musculoskeletal saunders

A client is being discharged to home after spinal fusion with insertion of instrumentation (rod). The unit nurse should consult with the continuing care nurse regarding the need for modification of the home environment if the client makes which statement?

My bedroom and bathroom are on the second floor of my home."

The nurse is planning discharge teaching for a client diagnosed and treated for compartment syndrome. Which information should the nurse include in the teaching?

"Bleeding and swelling caused increased pressure in an area that couldn't expand." Compartment syndrome is caused by bleeding and swelling within a tissue compartment that is lined by fascia, which does not expand. The bleeding and swelling put pressure on the nerves, muscles, and blood vessels in the compartment, triggering the symptoms

The nurse teaches a client who is going to have a plaster cast applied about the procedure. Which statement by the client indicates a need for further teaching?

"I can bear weight on the cast in one-half hour." A plaster cast can tolerate weight bearing once it is dry, which takes from 24 to 72 hours, depending on the nature and thickness of the cast.

A client with a short-leg plaster cast complains of an intense itching under the cast. The nurse provides instructions to the client regarding relief measures for the itching. Which client statement indicates an understanding of appropriate measures to relieve the itching?

"I can use a hair dryer on the low setting and allow the cool air to blow into the cast."

A client has been experiencing muscle weakness over a period of several months. The health care provider suspects polymyositis. Which client statement correctly identifies a confirmation of test results and this diagnosis?

"I will know I have polymyositis if the muscle fibers are inflamed. In polymyositis, necrosis and inflammation are seen in muscle fibers and myocardial fibers.

A client has had a bone scan done. The nurse determines that the client demonstrates understanding of postprocedure care when the client makes which statement?

"I need to drink plenty of water for 1 to 2 days after the procedure." the client is encouraged to drink large amounts of water for 24 to 48 hours to flush the radioisotope from the system

A male client arrives in the hospital emergency department and tells the nurse that he twisted his ankle while jogging. The client is seen by the health care provider and is diagnosed with a sprained ankle. The nurse provides instructions to the client regarding home care for the injury. Which statement, if made by the client, would indicate an understanding of appropriate care measures for the next 24 hours?

"I should elevate my foot above the level of the heart."

The nurse has completed giving discharge instructions to a client after total knee arthroplasty and replacement with a prosthetic system. The nurse teaches the client about weight-bearing status. What information should the nurse include?

"You will use full weight bearing by discharge."

plaster cast teaching

- A cool setting on the hair dryer can be used to dry a plaster cast (heat cannot be used on a plaster cast because the cast heats up and burns the skin). - not to stick anything under the cast because of the risk of breaking skin integrity. - The client is instructed to monitor the extremity for circulatory impairment, such as pain, swelling, discoloration, tingling, numbness, coolness, or diminished pulse.

The nurse is gathering subjective and objective data from a client with a diagnosis of suspected rheumatoid arthritis (RA). The nurse would expect to note which early signs and symptoms of RA? Select all that apply.

- Fatigue - Morning stiffness

A client with a 4-day-old lumbar vertebral fracture is experiencing muscle spasms. Which are interventions to aid the client in relieving the spasm? Select all that apply.

- Heat - Analgesics - Muscle relaxers - Intermittent traction Heat, analgesics, muscle relaxers, and traction all may be used to relieve the pain of muscle spasm in the client with a vertebral fracture. Ice is applied to a painful site only for the first 48 to 72 hours

The nurse has given the client instructions about crutch safety. Which statement indicates that the client understands the instructions? Select all that apply.

- I should not use someone else's crutches." - "I need to remove any scatter rugs at home." - "I need to have spare crutches and tips available."

A client who sustained a severe sprain of the ankle is told by the health care provider that the pain experienced is caused by muscle spasm and swelling in the area of the injury. Which interventions should the nurse anticipate will be included in the client's initial plan of care? Select all that apply.

- Ice bags - Elevation - Compression bandage sprains are treated with RICE, which stands for rest, ice, compression, and elevation.

A client is complaining of knee pain. The knee is swollen, reddened, and warm to the touch. The nurse interprets that the client's signs and symptoms are compatible with which conditions? Select all that apply.

- Infection - Recent injury - Inflammation

The nurse is caring for a client with osteoarthritis. The nurse performs an assessment knowing that which clinical manifestations are associated with the disorder? Select all that apply.

- Joint pain that diminishes after rest - Joint pain that intensifies with activity

A client has just undergone spinal fusion after experiencing herniation of a lumbar disk. The nurse should include which interventions to maintain client safety after this procedure? Select all that apply.

- Keep the head of the bed flat. - Place pillows under the length of the legs. - Use logrolling technique for repositioning. - Assist the client with eating meals and drinking fluids.

The nurse is creating a plan of care for a client scheduled for a left total hip arthroplasty. Which interventions should the nurse include in the plan to prevent complications of the surgery? Select all that apply.

- Keep the leg slightly abducted. - Teach leg exercises to the client. - Use aseptic technique for wound care. - Prevent hip flexion beyond 90 degrees. A total hip arthroplasty (THA) is also known as a total hip replacement (THR).

what exercises can be performed in right skeletal lower leg traction

- Pulling up using the trapeze - Flexing and extending the feet - Doing quadriceps-setting and gluteal-setting exercises

The nurse is caring for a client diagnosed with osteomyelitis. Which data noted in the client's record are supportive of this diagnosis? Select all that apply.

- Pyrexia - Elevated white blood cell count - Elevated erythrocyte sedimentation rate - Bone scan impression indicative of infection

The nurse has delegated the ambulation of a client to the unlicensed assistive personnel (UAP). Which actions by the UAP support a clear understanding of the appropriate steps to carry out this task safely? Select all that apply.

- Remove clutter that may interfere with ambulation. - Assist client in applying nonskid shoes before ambulation. - Instruct client to sit up on the bedside and dangle before ambulation. - Observe the client for dizziness during ambulation and report immediately.

Which tests can be used to diagnose gout? Select all that apply.

- Serum uric acid level - Synovial fluid aspiration - 24-hour urine uric acid level

The nurse has given activity guidelines to a client with chronic low back pain. The nurse determines that the client understands the instructions if the client states to do which activities? Select all that apply.

- Sitting using a lumbar roll or pillow - Standing with one foot on a step or stool

The nurse is collecting data related to a client's risk factors associated with osteoporosis. Which data should the nurse include? Select all that apply.

- Thin body build - Smoking history - Postmenopausal age - Chronic corticosteroid use - Family history of osteoporosis

The nurse is providing dietary instructions to a client with osteoporosis and is discussing appropriate food items to include in the diet. Which food items should the nurse recommend as being high in calcium? Select all that apply.

- Tofu - Salmon - Spinach - Sardines

The nurse is caring for a client with acute back pain. Which are the most likely causes of this problem? Select all that apply.

- Twisting of the spine - Hyperflexion of the spine - Herniation of an intervertebral disk Acute back pain is sudden in onset and is usually precipitated by injury to the lower back, such as with hyperflexion, twisting, or disk herniation.

The home health nurse is planning to teach a client with osteoporosis about home modifications to reduce the risk of falls. Which recommendations would be necessary to include in the teaching plan? Select all that apply.

- Use night lights. - Remove scatter rugs. - Use staircase railings. - Place hand rails in the bathroom.

Risk factors for osteoporosis

- sedentary lifestyle, - cigarette smoking, - excessive alcohol consumption, - chronic illness, - long-term use of anticonvulsants and furosemide - diet that is deficient in calcium

The nurse in the hospital emergency department is caring for a client with a fractured arm and is preparing the client for a reduction of the fracture that will be done in the casting room in the emergency department. The nurse should take which actions? Select all that apply.

-Administer a prescribed analgesic. - Explain the procedure to the client. -Obtain informed consent for the procedure.

The nurse is caring for a client after the application of a plaster cast for a fractured left radius. The nurse should suspect impairment with the neurovascular status of the client's casted extremity if which findings are noted? Select all that apply.

-Client report of severe, deep, unrelenting pain - Client report of pain as nurse assesses finger movement - Client report of numbness and tingling sensation in the fingers

Which cast care instructions should the nurse provide to a client who just had a plaster cast applied to the right forearm? Select all that apply.

-Keep the cast clean and dry. - Allow the cast 24 to 72 hours to dry. - Keep the cast and extremity elevated

The nurse is caring for a client who is an athlete and has sustained an injury to the anterior cruciate ligament. The nurse is providing education to the client regarding the potential treatment measures for this injury. What should the nurse include in the teaching? Select all that apply.

-Physical therapy - Knee immobilizer - Aspiration of joint fluid - Antiinflammatory medications

The nurse is obtaining a health history from a client and is assessing for risk factors associated with osteoporosis. The nurse would be mostconcerned if which data were obtained? Select all that apply.

-The client reports that she doesn't exercise much at all. - The client reports that she smokes a few cigarettes a day. - The client reports that she is taking phenytoin to treat a seizure disorder. - The client reports that she takes a daily low dose of prednisone to treat a chronic respiratory condition.

how many types of traction are there

2 types skeletal and skin (buck's traction)

The nurse is repositioning a client who has been returned to the nursing unit after internal fixation of a fractured right hip with a femoral head replacement. The nurse should use which method to reposition the client?

A pillow to keep the right leg abducted during turning

The nurse is planning to teach a client how to stand on crutches. The nurse will incorporate into written instructions that the client should be told to place the crutches in what manner?

6 inches (15 cm) to the front and side of the toes

A client has had surgery to repair a fractured left hip. When repositioning the client from side to side in the bed, what should the nurse plan to use as the most important item for this maneuver?

Abductor splint (abduction take away from the body)

A client is being transferred to the nursing unit from the postanesthesia care unit after spinal fusion with rod insertion. The nurse should prepare to transfer the client from the stretcher to the bed by using which best method?

A transfer (slider) board and the assistance of three people

The nurse is reviewing the postprocedure plan of care formulated by a nursing student for a client scheduled for a bone biopsy. The nurse determines that the student needs additional information about postprocedure care if which inaccurate intervention is documented?

Administering opioid analgesics intramuscularly

The nurse is giving a client with a left leg cast crutch-walking instructions using the three-point gait. The client is allowed touch-down of the affected leg. The nurse should tell the client to perform which action?

Advance the crutches along with the left leg, and then advance the right leg.

sign fat embolus is resolving

An altered mental state is an early indication of fat emboli; therefore, clear mentation is a good indicator that a fat embolus is resolving.

The nurse is teaching a client who had a lumbar laminectomy how to perform activities of daily living without causing strain on the back. Which action performed by the client indicates a need for further instruction?

Bends over to tie shoes

A client is treated in a health care provider's office for a sprained ankle after a fall. Radiographic examination has ruled out a fracture. Before sending the client home, the nurse plans to teach the client to avoid which activity in the next 24 hours?

Applying a heating pad Soft tissue injuries such as sprains are treated by RICE (rest, ice, compression, and elevation) for the first 24 hours after the injury. Ice is applied intermittently for 20 to 30 minutes at a time. Heat is not used in the first 24 hours

The nurse is performing an assessment on a client after a closed reduction of a fractured right humerus and application of a plaster cast. To assess for signs of compartment syndrome, the nurse should perform which action?

Assess capillary refill, temperature, color, and amount of pain in the right hand.

A client is complaining of low back pain that radiates down the left posterior thigh. The nurse should ask the client if the pain is worsened or aggravated by which factor?

Bending or lifting

The nurse is caring for a client diagnosed with osteitis deformans (Paget's disease). Which does the nurse identify as the cause of the client's stooped posture and bowing of lower extremities?

Bone resorption and regeneration Paget's disease is characterized by skeletal deformities resulting from abnormal bone resorption followed by abnormal regeneration

The nurse is evaluating goal achievement for a client in traction with impaired physical mobility. The nurse determines that the plan of care needs to be revised if which outcome is noted?

Bowel movement every 4 days

The nurse is caring for the client who has skeletal traction applied to the left leg. The client complains of severe left leg pain. The nurse checks the client's alignment in bed and notes that proper alignment is maintained. Which is the priority nursing action?

Call the health care provider. Severe pain in a client in skeletal traction may indicate a need for realignment, or the traction weights applied to the limb may be too heavy.

The nurse is preparing a plan of care for a client who is scheduled to return from the recovery room after a left total knee arthroplasty. The nurse includes in the plan of care to assess the client's neurovascular status the monitoring of which parameter?

Capillary refill, sensation, color, and pulse of the left foot The nurse would check capillary refill, sensation, color, and pulse of the affected extremity in a neurovascular assessment

A client is admitted to the emergency department with an open fracture of the right tibia. What intervention is most appropriatefor this client?

Check the neurovascular status of the area distal to the extremity.

The nurse is caring for a client with a fractured tibia and fibula. Eight hours after a long leg cast is applied, the client reports a significant increase in pain level even after administration of the prescribed dose of opioid analgesic. What is the initial nursing action?

Check the neurovascular status of the toes on the casted leg.

The nurse is assigned to care for a client in traction. The nurse creates a plan of care for the client and should include which action in the plan?

Check the weights to ensure that they are off of the floor.

A client has been diagnosed with gout, and the nurse provides dietary instructions. The nurse determines that the client needs additional teaching if the client states that it is acceptable to eat which food?

Chicken liver Liver and other organ meats should be omitted from the diet of a client who has gout because of their high purine content. Purines are a form of protein

The nurse is providing instructions to a client regarding ambulation after the application of a fiberglass cast to the lower leg. The nurse determines that the client understands the instructions if the client states that weight bearing on the casted leg can begin at which time period?

Within 20 to 30 minutes of application

The nurse is caring for a client being treated for fat embolus after multiple fractures. Which data would the nurse evaluate as the most favorable indication of resolution of the fat embolus?

Clear mentation

The nurse is caring for a client with a radius fractured across the shaft and bone splintered into fragments. Information about which type of fracture should be included by the nurse in the client's education?

Comminuted fracture

The nurse is caring for a client who had surgery to repair a fractured left-sided hip using a posterior approach. In implementing hip precautions, which action should the nurse teach the client to avoid?

Crossing legs at the ankle

The home care nurse is providing instructions to a client regarding the use of crutches. The client asks the nurse to demonstrate the method for going down the stairs with the crutches. How should the nurse accurately demonstrate this technique?

Crutches and the affected leg down, followed by the unaffected leg

crutch measurement

Crutches are measured so that the tops are 2 to 3 fingerwidths from the axillae. This ensures that the client's axillae are not resting on the crutch or bearing the weight of the crutch, which could result in injury to the nerves of the brachial plexus.

The nurse is caring for a client diagnosed with osteomyelitis. Which mechanism of the disease process can result in necrosis of the bone?

Devascularization

The nurse is preparing to perform pin site care for a client in skeletal traction. On assessment of the pin site, the nurse notes the presence of serous drainage. Which nursing action would be appropriate?

Document the findings

The nurse is caring for a client who was just admitted to the hospital with a diagnosis of a fractured right hip sustained from a fall 5 hours earlier. The nurse creates a plan of care for the client and includes interventions related to monitoring for signs of fat embolism. Which findings should be listed in the care plan as a sign/symptom of fat embolism?

Dyspnea and chest pain The signs of fat embolism are associated with alterations in respiratory status or neurological status. Dyspnea, petechiae, and chest pain are signs of fat embolism.

The nurse is receiving a client from the postanesthesia care unit following left above-knee amputation. Which is the priority nursing action at this time?

Elevate the foot of the bed. Edema of the residual limb is controlled by elevating the foot of the bed for the first 24 hours after surgery. After the first 24 hours, the residual limb is placed flat on the bed to reduce hip contracture

The nurse is caring for a client who has just had a plaster leg cast applied. The nurse should plan to prevent the development of compartment syndrome by performing which action?

Elevate the limb slightly.

The nurse is admitting a client with multiple trauma injuries to the nursing unit. The client has a leg fracture and had a plaster cast applied. Which position would be best for the casted leg?

Elevated on pillows continuously for 24 to 48 hours

The nurse is assessing a client with a shortened, adducted, and externally rotated left leg. On the basis of this finding, which condition should the nurse anticipate?

Fracture of the femoral neck Typical signs after femoral neck fracture include shortening of the affected leg, adduction, and external rotation.

A client is being discharged to home after application of a plaster leg cast. Which statement indicates that the client understands proper care of the cast?

I need to avoid getting the cast wet."

Which teaching point is the priority when the nurse is teaching the client about caring for a plaster cast?

Immediately report any increase in drainage or interruption in cast integrity. Increases in drainage or interruption in cast integrity will affect healing and could lead to osteomyelitis.

A client has sustained a closed fracture and has just had a cast applied to the affected arm. The client is complaining of intense pain. The nurse elevates the limb, applies an ice bag, and administers an analgesic, with little relief. Which problem may be causing this pain?

Impaired tissue perfusion

The nurse is performing a neurovascular assessment on a client with a cast on the left lower leg. The nurse notes the presence of edema in the foot below the cast. The nurse should make which interpretation about this finding?

Impaired venous return

The nurse has a prescription to place a client with a herniated lumbar intervertebral disk on bed rest in Williams' position to minimize the pain. The nurse should put the bed in what position?

In semi Fowler's position, with the knees slightly flexed

The nurse is caring for a client at risk for fat embolism because of a fracture of the left femur and pelvis sustained in a fall. The client also sustained a head injury, is comatose, and is unable to communicate verbally. Which assessment findings should the nurse identify as early signs of possible fat embolism?

Increased heart rate and adventitious breath sounds

A client immobilized in skeletal leg traction complains of being bored and restless. Based on these complaints, the nurse identifies which client problem as the priority?

Inability to entertain self

A client being measured for crutches asks the nurse why the crutches cannot rest up underneath the arm for extra support. The nurse responds knowing that which would most likely result from this improper crutch measurement?

Injury to the brachial plexus nerves

The nurse is caring for a client with a hip fracture who has just been placed in Buck's traction. What intervention is most importantfor the nurse to perform?

Inspect the skin at least every 8 hours for signs of irritation or inflammation.

The nurse is assigned to care for a client who is in Buck's traction. The nurse prepares a plan of care for the client and includes which nursing action in the plan?

Inspect the skin under the boot at least every 8 hours. When possible, remove the belt or boot that is used for skin traction every 8 hours to inspect under the device for skin irritation and breakdown

A client has been diagnosed with subluxation of the shoulder. The nurse explains to the client that which injury has occurred to the joint?

It has incompletely dislocated. A subluxation is an incomplete dislocation of the joint surfaces.

The nurse is preparing a client for an arthroscopy of the knee. When providing teaching, which information is essential for the nurse to include?

It will identify if there is joint injury and provide a route for surgical repair if indicated. Arthroscopy is used to diagnose acute and chronic conditions of the joint. In addition, surgical repairs can be done during this procedure

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

Left heel Common areas that are under pressure and are at risk for breakdown include the heel of the good leg (which is used as a brace when pushing up in bed). The right heel is elevated because of traction.

The nurse is teaching a client with a right arm cast how to prevent stiff or frozen shoulder. What should the nurse instruct the client to do?

Lift the shoulder of the casted arm over the head periodically throughout the day.

The nurse is lecturing to a group of women who are at high risk for osteoporosis. The nurse should inform the women about which most important measure?

Limit caffeine intake. Excessive caffeine intake can increase calcium loss in the urine

A client has undergone fasciotomy to treat compartment syndrome of the leg. The nurse should anticipate that which type of wound care to the fasciotomy site will be prescribed?

Moist sterile saline dressings The fasciotomy site is not sutured but is left open to relieve pressure and edema. The site is covered with moist sterile saline dressings.

fracture pain

Most pain associated with fractures can be minimized with rest, elevation, application of cold, and administration of analgesics. Pain that is not relieved by these measures should be reported to the health care provider because pain unrelieved by medications and other measures may indicate neurovascular compromise.

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

Moves the cane when the right leg is moved

The nurse is caring for a client admitted for a herniated intervertebral lumbar disk who is complaining about stabbing pain radiating to the lower back and the right buttock. The nurse determines that the client's signs/symptoms are most likely due to which condition?

Muscle spasm in the area of the herniated disk

A client who had a body cast applied 2 days earlier begins to complain of anorexia, nausea, and abdominal discomfort. The nurse should take which immediate action?

Notify the health care provider. The client who has been placed in a body cast is at risk for the development of cast syndrome. This results from pressure on the mesenteric artery and can lead to intestinal obstruction

The nurse has conducted teaching with a client in an arm cast about the signs and symptoms of compartment syndrome. The nurse determines that the client understands the information if the client states that he or she should report which early symptom of compartment syndrome?

Numbness and tingling in the fingers

The nurse is planning measures to increase bed mobility for a client in skeletal leg traction. Which item should the nurse consider to be most helpful for this client?

Overhead trapeze

A client with a fractured femur experiences sudden dyspnea, tachypnea, and tachycardia. A set of arterial blood gas tests reveals the following: pH, 7.35 (7.35); Paco2, 43 mm Hg (43 mm Hg); Pao2, 58 mm Hg (58 mm Hg); HCO3, 23 mEq/L (23 mmol/L). The nurse interprets that the client probably has experienced fat embolus because of the result of which parameter?

Pao2 normal Pao2 is 80-100

The nurse is caring for a client who sustained an open fracture and is diagnosed with acute osteomyelitis of the right lower extremity. Which intervention should the nurse plan to perform?

Perform sterile dressing changes.

The nurse has suggested specific leg exercises for a client immobilized in right skeletal lower leg traction. The nurse determines that the client needs further instruction if the nurse observes the client performing which action?

Performing active range of motion to the right ankle and knee

The client is complaining of skin irritation from the edges of a cast applied the previous day. Which action should the nurse take?

Petal the cast edges with adhesive tape. The nurse petals the edges of the cast with tape to minimize skin irritation.

The home care nurse visits a client who has a cast applied to the left lower leg. On assessment of the client, the nurse notes the presence of skin irritation from the edges of the cast. Which nursing intervention is most appropriate?

Petal the cast edges with appropriate material.

The nurse is caring for an older adult who has been placed in Buck's extension traction after a hip fracture. On assessment of the client, the nurse notes that the client is disoriented. What is the best nursing action based on this information?

Place a clock and calendar in the client's room.

The nurse is caring for a client in skeletal leg traction with an overbed frame. Which nursing intervention will best assist the client with self-positioning in bed?

Place a trapeze on the bed frame to provide a means for the client to lift the hips off the bed.

A client who has experienced nonunion of a fracture is scheduled for bone grafting using cadaver bone. The client appears restless and anxious about the procedure. After determining that the client understands the surgical procedure, the nurse should explore which item next?

Potential worry about contracting hepatitis or possibly human immunodeficiency virus infection

The nurse is assessing the casted extremity of a client. Which sign is indicative of infection?

Presence of a "hot spot" on the cast

The nurse is assisting in performing a physical assessment of a right-handed client's musculoskeletal system. Which would be an abnormal finding?

Presence of fasciculations Fasciculations are fine-muscle twitches that are not normally present.

A client with a hip fracture asks the nurse about Buck's (extension) traction that is being applied before surgery and what is involved. The nurse should provide which information to the client?

Provides comfort by reducing muscle spasms, provides fracture immobilization, and involves pulleys and wheels

A client who has experienced a stroke has partial hemiplegia of the left leg. The nurse interprets that the client could benefit from the support and stability provided by which item?

Quad cane

RICE

Soft tissue injuries such as sprains are treated with RICE (rest, ice, compression, and elevation) for the first 24 to 48 hours after the injury, depending on health care provider prescription. Ice is applied intermittently for 20 to 30 minutes at a time. Heat is not used for the first 24 hours because this could cause venous congestion, thereby increasing edema and pain.

The home health nurse visits a client who is having an acute attack of gout. The nurse determines that the client needs further instruction regarding the treatment of gout if the client states to take which action?

Restricting fluids Ample fluid intake is encouraged to promote the excretion of uric acid.

A client who has been taking high doses of acetylsalicylic acid to relieve pain from osteoarthritis now has more generalized joint pain and an elevated temperature. The nurse should assess for which complication to determine whether the client has other signs of aspirin toxicity?

Ringing in the ears

A client with diabetes mellitus has had a right below-knee amputation. Given the client's history of diabetes mellitus, which complication is the client at most risk for after surgery?

Separation of the wound edges

The nurse is caring for a client admitted for a fractured hip status post fall at home. On assessment of the client's affected lower extremity, which signs/symptoms would most likely be noted?

Shortening and external rotation Signs of a hip fracture include shortening and deformity. The affected leg externally rotates

The nurse is creating a plan of care for a client in skin traction. The nurse should monitor for which priority finding in this client?

Signs of skin breakdown

Skin traction (Buck's traction)

Skin traction is achieved by Ace wraps, boots, or slings that apply a direct force on the client's skin. Traction is maintained with 5 to 8 lb (2.3 to 3.6 kg) of weight, and this type of traction can cause skin breakdown.

A client has been placed in Buck's extension traction. The nurse can provide for countertraction to reduce shear and friction by performing which action?

Slightly elevating the foot of the bed For the client in Buck's extension traction (which is applied to a leg), the foot of the bed is elevated.

The nurse is caring for a client with a swollen left ankle who has difficulty bearing weight on this leg and states that he twisted his ankle. Based on these findings, which condition does the nurse determine the client has most likelyexperienced?

Sprain A sprain is an injury to a ligament caused by a twisting motion. Signs and symptoms include pain, swelling, and inability to use the joint or bear weight normally

The clinic nurse is performing an assessment on a client with a diagnosis of rheumatoid arthritis (RA). The nurse checks for which assessment finding that is associated with RA?

Systemic symptoms such as fatigue, anorexia, and weight loss

A client has just been admitted to the hospital with a fractured femur and pelvic fractures. The nurse should plan to carefully monitor the client for which signs/symptoms?

Tachycardia and hypotension Clients who experience fractures of the femur, pelvis, thorax, and spine are at risk for hypovolemic shock. Bone fragments can damage blood vessels, leading to hemorrhage into the abdominal cavity and the thigh

A client was admitted to the hospital 2 hours ago following multiple fractures to the pelvis and soft tissue injury to the abdomen. Diagnostic studies have ruled out perforation of abdominal organs. The nurse places highest priority on monitoring this client for which changes in vital signs?

Tachycardia, hypotension Clients who experience fractures of the femur, pelvis, thorax, and spine are at risk for hypovolemic shock. Bone fragments can damage blood vessels, leading to hemorrhage into the abdominal cavity and, in the case of a fractured femur, into the thigh.

The nurse is caring for a client diagnosed with the rotator cuff lesion. The nurse assesses the client knowing that the client most likely has which structure affected?

Tendon

The nurse in the hospital emergency department is assessing a client with an open leg fracture. The nurse should inquire about the last time the client had which done?

Tetanus vaccine

The home care nurse has instructed a client how to perform the three-point gait with the use of crutches. The nurse observes the client using this gait to ensure correct performance of the maneuvers. Which observation, if made by the nurse, would indicate that the client understands how to perform this type of gait?

The client moves both crutches forward, along with the affected leg, and then moves the unaffected leg forward.

The nurse is preparing to teach a client how to safely use crutches. Before initiating the teaching, the nurse performs an assessment on the client. The priority nursing assessment should include which information?

The client's vital signs, muscle strength, and previous activity level

The nurse is planning to teach proper use of a thoracolumbosacral orthosis to a client who has had spinal fusion with instrumentation. The nurse should include which teaching point in the discussion with the client?

The device is applied before getting out of bed in the morning. If not required constantly, the brace is applied in the morning before getting out of bed.

The earliest symptom of compartment syndrome is paresthesia (numbness and tingling in the fingers). Other symptoms include pain unrelieved by opioids, pain that increases with limb elevation, and pallor and coolness to the distal limb. Cyanosis is a late sign. Pain that is out of proportion to the severity of the fracture,

The earliest symptom of compartment syndrome is paresthesia (numbness and tingling in the fingers). Other symptoms include pain unrelieved by opioids, pain that increases with limb elevation, and pallor and coolness to the distal limb. Cyanosis is a late sign. Pain that is out of proportion to the severity of the fracture,

The nurse is caring for a client admitted for a torn meniscus. What is the focus of the nurse's immediate assessment?

The knee The knee is a common area for meniscal tears because it is frequently injured as a result of falls and sports injuries

A client is having a plaster cast placed on the lower extremity that will extend from mid-thigh to the center of the foot. Which instruction should be given to the client before hospital discharge?

The need to notify the health care provider immediately if the client notices numbness or swelling or if the foot becomes cold and pale

The nurse is caring for a client with a long bone fracture at risk for fat embolism. The nurse specifically monitors for the earliest signs of this complication by performing an assessment of which item(s)?

The neurological and respiratory systems. The early signs of the complication of fat embolism include changes in the client's mental status and signs of impaired respiratory function

The nurse is planning to teach the client with below-the-knee amputation about care to prevent skin breakdown. Which point should the nurse include in developing the teaching plan?

The socket of the prosthesis must be dried carefully before it is used.

The nurse is providing care for a client admitted 3 days ago with a severe left ankle contusion. The nurse determines that heat application to the area has been effective if which has occurred?

There is reabsorption of blood noted at the injured site. The primary benefit from applying heat to a contusion is to speed up the rate of absorption of blood

Buck's Traction (skin traction)

To achieve proper traction, weights need to be free-hanging, with knots kept away from the pulleys. Weights should not be kept resting on a firm surface. The head of the bed is usually kept low to provide countertraction

A client is complaining of pain underneath a cast in the area of a bony prominence. The nurse interprets that this client may need which intervention?

To have a window cut in the cast A window may be cut in a dried cast to relieve pressure in an area of a bony prominence, to assess pulses, to relieve discomfort, or to remove drains

The nurse is caring for a client with a diagnosis of gout. Which laboratory value would the nurse expect to note in the client?

Uric acid level of 9.0 mg/dL (0.54 mmol/L In addition to the presence of clinical manifestations, gout is diagnosed by the presence of persistent hyperuricemia, with a uric acid level higher than 8 mg/dL

The nurse determines that a client's skeletal traction needs correction if which observation is made?

Traction ropes rest against the footboard. Traction ropes must hang free of the bed

The nurse develops a plan of care for a client with a spica cast that covers a lower extremity and documents that the client is at risk for constipation. When planning for bowel elimination needs, the nurse should include which in the plan of care?

Use a fracture pan for bowel elimination.

The nurse is developing a plan of care for a client in Buck's traction. The plan of care should include assessing the client for which finding indicating a complication associated with the use of this type of traction?

Weak pedal pulses Weak pedal pulses are a sign of vascular compromise, which can be caused by pressure on the tissues of the leg by the elastic bandage used to secure the traction system

Buck's Traction

a type of skin traction. The nurse inspects the skin of the limb in traction at least once every 8 hours for irritation or inflammation. There are no pins to care for with skin traction. Massaging the skin with lotion is not indicated. The nurse never releases the weights of traction unless specifically prescribed by the health care provider.

fat embolsim

can occur long bones

The nurse is planning discharge teaching for a client admitted with a fracture of the leg that does not extend all the way through the bone. The nurse should include information about which types of fractures?

incomplete

total knee arthroplasty

knee replacement Pain with knee extension is a common complaint of clients after knee arthroplasty; therefore, administering an analgesic would be the appropriate action

Osteomalacia

softening of your bones, most often caused by severe vitamin D deficiency. The softened bones of children and young adults with osteomalacia can lead to bowing during growth, especially in weight-bearing bones of the legs. Osteomalacia in older adults can lead to fractures.

compartment syndrome 5 P's

unrelieved pain, paresthesia, pallor, paralysis, pulselessness (fasciotomy)

The nurse has reviewed activity restrictions with a client who is being discharged after insertion of a femoral head prosthetic system. What statement by the client will help the nurse determine that the client understands the material presented?

use a raised toilet The client who has had an insertion of a femoral head prosthesis should use a raised toilet seat