Musculoskeletal

A client is complaining of pain underneath a cast in the area of a bony prominence. Which would the nurse anticipate?

A window will be cut in the cast.

Dantrolene sodium is prescribed for a client experiencing flexor spasms, and the client asks the nurse about the action of the medication. The nurse responds knowing that which is the therapeutic action of this medication?

Acts directly on the skeletal muscle to relieve spasticity

The nurse is caring for a client with diabetes mellitus who is scheduled to have a right below-knee amputation. The nurse assesses which factors that can put this client at risk for amputation?

Bony deformity, limited joint mobility, Peripheral neuropathy, peripheral vascular disease and history of skin ulcers or previous amputation

The nurse is administering an intravenous dose of methocarbamol to a client with multiple sclerosis. For which adverse effect would the nurse monitor?

Bradycardia Rationale:Intravenous administration of methocarbamol can cause hypotension and bradycardia.

The nurse is caring for a client with a fresh application of a plaster leg cast. The nurse would plan to prevent the development of compartment syndrome by which action?

Elevating the limb and applying ice to the affected leg

Which data would indicate a potential complication associated with age-related changes in the musculoskeletal system?

Overall sclerotic lesions Rationale:Sclerotic lesions occur as bone resorption increases and results in replacement of original bone with fibrous material. This condition occurs in Paget's disease, an age-related disorder.

Alendronate is prescribed for a client with osteoporosis, and the nurse is providing instructions for the administration of the medication. Which instruction would the nurse reinforce?

Take the medication with a full glass of water after rising in the morning. The medication needs to be taken with a full glass of water after rising in the morning. The client should not eat or drink anything for 30 minutes following administration and should not lie down after taking the medication.

A client with acute muscle spasms has been taking baclofen. The client calls the clinic nurse because of continuous feelings of weakness and fatigue and asks the nurse about discontinuing the medication. The nurse would make which appropriate response to the client?

"Weakness and fatigue commonly occur and will diminish with continued medication use."

The nurse is preparing a list of cast care instructions for a client who just had a plaster cast applied to his right forearm. Which instructions would the nurse include on the list?

Keep the cast and extremity elevated, the cast needs to be kept clean and dry, and allow the wet cast 24 t o 72 hours to dry

A client has had skeletal traction applied to the right leg and has an overhead trapeze available for use. The nurse would monitor which area as a high-risk area for pressure and breakdown?

Left heel Rationale:Common areas that are under pressure and are at risk for breakdown include the elbows (if they are used for repositioning instead of a trapeze) and the heel of the good leg (which is used as a brace when pushing up in bed). Other pressure points caused by the traction include the ischial tuberosity, popliteal space, and Achilles tendon.

The nurse is reviewing the laboratory studies on a client receiving dantrolene sodium. Which laboratory test(s) would identify an adverse effect associated with the administration of this medication?

Liver function tests Rationale:Dose-related liver damage is the most serious adverse effect of dantrolene. To reduce the risk of liver damage, liver function tests should be performed before treatment and periodically throughout the treatment course. It is administered in the lowest effective dosage for the shortest time necessary.

A client receives a prescription for methocarbamol, and the nurse reinforces instructions to the client regarding the medication. Which client statement would indicate a need for further teaching?

"If my vision becomes blurred, I don't need to be concerned about it." Rationale:There is a need for further teaching when the client says, "If my vision becomes blurred, I don't need to be concerned." The client needs to be told that the urine may turn brown, black, or green. Other adverse effects include blurred vision, nasal congestion, urticaria, and rash. The client needs to be instructed that if these adverse effects occur, the primary health care provider needs to be notified. The medication is used to relieve muscle spasms.

The nurse is reviewing the record of a client who has been prescribed baclofen. Which disorder would alert the nurse to contact the primary health care provider (PHCP)?

A seizure disorder Rationale:Clients with seizure disorders may have a lowered seizure threshold when baclofen is administered. Concurrent therapy may require an increase in the anticonvulsive medication.

A client is treated in the primary health care provider's office for a sprained ankle. Before sending the client home, the nurse plans to reinforce instructions to the client about which item to avoid in the next 24 hours?

Applying a heating pad Rationale:Heat is not used in the first 24 hours after a sprained ankle because it could increase venous congestion, which would increase edema and pain. Soft tissue injuries such as sprains are treated by RICE (rest, ice, compression, elevation) for the first 24 hours after the injury. Ice is applied intermittently for 20 to 30 minutes at a time.

The nurse is caring for a client who has had skeletal traction applied to the left leg. The client is complaining of severe left leg pain. Which action would the nurse take first?

Check the client's alignment in bed. Rationale:A client who complains of severe pain may need realignment or may have had traction weights prescribed that are too heavy. The nurse realigns the client and, if ineffective, calls the PHCP. Severe leg pain, once traction has been established, indicates a problem. Medicating the client should be done after trying to determine and treat the cause. Providing pin care is unrelated to the problem as described.

The nurse is monitoring a client receiving baclofen for side effects related to the medication. Which would indicate that the client is experiencing a side effect?

Drowsiness

The nurse is assigned to care for a client with multiple traumas who is admitted to the hospital. The client has a leg fracture, and a plaster cast has been applied. In positioning the casted leg, the nurse would perform which intervention?

Elevate the leg on pillows continuously for 24 to 48 hours. Rationale:A casted extremity is elevated continuously for the first 24 to 48 hours to minimize swelling and to promote venous drainage.

The nurse is checking the casted extremity of a client. The nurse would check for which sign indicative of infection?

Presence of a "hot spot" on the cast

A client has been placed in Buck's extension traction. Which technique provided by the nurse will provide countertraction?

Slightly elevating the foot of the bed

During the monitoring of a client's response to disease-modifying antirheumatic drugs (DMARDs), which findings would the nurse interpret as acceptable responses?

Symptom control during periods of emotional stress, Normal white blood cell, platelet, and neutrophil counts, Radiological findings that show nonprogression of joint degeneration, An increased range of motion in the affected joints 3 months into therapy

A client with a hip fracture asks the nurse why Buck's extension traction is being applied before surgery. The nurse's response is based on the understanding that Buck's extension traction has which primary function?

Provides comfort by reducing muscle spasms and provides fracture immobilization Rationale:Buck's extension traction is a type of skin traction often applied after hip fracture, before the fracture is reduced in surgery. It reduces muscle spasms and helps immobilize the fracture. It does not lengthen the leg for the purpose of preventing blood vessel severance. It also does not allow for bony healing to begin.

The client has been taking medication for rheumatoid arthritis for 3 weeks. During the administration of etanercept, it is most important for the nurse to collect which data?

The white blood cell and platelet counts Rationale:Infection and suppression can occur as a result of etanercept.

Cyclobenzaprine is prescribed for a client to treat muscle spasms, and the nurse is reviewing the client's record. Which disorder would indicate a need to contact the primary health care provider (PHCP) regarding the administration of this medication?

glaucoma Rationale:Because this medication has anticholinergic effects, it should be used with caution in clients with a history of urinary retention, angle-closure glaucoma, and increased intraocular pressure. Cyclobenzaprine hydrochloride should be used only for short-term 2- to 3-week therapy.

The nurse has provided instructions to a client with a herniated lumbar disk about proper body mechanics and other items pertinent to low back care. The nurse determines that the client needs further teaching if the client verbalizes which action should be done?

Get out of bed by sitting straight up and swinging the legs over the side of the bed. Rationale:The client needs further teaching if the client says sitting straight up and swinging the legs over the side is the way to get out of bed. Clients are taught to get out of bed by sliding near the edge of the mattress. The client then rolls onto one side and pushes up from the bed, using one or both arms. The back is kept straight, and the legs are swung over the side.

The nurse is evaluating the client's use of a cane for left-sided weakness. The nurse would intervene and correct the client if the nurse observed that the client performed which action?

Moves the cane when the right leg is moved Rationale:The cane is held on the stronger side to minimize stress on the affected extremity and provide a wide base of support. The cane is held 6 inches lateral to the fifth great toe. The cane is moved forward with the affected leg. The client leans on the cane for added support while the stronger side swings throug

The nurse has provided instructions regarding specific leg exercises for the client immobilized in right skeletal lower leg traction. The nurse determines that the client needs further teaching if the nurse observes the client doing which activity?

Performing active range of motion (ROM) to the right ankle and knee Rationale: Performing active ROM to the affected leg can be harmful.

The nurse is caring for a client with osteoarthritis. The nurse collects data, knowing that which is a sign/symptom associated with this disorder?

Dull aching pain in the affected joints Rationale:The sign/symptom associated with osteoarthritis is dull, aching pain that occurs in the affected joints. Unlike rheumatoid arthritis, systemic manifestations are absent and joint involvement is not symmetrical. The stiffness and joint pain that occur in osteoarthritis diminish after rest and intensify after activity, and they may be aggravated by cold, damp weather. No specific laboratory findings are useful in diagnosing osteoarthritis. Morning stiffness, an elevated sedimentation rate, and a positive rheumatoid factor occur in rheumatoid arthritis.

The nurse is planning to reinforce instructions to the client about how to stand on crutches. In the instructions, the nurse would plan to tell the client to place the crutches in which position?

8 inches to the front and side of the client's toes Rationale:The classic tripod position is taught to the client before giving instructions on gait. The crutches are placed anywhere from 6 to 10 inches in front and to the side of the client, depending on the client's body size. This provides a wide enough base of support to the client and improves balance.