review for medsurg exam #2

Exploring factors related to the client's home environment.

A 68-year-old female client who had a total hip replacement is to be discharged because her healing is almost complete. Which of the following would be most important for this client?

"My toes are stiff."

A client has a plaster cast applied to the left leg. Which of the following comments by the client following the procedure should the nurse address first?

Inability to flex index and middle fingers

A client is diagnosed with carpal tunnel syndrome. Which of the following assessment findings would the nurse expect?

Changing the client's position within prescribed limits.

A client who is undergoing skeletal traction complains of pressure on bony areas. Which action would be most appropriate to provide comfort for the client?

Fasciotomy

A client with a fracture develops compartment syndrome that requires surgical intervention. The nurse would most likely prepare the client for which of the following?

Observing for safety hazards that could be a fall risk

A family member is caring for an older adult client with osteomalacia in the home. When the home health nurse comes to evaluate the client, what should be a focus point of the visit?

The patient's tibial nerve is functional.

A nurse is assessing a patient who is receiving traction. The nurse's assessment confirms that the patient is able to perform plantar flexion. What conclusion can the nurse draw from this finding?

Evidence shows minimal benefits from most CAM therapies.

A nurse is assessing a patient with rheumatoid arthritis. The patient expresses his intent to pursue complementary and alternative therapies. What fact should underlie the nurse's response to the patient?

administration of nonsteroidal anti-inflammatory drugs (NSAIDs) and initiation of an exercise program.

A nurse is managing the care of a client with osteoarthritis. Appropriate treatment strategies for osteoarthritis include:

Impaired Physical Mobility • Acute Pain • Disturbed Auditory Sensory Perception • Risk for Injury

A nurse is providing care for a patient who has a recent diagnosis of Paget's disease. When planning this patient's nursing care, interventions should address what nursing diagnoses? Select all that apply.

Sprain

A patient complains of pain in the right knee, stating, "My knee got twisted when I was going down the stairs." The patient was diagnosed with an injury to the ligaments and tendons of the right knee. Which terminology, documented by the nurse, best reflects the injury?

Removing all small rugs from the home

A patient diagnosed with osteoporosis is being discharged home. Which of the following is the priority education the nurse should provide?

Calcitonin • Bisphosphonates

A patient has been admitted to the medical unit for the treatment of Paget's disease. When reviewing the medication administration record, the nurse should anticipate what medications? Select all that apply.

Nonsteroidal anti-inflammatory drugs (NSAIDs)

A patient with rheumatoid arthritis is complaining of joint pain. What intervention is a priority to assist the patient?

Discuss the complications that the client's may experience if he doesn't cooperate with the care plan.

After undergoing surgery the previous day for a total knee replacement, a client states that he doesn't feel ready to ambulate yet. What should the nurse do?

Osteomyelitis

An 80-year-old man in a long-term care facility has a chronic leg ulcer and states that the area has become increasingly painful in recent days. The nurse notes that the site is now swollen and warm to the touch. The patient should undergo diagnostic testing for what health problem?

Long bone bowing

Assessment of a client reveals signs and symptoms of Paget's disease. Which of the following would be most likely?

lack of exposure to sunshine.

Lifestyle risk factors for osteoporosis include

Osteitis deformans

Localized rapid bone turnover, most commonly affecting the skull, femur, tibia, pelvic bones, and vertebrae, is characterized by which of the following bone disorders?

Staphylococcus

Most cases of osteomyelitis are caused by which of the following microorganisms?

"Some bunions are congenital; others are caused by wearing shoes that are too short or narrow."

On a visit to the family physician, a client is diagnosed with a bunion on the lateral side of the great toe, at the metatarsophalangeal joint. Which statement should the nurse include in the teaching session?

Ineffective Coping related to prolonged immobility

The client with a fractured femur is upset and agitated that skeletal traction will be necessary for 6 to 8 weeks. The client states, "How can I stay like this for weeks? I can't even move!" Based on these statements, the nurse would identify which of the following as the most appropriate nursing diagnosis?

Advise the client who is lying on the stomach to adduct the stump so it presses against the other leg. • Advise the client to use a trochanter roll.

The nurse is taking care of a client who underwent a leg amputation. What teachings should the nurse offer such a client to prevent abduction deformity? Choose all correct options.

Leukocytosis and localized bone pain

Which assessment findings would the nurse expect in a client diagnosed with osteomyelitis?

Risk for injury related to amputation

Which nursing diagnosis is a priority for a client with a traumatically amputated lower extremity?

Administering large doses of I.V. antibiotics as ordered

A client is admitted with acute osteomyelitis that developed after an open fracture of the right femur. When planning this client's care, the nurse should anticipate which measure?

Assuring the client she won't be cut

A 12-year-old girl fractured her right leg several weeks ago while skiing and is returning to the orthopedist to have her cast removed. What is of primary importance in your nursing management during cast removal?

Nerve

A 17-year-old high school junior was involved in a motor vehicle collision and brought to the ED via squad. His left arm was severely traumatized in the accident and he was taken immediately to surgery. He is admitted to the ICU where you practice nursing, and the physician has ordered close monitoring for compartment syndrome. What musculoskeletal structure does compartment syndrome affect?

The skin of the lower left leg is pale. • The left leg is shorter than the right. • Limited range of motion of the left hip.

A client arrives in the emergency room complaining of severe pain in her left hip after falling out of the bed. What indication upon assessment does the nurse recognize as a dislocated left hip? Select all that apply.

Degenerative joint disease

A client comes to the emergency department complaining of pain in the right leg. When obtaining the history, the nurse learns that the client has a history of obesity and hypertension. Based on this information the nurse anticipates the client having which musculoskeletal disorder?

Assessing movement and sensation in the fingers of the right hand

A client has a Fiberglas cast on the right arm. Which action should the nurse include in the care plan?

Maintaining pin care.

A client has undergone an external fixation. Which actions would be the priority for this client?

"We will need to monitor the status of the laceration to be sure it does not get infected."

A client is seen in the emergency department for an injury acquired from falling off of a bicycle and fracturing the arm. The client also has a long laceration that has been sutured in the same area. The client asks the nurse why a splint is applied and not a cast. What is the best explanation by the nurse?

Elevates the arm and applies an ice pack

A client presents to the emergency department gently holding the left arm, which is slightly swollen and painful to the touch. Based on these findings, the nurse:

"The diagnosis won't be based on the findings of a single test but by combining all data found."

A client suspected of having systemic lupus erythematosus (SLE) is being scheduled for testing. She asks which of the tests ordered will determine if she is positive for the disorder. Which statement by the nurse is most accurate?

"I should use my heating pad this evening to reduce some of the pain in my knee."

A client undergoes an arthroscopy at the outpatient clinic. After the procedure, the nurse provides discharge teaching. Which response by the client indicates the need for further teaching?

"Immobilization of the fracture will promote healing by maximizing contact of bone fragments." • "Fractured bones require a good blood supply and adequate nutrition for healing." • "Weight bearing stimulates healing of the long bones of the leg, if the fracture is stabilized."

A client who has fractured the radial head asks the nurse about factors that will promote bone healing. Which statement should the nurse include when responding to the client? Select all that apply.

bone biopsy

A client with suspected osteomalacia has a fractured tibia and fibula. What test would give a definitive diagnosis of osteomalacia?

Apply lotions and take warm baths or soaks.

A client's cast is removed. The client is worried because the skin appears mottled and is covered with a yellowish crust. What advice should the nurse give the client to address the skin problem?

Fatigue Related to Pain

A clinic nurse is caring for a patient newly diagnosed with fibromyalgia. When developing a care plan for this patient, what would be a priority nursing diagnosis for this patient?

Fingers on the left hand are swollen and cool

A nurse is caring for a client with a cast on his left arm after sustaining a fracture. Which assessment finding is most significant for this client?

"You'll be encouraged to drink water after the administration of the radioisotope injection."

A nurse is caring for a patient who has been scheduled for a bone scan. What should the nurse teach the patient about this diagnostic test?

Computed tomography (CT) • Magnetic resonance imaging (MRI) • Ultrasound • X-ray

A nurse is caring for a patient who is being assessed following complaints of severe and persistent low back pain. The patient is scheduled for diagnostic testing in the morning. Which of the following are appropriate diagnostic tests for assessing low back pain? that apply.

Use the arm for light activities within the range of motion.

A nurse is preparing to discharge an emergency department patient who has been fitted with a sling to support her arm after a clavicle fracture. What should the nurse instruct the patient to do?

Slow discontinuation of corticosteroid therapy can halt the progression of the osteoporosis.

A nurse is providing a class on osteoporosis at the local seniors' center. Which of the following statements related to osteoporosis is most accurate?

An elevated parathyroid hormone level

A nurse is providing care for a patient whose pattern of laboratory testing reveals longstanding hypocalcemia. What other laboratory result is most consistent with this finding?

Cereal with milk, a scrambled egg, and grapefruit

A nurse is teaching a patient with osteomalacia about the role of diet. What would be the best choice for breakfast for a patient with osteomalacia?

Colchicine

A nurse should expect to administer which medication to a client with gout?

Staphylococcus aureus

A patient presents to a clinic complaining of a leg ulcer that isn't healing; subsequent diagnostic testing suggests osteomyelitis. The nurse is aware that the most common pathogen to cause osteomyelitis is what?

Prepare for cast removal. • Provide support to the injured extremity.

A patient with a short arm cast is suspected to have compartment syndrome. What actions should the nurse include in the plan of care? Select all that apply.

"You seem like you're feeling angry. Is that something that we could talk about?"

A patient with an exacerbation of systemic lupus erythematosus (SLE) has been hospitalized on the medical unit. The nurse observes that the patient expresses angerand irritation when her call bell isn't answered immediately. What would be the most appropriate response?

The foot should be elevated in order to prevent edema.

An orthopedic nurse is caring for a patient who is postoperative day one following foot surgery. What nursing intervention should be included in the patient's subsequent care?

depressed.

An x-ray demonstrates a fracture in which the fragments of bone are driven inward. This type of fracture would be which of the following?

trauma, such as penetrating wounds or compound fractures; vascular insufficiency in clients with diabetes or peripheral vascular disease; and surgical contamination, such as pin sites of skeletal traction.

Mr. Quinn has just been diagnosed with osteomyelitis. Osteomyelitis is an infection of the bone, resulting in limited blood supply to the bone, inflammation of and pressure on the tissue, bone necrosis, and formation of new bone around devitalized bone tissue. What are possible causes of osteomyelitis? Select all that apply.

Susceptibility • Abnormal innate and adaptive immune responses • Autoantibodies immune complexes • Inflammation • Damage

The immune abnormalities that characterize systemic lupus erythematosus (SLE) include which of the following? Select all that apply.

Anticoagulation therapy

The nurse is assigned to care for a client who has had a total knee arthroplasty yesterday. What type of pharmacologic therapy does the nurse anticipate administering to this client to prevent complications related to the surgery?

Risk for ineffective therapeutic regimen management

The nurse is caring for a client who lives alone and had a total knee replacement. An appropriate nursing diagnosis for the client is:

Fatigue • Pain • Alteration in self-concept • Fluid and electrolyte imbalance

The nurse is caring for a patient who has been diagnosed with "rheumatic disease." What nursing diagnoses will most likely apply to this patient's care? Select all that apply

Atrophy of right calf muscle

The nurse is performing a musculoskeletal assessment of a patient in a nursing home who had a stroke 2 years ago and who has right-sided hemiplegia. The nurse notes that the girth of the patient's right calf is 2 inches less in diameter than the left calf. The nurse attributes the decreased girth to which of the following?

The skin may be covered with a yellowish crust that will shed in a few days.

The nurse is preparing a client to have his cast cut off after having it for 6 weeks to treat a fracture tibia. What should the nurse inform the client prior to the cast being removed?

"Your symptoms are a result of your body attacking itself."

The nurse is teaching a patient about her rheumatic disease. What statement best helps to explain "autoimmunity"?

Walk or perform weight-bearing exercises

The nurse teaches the patient with a high risk for osteoporosis about risk-lowering strategies including which of the following actions?

Walk or perform weight-bearing exercises outdoors

The nurse teaches the patient with a high risk for osteoporosis about risk-lowering strategies including which of the following actions?

Decreased range of motion • Decreased endurance • Joint stiffness

Which assessment parameter would the nurse expect to find when assessing the older adult with a musculoskeletal disorder? Select all that apply.

Caucasian women

Which group is at the greatest risk for osteoporosis?

Handle wet cast with palms of hands. • Trim, reshape, and smooth edges of cast.

Which intervention would the nurse implement with the client in a plaster cast? Select all that apply.

Ensure the pins or wires are covered with caps. • Position trapeze within the client's reach. • Instruct the client on isometric exercises for immobilized extremity.

Which intervention would the nurse implement with the client in skeletal traction? Select all that apply.

Right calf warm and swollen

Which nursing assessment finding indicates the client with traction has not met expected outcomes?

Risk for injury related to altered mobility

Which nursing diagnosis is most appropriate for an elderly client with osteoarthritis?

Calcitonin

Which of the following inhibits bone resorption and promotes bone formation?

Compartment syndrome

Which of the following is a neurovascular problem caused by pressure within a muscle area that increases to such an extent that microcirculation diminishes?

Loss of bone mass

Which of the following is an age-related change to the musculoskeletal system?

Open reduction

Which of the following orthopedic surgeries is done to correct and align a fracture after surgical dissection and exposure of the fracture?

The bone is surgically exposed and realigned. • It is performed in the operating room. • The client usually receives general or spinal anesthetic.

Which of the following statements describe open reduction of a fracture? Select all that apply.

The patient with elevated pressure level within the muscles • The patient with a plaster cast applied immediately after injury • The patient with hemorrhage in the site of injury

Which patient(s) is most likely to have compartment syndrome after sustaining a fracture? Select all that apply.

Fasciotomy

Which term describes a surgical procedure to release constricting muscle fascia so as to relieve muscle tissue pressure?

Osteomalacia

is a metabolic bone disease characterized by inadequate mineralization of bone

Epicondylitis (tennis elbow)

is a painful inflammation of the elbow that is caused by injury following excessive pronation and supination of the forearm, such as that which occurs when playing tennis, pitching a ball, or rowing. Client reports pain radiating down the dorsal surface of the forearm and a weak grasp.