D. Spiral

B. Comminuted RATIONALE: A- tendon has pulled away a fragment of bone C- the loading force to the long axis of a bone collapses (common in vertebral fxs) D- The break twists around the bone's shaft

A nurse is providing nutrition education to a client who has osteomalacia. The nurse should identify that this condition is caused by which of the following nutrients? A. Fluoride B. Vitamin A C. Vitamin D D. Phosphorus

C. Vitamin D

A nurse is assessing a client who has osteoarthritis. The clients medical record indicates the presence of Heberden's nodes. Which of the following findings should the nurse expect? A. Inflamed, fluid filled sacs over the joints B. Clubbing of the fingernails C. Flexion contracture of the fingers D. Hard lumps over the joints of the fingers

D. Hard lumps over the joints of the fingers RATIONALE: Heberden's nodes are bony lumps/nodules

What are the 5 P's of compartment syndrome?

P- Pain (intense) P- Pallor P- Paresthesia's P- Paralysis P- Pulselessness

What is a greenstick fracture?

Partial fracture where only one side is broken

What are some purine rich foods that patients with GOUT should avoid?

Red & organ meat Shellfish Fructose drinks Teaching: -Increase fluid intake -Reduce stress -No "starvation" dieting

What labs will be elevated in a patient with Paget's disease?

Serum alkaline phosphatase & urinary hydroxyproline (osteoclast activity)

What common complication is a/w RA that causes dry mouth, dry vagina and dry eyes?

Sjogren's Syndrome

What is a DXA scan used for?

To diagnose osteoporosis

What causes Osteomalacia?

Vitamin D deficiency (adult equivalent of Rickets in children)

What is skin traction?

Weights attached to the patient's skin to immobilize the area and decrease muscle spasms before surgery, or to reduce a fx

What is the treatment for compartment syndrome?

-AVOID use of cold -Do NOT elevate affected limb -Fasciotomy, amputation (sx)

How should a patient who is post-op hip arthroplasty be positioned?

-Abduction device between the legs to prevent dislocation -Keep heels of bed to avoid pressure injuries -Encourage use of overhead trapeze bar for repositioning -Use elevated toilet seat and avoid low chairs -Do not cross ankles/legs -Do not allow hip flexion >90 degrees

What deformities are common with RA?

-Ankylosis (joint fixation & deformity) -Ulnar drift -Swan neck & boutonniere deformities

What is the treatment for Osteomyelitis (bone infection)?

-LONG TERM abx therapy May also need surgical debridement of the bone or hyperbaric O2 therapy

What labs will be evident in a patient with RA?

-Positive Rheumatoid Factor (RF) antibody -Positive ANA titer

What is the purpose of an Arthroscopy and in which patients is it C/I?

-Provides visualization of the internal structure of a joint and allows for collection of biopsies -C/I if the patient cannot bend the joint at least 40 degrees

What is the pre-op nursing care for an Arthroplasty?

-Take epoetin alfa or advise pt to provide autologous blood donation several weeks before sx to prevent post-op anemia -Advise patient to shower with antiseptic soap before surgery

What is the patient teaching for RA?

-Take warm SHOWER to relieve morning stiffness -Activity to preserve ROM -Use assistive devices

A nurse is teaching a group of clients at a senior center about the risk factors for osteoporosis. Which of the following statements should the nurse include in the teaching? A. "Extended periods of immobility increases your risk of osteoporosis" B. "Prolonged periods of sun exposure increases your risk of osteoporosis" C. "Eating a diet high in protein can reduce your risk of osteoporosis" D. Corticosteroid therapy will reduce your risk of osteoporosis"

A. "Extended periods of immobility increases your risk of osteoporosis"

A nurse is preparing a client for an electromyogram (EMG). Which of the following statements indicates that the client understands the pre-procedure teaching? A. "This test will help my doctor know if my nerves are working correctly" B. "The doctor will be able to fix the problem with my arm during this procedure" C. "I cannot eat or drink for at least 10hr before I have this procedure" D. "I will get enough sedation to put me to sleep for this procedure"

A. "This test will help my doctor know if my nerves are working correctly" RATIONALE: An EMG shows electrical activity within the muscles during contraction; it is useful for discriminating between muscular dysfunction and nerve dysfunction

A nurse in an acute care clinic is talking with a client who reports that the osteoarthritis pain in her knees is increasing each day. The client wants to discuss non-pharmacological approaches to help relieve her pain. Which of the following interventions should the nurse suggest? A. Applying warm compresses to sore joints B. Decreasing the daily intake of dietary protein C. Keeping joints in extension during rest periods D. Limiting sleep to 6 to 7 hr per night

A. Applying warm compresses to sore joints

A nurse is talking with an older adult client who has an elevated risk for osteoporosis about strategies for preventing bone loss. Which of the following instructions should the nurse provide? A. Begin a program of brisk walking B. Take 800mg of calcium per day C. Drink plenty of sparkling water D. Drink 8oz of red wine each day

A. Begin a program of brisk walking

A nurse is assessing a client who is 24hr postoperative following an above the elbow amputation. Which of the following findings should the nurse identify as the priority? A. Client report of muscle spasms B. Inability to get dressed without assistance C. Client report of feelings of anger D. Refusal to look at the affected limb

A. Client report of muscle spasms RATIONALE: Physiological needs first

A nurse is providing discharge instructions for a client who is postoperative following inner maxillary fixation with wiring. Which of the following pieces of information should the nurse include? A. Cut the wiring if emesis occurs B. Consume 3 meals daily as part of a low-protein diet C. Swab the mouth with hydrogen peroxide if wiring produces oral irritation D. Resume a soft diet in 3-5 days

A. Cut the wiring if emesis occurs RATIONALE: Inner maxillary fixation involves wiring of the teeth to support the fx'd jaw by holding the jawbones together. The wires are left in place until the fx is healed. To preserve the airway, the nurse should have wire cutters available to cut them immediately if emesis occurs. The client should then return to the provider ASAP for re-wiring B- adequate protein is required for wound healing; small frequent meals can reduce nausea C- Report any irritation to the provider D- Liquid diet is needed for 1-4 weeks post op

A nurse is caring for a client who has osteoporosis and a new prescription for calcium supplements. Which of the following foods should the nurse recommend to promote calcium absorption? A. Fortified milk B. Ripe bananas C. Steamed broccoli D. Green leafy vegetables

A. Fortified milk RATIONALE: Vitamin D to promote calcium absorption

A nurse is teaching a client who has a cast on his left arm to treat a forearm fracture. Which of the following statements indicates that the client understands the teaching? A. I'll call the doctor's office if my fingers get colder on the arm with the cast B. If I have any itching under the cast, I'll try to reach the area with a cotton swab C. If my fingers swell, I should put a heating pad on them and rest D. If I have any tingling under my cast, I'll know I need to move my fingers more

A. I'll call the doctor's office if my fingers get colder on the arm with the cast RATIONALE: this is an unexpected finding- notify provider B- don't use ANY objects under the cast; CAN try blowing cool air from a blow dryer to relieve itching C- elevate and icepacks D- Compartment syndrome! Report immediately

A nurse is providing teaching for a client following a below the knee amputation. Which of the following pieces of information should the nurse include in the teaching? A. Instruct the client to lie prone while in bed B. Ensure the client sleeps on a soft mattress C. Pull up the residual limb while in bed D. Keep the residual limb exposed to air to heal

A. Instruct the client to lie prone while in bed RATIONALE: for 20-30min every 3-4hr B- FIRM C- push DOWN the residual limb while in bed to prepare the limb for the prosthetic and reduces the incidence of phantom pain D- WRAP the residual limb in elastic bandage to assist with shrinking the limb

A nurse is caring for a client who has chronic phantom limb pain following an above-knee amputation. Which of the following medication prescriptions should the nurse verify with the provider? A. Meperidine B. Amitryptyline C. Gabapentin D. Propranolol

A. Meperidine RATIONALE: Opioids are more effective for RESIDUAL limb pain rather than phantom; also, Meperidine is not recommended for chronic pain because long-term use can cause accumulation of a toxic metabolite

A nurse is caring for a client who is wearing a halo fixator. Which of the following interventions should the nurse implement? SATA A. Monitor the client's vital signs every 4hr B. Monitor the client's pin sites for loosening C. Hold the halo device when turning the client D. Check the client's skin to ensure the jacket is not applying pressure E. Adjust the screws holding the client's halo device in place to ensure a proper fit

A. Monitor the client's vital signs every 4hr B. Monitor the client's pin sites for loosening D. Check the client's skin to ensure the jacket is not applying pressure RATIONALE: C- NEVER hold/pull on the client's halo device to turn/reposition the client as this can cause misalignment and loosen the screws that are secured to the clients skull E- NEVER adjust; the provider is the only one who should make adjustments if needed

A nurse is preparing to care for a client who is in balanced skeletal traction to stabilize a femur fracture. Which of the following actions should the nurse include in the client's plan of care? A. Offering the client a diet high in fluid and fiber B. Encouraging active ROM of the affected leg C. Removing the weights prior to repositioning the client D. Inspecting pin sites every 24hr for drainage

A. Offering the client a diet high in fluid and fiber RATIONALE: a client who is immobile is at risk for constipation B- not feasible since the traction apparatus limits mobility C- should not be removed D- every 8-12hr

A nurse is providing discharge teaching to a client who has osteoarthritis. Which of the following instructions should the nurse include? A. Rest frequently after periods of inactivity B. Perform your exercises only on days that you feel good C. Perform your exercises after applying cold packs to your joints D. Place a large pillow under your knees when lying down

A. Rest frequently after periods of inactivity RATIONALE: B- be consistent C- heat D- NO, can l/t contractures

A nurse is caring for a client who had a below-the-knee amputation for gangrene of the right foot. The client reports sensations of burning and crushing pain in the toes of the absent right foot. Which of the following statements should the nurse make? A. This type of pain usually decreases over time as the limb becomes less sensitive B. Try to look at the surgical wound as a reminder the limb is gone C. Use cold compresses intermittently to decrease these pain sensations D. Grief over the lost limb can sometimes cause denial that the limb is really gone

A. This type of pain usually decreases over time as the limb becomes less sensitive

A nurse is assessing a client who is 48hr postoperative following an open reduction and internal fixation of a fractured tibia. Which of the following findings should the nurse report to the provider? A. Toes that are cold to the touch B. Serous drainage from the pin sites C. Blanching of the toenail beds with pressure D. Pink tissue around the fixator insertion sites

A. Toes that are cold to the touch RATIONALE: manifestation of compartment syndrome! B- expected for first 2-3 days C- blanching is normal/expected D- expected

A nurse is caring for a client who had a fiberglass cast placed on her left arm several hours ago and now reports itching under the cast. Which of the following actions should the nurse plan to take? A. Use a hair dryer on a cool setting to blow air into the cast B. Ask the provider to bivalve the cast C. Provide the client with a sterile cotton swab to rub the affected skin D. Wrap the extremity with a dry heating pad

A. Use a hair dryer on a cool setting to blow air into the cast RATIONALE: Or an empty 60mL plunger syringe

A nurse is preparing a client for MRI of the spine. Which of the following pieces of information should the nurse give the client prior to the procedure? A. You can have a mild sedative before the procedure B. You'll have to lie still on your back for 15-20min C. You can't have this test if you've had cataract surgery D. Your exposure to radiation will be minimal

A. You can have a mild sedative before the procedure RATIONALE: for anxiety, if needed B- for 45-60min D- no exposure at all with MRI's

A nurse is caring for a client with a hip fx who has Buck's extension traction in place. Which of the following pieces of information should the nurse give the client about this type of traction? SATA A. You'll have considerably less pain with the traction in place B. You'll have the traction in place for a week or so C. The traction will help decrease muscle spasms D. The weights act as a pulling force to keep your leg and hip still E. We have to make sure the weights are just barely touching the floor

A. You'll have considerably less pain with the traction in place C. The traction will help decrease muscle spasms D. The weights act as a pulling force to keep your leg and hip still RATIONALE: B-just prior to surgery E- weights must stay suspended at all times and should not touch the floor

What is Arthrocentesis done for?

Aspiration of synovial fluid from joint cavity or can inject meds

A nurse is providing discharge teaching for a client who had a left total hip arthroplasty. Which of the following client statements indicates the teaching was effective? A. "I should expect swelling of the affected leg for several weeks" B. "I should not cross my legs at the ankles or knees" C. "I will inspect my hip incision every other day for redness" D. "I can bend over at the hip to pick up objects"

B. "I should not cross my legs at the ankles or knees" RATIONALE: This is to avoid dislocation A- report swelling (possible DVT) C- daily D- avoid and do not flex the hip more than 90 degrees

A nurse is teaching a client who had an amputation of the left lower leg 3 days ago. Which of the following statements indicates that the client understands how to care for the incision and his left upper leg? A. "I should use powder inside my limb sock to keep it cool" B. "I will lie on my stomach for 30min a few times a day" C. "I should expect some drainage with a strong odor because I had gangrene" D. "I will keep elevated my leg on 2 pillows to keep the swelling down"

B. "I will lie on my stomach for 30min a few times a day" RATIONALE: the client should lie prone 3-4 times per day for 20-30 min to help reduce risk of hip flexion contractures D- do not elevate the residual limb on pillows for the first 24-48hr after the procedure because this can lead to hip or knee flexion contractures

A nurse is providing post-procedural teaching to a client who had a diagnostic knee arthroscopy. Which of the following statements indicates that the client understands the nurse's instructions? A. "I'll take aspirin to relieve my pain" B. "I'll keep my leg elevated for the first day" C. "I'll put a heating pad on my leg for the first day" D. "I'll resume my usual activities as soon as I leave"

B. "I'll keep my leg elevated for the first day" RATIONALE: should be kept elevated for 12-24hr to help reduce pain and swelling A- bleeding risk C- ICE D- short-term activity restrictions

A nurse is preparing a client who is scheduled to have an arthroscopy the following day. Which of the following statements indicates that the client understands the pre-procedure teaching? A. "I have to keep my leg straight throughout the whole procedure" B. "The doctor will be able to see if I have signs of RA" C. "I should expect to stay overnight until I can walk around" D. "I'll have a scar that will be about an inch long"

B. "The doctor will be able to see if I have signs of RA" RATIONALE: An arthroscopy helps with diagnosing musculoskeletal disorders, such as RA, OA, and internal joint injuries A- will be able to flex the knee at least 40 degrees C- should be able to ambulate with crutches D- 0.24in long

A nurse is preparing a client for a bone scan. Which of the following statements indicates that the client understands the pre-procedure teaching? SATA A. I will have to drink a radioactive solution before the test begins B. A special camera will scan the bones in my entire body C. There will be better absorption of the radiation by healthy bone D. I'll have to drink a lot of water to help get the radiation out of my body E. I understand the radiation is harmless, and I don't have to worry about it

B. A special camera will scan the bones in my entire body D. I'll have to drink a lot of water to help get the radiation out of my body E. I understand the radiation is harmless, and I don't have to worry about it RATIONALE: The radioactive material is not dangerous because it deteriorates quickly and exits via urine and stool

A nurse is caring for a client who is 72hr postoperative following an above-knee amputation. Which of the following actions should the nurse take? A. Elevate the residual limb on a soft pillow B. Assist the client into a prone position every 4hr C. Re-apply a bandage to the residual limb every 12hr D. Apply dressings to the site in a proximal-to distal direction

B. Assist the client into a prone position every 4hr RATIONALE: For 20-30min every 3-4hr A- avoid elevation for 72hr to decrease risk of flexion contractures C- Every 4-6hr to assist in preparation of prosthetic limb D- distal to proximal direction to prevention restriction of BF

A nurse is caring for a client who has a fractured hip and was placed in Buck's traction 4hr ago. Which of the following actions should the nurse take? A. Inspect the client's skin underneath the boot every 12 hr B. Encourage the client to perform dorsiflexion of the affected extremity every 2hr C. Remove the weights from the traction while repositioning the client in bed D. Loosen the ropes if the client reports muscle spasms in the affected extremity

B. Encourage the client to perform dorsiflexion of the affected extremity every 2hr RATIONALE: A- every 8 hr C- the weights should never be removed without a prescription from the provider; the purpose of the weights is to decrease muscle spasms D- The ropes of the traction should never be loosened

A nurse in the ED is assessing a client who was in a MVA 2 days ago and sustained fractures of his tibia, ulna, and several ribs. The client is now disoriented to time and place and has an SaO2 of 87%. The nurse notes generalized petechiae on the client's skin. Which of the following complications should the nurse expect? A. Hypovolemic shock B. Fat embolism syndrome C. Thrombophlebitis D. Avascular bone necrosis

B. Fat embolism syndrome RATIONALE: The triad of neuro changes, petechial rash, and hypoxemia are findings of fat embolism syndrome; RF include multiple fx's and a fracture of a long bone

A nurse is caring for a client who is in skeletal traction following a femur fracture. On entering, the nurse finds that the client has slid toward the foot of the bed, and the traction weight is resting on the floor. Which of the following actions should the nurse take? A. Remove the weight temporarily to reposition the client to the correct alignment in bed B. Have the client use a trapeze to pull himself up while ensuring the weight hangs freely C. Lift the rope off the pulley while the client rocks back and forth to reposition himself D. Lift the weight manually while another staff member moves the client up in bed

B. Have the client use a trapeze to pull himself up while ensuring the weight hangs freely RATIONALE: The nurse should ensure that the traction weight is hanging freely A- should never remove without a prescription

A nurse is teaching a client who is on bed rest about preventing complications. Which of the following client statements indicates an understanding of the teaching? A. I should perform ROM exercises once per day B. I should cough and deep breath every hour C. I should change my position every 4hr D. I should perform foot and ankle pumps every 3hr

B. I should cough and deep breath every hour RATIONALE: A- 3-4 x's/day C- every 1-2hr D- every 1-2hr

A nurse is caring for a client immediately following application of a plaster cast. The nurse should monitor and report which of the following findings as an indication of compartment syndrome? A. Sensation of heat on the surface of the cast B. Paresthesias of the extremity C. Pruritus of the extremity D. Musty odor noted from cast materials

B. Paresthesias of the extremity RATIONALE: other findings include numbness, tingling, weakness, and pain that does not respond to meds A- expected C- expected D- expected for 24-72hr until drying is complete

A nurse is caring for a client who has a pelvic fracture. The client reports sudden SOB, stabbing chest pain, and feelings of doom. The client is experiencing which of the following complications? A. Pneumonia B. Pulmonary embolus C. Tension pneumothorax D. Tuberculosis

B. Pulmonary embolus RATIONALE: The client may also exhibit tachycardia and chest petechiae with decreased SaO2; notify rapid response team immediately

A nurse is caring for a client who is 3 days postoperative following a below-the-knee amputation. Which of the following actions should the nurse take? A. Place the client on a soft mattress B. Rewrap the residual limb with a bandage 3 times per day C. Assist the client into a prone position for 20min every 8hr daily D. Turn the client every 4hr while in bed

B. Rewrap the residual limb with a bandage 3 times per day RATIONALE: This keeps the bandage taught, which ensure the residual limb will shrink; rewrapping the bandage also allows the nurse to check the skin for redness/breakdown A- FIRM mattress to prevent contractures C- Prone position for 20-30min every 3-4hr daily to help prevent hip contractures D- Every 2 hr

A nurse is caring for a client who is 3 days postoperative following a right total hip arthroplasty. While transferring the client to a chair, the client cries out in pain. The nurse should assess the client for which of the following manifestations fo dislocation of the hip prosthesis? A. Bulging in the area over the surgical incision B. Shortening of the right leg C. Sensation of warmth over the surgical incision D. Pallor following elevation of the right leg

B. Shortening of the right leg RATIONALE: other findings include increased hip pain, inability to move the extremity, and rotation of the hip internally or externally

A nurse is providing teaching about disease management to a client who has RA. Which of the following responses by the client indicates an understanding of the teaching? A. "I will take a hot bath every morning to decrease my stiffness" B. "When my arthritis acts up, I will rest all day and avoid exercising" C. "I will have handrails installed in my bathroom and halls" D. "I will avoid taking naps so I sleep better at night"

C. "I will have handrails installed in my bathroom and halls" RATIONALE: A- should be hot showers (safety risk with tubs) B- Immobility will further hinder joint movement D- balance rest and activity with 1-2 naps during the day

A nurse is preparing a client who is postoperative following a total hip arthroplasty for discharge. Which of the following statements indicates that the client understands the instructions? A. "I'll use alcohol pads to clean my incision each day" B. "When I'm doing my exercises, I'll include bent-leg raises" C. "I'll use a reacher to help me pick up anything from the floor" D. "When I can walk without my walker, I can stop attending PT"

C. "I'll use a reacher to help me pick up anything from the floor" RATIONALE: This is to prevent dislocation; the client must avoid flexing at 90 degrees at the waist A- use soap and water B- perform STRAIGHT leg raises, ankle pumps, and other exercises per PT

A nurse is caring for a client who is postoperative following a total knee arthroplasty and has been prescribed a continuous passive motion (CPM) machine and PCA. The client tells the nurse "I am in so much pain". Which of the following actions should the nurse take first? A. Remind the client to push the button for the PCA device B. Discuss activities the client may use to distract them from the pain C. Ask the client to describe the characteristics of the pain D. Pause the CPM machine briefly to apply a cold pack to the client's knee

C. Ask the client to describe the characteristics of the pain RATIONALE: Assessment first to create a plan of action

A nurse is reviewing the medical record of a client who has a prescription for probenecid to treat gout. The nurse should identify that which of the following medications can interact with probenecid? A. Colchicine B. Naproxen C. Aspirin D. Prednisone

C. Aspirin RATIONALE: Aspirin can decrease the effectiveness of probenecid

A nurse is performing medication reconciliation for a newly admitted client who has RA. Which of the following medications should the nurse identify as the treatment for this condition? A. Misoprostol B. Dantrolene C. Celecoxib D. Colchicine

C. Celecoxib RATIONALE: COX-2 inhibitor NSAID A- cytoprotectant B- muscle relaxant D- for acute gout

A nurse in the ED is caring for a client who reports pain in her left leg following a MVA. The client's left leg has bruising, swelling, and displacement of the bones. Which of the following actions should the nurse take first? A. Obtain an x-ray of the injured leg B. Apply ice packs to the affected area C. Check neurovascular status distal to the injury D. Elevate the affected leg on 2 pillows

C. Check neurovascular status distal to the injury

A nurse is assessing a client who has a fractured left femur and is in skeletal traction. Which of the following findings should the nurse report to the provider? A. Ecchymosis of the thigh B. Serous drainage at the pin site C. Chest petechiae D. Muscle spasms in the left leg

C. Chest petechiae RATIONALE: Indication of fat embolism syndrome A-expected B- expected D- expected

A nurse is assessing a female client who reports severe joint pain. The nurse should identify that which of the following factors places the client at risk for GOUT? A. Perimenopause B. Migraine HA's C. Diuretic use D. Irritable bowel syndrome

C. Diuretic use RATIONALE: A- POST menopausal B- RF for fibromyalgia D- RF for fibromyalgia

A nurse is caring for a client who is postoperative following shoulder surgery. The client has a prescription to keep the affected arm adducted. Which of the following instructions should the nurse share with the client? A. Keep your arm bent at the elbow B. Use a pillow to prop your shoulder up close to your ear C. Hold your arm against the side of your body D. Position your arm with the shoulder at a 90 degree angle

C. Hold your arm against the side of your body

A home health nurse is performing an assessment on a client who is 1 week postoperative following a total knee replacement. Which of the following statements by the client indicates an understanding of the teaching? A. I will discontinue the blood thinner my doctor prescribed once I am at home B. I will keep a pillow under my knee when I am in bed C. I plan to use a walker to help me get around D. I will discontinue using the CPM machine when I get home

C. I plan to use a walker to help me get around RATIONALE: The client will receive a prescription for a walker, cane or crutches to promote ambulation following sx A- NO B- NO- can promote contracture D- will be continued at home

A nurse is providing preoperative teaching for a client who is scheduled for a total knee arthroplasty. Which of the following statements by the client indicates an understanding of the teaching? A. I will wear a continuous movement machine on my knee for 24hr/day B. I should avoid taking NSAID medications for pain after surgery C. I should wear elastic stockings on both of my legs D. I will begin exercising my legs the day after surgery

C. I should wear elastic stockings on both of my legs RATIONALE: to prevent VTE A- only prescribed as needed, and only for a few hours at a time B- NSAIDs are used D- immediately after surgery

A nurse is preparing a client for discharge who is postoperative following a conventional lumbar disk excision. Which of the following statements indicates that the client understands the nurse's instructions? A. I should have no problem climbing stairs when I get home B. I'll wait about 3 weeks before I return to my usual activities C. I'll use my heating pad if I feel any muscle spasms in my back D. I can go back to driving in about 2 weeks

C. I'll use my heating pad if I feel any muscle spasms in my back RATIONALE: A- limit; but should start walking right away B- up to 6 weeks D- wait 6 weeks

A nurse is caring for a client who is postoperative following a lumbar disk excision. Which of the following interventions should the nurse include in the client's plan of care? A. Keep the client's legs flat with the knees extended B. Encourage the client to sit up in a chair for as long as possible C. Logroll the client in bed for care procedures D. Expect urinary retention for the first postoperative day

C. Logroll the client in bed for care procedures RATIONALE: A- knees with slight flexion to help relax back muscles B- AVOID sitting in the immediate post op period D- report immediately

A nurse is caring for a client who has a depressed skull fracture of the bone that makes up the larger part of the upper and side wall of the cranium. This fracture is located on which of the following bones? A. Sphenoid B. Occipital C. Parietal D. Frontal

C. Parietal

A nurse is planning care for a client following a total hip arthroplasty. Which of the following interventions should the nurse include in the plan? A. Position the client with her legs adducted B. Internally rotate the client's affected hip C. Place a pillow between the client's legs D. Instruct the client to avoid flexing her hip >95 degrees

C. Place a pillow between the client's legs RATIONALE: this reduces the risk of hip dislocation A- ABducted B- AVOID to reduce risk of dislocation D- avoid flexing more than 90 degrees

A nurse is assessing a client's skeletal system. The nurse should be in which of the following positions to screen the client for scoliosis? A. Standing beside the client, who is lying on the examination table B. Facing the client, who is sitting in a chair C. Standing behind the client, who is bent over at the waist D. Standing at the clients side, while the client leans back

C. Standing behind the client, who is bent over at the waist

A nurse is preparing a community education program about reducing the risk of osteoporosis. Which of the following pieces of information should the nurse include? A. Avoid sun exposure B. Take a calcium supplement once each day if at risk for osteoporosis C. Walking is the preferred mode of exercise to maintain strong bones D. Caffeine intake minimizes the risk of developing osteoporosis

C. Walking is the preferred mode of exercise to maintain strong bones RATIONALE: B- 1000 to 1500mg (1-1.5g) in DIVIDED daily doses is recommended

A nurse is caring for a client who is scheduled to undergo surgery to repair an open hip fracture. In which of the following positions should the nurse plan to place the client postoperatively? A. With the leg on the affected side adducted B. With the hip externally rotated on the affected side C. With the leg on the affected side abducted D. With the hip flexed to 90 degrees on the affected side

C. With the leg on the affected side abducted RATIONALE: The nurse should AVOID adduction, external rotation and flexion because it can cause the leg to dislocate

What needs to be initiated post op knee arthroplasty?

Continuous passive motion (CPM) immediately if ordered

A nurse is teaching a client who has a new prescription for alendronate for the treatment of Osteoporosis. Which of the following statements by the client indicates an understanding of the teaching? A. I will take the medication in the evening B. I will drink a full glass of milk with the medication C. I will take the medication at mealtime D. "I will sit upright after taking the medication"

D. "I will sit upright after taking the medication"

A nurse is discussing the plan of care with a client who has osteomyelitis of an open wound on his heel. Which of the following information should the nurse include? A. "You will need to apply a cold pack to the site 3 times a day" B. "Your provider might ask you to walk frequently to increase circulation to the area" C. "You will need to limit your consumption of high protein foods" D. "Your provider might prescribe a central catheter line for long-term antibiotic therapy"

D. "Your provider might prescribe a central catheter line for long-term antibiotic therapy" RATIONALE: Osteomyelitis is an acute or chronic bone infection; the client will require several weeks to months of IV antibiotic therapy for treatment

A nurse in the emergency department is preparing to discharge a client following a grade II (moderate) ankle sprain. Which of the following instructions should the nurse plan to give to the client? A. Perform passive ROM exercises of the ankle hourly B. Keep the affected extremity in a dependent position C. Wrap a loose dressing around the affected ankle D. Apply cold compresses to the extremity intermittently

D. Apply cold compresses to the extremity intermittently RATIONALE: For no more than 20min at a time

A nurse is teaching a client with arthritis who is experiencing joint pain that impairs mobility. Which of the following instructions should the nurse include? A. Engage your joints in resistance exercises B. Avoid using assistive devices when walking C. Perform passive exercises D. Apply heat to your joints prior to exercising

D. Apply heat to your joints prior to exercising RATIONALE: A- avoid B- USE them C- ACTIVE ROM exercises

A nurse is caring for a client who has a fractured right hip. Which of the following types of traction should the nurse expect the client to have prior to hip arthroplasty surgery? A. Balanced skeletal traction B. Pelvic belt C. Pelvic sling D. Buck's traction

D. Buck's traction RATIONALE: Buck's traction is used prior to hip arthroplasty to maintain alignment and prevent muscle spasms prior to surgery A. to stabilize fractures of the femur or pelvis, not the hip B. to treat back pain C- to stabilize PELVIC fractures

A nurse is preparing an in-service presentation about the basics of bone injuries. Which of the following types of fractures is especially common in children? A. Impacted B. Depressed C. Compound D. Greenstick

D. Greenstick RATIONALE: Greenstick= incomplete break in the bone; one side usually splinters, while the other side is bent but intact. This type is common in children because their bones are more flexible A- the force of the injury drives one fragment of bone into another B- common with skull & facial fx's C- sharp edge of the bone breaks through the skin

A nurse is reviewing the medical record of a female client. Which of the following findings should the nurse identify as a risk factor for osteoporosis? A. Decreased intake of phosphate containing foods B. Spending several hours in the sun daily C. Increased estrogen levels D. History of anorexia nervosa

D. History of anorexia nervosa RATIONALE: A- opposite is true (high phosphate= low calcium)

A nurse is assessing a client who has several risk factors for osteoporosis. Which of the following findings indicates that the client requires further evaluation for this disorder? A. Leg cramps with exercise B. Stress incontinence C. Abdominal distention D. Lower back pain

D. Lower back pain

A nurse is discussing the difference between RA and osteoarthritis with a newly licensed nurse. Which of the following pieces of information should the nurse include about osteoarthritis? A. Osteoarthritis is caused by autoimmune processes B. Osteoarthritis leads to a decreased ESR C. Osteoarthritis affected other organ systems D. Osteoarthritis can impair a joint on a single side of the body

D. Osteoarthritis can impair a joint on a single side of the body RATIONALE: VS RA, which is symmetrical B- increased

A nurse is teaching a client who has osteoporosis. Which of the following instructions should the nurse include in the teaching? A. Reduce dietary protein intake B. Apply ice to painful areas C. Increase calcium intake to 900mg/day D. Perform weight bearing exercises

D. Perform weight bearing exercises RATIONALE: A- increase B- heat C- 1200-1500mg

A nurse is caring for a client following a hip arthroplasty. The nurse places an abduction pillow on the client for which of the following purposes? A. To raise the bed linens off the client's feet to prevent plantar flexion B. To keep the client's heels off the bed to prevent pressure ulcers C. To position the client off the operative site while in bed D. To prevent dislocation of the the hip during position changes or movement

D. To prevent dislocation of the the hip during position changes or movement

How should a patient post op knee arthroplasty NEVER be placed?

Do not place a pillow under the knee or use a knee gatch! This can cause flexion contractures -Do not kneel or do deep-knee bends

What are the s/s of fat embolism?

Fat globule from bone marrow travels to lungs -Dyspnea -Confusion -Tachypnea -Tachycardia -Petechiae on upper body -Decreased SpO2

What does Paget's disease increase the risk of?

Fractures -Metabolic disorder that causes the bones to be soft, disorganized and weak

What puts a patient at an increased risk of fat embolism?

Fractures! (long bone & hip fractures most common)

What is primary gout due to?

Genetic defect in purine metabolism, causing overproduction of uric acid

What nodes are involved in OA?

Heberden's- distal interphalangeal joints Bouchard's- proximal interphalangeal joints

What is secondary gout due to?

Hyperuricemia caused by another disease; CKD or a medication (thiazide diuretics, beta blockers)

What is compartment syndrome?

Increased pressure within the muscle compartment of an extremity that impairs circulation

What are open/compound fractures at an increased risk for?

Infection (breaks skin surface)

What is the patient teaching prior to dental work or an invasive procedure if they have had an Arthroplasty?

Need antibiotics

What is the main difference between OA and RA?

OA- degenerative "wear and tear" RA- Inflammatory AUTOIMMUNE

What is the difference in pain characteristics of OA vs RA?

OA- pain with activity, better with rest RA- Pain after rest/immobility, better with activity (morning pain)

What is the difference in the areas affected with OA vs RA?

OA- unilateral RA- BILATERAL & SYMMETRICAL joint pain/swelling

What is the difference between osteoblasts and osteoclasts?

Osteoblasts BUILD bone Osteoclasts destroy bone