musculoskeletal ULTIMATE NCLEX queries

The nurse admits a 55-year-old female with multiple sclerosis to a long-term care facility. Which finding is of most immediate concern to the nurse? a. Ataxic gait b. Radicular pain c. Severe fatigue d. Urinary retention

A An ataxic gait is a staggering, uncoordinated gait. Fall risk is the highest in individuals with gait instability or visual or cognitive impairments. The other signs and symptoms (e.g., fatigue, urinary retention, radicular pain) may also occur in the patient with multiple sclerosis and need to be managed, but are not the priority.

When working with patients, the nurse knows that patients have the most difficulties with diarthrodial joints. Which joints are included in this group of joints (select all that apply)? a. Hinge joint of the knee b. Ligaments joining the vertebrae c. Fibrous connective tissue of the skull d. Ball and socket joint of the shoulder or hip e. Cartilaginous connective tissue of the pubis joint

A, D The diarthrodial joints include the hinge joint of the knee and elbow, the ball and socket joint of the shoulder and hip, the pivot joint of the radioulnar joint, and the condyloid, saddle, and gliding joints of the wrist and hand. The ligaments and cartilaginous connective tissue joining the vertebrae and pubis joint and the fibrous connective tissue of the skull are synarthrotic joints

46. The nurse administering the drug colchicine for gout will give 0.5 mg hourly for hours.

ANS: 12 Colchicine is given orally in a dose of 0.5 mg for a period of 12 hours or until relief from pain is achieved or diarrhea occurs. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1354 OBJ: 8 TOP: Colchicine KEY: Nursing Process Step: Implementation

48. The nurse takes into consideration that a healing fracture progresses through several healing stages. Place the stages in order of healing. (Separate letters by a comma and space as follows: A, B, C, D) a. Development of fibrin meshwork b. Collagen fibers collect calcium c. Osteoblasts home fracture site form d. Callus e. Formation of hematoma f. Clot formation g. Vascularization

ANS: F, E, A, C, G, B, D The healing stages of a fracture start with a clot formation, which leads to a hematoma. The development of a fibrin meshwork, which traps osteoblasts to keep the fracture site firm, vascularization, collagen fibers collect calcium to make the callus. Topic: Fracture healing Nursing Process Step: Planning Objective: 15 Cognitive Level: Analysis NCLEX: Physiological Integrity Text Reference: Page 4-64 PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1371 OBJ: 15 TOP: Fracture healing KEY: Nursing Process Step: Planning

43. The division of the skeletal system that comprises the skull, hyoid, vertebral column, and thorax is the division.

ANS: axial The axial division of the skeletal system is comprised of the skull, hyoid, vertebral column, and the throat. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1336 OBJ: 2 TOP: Skeletal divisions KEY: Nursing Process Step: Implementation

1. What is the movement of an extremity away from the midline of the body called? a. Abduction b. Adduction c. Flexion d. Extension

ANS: A Abduction is movement of an extremity away from the midline of the body. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1339 OBJ: 6 TOP: Movements KEY: Nursing Process Step: Implementation

12. Which finding would delay a computed tomography (CT) scan? a. Patient's allergy to shellfish b. Patient in first trimester of a pregnancy c. Patient's allergy to milk products d. Patient's gluten intolerance

ANS: A Allergy to shellfish predicts an allergy to the contrast media used in the CT scan. PTS: 1 DIF: Cognitive Level: Application REF: Page 1342 OBJ: 7 TOP: CT scan KEY: Nursing Process Step: Assessment

27. What should the nurse stress to a post-hip replacement patient in quadriceps setting exercises? a. Push knee down to mattress and raise heel off the bed b. Flex knee and extend foot c. Adduct leg and flex foot d. Lift leg and heel off the bed

ANS: A Pushing the knee down into the mattress and raising the heel will strengthen the quadriceps muscles. PTS: 1 DIF: Cognitive Level: Application REF: Page 1367, Patient Teaching OBJ: 14 TOP: Quad setting KEY: Nursing Process Step: Implementation

31. How is rheumatoid arthritis distinguished from osteoarthritis? a. Rheumatoid arthritis is an autoimmune, systemic disease; osteoarthritis is a degenerative disease of the joints. b. Rheumatoid arthritis is an autoimmune, degenerative disease; osteoarthritis is a systemic inflammatory disease. c. People with osteoarthritis are considered to be genetically predisposed; there is no known genetic component to rheumatoid arthritis. d. Osteoarthritis is often caused by a virus; viruses play no part in the pathogenesis of rheumatoid arthritis.

ANS: A RA is thought to be an autoimmune disorder. Degenerative joint disease is also known as osteoarthritis. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1344, Table 43-4 OBJ: 8 TOP: Rheumatoid arthritis KEY: Nursing Process Step: Assessment

14. What is the first priority nursing intervention for an impending fat embolism? a. Administer oxygen in a respiratory emergency b. Increase intravenous fluids c. Position in flat position to ease decreased blood pressure d. Cover with warm blanket

ANS: A The airway is always the first priority. If hypoxia is present, the physician will order the administration of oxygen. It is important for the nurse to check the liter flow of oxygen and educate patients and their families as to safety precautions necessary when oxygen is administered. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1377 OBJ: 17 TOP: Fat embolism KEY: Nursing Process Step: Implementation

11. What should the nurse include in the plan of care for a patient following a myelogram? a. Position in a semi-Fowler position for 8 hours to reduce potential of headache b. Place patient flat on back to compress puncture site c. Ambulate for brief periods to lessen postmyelogram headache d. Limit fluids to increase absorption of the dye

ANS: A The patient should be positioned in the semi-Fowler position for 8 hours to encourage the dye to stay in the lower spine and to reduce headache. PTS: 1 DIF: Cognitive Level: Application REF: Page 1340 OBJ: 7 TOP: Myelogram KEY: Nursing Process Step: Implementation

39. Which of the following are the main purposes of traction? (Select all that apply.) a. Align and stabilize a fracture b. Prevent deformities c. Relieve muscle spasms d. Promote bed rest e. Increase circulation to the rest of the body

ANS: A, B, C Skin and skeletal traction provide alignment and stabilize a fracture. This prevents deformities and relieves muscle spasms by putting muscles under tension until they are fatigued. PTS: 1 DIF: Cognitive Level: Application REF: Page 1383 OBJ: N/A TOP: Traction KEY: Nursing Process Step: Assessment

42. Which instructions should the nurse include in a teaching plan for a person with gouty arthritis? (Select all that apply.) a. Avoid excessive alcohol. b. Maintain rest and immobility while disease is symptomatic. c. Check urine and urine output for possible kidney stones. d. Include food high in purine in the diet. e. Use bed cradle to support linens.

ANS: A, B, C, E The person with gout should avoid alcohol and food with high purine content, maintain rest and immobility while symptomatic, and check urine and urine output for possible kidney stones. PTS: 1 DIF: Cognitive Level: Application REF: Page 1354 OBJ: 8 TOP: Gout KEY: Nursing Process Step: Implementation

40. The characteristics of osteoarthritis that should be included in a teaching plan would include that osteoarthritis (select all that apply): a. will cause the formation of Heberden nodes. b. can involve other organs. c. results from wear and tear. d. may affect only one side of the body. e. may cause constitutional symptoms of fatigue and fever. f. will cause marked erythema and edema of hands.

ANS: A, C, D Osteoarthritis is a disease caused by wear and tear of the joints, causing the appearance of Heberden nodes on the fingers without marked edema or erythema. The disease may only affect one side of the body and does not cause constitutional symptoms. PTS: 1 DIF: Cognitive Level: Application REF: Page 1344, Table 43-4 OBJ: 10 TOP: Osteoarthritis KEY: Nursing Process Step: Planning

38. What does prolonged bed rest put the older adult at risk for? a. Ankylosing spondylitis b. Pathologic fractures c. Osteomyelitis d. Gout

ANS: B Immobilization results in bone resorption, and the bone tissue becomes less dense. Prolonged bed rest puts the patient at risk for pathologic fracture. This is a serious concern for an older adult in terms of regaining mobility. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1344 OBJ: 11 TOP: Disorders of musculoskeletal system KEY: Nursing Process Step: Assessment

32. Which patient is most likely to develop osteoporosis? a. 43-year-old African American woman b. 57-year-old white woman c. 48-year-old African American man d. 62-year-old Latino woman

ANS: B White and Asian women have a higher incidence of osteoporosis than African American women or Hispanic women because of the greater bone density in the African American. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1356, Culture OBJ: 11 TOP: Osteoporosis KEY: Nursing Process Step: Assessment

41. What are the three vital functions muscles perform when they contract? (Select all that apply.) a. Absorb uric acid b. Maintenance of posture c. Motion d. Store minerals e. Production of heat f. To assist in return of venous blood to the left side of the heart

ANS: B, C, E The three vital functions muscles perform when they contract are maintenance of posture, motion, and production of 85% of body heat. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1336 OBJ: 6 TOP: Functions of muscular system KEY: Nursing Process Step: Assessment

25. A patient has undergone a bipolar hip repair (hemiarthroplasty). Which is the most appropriate instruction? a. Sit in whatever position is most comfortable b. Sit in a firm, straight-backed chair at a 90-degree angle c. Avoid crossing the legs d. Begin full weight bearing as soon as tolerated

ANS: C Instructing the patient not to cross the legs is important because crossing the legs can adduct the affected extremity and dislocate the hip. PTS: 1 DIF: Cognitive Level: Application REF: Page 1367, Figure 43-18 OBJ: 14 TOP: Hip replacement KEY: Nursing Process Step: Implementation

3. What should the nurse instruct the patient before a magnetic resonance imaging (MRI) procedure? a. Void to completely empty the bladder b. Omit all citrus food for 12 hours before the procedure c. Remove all metal, such as jewelry, glasses, and hair clips d. Wear only cotton garments for the procedure

ANS: C MRI procedures require that the patient remove all metal because it will become magnetized. PTS: 1 DIF: Cognitive Level: Application REF: Page 1341 OBJ: 7 TOP: Diagnostic examinations KEY: Nursing Process Step: Assessment

6. The patient that has a bipolar hip replacement following an intracapsular fracture has an order to be turned every 2 hours. The nurse understands that the correct nursing intervention is to keep the legs: a. together so they do not separate while turning. b. flexed to stabilize the prosthesis. c. abducted so the prosthesis does not become dislocated. d. adducted to prevent additional pain for the patient with turning.

ANS: C Nursing interventions also involve postoperative maintenance of leg abduction by using an abduction splint for 7 to 10 days to prevent dislocation of the prosthesis. PTS: 1 DIF: Cognitive Level: Application REF: Page 1367, Figure 43-13 OBJ: 14 TOP: Maintaining abduction KEY: Nursing Process Step: Implementation

36. Calcium is a mineral found in many foods that can slow bone loss during the aging process. Which food is high in calcium? a. Oranges b. Bananas c. Spinach d. Eggs

ANS: C Spinach and green vegetables, as well as yogurt, are considered calcium-rich foods. Fresh oranges, bananas, and eggs are not good calcium choices. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1355, Patient Teaching OBJ: 11 TOP: Osteoporosis KEY: Nursing Process Step: Implementation

35. In order for a patient to flex the lower leg, which muscle must be contracted? a. Quadriceps b. Gastrocnemius c. Biceps femoris d. Rectus femoris

ANS: C The contraction of the biceps femoris allows for the contraction of the lower leg. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1335, Table 43-1 OBJ: 4 TOP: Muscle action KEY: Nursing Process Step: Implementation

7. A patient has been casted to stabilize a fracture of the right radius and ulna. The nurse assesses a capillary refill of 5 seconds and cold fingers of the right hand. Which initial intervention should the nurse deploy? a. Notify the charge nurse of a probable compartment syndrome b. Apply a warm compress to the fingers to relieve swelling c. Elevate the right hand to heart level to maintain arterial pressure d. Cut the cast off to release constriction

ANS: C The nurse should first elevate the right hand to heart level and notify the charge nurse. Permanent damage can occur in as little time as 6 hours. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1375 OBJ: 19 TOP: Compartment syndrome KEY: Nursing Process Step: Implementation

26. The nurse explains to a patient who has had a knee replacement that warfarin (Coumadin) is ordered to: a. increase the red blood cells. b. reduce the threat of hemorrhage. c. prevent formation of emboli. d. help stabilize the prosthesis.

ANS: C Warfarin (Coumadin) is a standard postsurgical drug to prevent the formation of emboli. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1367 OBJ: 13 TOP: Coumadin therapy KEY: Nursing Process Step: Implementation

29. What should the nurse stress to a patient who has had a hip replacement and is beginning strengthening exercises for the unaffected leg? a. Flex the knee and flex the foot b. Lift the leg from the mattress and rotate the foot c. Pull knee to chest and extend the foot d. Push foot down against the footboard for a count of five

ANS: D The unaffected leg should be strengthened by pushing the foot down against the footboard for a count of five and repeating frequently during the day. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1367, Patient Teaching OBJ: 13 TOP: Exercise KEY: Nursing Process Step: Implementation

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

Answer: A Rationale: A family history of height loss with aging may indicate osteoporosis, and the patient may need to consider preventative actions, such as calcium supplements. A sprained ankle 2 years previously will not cause any current or future musculoskeletal problems. A family history of tuberculosis is not a risk factor. Occasional nonsteroidal antiinflammatory drug (NSAID) use does not indicate any increased musculoskeletal risk. Cognitive Level: Application Text Reference: p. 1621 Nursing Process: Assessment NCLEX: Health Promotion and Maintenance

Based on the nurse's understanding of the physiology of bone and cartilage, the injury that the nurse would expect to heal most rapidly is a a. fracture of the midhumerus. b. torn knee cruciate ligament. c. fractured nose. d. severely sprained ankle.

Answer: A Rationale: Bone is dynamic tissue that is continually growing. Nasal fracture, sprains, and ligament tears injure cartilage, tendons, and ligaments, which are slower to heal. Cognitive Level: Application Text Reference: p. 1615 Nursing Process: Assessment NCLEX: Physiological Integrity

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

Answer: A Rationale: Fever, chills, and night sweats are suggestive of osteomyelitis. The other clinical manifestations are typical after a fracture repair. Cognitive Level: Application Text Reference: p. 1669 Nursing Process: Assessment NCLEX: Physiological Integrity

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

Answer: A Rationale: Footdrop is an indication that the foot is not being supported in a neutral position by a splint. Using crutches and monitoring the oral temperature are appropriate self-care activities. Frustration with the length of treatment is not an indicator of ineffective management of the osteomyelitis. Cognitive Level: Application Text Reference: p. 1672 Nursing Process: Diagnosis NCLEX: Health Promotion and Maintenance

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

Answer: A Rationale: The shank of the shoe should be rigid enough to support the foot. The other patient statements indicate that the teaching has been effective. Cognitive Level: Application Text Reference: pp. 1684-1685 Nursing Process: Evaluation NCLEX: Physiological Integrity

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

Answer: B Rationale: Bone pain is one of the common early manifestations of Paget's disease, and the nurse should ask about improvement in pain levels to determine whether the treatment is effective. Weight loss, anorexia, and frequent cough are not symptoms of Paget's disease. Cognitive Level: Application Text Reference: p. 1690 Nursing Process: Evaluation NCLEX: Physiological Integrity

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

Answer: B Rationale: Bursae are fluid-filled sacs that cushion joints and bony prominences. Fibrocartilage is a solid tissue that cushions some joints. Bursae are a specific type of connective tissue. The synovial membrane lines many joints but is not a bursa. Cognitive Level: Comprehension Text Reference: p. 1618 Nursing Process: Implementation NCLEX: Physiological Integrity

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

Answer: B Rationale: Gentamicin is nephrotoxic and can cause renal failure. Monitoring the patient's temperature before gentamicin administration is not necessary. Nausea is not a common side effect of IV gentamicin. There is no need to change the dressing before gentamicin administration. Cognitive Level: Application Text Reference: p. 1670 Nursing Process: Assessment NCLEX: Physiological Integrity

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

Answer: B Rationale: Osteogenic sarcoma is an aggressive cancer with early metastasis and is not considered cured by surgery alone. Postoperative chemotherapy will also be required. The other patient statements indicate that patient teaching has been effective. Cognitive Level: Application Text Reference: p. 1674 Nursing Process: Evaluation NCLEX: Physiological Integrity

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

Answer: C Rationale: DEXA testing is painless and noninvasive. No IV access is necessary. Contrast medium is not used. Because the procedure is painless, no antianxiety medications are required. Cognitive Level: Application Text Reference: p. 1625 Nursing Process: Implementation NCLEX: Physiological Integrity

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

Answer: C Rationale: The decreased height and the patient's age suggest that the patient may have osteoporosis and that bone density testing is needed. Diskography, MRI, and myelography are typically done for patients with current symptoms caused by musculoskeletal dysfunction and are not the initial diagnostic test for osteoporosis. Cognitive Level: Application Text Reference: pp. 1619, 1625 Nursing Process: Planning NCLEX: Health Promotion and Maintenance

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

Answer: D Rationale: Logrolling is used to maintain correct body alignment after laminectomy. The other positions will create misalignment of the spine. Cognitive Level: Application Text Reference: p. 1683 Nursing Process: Implementation NCLEX: Physiological Integrity

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

Answer: D Rationale: MRI is most useful in assessing for soft tissue injuries. Bone scanning and standard radiographs are used to assess for injures or lesions of bone. Arthroscopy is used for visualizing the joints. Cognitive Level: Comprehension Text Reference: p. 1625 Nursing Process: Assessment NCLEX: Physiological Integrity

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

Answer: D Rationale: Patients with permanent pacemakers cannot have MRI. An open MRI will not cause claustrophobia. The patient will need to be instructed to remove the hearing aid before the MRI, but this does not require consultation with the health care provider. Contrast medium will not be used, so shellfish allergy is not a contraindication to MRI. Cognitive Level: Application Text Reference: p. 1625 Nursing Process: Assessment NCLEX: Physiological Integrity

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

Answer: D Rationale: The goal for the patient with muscular dystrophy is to keep the patient active for as long as possible. The patient would not be confined to bed rest and would not require logrolling. Muscle biopsies are necessary to confirm the diagnosis but would not be ordered for a patient who already had a diagnosis. There is no indication that the patient requires a pureed diet. Cognitive Level: Application Text Reference: p. 1675 Nursing Process: Planning NCLEX: Physiological Integrity

The home care nurse visits an 84-year-old woman with pneumonia after her discharge from the hospital. Which assessment finding would the nurse expect because of age-related changes in the musculoskeletal system? a. Positive straight-leg-raising test b. Muscle strength is scale grade 3/5 c. Lateral S-shaped curvature of the spine d. Fingers drift to the ulnar side of the forearm

B Decreased muscle strength is an age-related change of the musculoskeletal system caused by decreased number and size of the muscle cells. The other assessment findings indicate musculoskeletal abnormalities. A positive straight-leg-raising test indicates nerve root irritation from intervertebral disk prolapse and herniation. An ulnar deviation or drift indicates rheumatoid arthritis due to tendon contracture. Scoliosis is a lateral curvature of the spine.

A 54-year-old patient admitted with cellulitis and probable osteomyelitis received an injection of radioisotope at 9:00 AM before a bone scan. The nurse should plan to send the patient for the bone scan at what time? a. 9:30 PM b. 10:00 AM c. 11:00 AM d. 1:00 PM

C A technician usually administers a calculated dose of a radioisotope 2 hours before a bone scan. If the patient was injected at 9:00 AM, the procedure should be done at 11:00 AM. 10:00 AM would be too early; 1:00 PM and 9:30 PM would be too late.

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

Correct Answer: A Rationale: The goal of hand surgery in RA is to restore function, not to correct for cosmetic deformity or treat the underlying process. Cognitive Level: Application Text Reference: p. 1664 Nursing Process: Evaluation NCLEX: Physiological Integrity

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

Correct Answer: C Rationale: Buck's traction keeps the leg immobilized and reduces muscle spasm. Flexion contractures are not likely to occur during the short time before surgery. Displacement of the hip is prevented by keeping the patient on bed rest before surgery. The leg is externally rotated because of the hip fracture, not because of traction. Cognitive Level: Comprehension Text Reference: p. 1653 Nursing Process: Implementation NCLEX: Physiological Integrity

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

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

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

Correct Answer: C Rationale: The axilla can become excoriated when a sling is used to support the arm, and the nurse should check the axilla and apply absorbent dressings to prevent this. A patient with a sling would not have traction applied by hanging. The patient will be encouraged to move the fingers on the injured arm to maintain function and to help decrease swelling. The patient will do active ROM on the uninjured side. Cognitive Level: Application Text Reference: p. 1640 Nursing Process: Planning NCLEX: Physiological Integrity

A patient is scheduled for an electromyogram (EMG). The nurse explains that this diagnostic test involves a. incision or puncture of the joint capsule. b. insertion of small needles into certain muscles. c. administration of a radioisotope before the procedure. d. placement of skin electrodes to record muscle activity.

Correct answer: b Rationale: Electromyography (EMG) is an evaluation of electrical potential associated with skeletal muscle contraction. Small-gauge needles are inserted into certain muscles and attached to leads that record electrical activity of muscle. Results provide information related to lower motor neuron dysfunction and primary muscle disease.

The bone cells that function in the resorption of bone tissue are called a. osteoids. b. osteocytes. c. osteoclasts. d. osteoblasts.

Correct answer: c Rationale: Osteoclasts participate in bone remodeling by assisting in the breakdown of bone tissue.

When grading muscle strength, the nurse records a score of 3, which indicates a. no detection of muscular contraction. b. a barely detectable flicker of contraction. c. active movement against full resistance without fatigue. d. active movement against gravity but not against resistance.

Correct answer: d Rationale: Muscle strength score of 3 indicates active movement only against gravity and not against resistance (see Table 62-4).

The nurse would anticipate administering which medication to clients receiving high-dose methotrexate (Trexall)? A. Cisplatin (Platinol) B. Bleomycin (Blenoxane) C. Leucovorin (Wellcovorin) D. Dactinomycin (Cosmegen)

c

A 50-year-old patient is reporting a sore shoulder after raking the yard. The nurse should suspect which problem? a. Bursitis b. Fasciitis c. Sprained ligament d. Achilles tendonitis

A Bursitis is common in adults over age 40 and with repetitive motion, such as raking. Plantar fasciitis frequently occurs as a stabbing pain at the heel caused by straining the ligament that supports the arch. Achilles tendonitis is an inflammation of the tendon that attaches the calf muscle to the heel bone, not the shoulder, and causes pain with walking or running. A sprained ligament occurs when a ligament is stretched or torn from a direct injury or sudden twisting of the joint, not repetitive motion.

Musculoskeletal assessment is an important component of care for patients on what type of long-term therapy? a. Corticosteroids b. β-Adrenergic blockers c. Antiplatelet aggregators d. Calcium-channel blockers

A Corticosteroids are associated with avascular necrosis and decreased bone and muscle mass. β-blockers, calcium-channel blockers, and antiplatelet aggregators are not commonly associated with damage to the musculoskeletal system.

The nurse is performing a musculoskeletal assessment of an 81-year-old female patient whose mobility has been progressively decreasing in recent months. How should the nurse best assess the patient's range of motion (ROM) in the affected leg? a. Observe the patient's unassisted ROM in the affected leg. b. Perform passive ROM, asking the patient to report any pain. c. Ask the patient to lift progressive weights with the affected leg. d. Move both of the patient's legs from a supine position to full flexion.

A Passive ROM should be performed with extreme caution and may be best avoided when assessing older patients. Observing the patient's active ROM is more accurate and safe than asking the patient to lift weights with her legs.

47. The nurse explains that the use of the brace allows a person with a cervical fracture to be mobile.

ANS: halo Halo braces attach to the skull with pins, which stabilize a cervical vertebral fracture, allowing the patient to be mobile. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1372, Figure 43-21 OBJ: 15 TOP: Halo brace KEY: Nursing Process Step: Implementation

44. A patient's patellar-femoral cartilage has deteriorated due to arthritis. The medial and lateral cartilage is undamaged. This patient is likely to undergo knee replacement surgery.

ANS: partial, unicompartmental Unicompartmental knee arthroplasty is also referred to as partial knee replacement and is performed on patients who have only one of the compartments of the knee affected by arthritis. Topic: Partial knee replacement Nursing Process Step: Planning Objective: 10 Cognitive Level: Comprehension NCLEX: Physiological Integrity Text Reference: Page 4-46 PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1361 OBJ: 10 TOP: Partial knee replacement KEY: Nursing Process Step: Planning

45. The emergency department nurse assesses the two cardinal signs of a hip fracture in a newly admitted patient, which are the of the injured leg and the rotation of that same leg.

ANS: shortening, external The two cardinal signs of a fractured hip are the appearance of the shortening of the affected leg and the external rotation of that same leg. PTS: 1 DIF: Cognitive Level: Application REF: Page 1366 OBJ: N/A TOP: Signs of hip fracture KEY: Nursing Process Step: Assessment

19. When the patient with rheumatoid arthritis complains about the daily exercise, the nurse encouragingly reminds the patient that exercises: a. keeps the joints from "freezing." b. will ensure better sleep. c. should be vigorous for joint stimulation. d. need not be done daily.

ANS: A Daily gentle exercises keep the joints from "freezing" and keep the muscles from weakening. PTS: 1 DIF: Cognitive Level: Application REF: Page 1349 OBJ: 8 TOP: Rheumatoid arthritis KEY: Nursing Process Step: Assessment

34. Certain foods may increase the pain associated with gout. Which foods have the highest concentration of purines? a. Brain, liver, kidney b. Lettuce, corn, potatoes c. Beef, pork, chicken d. Fruits and fruit juices

ANS: A Foods high in purines, such as brain, kidney, liver, and heart should be avoided, as well as alcohol. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1354 OBJ: 8 TOP: Gout KEY: Nursing Process Step: Assessment

23. A 16-year-old male patient presents in the emergency room with a pathologic fracture of the left femur and complains of pain on weight bearing. These are cardinal indicators of: a. osteogenic sarcoma. b. osteoporosis. c. rheumatoid arthritis. d. osteochondroma.

ANS: A Osteogenic sarcoma occurs in young men aged 10 to 25. They are malignant bone tumors that can cause a pathologic fracture and they are accompanied by pain on weight bearing. Osteochondromas are benign and usually do not cause fractures. PTS: 1 DIF: Cognitive Level: Application REF: Page 1393 OBJ: 20 TOP: Bone tumor KEY: Nursing Process Step: Assessment

24. The 14-year-old boy who is scheduled for left leg amputation says to the nurse, "What in the world am I going to do with only one leg?" What is the nurse's most therapeutic response? a. "What are you thinking about right now?" b. "With a prosthesis, you will be as good as new." c. "It is way too early to be concerned about that now." d. "When my brother had his leg removed, he did great!"

ANS: A The patient's concern should be acknowledged and the patient encouraged to express feelings. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1394 OBJ: 20 TOP: Fracture of hip KEY: Nursing Process Step: Implementation

33. The patient, age 58, is diagnosed with osteoporosis after densitometry testing. She has been menopausal for 5 years and has been concerned about her risk for osteoporosis because her mother has osteoporosis. In teaching her about her osteoporosis, which information does the nurse include? a. Even with a family history of osteoporosis, the calcium loss from bones can be slowed by increased calcium intake and exercise. b. Estrogen replacement therapy must be started to prevent rapid progression of her osteoporosis. c. With a family history of osteoporosis, there is no way to prevent or slow bone reabsorption. d. Continuous, low-dose corticosteroid treatment is effective in stopping the course of osteoporosis.

ANS: A To prevent osteoporosis, women are advised to have an adequate daily intake of calcium and vitamin D; exercise regularly; avoid smoking; decrease coffee intake; decrease excess protein in the diet; and engage in regular moderate activity such as walking, bike riding, or swimming at least 3 days a week. A contributing factor may be use of steroids. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1355 OBJ: 11 TOP: Osteoporosis KEY: Nursing Process Step: Implementation

16. Which foods should the home health nurse suggest for the patient with osteoporosis to help slow the disease? a. Leafy green vegetables b. Foods high in sodium c. Tea and coffee d. Vitamin A

ANS: A To slow the bone loss, a patient with osteoporosis should eat green leafy vegetables, foods low in sodium, and also avoid caffeine. Vitamin A does not help with the absorption of calcium. PTS: 1 DIF: Cognitive Level: Application REF: Page 1357, Patient Teaching OBJ: 11 TOP: Osteoporosis diet KEY: Nursing Process Step: Implementation

4. The nurse instructs the patient who is to have a unicompartmental knee replacement that a major advantage of this partial knee replacement is that: a. the patient will be up and walking 2 to 3 hours after the operation. b. the kneecap is completely removed. c. the procedure is especially helpful in the treatment of rheumatoid arthritis. d. a small titanium disk replaces the worn cartilage.

ANS: A Unicompartmental knee arthroplasty is also referred to as partial knee replacement in which the worn cartilage is replaced with a plastic disk. It is not as invasive as a full knee replacement and does not disturb the kneecap so that the patient can be up and walking in 2 to 3 hours after surgery. It is not recommended for RA patients. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1361 OBJ: 13 TOP: Unicompartmental knee replacement KEY: Nursing Process Step: Implementation

30. The office nurse has noted the presence of an increase in lumbar curvature in a 20-year-old female patient. What is this condition known as? a. Scoliosis b. Lordosis c. Kyphosis d. Spondylitis

ANS: B Common deformities include an increase in the curve at the lumbar space region that throws the shoulder back, making the "lordly or kingly" appearance that is known as lordosis. Scoliosis involves the S curvature of the spine. Kyphosis is the rounding of the thoracic spine. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1396 OBJ: 22 TOP: Lordosis KEY: Nursing Process Step: Assessment

17. What should the nurse include in the teaching plan for a patient who is taking alendronate (Fosamax)? a. Take drug with any meal b. Take drug first thing in the morning c. Drink at least 5 oz of milk before taking drug d. Take drug with an antacid to avoid heartburn

ANS: B Alendronate (Fosamax) should be taken on an empty stomach first thing in the morning with 6 oz of water, accompanied by no other medication. PTS: 1 DIF: Cognitive Level: Application REF: Page 1356, Table 43-6 OBJ: 8 TOP: Osteoporosis drug KEY: Nursing Process Step: Planning

8. A patient had an open reduction with internal fixation (ORIF) for a compound fracture of the left tibia and has been placed in a long leg cast. The assessments by the nurse are: left foot warm/pink, pedal pulse weaker than right, capillary refill 3 seconds, and small 1 cm area of blood on cast. What should the nurse do? a. Notify charge nurse of impending compartment syndrome b. Document that all assessments are within normal limits c. Inform charge nurse about probable hemorrhage d. Place warm compresses on left foot

ANS: B All of the assessments are within normal limits. A small amount of blood on the cast is expected and should be monitored. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1397 OBJ: 19 TOP: Compound fracture KEY: Nursing Process Step: Assessment

10. Which patient statement indicates the need for additional teaching for a patient with rheumatoid arthritis who is taking meloxicam (Mobic)? a. "I am keeping a daily record of my blood pressure." b. "I take aspirin before I go to bed." c. "I know I can take meloxicam with or without regard to meals." d. "I weigh every day so I will be aware of any weight gain."

ANS: B Aspirin or products containing aspirin should be avoided while taking meloxicam. PTS: 1 DIF: Cognitive Level: Application REF: Page 1346, Table 43-5 OBJ: 9 TOP: Rheumatoid arthritis KEY: Nursing Process Step: Evaluation

9. When a patient recovering from a fractured tibia asks what callus formation is, the nurse tells her it is: a. when blood vessels of the bone are compressed. b. a part of the bone healing process after a fracture when new bone is being formed over the fracture site. c. the formation of a clot over the fracture site. d. when the hematoma becomes organized and a fibrin meshwork is formed.

ANS: B Callus formation occurs when the osteoblasts continue to lay the network for bone buildup and osteoclasts destroy dead bone. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1371 OBJ: 15 TOP: Bone healing KEY: Nursing Process Step: Implementation

18. The patient has been diagnosed as having gouty arthritis. The patient asks the nurse to explain the cause of the inflammation of the great toe. What is the most appropriate nursing response? a. "You have calcium oxalate deposits that are seen in gouty arthritis." b. "The inflammation is from small accumulations of uric acid crystals, which are called tophi." c. "The small nodules are not related to the arthritis condition." d. "You have fat deposits that are common with gouty arthritis."

ANS: B Gout is a metabolic disease resulting from an accumulation of uric acid in the blood. It is an acute inflammatory condition associated with ineffective metabolism of purines. PTS: 1 DIF: Cognitive Level: Application REF: Page 1353 OBJ: 8 TOP: Gouty arthritis KEY: Nursing Process Step: Implementation

28. What should the home health nurse include assessment for in the plan of care for an 82-year-old female with severe kyphosis from ankylosis? a. Urinary output b. Respiratory effort c. Sleep cycle d. Nutritional status

ANS: B Severe kyphosis may hinder the patient's ability to expand the ribcage and interfere with easy respiration. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1350 OBJ: 22 TOP: Kyphosis KEY: Nursing Process Step: Implementation

22. What should the nurse do when a patient with osteomyelitis is admitted with an open wound that is draining? a. Enforce a low calorie diet b. Initiate drainage and secretion precautions c. Frequently do passive ROM on the elbow d. Ambulate several times daily

ANS: B The patient with osteomyelitis should be at least in drainage and secretion precaution. The limb should be positioned for maximum comfort and left at rest. These patients are usually on bed rest and require a high-calorie, high-protein diet. PTS: 1 DIF: Cognitive Level: Application REF: Page 1358 OBJ: 19 TOP: Osteomyelitis KEY: Nursing Process Step: Implementation

5. A patient who has had a right below the knee amputation continues to complain of unpleasant sensation in the right foot. What can the nurse explain about this "phantom pain"? a. It only exists in the mind. b. It is a complication following an amputation and can be clarified by the surgeon. c. It is related to the severed nerves that are still sending messages to the brain. d. It occurs when the person becomes focused on the loss of the limb.

ANS: C Phantom pain (pain felt in the missing extremity as if it were still present) may occur and be frightening to the patient. Phantom pain occurs because the nerve tracts that register pain in the amputated area continue to send a message to the brain (this is normal). PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1394 OBJ: 21 TOP: Phantom pain KEY: Nursing Process Step: Implementation

15. A patient, age 68, has suffered an intertrochanteric fracture of the right hip. Before surgery, to provide support and comfort, an immobilizing device of a is applied. a. Thomas splint b. Bryant traction c. Russell traction d. Buck traction

ANS: D Buck traction is a form of traction used as a temporary measure to provide support and comfort to a fractured extremity until a more definite treatment is initiated. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1383 OBJ: 21 TOP: Fracture KEY: Nursing Process Step: Implementation

2. What is the large, fan-shaped muscle that covers the anterior chest from the sternum to the proximal end of the humerus and acts on the joint of the shoulder to flex, adduct, and rotate? a. Serratus anterior b. Intercostal c. Transversus abdominis d. Pectoralis major

ANS: D Pectoralis major is the large, fan-shaped muscle that covers the anterior chest and is an adductor muscle, which will cause the shoulder to flex. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1341, Figure 43-4 OBJ: 4 TOP: Muscle functions KEY: Nursing Process Step: Assessment

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

Answer: A Rationale: Prevention of constipation caused by immobility is a goal for the patient with low back pain. The knee should be flexed to prevent pressure on the muscles and support structures of the spine. Heat and cold should be alternated. The prone position places more strain on the back and should be avoided. Cognitive Level: Application Text Reference: p. 1676 Nursing Process: Planning NCLEX: Physiological Integrity

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

Answer: A Rationale: Sardines, yogurt, and milk are all high in calcium. The other choices have some foods that are high in calcium but also include foods that are low in calcium, such as eggs, apples, and grapefruit. Cognitive Level: Application Text Reference: p. 1689 Nursing Process: Evaluation NCLEX: Physiological Integrity

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

Answer: A Rationale: Sit-ups and leg lifts will help to strengthen the muscles that support the back. Flexion of the hips and knees places less strain on the back. Modifications in the way the patient lifts boxes are needed, but sitting for prolonged periods can aggravate back pain. The patient should not lift above the level of the elbows. Cognitive Level: Application Text Reference: p. 1677 Nursing Process: Evaluation NCLEX: Health Promotion and Maintenance

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

Answer: A Rationale: The patient's clinical manifestations suggest hemarthrosis, and the appearance of blood in the synovial fluid is expected. Purulent fluid occurs when there is a joint infection. Straw-colored fluid is normal and will not be expected when the knee is swollen and painful. Thick fluid suggests infection. Cognitive Level: Comprehension Text Reference: p. 1628 Nursing Process: Assessment NCLEX: Physiological Integrity

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

Answer: B Rationale: Osteoporosis occurring in the vertebrae produces a gradual loss of height. Bowed legs are associated with osteomalacia. Low intake of dairy products is a risk factor for osteoporosis, but it does not indicate that osteoporosis is present. Frequent falls increase the risk for fractures but are not an indicator of osteoporosis. Cognitive Level: Comprehension Text Reference: p. 1687 Nursing Process: Assessment NCLEX: Physiological Integrity

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

Answer: B Rationale: Immobilization of the affected leg helps to decrease pain and reduce the risk for pathologic fractures. Weight-bearing exercise increases the risk for pathologic fractures. NSAIDs are frequently prescribed to treat pain. Flexion of the affected limb is avoided to prevent contractures. Cognitive Level: Application Text Reference: pp. 1670-1671 Nursing Process: Planning NCLEX: Physiological Integrity

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

Answer: B Rationale: The patient's pain will make it more difficult to accomplish tasks like putting on a shirt or jacket. This pain should not impact the patient's ability to feed himself or herself or use the toilet because these tasks do not involve moving the arm behind the patient. The arm will not usually be positioned behind the patient during sleeping. Cognitive Level: Application Text Reference: pp. 1620-1622 Nursing Process: Assessment NCLEX: Health Promotion and Maintenance

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

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

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

Answer: C Rationale: Corticosteroid use may lead to skeletal problems such as avascular necrosis and osteoporosis. The use of HRT and calcium supplements will help prevent osteoporosis. NSAID use does not increase the risk for musculoskeletal problems. Cognitive Level: Application Text Reference: p. 1619 Nursing Process: Assessment NCLEX: Health Promotion and Maintenance

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

Answer: C Rationale: Repositioning a patient is included in the education and scope of practice of nursing assistants, and an experienced nursing assistant would be familiar with logrolling. Evaluation of the effectiveness of pain medications, assessment of neurologic function, and evaluation of a patient's readiness to ambulate after surgery require higher-level nursing education and scope of practice. Cognitive Level: Application Text Reference: pp. 1683-1684 Nursing Process: Planning NCLEX: Safe and Effective Care Environment

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

Answer: C Rationale: Resting with the head elevated and knees flexed will reduce the strain on the back and decrease muscle spasms. Twisting from side to side will increase tension on the lumbar area. A pillow placed under the upper back will cause strain on the lumbar spine. Alternate application of cold and heat should be used to decrease pain. Cognitive Level: Application Text Reference: pp. 1676-1677 Nursing Process: Planning NCLEX: Physiological Integrity

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

Answer: C Rationale: The patient will be on IV antibiotics for several months, and the patient will need to recognize signs of infection at the IV site and how to care for the catheter during daily activities such as bathing. IV antibiotics rather than oral antibiotics are used for acute osteomyelitis. Patients are instructed to avoid exercise and heat application because these will increase swelling and the risk for spreading infection. Cognitive Level: Application Text Reference: p. 1670 Nursing Process: Implementation NCLEX: Physiological Integrity

In reviewing bone remodeling, what should the nurse know about the involvement of bone cells? a. Osteoclasts add canaliculi. b. Osteoblasts deposit new bone. c. Osteocytes are mature bone cells. d. Osteons create a dense bone structure.

B Bone remodeling is achieved when osteoclasts remove old bone and osteoblasts deposit new bone. Osteocytes are mature bone cells, and osteons or Haversian systems create a dense bone structure, but these are not involved with bone remodeling.

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

Answer: D Rationale: The postoperative movement and sensation of the extremities should be unchanged (or improved) from the preoperative assessment. If the numbness and tingling are new, this information should be immediately reported to the surgeon. Numbness and tingling are not symptoms associated with hemorrhage at the site. Turning the patient will not relieve the numbness. Cognitive Level: Application Text Reference: p. 1683 Nursing Process: Implementation NCLEX: Physiological Integrity

A female patient with a long-standing history of rheumatoid arthritis has sought care because of increasing stiffness in her right knee that has culminated in complete fixation of the joint. The nurse would document the presence of which problem? a. Atrophy b. Ankylosis c. Crepitation d. Contracture

B Ankylosis is stiffness or fixation of a joint, whereas contracture is reduced movement as a consequence of fibrosis of soft tissue (muscles, ligaments, or tendons). Atrophy is a flabby appearance of muscle leading to decreased function and tone. Crepitation is a grating or crackling sound that accompanies movement.

A 57-year-old postmenopausal woman is scheduled for dual-energy x-ray absorptiometry (DXA). Which statement, if made by the patient to the nurse, indicates understanding of the procedure? a. "The bone density in my heel will be measured." b. "This procedure will not cause any pain or discomfort." c. "I will not be exposed to any radiation during the procedure." d. "I will need to remove my hearing aids before the procedure."

B Dual-energy x-ray absorptiometry (DXA) is painless and measures the bone mass of spine, femur, forearm, and total body with minimal radiation exposure. A quantitative ultrasound (QUS) evaluates density, elasticity, and strength of bone using ultrasound of the calcaneus (heel). Magnetic resonance imaging would require removal of objects such as hearing aids that have metal parts.

A 42-year-old man who is scheduled for an arthrocentesis arrives at the outpatient surgery unit and states, "I do not want this procedure done today." Which response by the nurse is most appropriate? a. "When would you like to reschedule the procedure?" b. "Tell me what your concerns are about this procedure." c. "The procedure is safe, so why should you be worried?" d. "The procedure is not painful because an anesthetic is used."

B The nurse should use therapeutic communication to determine the patient's concern about the procedure. The nurse should not provide false reassurance. It is not appropriate for the nurse to assume the patient is concerned about pain or to assume the patient is asking to reschedule the procedure.

A 63-year-old woman has been taking prednisone (Deltasone) daily for several years after a kidney transplant to prevent organ rejection. What is most important for the nurse to assess? a. Staggering gait b. Ruptured tendon c. Back or neck pain d. Tardive dyskinesia

C Osteoporosis with resultant fractures is a frequent and serious complication of systemic corticosteroid therapy. The ribs and vertebrae are affected the most, and patients should be observed for signs of compression fractures (back and neck pain). Phenytoin (Dilantin) is an antiseizure medication. An adverse effect of phenytoin is an ataxic (or staggering) gait. A rare adverse effect of ciprofloxacin (Cipro) and other fluoroquinolones is tendon rupture, usually of the Achilles tendon. The highest risk is in people age 60 and older and in people taking corticosteroids. Antipsychotics and antidepressants may cause tardive dyskinesia, which is characterized by involuntary movements of the tongue and face.

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

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

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

Correct Answer: A Rationale: Phantom limb pain is treated like any other type of postoperative pain would be treated. Explanations of the reason for the pain may be given, but the nurse should still medicate the patient. The compression bandage is left in place except during physical therapy or bathing. Although the pain may decrease over time, it still requires treatment now. Cognitive Level: Comprehension Text Reference: pp. 1660-1661 Nursing Process: Implementation NCLEX: Physiological Integrity

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

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

11. A patient in the emergency department is diagnosed with a patellar dislocation. The initial patient teaching by the nurse will focus on the need for a. conscious sedation. b. a knee immobilizer. c. gentle knee flexion. d. cast application.

Correct Answer: A Rationale: The first goal of collaborative management is realignment of the knee to its original anatomic position, which will require anesthesia or conscious sedation. Immobilization of the joint will be done after realignment. Later, gentle ROM exercises may be started if the joint is stable. Casting is not usually required for dislocations. Cognitive Level: Application Text Reference: p. 1632 Nursing Process: Implementation NCLEX: Physiological Integrity

A patient who has severe peripheral arterial disease and ischemic foot ulcers is upset with the health care provider's recommendation to have an above-the-knee amputation. The patient tells the nurse, "If they want to cut off my leg, they should just shoot me instead." The most appropriate response to the patient's statement is, a. "Let's talk about how you feel this surgery will affect you." b. "If you do not want the surgery, you do not have to have it." c. "I understand why you are upset, but there really is no choice because your leg is so badly diseased." d. "Many people are able to function normally with a prosthesis after amputation, and you can too."

Correct Answer: A Rationale: The initial nursing action should be to assess how the patient feels about the amputation and what the patient knows about the procedure and rehabilitation process. Discussion about the patient's option to not have the procedure, the reason the procedure is needed, or rehabilitation after the procedure may be appropriate after the nurse knows more about the patient's current level of knowledge and emotional state. Cognitive Level: Application Text Reference: p. 1659 Nursing Process: Implementation NCLEX: Psychosocial Integrity

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

Correct Answer: A Rationale: The pain medication should be given so that it has time to take effect before the patient is ambulated. The other medications will not affect whether the patient can ambulate or not, although the antibiotic and anticoagulant medications should be given as soon as possible in order to maintain therapeutic blood levels. Cognitive Level: Application Text Reference: p. 1647 Nursing Process: Implementation NCLEX: Physiological Integrity

10. A patient with a comminuted fracture of the right femur has Buck's traction in place while waiting for surgery. To assess for pressure areas on the patient's back and sacral area and to provide skin care, the nurse should a. have the patient lift the buttocks by bending and pushing with the left leg. b. turn the patient partially to each side with the assistance of another nurse. c. place a pillow between the patient's legs and turn gently to each side. d. loosen the traction and have the patient turn onto the unaffected side.

Correct Answer: A Rationale: The patient can lift the buttocks off the bed by using the left leg without changing the right-leg alignment. Turning the patient will tend to move the leg out of alignment. Disconnecting the traction will interrupt the weight needed to immobilize and align the fracture.

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

Correct Answer: A Rationale: The patient should be adequately medicated for pain before any attempt to ambulate. Instructions about the benefits of ambulation may increase the patient's willingness to ambulate, but decreasing pain with ambulation is more important. The presence of an incisional drain or timing of dressing change will not impact on ambulation. Cognitive Level: Application Text Reference: pp. 1654, 1647 Nursing Process: Implementation NCLEX: Physiological Integrity

12. Following a motor-vehicle accident, a patient arrives in the emergency department with massive right lower-leg swelling. Which action will the nurse take first? a. Elevate the leg on pillows. b. Apply a compression bandage. c. Place ice packs on the lower leg. d. Check leg pulses and sensation.

Correct Answer: D Rationale: The initial action by the nurse will be to assess the circulation to the leg and to observe for any evidence of injury such as fractures or dislocations. After the initial assessment, the other actions may be appropriate based on what is observed during the assessment.

A patient with comminuted fractures of the tibia and fibula is treated with open reduction and application of an external fixator. The next day, the patient complains of severe pain in the leg, which is unrelieved by ordered analgesics. The patient's toes are pink, but the patient complains of numbness and tingling. The most appropriate action by the nurse is to a. notify the patient's health care provider. b. check the patient's blood pressure. c. assess the external fixator pins for redness or drainage. d. elevate the extremity and apply ice over the wound site.

Correct Answer: A Rationale: The patient's clinical manifestations point to compartment syndrome and delay in diagnosis, and treatment may lead to severe functional impairment. There is no reason to suspect that patient's symptoms are caused by hypotension or hypertension or by infection at the pin sites. Elevation of or ice application to the leg will decrease arterial flow and further reduce perfusion. Cognitive Level: Application Text Reference: pp. 1650-1651 Nursing Process: Implementation NCLEX: Physiological Integrity

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

Correct Answer: A Rationale: The patient's information about running 3 to 4 miles daily after starting an exercise program only 2 months previously suggests that the shin splints are caused by overuse. Radiographs are not indicated for the type of injury described by the patient. Shin splints are not a normal or expected response to running. Because the patient expresses enjoyment of running, it would not be appropriate for the nurse to suggest a different sport. Cognitive Level: Application Text Reference: p. 1630 Nursing Process: Implementation NCLEX: Physiological Integrity

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

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

13. Following the application of a hip spica cast for a patient with a fracture of the proximal third of the left femur, an appropriate nursing intervention is to a. use the cast support bar to reposition the patient every 2 to 3 hours. b. ask the patient about any abdominal discomfort or nausea. c. discuss the reasons for remaining on bed rest for several weeks. d. promote drying of the cast by placing the patient in a prone position every 4 hours.

Correct Answer: B Rationale: Assessment of bowel tones, abdominal pain, and nausea and vomiting will detect the development of cast syndrome. To avoid breakage, the support bar should not be used for repositioning. After the cast dries, the patient can begin ambulating with the assistance of physical therapy personnel. The patient should not be placed in the prone position until the cast has dried to avoid breaking the cast. Cognitive Level: Application Text Reference: p. 1640 Nursing Process: Implementation NCLEX: Physiological Integrity

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

Correct Answer: B Rationale: Immediate care after a sprain or strain injury includes the application of cold and compression to the injury to minimize swelling. The other actions should be taken after the ankle is wrapped with a compression bandage and ice is applied. Cognitive Level: Application Text Reference: p. 1631 Nursing Process: Implementation NCLEX: Physiological Integrity

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

Correct Answer: B Rationale: Increased swelling or numbness may indicate increased pressure at the injury, and the health care provider should be notified immediately to avoid damage to nerves and other tissues. The patient should be encouraged to move the joints above and below the cast to avoid stiffness. There is no need to elevate the shoulder, although the forearm should be elevated to reduce swelling. NSAIDs are appropriate to treat pain after a fracture. Cognitive Level: Application Text Reference: p. 1646 Nursing Process: Implementation NCLEX: Physiological Integrity

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

Correct Answer: B Rationale: Leaning over would flex the hip at greater than 90 degrees and predispose the patient to hip dislocation. The other patient actions are appropriate and do not require any immediate action by the nurse to protect the patient. Cognitive Level: Application Text Reference: p. 1654 Nursing Process: Assessment NCLEX: Physiological Integrity

A patient is to be discharged from the hospital 4 days after undergoing a total hip arthroplasty. A statement by the patient that indicates a need for additional discharge instructions is a. "I should not cross my legs while sitting." b. "I can sleep in any position that is comfortable for me." c. "I will use a toilet elevator on the toilet seat." d. "I will have someone else put on my shoes and socks."

Correct Answer: B Rationale: The patient needs to sleep in a position that allows excessive internal rotation or flexion of the hip. The other patient statements indicate that the patient has understood the teaching. Cognitive Level: Application Text Reference: p. 1654 Nursing Process: Evaluation NCLEX: Physiological Integrity

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

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

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

Correct Answer: B Rationale: The patient's clinical manifestations and history are consistent with a pulmonary embolus, and the nurse's first action should be to ensure adequate oxygenation. The nurse should offer reassurance to the patient, but meeting the physiologic need for oxygen is a higher priority. The health care provider should be notified after the oxygen is started and pulse oximetry and assessment for deep vein thrombosis (DVT) are obtained. Cognitive Level: Application Text Reference: p. 1646 Nursing Process: Implementation NCLEX: Physiological Integrity

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

Correct Answer: B Rationale: The vital signs should be monitored frequently to assess for hemorrhage because the nurse will not be able to visualize the surgical site. Flexion contracture of the hip would be encouraged by elevating the residual limb on a pillow. The patient is placed in a prone position after amputation to prevent hip flexion, but this would not be done during the immediate postoperative period. Cognitive Level: Application Text Reference: p. 1660 Nursing Process: Implementation NCLEX: Physiological Integrity

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

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

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

Correct Answer: C Rationale: After knee arthroplasty, active or passive flexion exercises are used to obtain a 90-degree flexion of the knee. The patient is ambulated the first postoperative day. A compression bandage is used to hold the knee in an extended position after surgery. Full weight bearing is expected before discharge, but it is not started early after surgery. Cognitive Level: Application Text Reference: p. 1664 Nursing Process: Planning NCLEX: Physiological Integrity

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

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

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

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

A patient is admitted to the emergency department with possible fractures of the bones of the left lower extremity. The initial action by the nurse should be to a. splint the lower leg. b. elevate the left leg. c. check the popliteal, dorsalis pedis, and posterior tibial pulses. d. obtain information about the patient's tetanus immunization status.

Correct Answer: C Rationale: The initial nursing action should be assessment of the neurovascular status of the injured leg. After assessment, the nurse may need to splint and elevate the leg, based on the assessment data. Information about tetanus immunizations should be done if there is an open wound. Cognitive Level: Application Text Reference: p. 1642 Nursing Process: Assessment NCLEX: Physiological Integrity

A patient is admitted with facial injuries after a bicycle accident and has a repair of a fractured mandible. When doing postoperative teaching, the nurse will include information about a. the use of sterile technique for dressing changes. b. the importance of including high-fiber foods in the diet. c. when the patient may need to cut the immobilizing wires. d. self-administration of nasogastric tube feedings.

Correct Answer: C Rationale: The jaw will be wired for stabilization, and the patient should know what emergency situations require that the wires be cut to protect the airway. There are no dressing changes for this procedure. The diet is liquid, and patients are not able to chew high-fiber foods. Initially, the patient may receive nasogastric tube feedings, but by discharge the patient will swallow liquid through a straw. Cognitive Level: Application Text Reference: p. 1657 Nursing Process: Implementation NCLEX: Physiological Integrity

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

Correct Answer: C Rationale: When using crutches, patients are usually taught to move the assistive device and the injured leg forward at the same time and then to move the unaffected leg. Patients are discouraged from using furniture to assist with ambulation. The patient is taught to place weight on the hands, not in the axilla, to avoid nerve damage. If the 2- or 4-point gaits are to be used, the crutch and leg on opposite sides move forward, not the crutch and same-side leg. Cognitive Level: Application Text Reference: p. 1648 Nursing Process: Evaluation NCLEX: Safe and Effective Care Environment

When counseling an older patient about ways to prevent fractures, which information will the nurse include? a. Tacking down scatter rugs in the home is recommended. b. Occasional weight-bearing exercise will improve muscle and bone strength. c. Most falls happen outside the home. d. Buying shoes that provide good support and are comfortable to wear is recommended.

Correct Answer: D Rationale: Comfortable shoes with good support will help to decrease the risk for falls. Scatter rugs should be eliminated, not just tacked down. Regular weight-bearing exercise will improve strength, but occasional exercise is not helpful in improving strength. Falls inside the home are responsible for many injuries. Cognitive Level: Application Text Reference: p. 1630 Nursing Process: Implementation NCLEX: Health Promotion and Maintenance

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

Correct Answer: D Rationale: The patient lies in the prone position several times daily to prevent flexion contractures of the hip. The limp sock should be changed daily. Lotion should not be used on the stump. The residual limb should not be elevated because this would encourage flexion contracture. Cognitive Level: Application Text Reference: p. 1661 Nursing Process: Evaluation NCLEX: Physiological Integrity

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

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

A normal assessment finding of the musculoskeletal system is a. no deformity or crepitation. b. muscle and bone strength of 4. c. ulnar deviation and subluxation. d. angulation of bone toward midline.

Correct answer: a Rationale: Normal physical assessment findings of the musculoskeletal system include normal spinal curvatures; no muscle atrophy or asymmetry; no joint swelling, deformity, or crepitation; no tenderness on palpation of muscles and joints; full range of motion of all joints without pain or laxity; and muscle strength score of 5.

The increased risk for falls in the older adult is most likely due to a. changes in balance. b. decrease in bone mass. c. loss of ligament elasticity. d. erosion of articular cartilage.

Correct answer: a Rationale: Aging can cause changes in a person's sense of balance, making the person unsteady, and proprioception may be altered. The risk for falls also increases in older adults partly because of a loss of strength.

A patient with tendonitis asks what the tendon does. The nurse's response is based on the knowledge that tendons a. connect bone to muscle. b. provide strength to muscle. c. lubricate joints with synovial fluid. d. relieve friction between moving parts.

Correct answer: a Rationale: Tendons are composed of dense, fibrous connective tissue that contains bundles of closely packed collagen fibers arranged in the same plane for additional strength. They connect the muscle sheath to adjacent bone.

While obtaining subjective assessment data related to the musculoskeletal system, it is particularly important to ask a patient about other medical problems such as a. hypertension. b. thyroid problems. c. diabetes mellitus. d. chronic bronchitis.

Correct answer: c Rationale: The nurse should question the patient about past medical problems because certain illnesses are known to affect the musculoskeletal system directly or indirectly. These diseases include tuberculosis, poliomyelitis, diabetes mellitus, parathyroid problems, hemophilia, rickets, soft tissue infection, and neuromuscular disabilities.

To prevent muscle atrophy, the nurse teaches the patient with a leg immobilized in traction to perform (select all that apply) a. flexion contractions. b. tetanic contractions. c. isotonic contractions. d. isometric contractions. e. extension contractions.

Correct answer: d Rationale: Isometric contractions increase the tension within a muscle but do not produce movement. Repeated isometric contractions make muscles grow larger and stronger. Muscular atrophy (i.e., decrease in size) occurs with the absence of contraction that results from immobility.

While performing passive range of motion for a patient, the nurse puts the ankle joint through the movements of (select all that apply) a. flexion and extension. b. inversion and eversion. c. pronation and supination d. flexion, extension, abduction, and adduction. e. pronation, supination, rotation, and circumduction.

Correct answers: a, b Rationale: Common movements that occur at the ankle include inversion, eversion, flexion, and extension.

A 54-year-old patient is about to have a bone scan. In teaching the patient about this procedure, the nurse should include what information? a. Two additional follow-up scans will be required. b. There will be only mild pain associated with the procedure. c. The procedure takes approximately 15 to 30 minutes to complete. d. The patient will be asked to drink increased fluids after the procedure.

D Patients are asked to drink increased fluids after a bone scan to aid in excretion of the radioisotope, if not contraindicated by another condition. No follow-up scans and no pain are associated with bone scans that take 1 hour of lying supine.

An 82-year-old patient is frustrated by her flabby belly and rigid hips. What should the nurse tell the patient about these frustrations? a. "You should go on a diet and exercise more to feel better about yourself." b. "Something must be wrong with you because you should not have these problems." c. "You have arthritis and need to go on nonsteroidal antiinflammatory drugs (NSAIDs)." d. "Decreased muscle mass and strength and increased hip rigidity are normal changes of aging."

D The musculoskeletal system's normal changes of aging include decreased muscle mass and strength; increased rigidity in the hips, neck, shoulders, back, and knees; decreased fine motor dexterity; and slowed reaction times. Going on a diet and exercising will help but not stop these changes. Telling the patient "Something must be wrong with you..." will not be helpful to the patient's frustrations.

The erythrocyte sedimentation rate (ESR) is decreased with which condition? Osteoarthritis Rheumatic fever Rheumatoid arthritis Polymyalgia rheumatica

Osteoarthritis The ESR determines how much inflammation is in the body and is decreased with osteoarthritis. Osteoarthritis is a breakdown of joint cartilage. The rate is increased with rheumatic fever and rheumatoid arthritis (RA) and is very high with polymyalgia rheumatica. RA is a progressive inflammatory disease.

20. The nurse clarifies to a patient who is being evaluated for possible rheumatoid arthritis that the elevated erythrocyte sedimentation rate indicates the presence of: a. immunoglobulin M. b. abnormal serum protein. c. increased inflammatory reaction in the body. d. C-reactive protein.

ANS: C The ESR indicates an increase in the inflammatory reactions in the body. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1345 OBJ: 8 TOP: Rheumatoid arthritis KEY: Nursing Process Step: Implementation

13. Forty-eight hours after a patient sustained a fractured femur in a car accident, the nurse assessed a pulse of 110, respirations at 25, and labored crackles in both lung fields. The nurse immediately reports to the charge nurse the probability of a(n): a. impending pneumonia. b. atelectasis. c. fat embolism. d. anxiety attack.

ANS: C A pulmonary fat embolism involves the embolization of fat tissue with platelets and circulation of free fatty acids within the pulmonary circulation. Dyspnea, tachypnea, and chest pain are symptomatic of a fat embolus. PTS: 1 DIF: Cognitive Level: Application REF: Page 1376 OBJ: 17 TOP: Fat embolism KEY: Nursing Process Step: Assessment

21. What should the nurse instruct the patient before the initiation of the antimalarial drug hydroxychloroquine (Plaquenil)? a. Get a complete blood count to assess anemia. b. Get a chest x-ray. c. Get an eye examination. d. Take prophylaxis for malaria.

ANS: C An eye examination should be completed before starting the drug and an eye examination should be done every 6 months while on the drug, because the drug can damage the retina and lead to blindness. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1336, Table 43-5 OBJ: 8 TOP: Gout KEY: Nursing Process Step: Implementation

37. A 56-year-old female patient is being seen for osteoarthritis of the knee in the clinic. What should the nurse recommend when discussing strengthening exercises? a. Jogging b. Walking rapidly on a treadmill c. Bicycling d. Aerobic exercises

ANS: C Bicycling or swimming is recommended for osteoarthritis of the hip or knee. Jogging would put undue stress on knee joints. Climbing stairs should be avoided. Walking should be done on level ground, not up or down elevations. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1351, Box 43-3 OBJ: 10 | 11 TOP: Osteoarthritis KEY: Nursing Process Step: Implementation

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

Answer: A Rationale: The patient's height and weight indicate obesity, which places stress on weight-bearing joints. The use of whole milk, avoiding fruits and vegetables, and use of a daily multivitamin are not risk factors for musculoskeletal problems. Cognitive Level: Application Text Reference: p. 1621 Nursing Process: Assessment NCLEX: Health Promotion and Maintenance

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

Answer: C Rationale: Progression of osteoporosis can be slowed by increasing calcium intake and weight-bearing exercise. Estrogen replacement therapy does help to prevent osteoporosis, but it is not the only treatment and is not appropriate for some patients. Corticosteroid therapy increases the risk for osteoporosis. Cognitive Level: Application Text Reference: p. 1689 Nursing Process: Implementation NCLEX: Physiological Integrity

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

Answer: C Rationale: The usual technique in the physical assessment is to begin with inspection. Abnormalities in muscle mass or configuration will allow the nurse to perform a more focused assessment of abnormal areas. The other assessments are also included in the assessment but are usually done after inspection. Cognitive Level: Comprehension Text Reference: p. 1621 Nursing Process: Assessment NCLEX: Health Promotion and Maintenance

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

Answer: C Rationale: To avoid esophageal erosions, the patient taking bisphosphonates should be upright for at least 30 minutes after taking the medication. Fosamax should be taken on an empty stomach, not after taking other medications or eating. Leg cramps and hot flashes are not side effects of bisphosphonates. Cognitive Level: Application Text Reference: p. 1689 Nursing Process: Implementation NCLEX: Physiological Integrity

A 20-year-old baseball pitcher has an arthroscopic repair of a rotator cuff injury performed in same-day surgery. When the nurse plans postoperative teaching for the patient, which information will be included? a. "You have an appointment with a physical therapist for tomorrow." b. "Leave the shoulder immobilizer on for the first few days to minimize pain." c. "The doctor will use the drop-arm test to determine the success of the procedure." d. "You should try to find a different position to play on the baseball team."

Correct Answer: A Rationale: Physical therapy after a rotator cuff repair begins on the first postoperative day to prevent "frozen shoulder." A shoulder immobilizer is used immediately after the surgery, but leaving the arm immobilized for several days would lead to loss of ROM. The drop-arm test is used to test for rotator cuff injury, but not after surgery. The patient may be able to return to pitching after rehabilitation.

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

Correct Answer: C Rationale: A patient having an ORIF is at risk for problems such as wound infection and osteomyelitis. After an ORIF, patients typically are mobilized starting the first postoperative day, so problems caused by immobility are not as likely. Cognitive Level: Application Text Reference: p. 1638 Nursing Process: Diagnosis NCLEX: Physiological Integrity

3. A checkout clerk in a grocery store has muscle and tendon tears that have become inflamed, causing pain and weakness in the left hand and elbow. The nurse identifies these symptoms as related to a. muscle spasms. b. meniscus injury. c. repetitive strain injury. d. carpal tunnel syndrome.

Correct Answer: C Rationale: The patient's occupation and the inflammation, pain, and weakness in the elbow and hand suggest a repetitive strain injury. Muscle spasms would be characterized by a palpable, firm muscle mass during the spasm. Meniscus injury would affect the knee. Carpal tunnel syndrome is characterized by weakness and numbness of the hand.

A patient with lower-leg fractures has an external fixation device in place and is scheduled for discharge. Which information will the nurse include in the discharge teaching? a. "You will need to remain on bed rest until bone healing is complete." b. "The external fixator can be removed during the bath or shower." c. "Prophylactic antibiotics are needed until the external fixator is removed." d. "You will need to assess and clean the pin insertion sites daily."

Correct Answer: D Rationale: Pin insertion sites should be cleaned daily to decrease the risk for infection at the site. An external fixator allows the patient to be out of bed and avoid the risks of prolonged immobility. The device is surgically placed and is not removed until the bone is stable. Prophylactic antibiotics are not routinely given when an external fixator is used. Cognitive Level: Application Text Reference: p. 1641 Nursing Process: Implementation NCLEX: Physiological Integrity

4. When working with a patient whose job involves many hours of word processing, the nurse will teach the patient about the need to a. do stretching and warm-up exercises before starting work. b. wrap the wrists with a compression bandage every morning. c. use acetaminophen (Tylenol) instead of NSAIDs for wrist pain. d. obtain a keyboard pad to support the wrist while word processing.

Correct Answer: D Rationale: Repetitive strain injuries caused by prolonged times working at a keyboard can be prevented by the use of a pad that will keep the wrists in a straight position. Stretching exercises during the day may be helpful, but these would not be needed before starting. Use of a compression bandage is not needed, although a splint may be used for carpal tunnel syndrome. NSAIDs are appropriate to use to decrease swelling. Cognitive Level: Application Text Reference: p. 1633 Nursing Process: Implementation NCLEX: Health Promotion and Maintenance