The Client with Musculoskeletal Health Problems
A healthcare provider (HCP) prescribes a lengthy x-ray examination for a client with osteoarthritis. Which action by the nurse would demonstrate client advocacy? 1. Contact the x-ray department, and ask the technician if the lengthy session can be divided into shorter sessions 2. Contact the HCP to determine if an alternative examination could be scheduled 3. Request a prescription for acetaminophen prior to the examination 4. Request padding for the hard x-ray table
1. Contact the x-ray department, and ask the technician if the lengthy session can be divided into shorter sessions
The nurse is caring for an older adult male who had open reduction internal fixation (ORIF) of the right hip 24 hours ago. The client is now experiencing shortness of breath and reports having "tightness in my chest." The nurse reviews the recent lab results. The nurse should report which lab results to the healthcare provider? 1. Hematocrit (Hct): 40% (0.4) 2. Serum glucose: 120 mg/dL (6.7 mol/L) 3. Troponin: 1.4 mcg/L (1.4ug/L) 4. Erythrocyte sedimentation rate (ESR): 22 mm/h
3. Troponin: 1.4 mcg/L (1.4ug/L)
A client with an extra capsular hip fracture returns to the nursing unit after internal fixation and pin insertion with a drainage tube at the incision site. Her husband asks, "Why does she have this tube inserted in her hip?" Which response would be best? 1."The tube helps us to detect a wound infection early on" 2."This way we will not have to irrigate the wound" 3."Fluid will not be allowed to accumulate at the site" 4."We have a way to administer antibiotics into the wound"
3."Fluid will not be allowed to accumulate at the site"
The nurse should instruct the client with low back pain to avoid: 1.Keeping light objects below the level of the elbows when lifting 2.Leaning forward while bending the knees 3.Exceeding the prescribed exercise program 4.Sleeping on the side with legs flexed
3.Exceeding the prescribed exercise program
A client is discharged with the following prescription for severe back pain from a herniated intravertebral disc: hydrocodone 5 mg, acetaminophen 500 mg, one-half to one tablet by mouth each 8 to 12 hours as needed. The nurse should instruct the client to:
1.
Which information should the nurse include in the teaching session when preparing a client for arthrocentesis? Select all that apply. 1."A local anesthetic agent may be injected into the joint site for your comfort." 2."A syringe and needle will be used to withdraw fluid from your joint." 3."The procedure, although not painful, will provide immediate relief." 4."You will need to wear a compression bandage for several days after the procedure."
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A client is to have a total hip replacement. What nursing action should the preoperative plan include? Select all that apply? 1. Administer antibiotics as prescribed to ensure therapeutic blood levels 2. Apply leg compression device 3. Request a trapeze be added to the bed 4. Teach isometric exercises of quadriceps and gluteal muscles 5. Demonstrate crutch walking with a three-point gait 6. Place Buck's traction on the bed
1. Administer antibiotics as prescribed to ensure therapeutic blood levels 3. Request a trapeze be added to the bed 4. Teach isometric exercises of quadriceps and gluteal muscles
A client with rheumatoid arthritis is taking high doses of non steroidal anti-inflammatory medications. Th nurse should instruct the client to: 1. take prescribed medication with food to lessen the likelihood of an upset stomach 2. not stop taking the medication suddenly; the dose needs to be decreased gradually 3. use mouthwash to rinse the mouth after taking this medication 4. not drive if dizziness occurs
1. take prescribed medication with food to lessen the likelihood of an upset stomach
A client with rheumatoid arthritis states, "I cannot do my household chores without becoming tired. My knees hurt whenever I walk." Which goal for this client should take priority? 1. Conserve energy 2. Adapt self-care skills 3. Develop coping skills 4. Employ a housekeeping service
1. Conserve energy
The client diagnosed with osteoarthritis tells the nurse, "My friend takes steroid pills for her rheumatoid arthritis. Should I be taking steroids too?" What should the nurse explain to the client? 1. Intra-articular corticosteroid injections are used to treat osteoarthritis 2. Oral corticosteroid can be used in osteoarthritis 3. A systemic effect is needed in osteoarthritis 4. Rheumatoid arthritis and osteoarthritis are two similar diseases
1. Intra-articular corticosteroid injections are used to treat osteoarthritis
The nurse is teaching the client to administer enoxaparin following a total hip replacement. What should the nurse instruct the client to do? Select all that apply 1. Report promptly any difficulty breathing, rash or itching 2. Notify the healthcare provider (HCP) of unusual bruising 3. Avoid all aspirin-containing medications 4. Wear or carry medical identification 5. Expel the air bubble from the syringe before the injection 6. Remove the needle immediately after the medication is injected
1. Report promptly any difficulty breathing, rash or itching 2. Notify the healthcare provider (HCP) of unusual bruising 3. Avoid all aspirin-containing medications 4. Wear or carry medical identification
Of the clients listed below, who is at risk for developing rheumatoid arthritis (RA)? Select all that apply. 1. adults between the ages of 20 and 50 years 2. adults who have had an infectious disease with the Epstein-Barr virus 3.adults who are of the male gender 4. adults who possess the genetic link, specifically HLA-DR4 5. adults who also have osteoarthritis
1. adults between the ages of 20 and 50 years 2. adults who have had an infectious disease with the Epstein-Barr virus 4. adults who possess the genetic link, specifically HLA-DR4
A postmenopausal client is scheduled for a bone density scan. The nurse should instruct the client to: 1. remove all metal objects on the day of the scan 2. consume foods and beverages with a high content of calcium for 2 days before the test 3. ingest 600 mg of calcium gluconate by mouth for 2 weeks before the test. 4. report any significant pain to the healthcare provider (HCP) at least 2 days before the test
1. remove all metal objects on the day of the scan
Which statement indicates that the client with osteoarthritis understands the effects of capsaicin cream? 1."I always wash my hands right after I apply the cream." 2."After I apply the cream, I wrap my knee with an elastic bandage." 3."I keep the cream in the cabinet above the stove in the kitchen." 4."I also use the same cream when I get a cut or a burn."
1."I always wash my hands right after I apply the cream."
After teaching the client with severe rheumatoid arthritis about prescribed methotrexate, which statement indicates the need for further teaching? 1."I will take my vitamins while I am on this drug." 2."I must not drink any alcohol while I am taking this drug." 3."I should brush my teeth after every meal." 4."I will continue taking my birth control pills."
1."I will take my vitamins while I am on this drug."
Which information should the nurse include when performing discharge teaching with a client who had an anterolateral approach for a total hip replacement? Select all that apply 1.Avoid turning the toes or knee outward 2.Use an abduction pillow between the legs when in bed 3.Use an elevated toilet seat and shower chair 4.Do not extend the operative leg backward 5.Restrict motion for 2 weeks after surgery
1.Avoid turning the toes or knee outward 3.Use an elevated toilet seat and shower chair 4.Do not extend the operative leg backward
Following a total joint replacement, which complication has the greatest likelihood of occurring? 1.Deep vein thrombosis (DVT) 2.Polyuria 3.Displacment of the new joint 4.Wound evisceration
1.Deep vein thrombosis (DVT)
Following a client's total hip replacement, what should the nurse do? Select all that apply 1. With the aid of a coworker, turn the client from the supine to the prone position every 2 hours 2. Encourage the client to use the overhead trapeze to assist with position changes 3. For meals, elevate the head of the bed to 90 degrees 4. Use a fracture bedpan when needed by the client 5. When the client is in bed, prevent thromboembolism by encouraging the client to do toe-pointing exercises
2. Encourage the client to use the overhead trapeze to assist with position changes 4. Use a fracture bedpan when needed by the client 5. When the client is in bed, prevent thromboembolism by encouraging the client to do toe-pointing exercises
A 25-year-old client with hydroxychloroquine for rheumatoid arthritis reports difficulty seeing out of the left eye. What does this finding indicate? 1. development of cataract 2. possible retinal degeneration 3. part of the disease process 4. a coincidental occurence
2. possible retinal degeneration
After teaching a client with osteoarthritis about the importance of regular exercise, which statement indicates the client has understood the teaching? 1."Preforming range-of-motion exercises will increase my joint mobility." 2."Exercise helps to drive synovial fluid through the cartilage" 3."Joint swelling should determine when to stop exercising" 4."Exercising in the outdoors year-round promotes joint relaxation"
2."Exercise helps to drive synovial fluid through the cartilage"
The nurse is assessing a client for neurologic impairment after a total hip replacement. Which finding indicates impairment in the affected extremity? 1.decreased distal pulse 2.inability to move 3.diminished capillary refill 4.coolness to the touch
2.inability to move
The nurse advises the client who has had a femoral head prosthesis placement on the type of chair to sit in during the first 6 to 8 weeks after surgery. Which chair would be the correct type to recommend? 1. a desk-type swivel chair 2. a padded upholstered chair 3. a high-backed chair with armrests 4. a recliner with an attached footrest
3. a high-backed chair with armrests
On a visit to the clinic, a client reports the onset of early symptoms of rheumatoid arthritis. The nurse should conduct a focused assessment for: 1. limited motion of joints 2. deformed joints of the hands 3. early morning stiffness 4. rheumatoid nodules
3. early morning stiffness
The nurse is instructing the client who will have a total hip replacement tomorrow. Which information is most important to include in the teaching plan at this time? 1. Teach how to prevent hip flexion 2. Demonstrate coughing and deep-breathing techniques 3. Show the client what an actual hip prosthesis looks like 4. Assess the client's fears about the procedure
4. Assess the client's fears about the procedure
After teaching the client with rheumatoid arthritis about measures to conserve energy in actives of daily living involving the small joints, which activity observed by the nurse indicates the need for additional teaching? 1. pushing with palms when rising from a chair 2. holding packages close to the body 3. sliding objects 4. carrying a laundry basket with clinched fingers and fists
4. carrying a laundry basket with clinched fingers and fists
Which condition should the nurse assess when completing the history and physical examination of a client diagnosed with osteoarthritis? 1. anemia 2. osteoporosis 3. weight loss 4. local joint pain
4. local joint pain
Following a total hip replacement, the nurse should position the client by: 1. placing weights alongside the affected extremity to keep the extremity from rotating 2. elevating both feet on two pillows 3. keeping the lower extremities adducted by use of an immobilization binder around both legs 4. maintaining the extremity in slight abduction using an abduction splint or pillows placed between the thighs
4. maintaining the extremity in slight abduction using an abduction splint or pillows placed between the thighs
The teaching plan for the client with rheumatoid arthritis includes rest promotion. What position of the involved joints should the nurse tell the client to avoid when at rest? 1. keeping all joints aligned 2. elevating the affected joints 3. lying in a prone position 4. maintaining the joints in a flexed position
4. maintaining the joints in a flexed position
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Air cell should be centered on the back of clients calf
A client is in the acute phase of rheumatoid arthritis. In which order of priority from first to last should the nurse establish the goals? All options must be used. 1. Relieve pain 2. Preserve joint function 3. Maintain usual ways of accomplishing tasks 4. Prevent joint deformity
All of them
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1.
A client with rheumatoid arthritis tells the nurse, "I know it is important to exercise my joints so that I will not lose mobility, but my joints are so stiff and painful that exercising is difficult." Which response by the nurse would be most appropriate? 1."You are probably exercising too much. Decrease your exercise to every other day." 2."Tell the healthcare provider about your symptoms. Maybe your analgesic medication can be increased." 3."Stiffness and pain are part of the disease. Learn to cope by focusing on activities you enjoy." 4."Take a warm tub bath or shower before exercising. This may help with your discomfort."
4."Take a warm tub bath or shower before exercising. This may help with your discomfort."
On the evening of surgery for a total knee replacement, a client wants to get out of bed. To safely assist the client, the nurse should; 1.Encourage the client to apply full weight bearing 2.Prescribe a walker for the client 3.Place a straight-backed chair at the foot of the bed 4.Apply a knee immobilizer
4.Apply a knee immobilizer
A client returns from the first session of scheduled physical therapy following total knee replacement surgery. The nurse assesses that the client's knee is swollen, slightly erythematous, and painful. The client rates the pain as 7 out of 10 and has not has any scheduled PRN pain medication today. What should the nurse do? Select all that apply 1. Gently massage the area to increase circulation to reduce pain 2.Administer pain medication as prescribed 3.Elevate the leg and apply a cold pack 4.Notify the HCP 5. Call physical therapy to cancel the next treatment
2.Administer pain medication as prescribed 3.Elevate the leg and apply a cold pack
A frail elderly client with a hip fracture is to use an alternating air pressure mattress at home to prevent pressure ulcers while recovering from surgery. The nurse is assisting the client's family to place the mattress. What should the nurse instruct the family to do? 1.Turn the mattress over so the air cells face the mattress of the bed, and cover the mattress with a bedsheet 2.Put a thick pad over the pressure mattress to prevent soiling, and place the bedsheet on top of the pad 3.Make the bed with the bedsheet on top of the pressure mattress 4.Make the bed, and then remove the pillow to allow full use of the mattress on the neck
3.Make the bed with the bedsheet on top of the pressure mattress
The client with rheumatoid arthritis tells the nurse, "I have a fiend who took gold shots and had a wonderful response. Why did my healthcare provider not let me try that?" Which response by the nurse would be most appropriate? 1."It is the healthcare provider's prerogative to decide how to treat you. The healthcare provider has chosen what is best for your situation." 2."Tell me more about your friend's arthritic condition. Maybe I can answer that question for you." 3."That drug is used for cases that are more advanced than yours. You are not eligible for this treatment now" 4."Every person is different. What works for one client may not always be effective for another."
4."Every person is different. What works for one client may not always be effective for another."
Which information should be included in the teaching plan for a client with osteoporosis? Select all that apply. 1. Maintain a diet with adequate amounts of vitamin D, as found in fortified milk and cereals 2. Choose good calcium sources, such as figs, broccoli, and almonds 3. Use alcohol in moderation because a moderate intake has no known negative effects 4. Try swimming as a good exercise to maintain bone mass 5. Avoid high-fat foods, such as avocados, salad dressing, and fried foods
1. Maintain a diet with adequate amounts of vitamin D, as found in fortified milk and cereals 2. Choose good calcium sources, such as figs, broccoli, and almonds 3. Use alcohol in moderation because a moderate intake has no known negative effects
A client who had a total hip replacement 2 days ago has developed an infection with a fever and profuse diaphoresis. The nurse establishes a goal to reduce the fluid deficit. Which outcome is the most appropriate? 1. the client drinks 2,000 mL of fluid per day 2. The client understands how to manage the incision 3. the client's bed linens are changed as needed 4. The client's skin remains cool throughout hospitalization
1. the client drinks 2,000 mL of fluid per day
The nurse is assessing a clients left leg for neurovascular changed following a total left knee replacement. Which are expected normal findings? Select all that apply 1.Moderate edema of the left knee 2.Skin warm to the touch 3.Capillary refill response of <3 seconds 4Moves toes 5.Pain Absent 6.Pulse on left leg weaker than right leg
1.Moderate edema of the left knee 2.Skin warm to the touch 3.Capillary refill response of <3 seconds 4Moves toes
The nurse is preparing a client who has had a knee replacement with a metal joint to go home. What should the nurse instruct the client to do? Select all that apply 1.Notify HCP about the joint prior to invasive procedures 2.Inform HCP prior to having MRI scans 3.Notify airport security that the joint may set off alarms on metal detectors 4.Refrain from carrying items weighing more than 5 lbs 5. Limit fluid intake to 1,000 mL/day
1.Notify HCP about the joint prior to invasive procedures 2.Inform HCP prior to having MRI scans 3.Notify airport security that the joint may set off alarms on metal detectors
A client had a posterolateral total hip replacement 2 days ago. What information should the nurse include in the client's plan of care? Select all that apply 1.When using a walker, encourage the client to keep the toes pointing inward 2.Position a pillow between the legs to maintain abduction 3.Allow the client to be in the supine position or in the lateral position on the unoperated side 4.Do not allow the client to bend down to tie or slip on shoes 5.Place ice on the incision after physical therapy
2.Position a pillow between the legs to maintain abduction 3.Allow the client to be in the supine position or in the lateral position on the unoperated side 4.Do not allow the client to bend down to tie or slip on shoes 5.Place ice on the incision after physical therapy
The nurse is assessing the home environment of an elderly client who is using crutches during the postoperative recovery phase after hip pinning. Which poses the greatest hazard to the client as a risk for falling at home? 1.a 4-year-old cocker spaniel 2.scatter rugs 3.snack tables 4.rocking chair
2.scatter rugs
A client who has a total hip replacement 4 days ago is worried about dislocation of the prosthesis. The nurse should respond by saying: 1. "Do not worry. Your new hip is very strong" 2."Use of a cushioned toilet seat helps prevent dislocation" 3."Activities that tend to cause adduction of the hip tend to cause dislocation, so try to avoid them" 4."Decreasing use of abductor pillow will strengthen the muscles to prevent dislocation"
3."Activities that tend to cause adduction of the hip tend to cause dislocation, so try to avoid them"
The nurse teaches a client about heat and cold treatments to manage arthritis pain. Which statement indicates that the client still has a knowledge deficit? 1."I can use heat and cold as often as I want." 2."With heat, I should apply it for no longer than 20 minutes at a time." 3."Heat-producing liniments can be used with other heat devices." 4."Ten to fifteen minutes per application is the maximum time for cold applications."
3."Heat-producing liniments can be used with other heat devices."
In preparation for total knee surgery, a 200-lb client with osteoarthritis must lose weight. Which exercise should the nurse recommend as best if the client has no contraindications? 1.Weight lifting 2.Walking 3.Aquatic exercise 4.Tai chi exercise
3.Aquatic exercise
The nurse has established a goal with a client to improve mobility following a hip replacement. Which outcome is realistic at the time of discharge from the surgical unit? 1.The client can walk throughout the entire hospital with a walker 2.The client can walk the length of a hospital hallway with minimal pain 3.The client has increased independence in transfers from bed to chair 4.The client can raise the affected leg 6 inches with assistance
3.The client has increased independence in transfers from bed to chair
When teaching a client with an extra capsular hip fracture scheduled for surgical internal fixation with the insertion of a pin, the nurse bases the teaching on the understanding that this surgical repair is the treatment of choice because: 1.Hemorrhage at the fracture site is prevented 2.Neurovascular impairment risk is decreased 3.The risk of infection at the site is lessened 4.The client is able to be mobilized sooner
4.The client is able to be mobilized sooner
A client in a double hip spica cast is constipated. The surgeon cuts a window into the front of the cast. Which outcome is intended? 1.The window will allow the nurse to palpate the superior mesenteric artery 2.The window will allow the surgeon to manipulate the fracture site 3.The window will allow the nurses to reposition the client 4.The window will provide some relief from pressure due to abdominal distention as a result of constipation
4.The window will provide some relief from pressure due to abdominal distention as a result of constipation
At which time should the nurse instruct the client to take ibuprofen, prescribed for left hip pain secondary to osteoarthritis, to minimize gastric mucosal irritation? 1. at bedtime 2. on arising 3. immediately after a meal 4. on an empty stomach
3. immediately after a meal
After surgery and insertion of a total hip prosthesis, a client develops severe sudden pain and an inability to move the extremity. The nurse interprets these findings as indicating: 1. a developing infection 2. bleeding in the operative site 3. joint dislocation 4. glue seepage into soft tissue
3. joint dislocation
A client has an intracapsular hip fracture. The nurse should conduct a focused assessment to detect: 1.Internal rotation 2.Muscle flaccidity 3.Shortening of the affected leg 4.Absence of pain in the fracture area
3.Shortening of the affected leg
After knee arthroplasty, the client has a sequential compression device (SCD). What should the nurse do? 1.Elevate the SCD on two pillows 2.Change the settings on the SCD to make the client more comfortable 3.Stop the SCD to remove dressings, and bathe the leg 4.Discontinue the SCD when the client is ambulatory
4.Discontinue the SCD when the client is ambulatory
A client who has had a total hip replacement has a dislocated hip prosthesis. The nurse should first: 1.Stabilize the leg with Buck's traction 2.Apply an ice pack to the affected hip 3.Position the client toward the opposite side of the hip 4.Notify the orthopedic surgeon
4.Notify the orthopedic surgeon
A client with osteoarthritis will undergo an arthrocentesis on a painful, edematous knee. What information should be included in the nursing plan of care? Select all that apply. 1. Explain the procedure 2. Administer preoperative medication 1hr before surgery 3. Instruct the client to immobilize the knee for 2 days after the surgery 4. Assess the site for bleeding 5. Offer pain medication
1. Explain the procedure 4. Assess the site for bleeding 5. Offer pain medication
The client has just has a total knee replacement for severe osteoarthritis. When assessing the client, which finding should lead the nurse to suspect possible nerve damage? 1.Numbness 2.Bleeding 3.Dislocation 4.Pinkness
1.Numbness
The laboratory notifies the nurse that a client who had a total knee replacement 3 days ago and is receiving hearing has an activated partial thromboplastin time (aPTT) of 95 seconds. After verifying the values, the nurse calls the HCP. The nurse should discuss with the HCP giving the client a prescription for: 1.Protamine sulfate 2.Vitamin K 3.Warfarin 4.Packed RBC
1.Protamine sulfate
When preparing a client for discharge from the hospital after a total knee replacement, the nurse should include which information in the discharge plan? Select all that apply. 1.Report signs of infection to HCP 2.Keep the affected leg and foot on the floor when sitting in a chair 3.Remove anti embolism stockings when sleeping 4.The physical therapist will encourage progressive ambulation with use of assistive devices 5.Change dressing daily
1.Report signs of infection to HCP 4.The physical therapist will encourage progressive ambulation with use of assistive devices
The nurse is assessing a client who had a left hip replacement 36 hrs ago. Which findings indicate the prosthesis is dislocated? Select all that apply 1.The client reported a "popping" sensation in the hip 2.The left leg is shorter than the right leg 3.The client has sharp pain in the groin 4.The client cannot move the right left 5.The client cannot wiggle the toes on the left leg
1.The client reported a "popping" sensation in the hip 2.The left leg is shorter than the right leg 3.The client has sharp pain in the groin
A client with a hip fracture has undergone surgery for insertion of a femoral head prosthesis. Which activity should the nurse instruct the client to avoid? 1.crossing the legs while sitting down 2.sitting on a raised commode seat 3.using an abductor splint while lying on the side 4.rising straight from a chair to a standing position
1.crossing the legs while sitting down
