MusculoSkeletal Chapter 40/Pediatrics

Considerations when caring for a client with a total hip replacement should include which of the following? Select all that apply. 1. Maintain the affected hip in the adduction position when moving client out of bed. 2. Pain control should include regularly scheduled analgesics and may necessitate use of as needed medications as well. 3. The client should sit in a chair at the correct height to encourage flexion of the joint. 4. Frequent neurovascular assessment should be done distal to the surgical site and compared with the unaffected side. 5. When turning, client should be log rolled to prevent leg from falling forward or backward.

Correct 2. Pain control should include regularly scheduled analgesics and may necessitate use of as needed medications as well. 4. Frequent neurovascular assessment should be done distal to the surgical site and compared with the unaffected side. 5. When turning, client should be log rolled to prevent leg from falling forward or backward.

A nurse is assessing an infant with talipes equinovarus (clubfoot) who has had a corrective boot cast applied. Which peripheral vascular assessment cannot be performed while the cast is in place? 1. Pulse 2. Color 3. Warmth 4. Blanching

Correct 1. Pulse The pedal pulse cannot be palpated under a boot cast. Assessments of the color, warmth, and blanching of the toes are all appropriate neurovascular checks.

The nurse is preparing an individualized teaching plan for a client with osteoarthritis. The nurse recognizes which abnormality as specific to osteoarthritis? 1. Ulnar drift 2. Heberden nodes 3. Swan neck deformity 4. Boutonnière deformity

Correct 2. Heberden nodes Heberden nodules are the bony or cartilaginous enlargements of the distal interphalangeal joints that are associated with osteoarthritis. Ulnar drift, Swan neck deformity, and Boutonnière deformity occur with rheumatoid arthritis.

A 3-year-old is placed in a bilateral hip spica cast for the treatment of developmental dysplasia of the hip. The nurse should teach the parents to monitor their child and report to the practitioner the occurrence of: 1. Warm toes 2. Leg numbness 3. Skin desquamation 4. Generalized discomfort

Correct 2. Leg numbness Numbness is a neurological symptom that should be reported immediately because it indicates pressure on the nerves and blood vessels. Warm toes indicate intact circulation to the lower extremities. Peeling skin is the result of inadequate skin care but can be managed easily with lotion or oil. Some degree of discomfort is expected after cast application.

An 11-year-old child with juvenile idiopathic arthritis will be receiving continued nonsteroidal antiinflammatory drug (NSAID) therapy at home. Which important toxic effect of NSAIDs must be included in the nurse's discharge instructions to the child and family? 1. Diarrhea 2. Hypothermia 3. Blood in the urine 4. Increased irritability

Correct 3. Blood in the urine Hematuria may result from the use of NSAIDs because they may cause nephrotoxicity. Diarrhea can occur but is not a sign of toxicity. Hypothermia does not occur with NSAIDs. Drowsiness, not hyperactivity, may occur.

A nurse is counseling a client who is at risk for developing osteoporosis. Which foods should the nurse recommend? Select all that apply. 1. Canned tuna 2. Scrambled eggs 3. Chicken breasts 4. Broiled beef steak 5. Baked sweet potato

Correct 3. Chicken breasts 4. Broiled beef steak One serving of white meat chicken or one serving of beef contains more than 200 mg of calcium. A serving of canned tuna, two eggs, and sweet potatoes contain less than 200 mg of calcium.

A nurse teaches a client about osteoporosis. Which client statement supports the nurse's conclusion that the teaching is effective? 1. "I know that certain illnesses can affect my body's calcium level." 2. "I think I can eat all the calcium I need rather than taking medication." 3. "I will begin to actively monitor my risk for this disease after menopause." 4. "I'm glad that drinking a little wine every day is advised to maintain calcium levels."

Correct 1. "I know that certain illnesses can affect my body's calcium level." Medical conditions such as hyperthyroidism, hypothyroidism, malabsorption syndromes, chronic renal failure, acute pancreatitis, and other metabolic conditions aggravate bone loss and can lead to development of osteoporosis. Although it is advisable to eat calcium-rich foods, calcium supplements also are recommended to ensure that women consume the appropriate recommended amount. Women need to monitor their risk for osteoporosis and increase their calcium intake before menopause because bone loss can occur at earlier ages. Women with osteoporosis need to make lifestyle modifications, such as avoidance of alcohol, cigarettes, and caffeine-containing substances.

A client with arthritis is taking ibuprofen (Motrin), a nonsteroidal antiinflammatory drug, and large doses of aspirin (ASA). The nurse teaches the client about the clinical manifestations of aspirin toxicity, including: 1. Feelings of drowsiness 2. Disturbances in hearing 3. Intermittent constipation 4. Metallic taste in the mouth

Correct 2. Disturbances in hearing Ringing in the ears occurs because of its effect on the eighth cranial nerve and is a classic symptom of aspirin toxicity. Feelings of drowsiness are not side effects of aspirin; ASA promotes comfort, which may permit rest. Aspirin may cause diarrhea, nausea, and vomiting. A metallic taste in the mouth is not a side effect of salicylates such as aspirin.

A client has a bone marrow aspiration performed. After the procedure, what is the first nursing action? 1. Position the client on the affected side. 2. Cleanse the site with an antiseptic solution. 3. Briefly apply pressure over the aspiration site. 4. Begin frequent monitoring of the client's vital signs.

Correct 3. Briefly apply pressure over the aspiration site. Brief pressure generally is enough to prevent bleeding. No special positioning is required. The site is cleansed before aspiration. Frequent monitoring is unnecessary

The nurse is caring for a client who had surgery for a total hip replacement. Which client position should be avoided? 1. Supine 2. Lateral 3. Orthopneic 4. Semi-Fowler

Correct 3. Orthopneic Orthopneic position involves hip flexion greater than 90 degrees. This puts stress on the operative site and may dislodge the prosthesis. Supine, lateral, and semi-Fowler positions are acceptable because little stress is placed on the operative site.

A nurse provides discharge instructions to a client who had surgery for a left total hip replacement. Which should the nurse include when teaching the client about how to protect the affected hip when in the sitting position? 1. While sitting in a soft chair, the left leg should be elevated in a straight-out position 2. Sit in a firm armchair with the left leg elevated on a high stool. 3. When sitting in a firm armchair, the left foot should be flat on the floor's surface. 4. Sit in a soft chair with pillows tucked under the left hip.

Correct 3. When sitting in a firm armchair, the left foot should be flat on the floor's surface. Using a firm high chair with the left foot flat on the floor puts the least strain on the prosthesis. A soft chair permits hip flexion greater than 90 degrees, which is contraindicated. Elevation of the leg places increased strain on the prosthesis and is contraindicated. A soft chair, even with pillows, cannot ensure the prevention of hip flexion greater than 90 degrees, which is contraindicated.

A client has a total hip replacement for long-standing degenerative bone disease of the hip. When assessing this client postoperatively, the nurse considers that the most common complication of hip surgery is: 1. Pneumonia 2. Hemorrhage 3. Wound infection 4. Pulmonary embolism

Correct 4. Pulmonary embolism A pulmonary embolism is the most common complication of hip surgery because of high vascularity and the release of fat cells from the bone marrow. The occurrence of pneumonia is rare because of early activity after surgery. In addition, the operative area is not in proximity to the diaphragm and lungs; therefore, it does not impede deep breathing. Postoperative hemorrhage with hip surgery is rare because bleeding at the operative site is not covert. The incidence of wound infection is no greater than with other postoperative clients.

On the first postoperative day after a total hip replacement a client asks for assistance onto the bedpan. What should the nurse instruct the client to do? 1. Use the elbows and hands to lift the pelvis off the bed. 2. Extend both legs and pull on the trapeze to lift the pelvis. 3. Turn gently toward the operative side while lifting the pelvis off the bed. 4. Flex the knee on the unoperated leg and pull on the trapeze to lift the pelvis.

Correct 4 Flex the knee on the unoperated leg and pull on the trapeze to lift the pelvis. The pelvis is elevated by actions involving the unaffected upper extremities and unoperated leg. It is impossible to lift the pelvis with the elbows and hands. The involved leg should not be used because it may dislodge the prosthesis. The client should not turn on the operative side immediately after surgery.

A teenage boy with a diagnosis of osteosarcoma is to have the affected leg amputated. What should the nurse do to promote psychological adjustment and early function immediately after surgery? 1. Allow him to change the first dressing. 2. Help him adjust to the temporary prosthesis. 3. Assign him to a room with another adolescent. 4. Have him meet with a member of a cancer survivor organization.

Correct 2. Help him adjust to the temporary prosthesis. A temporary prosthesis attached to a cast with a metal extension can be applied immediately after surgery. This will allow the adolescent to walk within several hours and helps start the adjustment process. The first dressing change is usually done by a member of the surgical team; also, this is too early to expect the adolescent to be ready to look at the surgical site. Assigning the adolescent to a particular room is usually done out of necessity rather than to promote psychological adjustment. It is too early to have another cancer survivor visit, but this may be done later in the recovery process.

A nurse is completing the discharge protocol for a 14-year-old adolescent with osteomyelitis. The nurse teaches the parents how and when to administer the intravenous antibiotic at home. The schedule for administration is four times a day. At what times should the parents administer the antibiotic? 1. 8 am, 12 pm, 4 pm, 8 pm 2. 8 am, 4 pm, 12 am, 4 am 3. 10 am, 2 pm, 10 pm, 2 am 4. 6 am, 12 pm, 6 pm, 12 am

Correct 4. 6 am, 12 pm, 6 pm, 12 am Intravenous antibiotics should be administered with doses equally spaced over 24 hours so a constant blood level of the drug is maintained. The 12 hours between the 8 pm and 8 am doses in the 8 am, 12 pm, 4 pm, and 8 pm dosing schedule is too long; the blood level of the antibiotic will drop and the therapy will not be as effective. Administering doses at 8 am, 4 pm, 12 am, and 4 am or at 10 am, 2 pm, 10 pm, and 2 am will not work because the doses are not equally spaced over 24 hours and the blood level of the antibiotic will not remain constant.

A nurse provides discharge teaching for a client who had a total hip replacement. Which statements made by the client indicate an understanding of the education? Select all that apply. 1. I should not climb any stairs. 2. I should not cross my legs. 3. I should avoid stretching exercises. 4. I should not sit in a low chair. 5. I should avoid lying prone for longer than 30 minutes.

Correct 2. I should not cross my legs. 4. I should not sit in a low chair. Crossing the legs past the midline of the body puts stress on the operative site, which increases the risk for dislocation of the prosthesis. Excessive flexion of the hip can cause dislocation of the prosthesis. Climbing stairs does not cause undue stress on the operative site. Stretching exercises are encouraged as long as no extremes of position are used. Lying prone for 30 minutes is encouraged because it prevents hip flexion contractures.

A client is scheduled for a closed magnetic resonance imaging test (MRI). The client states, "I'm a little scared of small places." What is the nurse's most appropriate response? 1. "Mild sedation is available if you are anxious about lying in a confined area." 2. "Maybe it is best that you not have this test. Let me talk with your health care provider." 3. "We will make sure that all metal objects are removed from the immediate area to avoid injury." 4. "You will be able to communicate with us by an intercom system, so you have nothing to worry about."

Correct 1. "Mild sedation is available if you are anxious about lying in a confined area." The response "Mild sedation is available if you are anxious about lying in a confined area" acknowledges the client's concern and offers a potential intervention that may reduce the client's anxiety. The response "Maybe it is best that you not have this test. Let me talk with your health care provider." is an inappropriate response because the test may be significant for diagnosing the client's health problem. If necessary, an open MRI may be performed; however, a closed, high-magnet scanner may produce more significant results than will be produced by an open, low-magnet scanner. Although the response "We will make sure that all metal objects are removed from the immediate area to avoid injury" is a true statement, this response may increase the client's anxiety. The response "You will be able to communicate with us by an intercom system, so you have nothing to worry about" dismisses the client's concerns and provides false reassurance.

An adolescent is admitted to the unit with a tentative diagnosis of a bone tumor of the left femur. During the admission procedure the adolescent casually asks, "Do they ever have to cut off a leg if someone has bone cancer?" How should the nurse respond? 1. "Sometimes it's necessary. What do you think about that treatment?" 2. "Most times the leg can be saved, but sometimes it may be necessary." 3. "I don't understand why you're asking. Do you think that this will happen to you?" 4. "The decision can't be made now, because the kind of bone cancer must be determined first."

Correct 1. "Sometimes it's necessary. What do you think about that treatment?" Acknowledging that amputation may be necessary and asking an open-ended question encourages further discussion of feelings. Telling the adolescent that most of the time the leg can be saved is evasive, provides false reassurance, and does not address the adolescent's feelings. This response is demeaning. A direct response not only does not address the adolescents feelings but also attacks the basis of these feelings. Telling the adolescent that the tumor is cancerous before a diagnosis has been made constitutes misinformation, which is unsafe nursing practice.

As a means of slowing the progression of the curvature, the preadolescent with scoliosis is fitted with a brace. How should the nurse respond to the parents' questions about when the brace will no longer be needed? 1. After cessation of bone growth 2. After the curvature has straightened 3. When the iliac crests are on the same level 4. When the adolescent is free of pain after prolonged standing

Correct 1. After cessation of bone growth Continuing growth causes changes in muscle, bone structure, and position. The brace is worn for 6 months after physical maturity, which is confirmed by radiographic examination showing cessation of bone growth. The brace is used to halt the progression of the curvature, not correct it. When the iliac crests are at the same level is not an appropriate criterion for removal of the brace. Pain is not usually a symptom of scoliosis.

A nurse is reviewing a postmenopausal client's history, which reveals that the client previously received hormonal replacement therapy (HRT) as treatment for osteoporosis. For which problem does HRT increase the client's risk? 1. Breast cancer 2. Rapid weight loss 3. Accelerated bone loss 4. Vaginal tissue atrophy

Correct 1. Breast cancer There is a relationship between HRT that combines estrogen and progesterone compounds and an increased incidence of invasive breast cancer. One side effect of HRT is weight gain with ankle and foot edema. Bone loss is retarded with HRT. Vaginal tissue maintains turgor and lubrication with HRT.

How should a nurse turn a 10-year-old child in a spica cast? 1. By log-rolling the body as one unit 2. By using the crossbar between the legs 3. By asking the child to sit up when changing position 4. By teaching the child how to assist by using the overhead trapeze

Correct 1. By log-rolling the body as one unit The child should be rolled as one unit, with the shoulders and hips turned at the same time to prevent injury. The crossbar is not used to facilitate turns because it may be dislodged, weakening the cast. The child will not be able to sit up because the cast immobilizes the hips. The overhead trapeze is used for lifting, not turning.

A nurse in a campus health clinic is assessing female students for risk factors associated with the future development of osteoporosis. What factors are included in this assessment? Select all that apply. 1. Cigarette smoking 2. Moderate exercise 3. Use of street drugs 4. Familial predisposition 5. Inadequate intake of dietary calcium

Correct 1. Cigarette smoking 4. Familial predisposition 5. Inadequate intake of dietary calcium Cigarette smoking is a high-risk behavior associated with an increased incidence of osteoporosis in later life. Familial predisposition is considered a risk factor for the development of osteoporosis. Inadequate calcium intake during the premenopausal years is a risk factor for the development of osteoporosis after menopause. Moderate exercise is not considered a risk factor for the development of osteoporosis, although a sedentary lifestyle is. Use of street drugs is not considered a risk factor for osteoporosis.

A nurse is teaching a high school student about scoliosis treatment options. On what should the nurse focus? 1. Effect on body image 2. Least invasive treatment 3. Continuation with schooling 4. Maintenance of contact with peers

Correct 1. Effect on body image Establishing an identity, the major developmental task of the adolescent, is related to the affirmation of self-image. To achieve this task there is a need to conform to group norms, one of which is appearance. The type of treatment is not an issue. Although it is important to continue schooling and to maintain contact with peers, the effect on body image is more important.

A client with osteoarthritis is admitted to the hospital for evaluation of a possible hip replacement. To prevent flexion contractures, the nurse recommends that, when in bed, the client should lie in the supine or prone position. The client voices hesitation, stating that these positions are uncomfortable for the knees and hips. What action should the nurse take? 1. Encourage the client to maintain extension for specific periods of time 2. Allow the client to lie in whatever position is most comfortable 3. Insert a pillow under the client's knees to relieve discomfort 4. Place the client in the semi-Fowler position most of the time

Correct 1. Encourage the client to maintain extension for specific periods of time Flexion contractures of the hips and knees can develop unless some periods of full extension are maintained. The most comfortable position that usually is assumed is one of flexion, which leads to contractures and should be avoided. Placing a pillow under the knees can cause flexion contractures of the hips and knees. Remaining in the semi-Fowler position can cause flexion contractures of the hips.

experiencing which complication? 1. Fat embolism 2. Urinary retention 3. Hypovolemic shock 4. Pulmonary embolism

Correct 1. Fat embolism The client most likely is experiencing fat embolism syndrome (FES). The average time of onset of FES is 18 to 24 hours after injury to long bones or crushing injury. Fat globules and tissue thromboplastin exit from bone marrow and local tissue as a result of injury. Fat molecules enter venous circulation, move to lungs, and embolize small capillaries. Petechial rash on neck, chest, conjunctivae, or axillae is a classic sign of FES (occurs in 50% to 60% of clients with FES). Increased temperature, pulse rate, and respirations are associated with FES; 75% of clients with FES exhibit neurologic signs, such as altered mental state, restlessness, agitation, lethargy, confusion, or coma. The client is not experiencing urinary retention because output indicates adequate hourly output of at least 50 mL/hr. The client is not experiencing hypovolemic shock. Although the client may experience tachypnea, tachycardia, and an increased temperature with hypovolemic shock, the blood pressure will decrease and urine output will decrease to less than 30 mL/hr. The client is not experiencing a pulmonary embolism; this is more likely to occur 4 to 10 days after trauma. Although tachypnea, tachycardia, an increased temperature, restlessness, and agitation are common with pulmonary embolism, the client is not exhibiting sudden chest pain, dyspnea, cough, or hemoptysis, or areas of dullness or crackles when auscultating breath sounds.

A nurse is completing the health history of a client admitted to the hospital with osteoarthritis. The nurse expects the client to report that which joints were involved initially? Select all that apply. 1. Hips 2. Knees 3. Ankles 4. Shoulders 5. Metacarpals

Correct 1. Hips 2. Knees Osteoarthritis affects the weight-bearing joints (e.g., hips and knees) first because they bear the most body weight. The resulting joint damage causes a series of physiologic responses (e.g., release of cytokines and proteolytic enzymes) that lead to more damage. Although the ankles are weight-bearing joints and eventually are affected, the motion in the ankles is not as great as in the hips and knees; thus, there is less degeneration. Shoulder joints are not the most likely to be involved first because these are not weight-bearing joints. Although the distal interphalangeal joints are affected frequently, the remaining interphalangeal joints and metacarpals are not.

A client who had a right total hip replacement is progressing from the use of a walker to the use of a cane. In which hand should the nurse teach the client to hold the cane? 1. Left hand 2. Right hand 3. Stronger hand 4. Dominant hand

Correct 1. Left hand A cane should be used on the unaffected side. Weight-bearing can be shared by a cane and an affected leg when they are advanced forward together. Teaching with the right hand promotes leaning toward the affected side and does not permit sharing of weight by the stronger left side of the body. Teaching with the stronger hand is unsafe; the stronger hand may not be the left hand. Teaching with the dominant hand is unsafe; the dominant hand may not be the left hand.

Spinal fusion is performed in an adolescent with scoliosis. What postoperative nursing intervention is specifically related to surgery for scoliosis? 1. Log-rolling every 2 hours 2. Checking the dressing frequently 3. Supervising deep-breathing exercises 4. Maintaining the adolescent in the supine position for 3 days

Correct 1. Log-rolling every 2 hours Log-rolling is necessary to prevent movement of the newly aligned and instrumented vertebrae and should be done frequently to prevent skin breakdown. Dressings are checked frequently in all postoperative clients; this action is nonspecific. Coughing and deep-breathing are done by most postoperative clients; this action is nonspecific. The client who has had a spinal fusion may be turned and still be protected from injury with log-rolling. Remaining in one position for 3 days could lead to skin breakdown from unrelieved pressure.

A client with arthritis increases the dose of ibuprofen (Motrin, Advil) to abate joint discomfort. After several weeks the client becomes increasingly weak. The client is admitted to the hospital and is diagnosed with severe anemia. What clinical indicators does the nurse expect to identify when performing an admission assessment? Select all that apply. 1. Melena 2. Tachycardia 3. Constipation 4. Clay-colored stools 5. Painful bowel movements

Correct 1. Melena 2. Tachycardia Ibuprofen irritates the gastrointestinal (GI) mucosa and can cause mucosal erosion, resulting in bleeding; blood in the stool (melena) occurs as the digestive process acts on the blood in the upper GI tract. Hemoglobin, which carries oxygen to body cells, is decreased with anemia; the heart rate increases as a compensatory response to increase oxygen to body cells. Constipation usually is related to immobility, a low-fiber diet, and inadequate fluid intake, not the data listed in this situation. Clay-colored stools are related to biliary problems, not GI bleeding. Painful bowel movements are related to hemorrhoids, not GI bleeding.

The nurse is caring for a client that had a hip replacement two days prior. After removing a bedpan from under the client, the nurse recognizes that a priority nursing intervention is to: 1. Provide perineal care. 2. Turn and position the client. 3. Give a complete bed bath. 4. Document the bowel movement.

Correct 1. Provide perineal care. Providing perineal care helps to preserve skin integrity for the client who is incapable to provide self-care. Turning and positioning the client after hip surgery who has decreased physical mobility is important in preventing skin breakdown but it is not an immediate client need. Giving a complete bed bath is not necessary after each bowel movement because only the perineal area had been soiled with a bowel movement. Documenting the bowel movement has to be done only after meeting immediate needs of the client.

Which information from the client's history does the nurse identify as a risk factor for developing osteoporosis? 1. Receives long-term steroid therapy 2. Has a history of hypoparathyroidism 3. Engages in strenuous physical activity 4. Consumes high doses of the hormone estrogen

Correct 1. Receives long-term steroid therapy Increased levels of steroids will accelerate bone demineralization. Hyperparathyroidism, not hypoparathyroidism, accelerates bone demineralization. Weight-bearing that occurs with strenuous activity promotes bone integrity by preventing bone demineralization. Although estrogen promotes deposition of calcium into bone, high levels will not be prescribed for osteoporosis; hormone replacement therapy is associated with an increased risk for breast cancer.

The nurse considers that a 70-year-old female can best limit further progression of osteoporosis by: 1. Taking supplemental calcium and vitamin D 2. Increasing the consumption of eggs and cheese 3. Taking supplemental magnesium and vitamin E 4. Increasing the consumption of milk and milk products

Correct 1. Taking supplemental calcium and vitamin D Research demonstrates that women past menopause need at least 1500 mg of calcium a day, which is almost impossible to obtain through dietary sources because the average daily consumption of calcium is 300 to 500 mg; vitamin D promotes the deposition of calcium into the bone. Consumption of eggs and cheese does not contain adequate calcium to meet requirements to prevent osteoporosis; these do not contain vitamin D unless fortified. If large amounts of magnesium are present, calcium absorption is impeded because magnesium and calcium absorption are competitive; vitamin E is unrelated to osteoporosis. Milk and milk products may not be consumed in quantities adequate to meet requirements to prevent osteoporosis.

After an infant who was born with talipes equinovarus (clubfoot) has the cast removed, the nurse teaches the mother how and when to exercise the baby's foot. The nurse concludes that the mother understands the instructions when she says that she will exercise the foot: 1. With each diaper change 2. Once a day in the morning 3. Twice a day after each nap 4. Every 4 hours during the day

Correct 1. With each diaper change Exercises should be performed often; association with a specific activity makes it easier to incorporate it into the lifestyle. Once or twice a day is not frequent enough. Although every 4 hours is frequent enough, such a rigid schedule is difficult to follow with an infant and compliance may falter.

A client diagnosed with osteomyelitis is being discharged. Which statement indicates a need for further teaching? 1. "I will take the antibiotic at the same time every day." 2. "I will take the antibiotic regularly until my symptoms subside." 3. "I will take the antibiotic with food if I develop gastric distress when on the antibiotic." 4. "I will notify my health care provider and stop taking the medication if I develop a rash or shortness of breath."

Correct 2. "I will take the antibiotic regularly until my symptoms subside." The antibiotic should be taken as prescribed for the full length of treatment prescribed. The client should not discontinue the medication when symptoms subside. The statements "I will take the antibiotic at the same time every day," "I will take the antibiotic with food if I develop gastric distress when on the antibiotic," and "I will notify my health care provider and stop taking the medication if I develop a rash or shortness of breath" demonstrate understanding of the discharge instructions.

A 2-year-old child with developmental dysplasia of the hip has a spica cast applied. The mother asks the nurse how to keep the cast clean. How should the nurse respond? 1. "Tuck a folded diaper above the perineal opening." 2. "Place plastic wrap or duct tape around the perineal edges of the cast." 3. "Wipe the cast with a wet cloth and sprinkle it with baby powder." 4. "Do the best you can, because it will get soiled no matter what you do."

Correct 2. "Place plastic wrap or duct tape around the perineal edges of the cast." Suggesting the use of a protective nonabsorbent material is supportive, constructive, practical, and factual. Placing a diaper above the perineal area will not protect the area beneath the perineum. Although water may or may not cause dissolution of cast material, the infant may inhale powder, which can cause respiratory difficulties. "Do the best you can" is a negative response that provides neither a suggestion nor support to the mother.

Which client is most at risk for osteoporosis? 1. A nonsmoking 60-year-old woman, 5 foot 7 inches tall and 173 lb 2. A 66-year-old white woman, 5 foot 1 inch and 100 lb, who is a paralegal 3. A 68-year-old black woman, 5 foot 5 and 140 lb, who is a retired receptionist 4. A 62-year-old woman, 5 foot 4 inches tall and 135 lb, who takes calcium carbonate daily

Correct 2. A 66-year-old white woman, 5 foot 1 inch and 100 lb, who is a paralegal A postmenopausal woman who is small-boned, thin, and relatively sedentary is at risk for osteoporosis; other risk factors are family history, and white or Asian ethnicity. The postmenopausal years are considered to be 65 years and older; however, each individual is unique. A perimenopausal woman who is relatively heavy and does not smoke is at less risk for osteoporosis than is a thin postmenopausal woman. The perimenopausal years are considered to be 45 to 64 years of age; however, each individual is unique. Postmenopausal women who are black are at lower risk for osteoporosis than are white and Asian women. A perimenopausal woman who takes a daily calcium supplement is at less risk for osteoporosis than a woman who does not take a calcium supplement.

A client is admitted to the hospital for a total hip replacement. The nurse is planning preoperative teaching about the nursing care to be delivered during the immediate postoperative period. Which is the most important factor that the nurse should focus on regarding immediate postoperative care? 1. Flexing the operative hip 2. Abducting the operative hip 3. Turning onto the operative side 4. Maintaining the contour position

Correct 2. Abducting the operative hip After surgery, abduction is maintained to reduce the chance of dislocation of the femoral head. Flexing the operative hip can lead to dislocation of the femoral head. Turning onto the operative side causes hip adduction, which can lead to dislocation of the femoral head. The contour position flexes the hip and can lead to dislocation of the femoral head.

A client, admitted to the hospital with a fractured hip, is scheduled for surgery for a total hip replacement. In which position should the nurse place the client's affected limb after surgery? 1. Adduction and flexion 2. Abduction and extension 3. Adduction and internal rotation 4. Abduction and external rotation

Correct 2. Abduction and extension Abduction and extension reduce stress on the joint capsule, preventing the hip prosthesis from becoming dislocated. Adduction and flexion strain the joint capsule, promoting dislocation of the hip prosthesis. Adduction and internal rotation strain the joint capsule, promoting dislocation of the hip prosthesis. Although abduction helps prevent dislocation of the prosthesis, external rotation puts strain on the joint capsule, promoting dislocation of the hip prosthesis.

The nurse is caring for a client four hours after the client's hip replacement surgery. When assisting the client out of bed, the nurse should: 1. Tell the client that both legs must have equal weight bearing 2. Advise the client that the legs must continually be kept wide apart 3. Sit the client in a straight-back chair so that the hips are kept flexed 4. Transfer the client using a mechanical lift because weight bearing on the leg is not allowed

Correct 2. Advise the client that the legs must continually be kept wide apart Abduction keeps the prosthesis firmly in place; adduction of the extremity may cause the prosthesis to dislocate. Only partial weight bearing on the affected leg is indicated initially. Sitting flexes the hips to 90 degrees; this is contraindicated initially because it can cause the prosthesis to dislocate. Full weight bearing on the unaffected leg and partial weight bearing on the affected leg generally are permitted on the second or third postoperative day.

A nurse is presenting a community education program about osteoporosis at a women's health conference. What factor should the nurse explain has contributed to the increased incidence of fractures associated with osteoporosis in the United States? 1. Dietary use of fat-free milk 2. Aging of the American population 3. Increased number of hysterectomies 4. Immobility associated with early retirement

Correct 2. Aging of the American population Because more people are living longer, the problem of osteoporosis in older adults, especially older women, is increasing. The dietary use of fat-free milk is unrelated to osteoporosis; the fat that is removed from milk does not contain calcium. The increase in the number of hysterectomies is unrelated to osteoporosis. Only the uterus is removed with a hysterectomy. Early retirement does not imply inactivity or immobility.

A client is going for a magnetic resonance imaging (MRI). Before taking the client to the procedure the nurse should ascertain: 1. Scheduled medications that have been given. 2. All metal, such as jewelry and hair ornaments, has been removed. 3. Adequate prehydration has been given. 4. The client has emptied the bladder.

Correct 2. All metal, such as jewelry and hair ornaments, has been removed. All metal must be removed because the MRI emits a strong magnetic field. All medications may not be necessary before the test. Being hydrated is not needed and may cause interruptions for client to void. The client should have the opportunity to void before going for the test as a convenience.

A client is admitted to the hospital for acute pain in the hip and a total hip replacement surgery is scheduled. The client was diagnosed recently with early dementia. The client appears oriented and alert, and responds appropriately when interviewed. When the nurse is providing preoperative teaching, the client says, "I don't want to have that surgery." The client's spouse voices a desire to proceed with the surgery to provide relief for the client. The nurse should: 1. Discuss with the client feelings about having surgery 2. Ask the client if a power of attorney for health care has been established 3. Continue with preparation for surgery as the spouse has requested 4. Continue with teaching, ensuring that the client understands the process

Correct 2. Ask the client if a power of attorney for health care has been established Consent for surgery should be given by the client; the spouse cannot do this unless he or she has power of attorney for health care. Although it is important to discuss feelings with the client, this does not address the legal issue. The legal issue needs to be clarified first. If the client does not want surgery, preoperative teaching probably will not be effective because the client will not be receptive. The legal issue needs to be clarified first.

A nurse is caring for a client who had a total hip replacement. What is the priority assessment when monitoring the client for hemorrhage? 1. Checking vital signs every four hours 2. Examining the bedding under the client 3. Measuring the circumference of the thigh 4. Observing for ecchymosis at the operative site

Correct 2. Examining the bedding under the client Because of the recumbent position, drainage may flow under the client and not be noticed. Checking vital signs every four hours should be done more frequently; however, the site is a more reliable indicator of hemorrhage. The girth of the thigh is not an indicator of hemorrhage. Dressings impede accurate assessment.

A 13-year-old girl is found to have idiopathic scoliosis. She is upset about the treatment regimen and is worried about being different from her friends. What should the nurse do to help the child maintain a positive self-image during treatment? 1. Remind her how crooked her back will be if she refuses treatment. 2. Help her investigate appropriate clothing to enhance her appearance. 3. Disregard her negative characteristics and focus on her positive attributes. 4. Refer her for psychological counseling until the treatment program is completed.

Correct 2. Help her investigate appropriate clothing to enhance her appearance. Clothes can be selected to minimize the appearance of a brace, especially if an effort is made to wear current styles. Reminding the child how she will look without treatment has a negative connotation that emphasizes the problem. Focusing only on positive attributes may be misinterpreted as unqualified praise; adults should give honest appraisals of both positive and negative attributes. There are no data to indicate that the child will not adjust to the treatment regimen.

In preparation for discharge, a client who had a total hip replacement is taught wound care by the nurse. The nurse identifies that the client understands the instructions when the client states, "I will: 1. Sit in a chair for several hours every day." 2. Inspect the incision for healing when I change the dressing." 3. Check to see whether the staples have dissolved within a few days." 4. Call the health care clinic if I see any clear drainage coming from the incision."

Correct 2. Inspect the incision for healing when I change the dressing." At each dressing change, the incision should be assessed for approximation of the edges, extent of healing, and signs of infection. Sitting should last for 45 minutes or less to prevent hip stiffness, hip flexion contracture, and prosthetic dislocation. Staples do not dissolve; they are removed by a health care provider. Serous drainage may persist until healing of the incision is complete.

The nurse teaches a pre-menopausal obese client about strategies to prevent osteoporosis. Which strategy identified by the client indicates that the teaching is effective? 1. Starts a rapid, strict weight reduction diet. 2. Joins a tennis league and practices every day. 3. Takes 1200 IU of vitamin D a day. 4. Signs up for a swimming class three times a week.

Correct 2. Joins a tennis league and practices every day. High-impact exercises (e.g., tennis, running, aerobics, dancing) are best for building bone mass. Weight loss should be slow and reasonable; restricting calories promotes production of the hormone leptin, which stimulates bone loss. The recommended intake of vitamin D for adults younger than 50 years of age (premenopausal women) is 800 IU; 1200 mg is the recommended daily dose of calcium for adults older than 50 years of age (postmenopausal women). Signing up for a swimming class three times a week may promote overall health and vigor; it will not increase the strength or mass of bone.

A client is diagnosed with osteoporosis. During teaching about high-calcium foods, the nurse and client evaluate the client's dietary intake from the previous day. The client recorded the intake in the chart. Which contains the best sources of calcium? 1. Breakfast 2. Lunch 3. Dinner 4. Snack

Correct 2. Lunch Lunch provides the best dietary sources of calcium; 1 ounce of cheddar cheese contains 204 mg, two slices of bread contain 64 mg, 1 cup of milk contains 300 mg, and 1 cup of raw, chopped spinach contains 54 mg, for a total of 622 mg of calcium. Breakfast is lower in calcium than lunch; two eggs contain 50 mg, a slice of toast contains 32 mg, and a 6-ounce cup of coffee contains 4 mg, for a total of 88 mg. Dinner is lower in calcium than lunch; a half breast of chicken contains 13 mg, 1 cup of sliced cooked carrots contains 41 mg, a baked potato contains 20 mg, and 1 cup of applesauce contains 17 mg, for a total of 91 mg. The snack is lower in calcium than the lunch; 8 ounces of strawberry yogurt contains 345 mg and an apple contains 10 mg, for a total of 355 mg of calcium.

A school nurse is screening children for scoliosis. In what age group is it usually identified? 1. Adolescence 2. Preadolescence 3. Early school years 4. Middle school years

Correct 2. Preadolescence Preadolescence is the time when scoliosis is most likely to become evident because of the growth spurt that occurs at this time. Although scoliosis may occur at any age, idiopathic scoliosis, the most common type, tends to become evident during the preadolescent growth spurt.

A client's osteoporosis has progressed dramatically in the last five years, and the client is especially prone to falling. Which statement best reflects the client's understanding of why the risk of falls has increased? 1. "I do not have the stamina that I used to have." 2. "At my age, I'm more prone to dizziness and falling." 3. "I have a curvature of my spine, and it is hard to keep my balance." 4. "Because I am bent over, I look down instead of up while I'm walking."

Correct 3. "I have a curvature of my spine, and it is hard to keep my balance." Increased convexity in the curvature of the thoracic spine as viewed from the side (kyphosis) alters the center of gravity, which contributes to alterations in balance and gait. Decreased endurance and fatigue should not change the center of gravity or alter the gait; a lack of stamina by itself should not cause falls. Age is incidental; one should not accept falls as an inescapable aspect of aging. The age of the client is not given. Although kyphosis alters the line of vision downward, this by itself will not cause increased falls.

A practitioner recommends that an adolescent with the diagnosis of osteogenic sarcoma have the affected leg amputated and then be treated with chemotherapy. The parents are concerned about what to tell their child and ask the nurse for advice. The nurse suggests that they discuss the: 1. Causes of cancer and details about the treatment 2. Chemotherapy and the possibility of an amputation 3. Amputation and provide information about chemotherapy 4. Treatment choices and explain that it is too soon for a final decision

Correct 3. Amputation and provide information about chemotherapy Honesty is essential in helping the adolescent accept the loss of the leg; only a brief discussion of chemotherapy is needed because otherwise the adolescent may be overwhelmed. A theoretical discussion and detailed information will not be heard or understood during a crisis situation. The amputation is necessary; lying avoids the issue and may destroy the adolescent's trust in parents and staff.

An adolescent who has had a leg amputated because of bone cancer begins to experience phantom limb sensations. How should the nurse respond when the client complains of pain and requests medication? 1. By withholding the medication to help prevent addiction 2. By stating that the limb has been removed and that the pain is psychological 3. By acknowledging that the pain is real and administering medication to relieve it 4. By explaining that the phantom limb sensation will subside within a few more days

Correct 3. By acknowledging that the pain is real and administering medication to relieve it Pain medication is required, along with intensive supportive nursing care. To the client the pain is real, requiring pain medication; addiction is not a concern at this time. Explaining that the pain is psychological in origin does not help relieve the pain; medication and emotional support are required. The pain may not recede within a few days; pain medication should be administered.

On the fourth day after a total hip replacement, a client appears angry and restless and states, "I can't stand this another minute. There's a wrinkle in my sheet, and my water is warm." The client changes position frequently and does not maintain eye contact with the nurse. What is the nurse's initial interpretation of the client's behavior? 1. Discomfort in the hip 2. Anger at the nursing staff 3. Elevation in the level of anxiety 4. Frustration with the need for leg abduction

Correct 3. Elevation in the level of anxiety When a client is anxious and has a decreased ability to cope, minor environmental irritants are magnified; eye contact is avoided to decrease additional stimuli. The client is changing position; discomfort is indicated by reports of pain, splinting, refusal to move, and alteration in vital signs. If the client were angry, eye contact would be maintained; prolonged eye contact may be used as a form of intimidation or aggression. If the client were frustrated about the need for leg abduction, the client would be verbalizing about the need to continue the abduction, not about a variety of other annoyances related to the immobility.

A nurse provides discharge teaching to a client that had a total hip replacement. The client states that the plan is to go swimming at the community pool the day after discharge. How should the nurse respond? 1. Encourage participation in this activity as there is an excellent range-of-motion 2. Instruct the client to take a friend along for safety 3. Explain that the incision should not be immersed in water until it has healed 4. Tell the client that swimming can substitute for the prescribed physical therapy

Correct 3. Explain that the incision should not be immersed in water until it has healed Because of the risk for infection, the client should avoid tub baths, hot tubs, pools, and bodies of water until after the wound has healed and these activities are approved by the health care provider. Immersion in water for a prolonged period interferes with wound healing because water may macerate tissue. Having a friend along does not change the fact that immersion in water for a prolonged period will interfere with wound healing. The client needs to continue physical therapy after discharge whether or not the client goes swimming

An infant has a plaster cast applied for clubfoot correction. What nursing intervention will hasten drying of the cast? 1. Using a blow dryer 2. Opening the window 3. Exposing the casted extremity 4. Covering the cast with a light sheet

Correct 3. Exposing the casted extremity Exposing the casted extremity is the safest way to dry the cast evenly. Besides the danger of burning the child, the cast may dry on the outside and remain damp within. Opening the window may create a draft and be uncomfortable for the child. Covering the cast with a light sheet will impede the circulation of air and delay drying.

A client who has a history of osteoporosis and vertebral compression has been coming to the clinic more frequently for prescription refills of hydrocodone/acetaminophen (Vicodin). What inference should the nurse make? 1. Half-life of the drug has decreased. 2. An idiosyncratic reaction has occurred. 3. Higher doses are needed to achieve pain relief. 4. An emotional dependence on the drug has developed.

Correct 3. Higher doses are needed to achieve pain relief. As the body adapts to the drug (tolerance), an increased dose is needed to produce the desired effect. The half-life of a drug does not change and is related to the time required for it to be absorbed, distributed, metabolized, and excreted from the body. Idiosyncratic reactions are unpredictable; these sporadic reactions are unrelated to dosage. The data are insufficient for the nurse to conclude that emotional or physiologic dependence has developed.

A client just had a total hip replacement and is experiencing restlessness and changes in mentation. Which complication does the nurse consider the client may be experiencing based on these responses? 1. Bladder spasms 2. Polycythemia vera 3. Hypovolemic shock 4. Pulmonary hypertension

Correct 3. Hypovolemic shock These signs occur with hypovolemic shock because less blood is being circulated to vital centers in the brain. A large loss of blood may occur during and after orthopedic surgery. Urinary retention, not bladder spasms, may occur after general anesthesia. Bladder spasms are associated with intermittent suprapubic pain. Anemia and deep vein thrombosis, not an increase in the total red blood cells (polycythemia vera), tend to occur after a total hip replacement. Polycythemia vera is associated with headache, irritability, and paresthesias of the hands and feet. Atelectasis and pneumonia, not pulmonary hypertension, tend to occur after general anesthesia. Pulmonary hypertension is associated with dyspnea, substernal chest pain, and fatigue.

An 89-year-old client with osteoporosis is admitted to the hospital with a compression fracture of the spine. The nurse identifies that a factor of special concern when caring for this client is the client's: 1. Irritability in response to deprivation 2. Decreased ability to recall recent facts 3. Inability to maintain an optimal level of functioning 4. Gradual memory loss resulting from change in environment

Correct 3. Inability to maintain an optimal level of functioning The onset of disabling illness will divert an older person's energies, making it difficult to maintain an optimum level of functioning. Irritability in response to deprivation is an expected response. Decreased ability to recall recent facts can result from the aging process and the change in environment; it is not as important as the loss of function. A gradual memory loss and some confusion are expected; a sudden memory loss is cause for alarm.

A client with a femoral fracture associated with osteomyelitis is immobilized for three weeks. Why does the nurse anticipate that the client may develop renal calculi? 1. The client's dietary patterns have changed since admission. 2. The client has more difficulty urinating in a supine position. 3. Lack of weight-bearing activity promotes bone demineralization. 4. Fracture healing requires more calcium, which increases total calcium metabolism.

Correct 3. Lack of weight-bearing activity promotes bone demineralization. All clients who are confined to bed for any considerable period risk losing calcium from bones. Calcium precipitates in the urine, resulting in formation of calculi. There is no indication that the client's diet has changed. Although the client may have more difficulty urinating in a supine position resulting from an inability to assume the preferred anatomic position and the emotional impact of using a urinal, it usually does not predispose the client to developing renal calculi, unless fluid intake is low or stasis occurs. The presence of a healing fracture does not increase total calcium metabolism; however, deposition of bone at the fracture site will be increased.

A nurse is assessing a client for the potential for osteoporosis. Which factor in the client's history increases the risk for this disorder? 1. Estrogen therapy 2. Hypoparathyroidism 3. Prolonged immobility 4. Excessive calcium intake

Correct 3. Prolonged immobility Prolonged immobility results in bone demineralization because there is decreased bone production by osteoblasts and increased resorption by osteoclasts. Estrogen helps prevent bone demineralization. Hypoparathyroidism decreases mobilization of calcium from the bones, thereby reducing the serum level of calcium. Decreased calcium intake or absorption may precipitate osteoporosis.

A nurse is teaching a mother how to care for her toddler who is in a spica cast. In what position should the nurse suggest that the mother place the toddler during a feeding? 1. Upright while on the mother's lap 2. Recumbent with a pillow under the head 3. Semi-Fowler on a padded, adjustable tilt board 4. Side-lying in the football hold, facing the mother

Correct 3. Semi-Fowler on a padded, adjustable tilt board Because of the child's age, lying on a tilt board is the best position; it permits upright feeding while fostering growth and development. Positioning the child on the mother's lap is difficult and unsafe for both mother and child because the combination of the child and the cast is too cumbersome and could result in a fall. The recumbent position makes feeding and digestion difficult; also, it may increase the risk of aspiration. The football hold is appropriate for an infant, not a toddler.

A 2-year-old child who was admitted to the hospital for further surgical repair of a clubfoot is standing in the crib, crying. The child refuses to be comforted and calls for the mother. As the nurse approaches the crib to provide morning care, the child screams louder. In light of the fact that this behavior is typical of the stage of protest, what is the most appropriate nursing intervention? 1. Using comforting measures while holding the child 2. Filling the basin with water and proceeding to bathe the child 3. Sitting by the crib and bathing the child later when the anxiety decreases 4. Postponing the bath for a day because a child this upset should not be traumatized further

Correct 3. Sitting by the crib and bathing the child later when the anxiety decreases The nurse should try to comfort the child by staying nearby until the child feels more relaxed. The bathing can be postponed until the child has had time to test the environment and is less anxious. Using comforting measures while holding the child may frighten the child more because the nurse is a stranger. Filling the basin with water and proceeding to bathe the child does not relieve the child's anxiety and will probably cause it to increase. Basic physiological needs must be met, and postponing the bath for a day would be negligent. However, the nurse should try to reduce the child's anxiety first.

When providing discharge teaching to a client who had a total hip replacement, the nurse should instruct the client to avoid: 1. Climbing stairs 2. Stretching exercises 3. Sitting in a low chair 4. Lying prone for more than 15 minutes

Correct 3. Sitting in a low chair Excessive flexion of the hip can cause dislocation of the femoral head. Climbing stairs should not cause undue strain on the operative site. Stretching exercises should be encouraged as long as no extremes of position are implemented. The client is permitted to lie prone more than 15 minutes; lying prone should be encouraged because it prevents hip flexion contractures.

A preadolescent brings home a note from the school nurse informing the parents that the child should be evaluated for scoliosis. The mother calls the school nurse to ask for a description of scoliosis. Before responding, the nurse recalls that in scoliosis: 1. The concave lumbar curvature is exaggerated. 2. There are pathological changes in the vertebrae. 3. There is a rotary deformity of the lateral curvature of the spine. 4. The curvature of the thoracic spine has an increased convex angulation.

Correct 3. There is a rotary deformity of the lateral curvature of the spine. A rotary deformity of the lateral curvature of the spine is the correct definition of scoliosis. An exaggerated concave lumbar curvature is a description of lordosis. There are no pathological changes in the vertebrae with scoliosis. A curvature of the thoracic spine with an increased convex angulation is a description of kyphosis

A nurse is assessing a client with the diagnosis of osteoporosis. What part of the client's body should the nurse assess to identify osteoporotic changes? 1. Long bones 2. Facial bones 3. Vertebral column 4. Joints of the hands

Correct 3. Vertebral column Compression fractures of the vertebrae are the most common fractures in clients with osteoporosis; a gradual collapse of vertebrae may be asymptomatic and observed as kyphosis. Changes in the long bones, associated with osteoporosis, are not observable to the naked eye. Changes in the facial bones, associated with osteoporosis, are not observable to the naked eye. Observable changes, such as inflammation in the joints and natural alignment of the bones, are associated with arthritis, not osteoporosis.

A 2-month-old infant is being treated with sequential casts for bilateral clubfoot (talipes equinovarus). New casts have just been applied. What should the nurse evaluate to determine that circulation to the feet remains sufficient? 1. Presence of posterior tibial pulses 2. Mobility of the knees when flexed 3. Warmth of the toes of both feet 4. Alignment of legs on x-ray

Correct 3. Warmth of the toes of both feet Peripheral vascular assessment includes comparing temperature, color, sensation, mobility, capillary refill, and if accessible, peripheral pulses. The posterior tibial pulse site is under the cast and is not accessible for palpation. Mobility of the knees when flexed is impossible because the cast extends from the thigh to just above the toes. X-rays permit assessment of bones, not of circulation.

The nurse is making rounds on a client who has developed severe bone marrow depression after receiving chemotherapy for cancer. Which of these actions by the nurse is appropriate? Select all that apply. 1. Monitor for signs of alopecia. 2. Encourage an increase in fluids. 3. Wash hands before entering the client's room. 4. Advise use of a soft toothbrush for oral hygiene. 5. Report an elevation in temperature immediately. 6. Encourage the client to eat raw, fresh fruits and vegetables.

Correct 3. Wash hands before entering the client's room. 4. Advise use of a soft toothbrush for oral hygiene. 5. Report an elevation in temperature immediately. It is essential to prevent infection in a client with severe bone marrow depression; thorough hand-washing before touching the client or client's belongings is important. Thrombocytopenia occurs with most chemotherapy treatment programs; using a soft toothbrush helps prevent bleeding gums. Any temperature elevation in a client with neutropenia must be reported to the health care provider immediately as it may be a sign of infection. Although alopecia does occur with chemotherapy, it is not related to bone marrow suppression. Increasing fluids will neither reverse bone marrow suppression nor stimulate hematopoiesis. This is not related to bone marrow suppression. Clients who have severe bone marrow depression must avoid eating raw fruits and vegetables, and undercooked meat, eggs, and fish to avoid possible exposure to microbes.

A 14-year-old girl in whom scoliosis has been diagnosed undergoes spinal fusion. On the first postoperative day her face is red, she is rigid, and she is crying because she is in pain. She has prescriptions for morphine sulfate for severe pain and an acetaminophen-codeine compound for moderate pain. What information should influence the nurse's choice of analgesic? 1. One dose of morphine may be given, but the drug should be restricted thereafter because it is addictive. 2. Adolescents tend to exaggerate their discomfort, particularly when they are immobilized by surgery or injury. 3. Spinal fusion causes considerable pain during the early postoperative days, and morphine is the more effective analgesic. 4. The acetaminophen-codeine compound is preferred because morphine can cause respiratory depression or respiratory arrest.

Correct 3.Spinal fusion causes considerable pain during the early postoperative days, and morphine is the more effective analgesic. Spinal fusion causes considerable pain for several days and requires a strong analgesic. The first postoperative day is too early to begin weaning the client from opiates. Adolescents are no more prone to exaggerating their discomfort than clients in any other age group. A more potent analgesic, such as morphine, is needed, and the prescribed dosage should not cause respiratory problems.

The mother of a 10-year-old boy with mild scoliosis asks the nurse, "How long will my son have to continue his exercises before he's better?" How should the nurse respond? 1. "At your son's age the exercise program is done for several months." 2. "Wearing a brace daily will probably result in quicker improvement." 3. "Surgery may be necessary, but it will be less involved if the exercises are done." 4. "Even if he keeps doing the exercises, we won't know how much he's improved until he's fully grown."

Correct 4. "Even if he keeps doing the exercises, we won't know how much he's improved until he's fully grown." As the child grows the curvature may progress despite the exercise program. The child should be checked often, because a brace or surgery may become necessary. The younger the child is, the longer he or she will need to exercise; the program should be continued until growth is complete. A brace or surgery may or may not be necessary; specific daily exercises may be all that are necessary to correct functional scoliosis. Maintaining the exercise program does not guarantee that if surgery becomes necessary it will be less involved.

A 76-year-old male client asks the nurse about the chances of getting osteoporosis like his wife. Which is the best response by the nurse? 1. "This is only a problem for women." 2. "Exercise is a good way to prevent this problem." 3. "You are not at risk because of your small frame." 4. "You might think about having a bone density test."

Correct 4. "You might think about having a bone density test." Osteoporosis is not restricted to women; it is a potential major health problem of all older adults. Estimates indicate that half of all women have at least one osteoporotic fracture, and the risk in men is estimated between 13% and 25%; a bone mineral density (BMD) measurement assesses the mass of bone per unit volume or how tightly the bone is packed. Osteoporosis also can occur in men. Exercise may decrease the occurrence of, but will not prevent, osteoporosis; a regimen including weight-bearing exercises is advised. A small frame is a risk factor for osteoporosis.

A nurse is taking the health history of a client who is to have surgery in one week. The nurse identifies that the client is taking ibuprofen (Advil) for discomfort associated with osteoarthritis and notifies the health care provider. Which drug does the nurse expect will most likely be prescribed instead of the Advil? 1. Naproxen (Aleve) 2. Ibuprofen (Motrin) 3. Ketorolac (Toradol) 4. Acetaminophen (Tylenol)

Correct 4. Acetaminophen (Tylenol) Acetaminophen is a nonopioid analgesic that inhibits prostaglandins, which serve as mediators for pain; it does not impact platelet function. Naproxen, ibuprofen, and ketorolac are nonselective nonsteroidal antiinflammatory drugs (NSAIDs) that are contraindicated for clients undergoing surgery; nonselective NSAIDs have an inhibitory effect on thromboxane, a strong aggregating agent, and can result in bleeding.

A client who had a right total hip replacement three days ago reports extreme tenderness in the right calf. On examination the nurse identifies a warm area occurring on the back of the leg, extending into the popliteal space. The physical therapist has just arrived to assist the client with ambulation and exercise. What should the nurse do to best meet this client's needs? 1. Assist the therapist in ambulating the client. 2. Administer the client's prescribed analgesic. 3. Reassure the client that pain can be expected after surgery. 4. Notify the health care provider regarding the client's status.

Correct 4. Notify the health care provider regarding the client's status. These findings indicate deep vein thrombosis. Ambulation and exercise are contraindicated; the health care provider should be notified so that appropriate tests and treatments can be implemented. Ambulation and exercise may precipitate an embolism, which is life threatening. Unexpected pain must be evaluated by the health care provider before medication is administered. An analgesic will mask pain, making it difficult to assess; once the client has been examined by the health care provider, the client can be medicated. Although pain in the operative area and sometimes extending into the leg is common after this type of surgery, severe tenderness must be evaluated.

A client with osteoarthritis who had a left total hip replacement returns to the unit after surgery. The nurse should place the client in which position? 1. Maintain the left leg in an adduction position. 2. Place the client in a right-lying position. 3. Place the left leg in an internal rotation. 4. Use pillows to keep the client's legs abducted.

Correct 4. Use pillows to keep the client's legs abducted. Abduction reduces stress on the joint capsule incision, preventing the prosthesis from becoming dislocated. Adduction strains the posterior joint capsule, fostering dislocation. A right-lying position would not allow the heels to be kept off the bed and would not allow proper abduction. Internal rotation strains the posterior joint capsule.

During a routine physical examination a 10-year-old girl is discovered to have scoliosis. The curve is diagnosed as mild and functional, and a daily exercise program is established. The next month, at the follow-up visit, the nurse determines that the child is complying with the exercise program when the girl states: 1. "I like doing my exercises with my brother so he can get stronger." 2. "I think my exercises will make me a better softball and soccer player." 3. "I do my exercises every day while my mother stays with me and watches." 4. "I count out loud when I do my exercises so my mother can hear that I'm doing them all."

Correct 2 "I think my exercises will make me a better softball and soccer player." The child is anticipating improvement; this reflects positive internal motivation, which helps maintain the child's interest and willingness to continue with the program. Motivation may diminish if the focus is on the brother rather than the child's need to do the exercises. Doing the exercises to please the mother, evidenced by having the mother watch every day or counting to show the mother that the exercises are being done, is external motivation, which is not as desirable as internal motivation.