Adult Health: MSK in class review

Which client statement does the nurse identify that reflects understanding of health interventions to prevent MSK problems? -"I will use a can when I walk" -"I should drink 24 oz of soda daily" -"I can exercise at least five times a week" -"I ignore pain just move more slowly"

"I cane exercise at least five times a week" -pts should not ignore changes in MSK pain

The client tells the nurse that he was jogging to train for a marathon, which has been a lifelong goal. He asks, "Will I ever be able to run a marathon now?" What is the appropriate nursing response? "Yes, once your ankle heals, you will be fine." "It is unlikely that your ankle will regain the necessary strength.""The health care provider will need to discuss that with you." "It sounds like you are concerned that you may not be able to achieve your goal."

"It sounds like you are concerned that you may not be able to achieve your goal." Acknowledging the client's goal recognizes his feelings and allows him to continue expressing his concerns. Telling the client he will be fine minimizes his concerns and provides false reassurance. Deferring the client's question to the health care provider does not acknowledge the client's feelings. Expressing doubt over the client's recovery makes premature assumptions and does not allow the client to continue expressing his feelings.

Which client statement about self-care indicates a need for further teaching by the nurse? "I am going to swim at the YWCA." "Low-fat yogurt is on my grocery list." "My husband is getting rid of our throw rugs." "Joining a bowling team helps me to exercise."

"Joining a bowling team helps me to exercise." Bowling should be avoided for clients with osteoporosis because it can contribute to compression fractures. Swimming, eating yogurt, and eliminating throw rugs in the house are all appropriate considerations for the client with osteoporosis.

A client with RA reports having ongoing difficulty with ADLs. What is the nurse's appropriate response? "Can you have your spouse help you?" "May I show you an alternative method?" "It's OK if you can't do things by yourself." "I will send you to an occupational therapist."

"May I show you an alternative method?" Although the physical appearance of a patient with severe RA may create the image that ADL independence is not possible, a number of alternative and creative methods can be used to perform these activities. Do not perform these activities for the patient unless asked. Those with RA do not want to be dependent. The nurse will assess the problem area, and suggest alternative methods. Referral to an OT could take place later, if the modified methods do not work.

The client's ankle heals, and his cast is removed. What teaching will the nurse provide regarding ongoing ankle care? "Scrub your lower leg and ankle to remove dead, scaly skin." "Wear a support stocking to prevent lower extremity swelling." "Keep your ankle in a low position to facilitate perfusion to the healed bone." "Exercise vigorously at least three times a day as advised by the physical therapist."

"Wear a support stocking to prevent lower extremity swelling." A support stocking can prevent swelling. The ankle should be supported on pillows. Dead scaly skin should be removed by soaking, not scrubbing. Exercise should be undertaken slowly.

The nurse is caring for four female clients. Which client does the nurse identify at highest risk for low bone density? -22 asian american -39 native american -44 african american -50 caucasian american

-50 caucasian american caucasian women tend to have the least amount of bone density of any group, which makes them more likely to have osteoporosis and fractures

The nurse is taking a history on a 45-year old female client who reports ongoing fatigue, joint pain, and difficulty moving in the morning. 1. What assessment questions should the nurse ask at this time?

-bilateral or unilateral -how long does the pain last -does it get better after you move around a bit -how long have you had Ask the client how long this has been happening. Ask how long it takes her in the morning to begin fully moving. Ask about any weight loss or fevers. Ask if any specific joints hurt.

The client has been well-managed on hydroxychloroquine for more than a year. After the sudden loss of her mother, she reports an increase increase in morning stiffness and joint pain. When she asks the nurse if she will need a different type of medication, what is the appropriate nursing response?

-flare ups due to stress -med schedule -taking it like prescribed

Which assessment data does the nurse anticipate in a client diagnosed with osteomalacia?

-lack of vitamin D Osteomalacia is the loss of bone related to lack of vitamin D which causes bone softening. Vitamin D is needed for calcium absorption in the small intestines. As a result of Vitamin D deficiency, normal bone building is disrupted, and calcification does not occur to harden the bone. Decreased bone mass occurs with osteoporosis. Lack of estrogen (post-menopausal) is associated with osteoporosis. Elevated blood sugar would not be anticipated with osteomalacia.

The primary health care provider prescribes hydroxychloroquine. What teaching will the nurse include when discussing this drug with the client?

-report blurred vision and headaches -eye exams -headache -take with meals This drug may take several months to become effective. Mild stomach discomfort, light-headedness, or headache are possible side effects. The most serious adverse effect of hydroxychloroquine is retinal damage. The client should be taught to report blurred vision or headache. Remind them to have an eye examination before taking the drug and every 6 months to detect changes in the cornea, lens, or retina. If this rare complication occurs, the primary health care provider will discontinue the drug.

The client is diagnosed with rheumatoid arthritis. She tells the nurse, "I'm glad I know what I have. Now I can take medicine and this will all go away."

-will not go away -does not cure -will lessen symtoms The nurse will respond that this is not a condition that goes away; however it can be effectively managed with drug therapy and lifestyle modifications.

The nurse is caring for a client with a crush injury to the lower extremities. For which complication will the nurse monitor? Confusion Acute kidney injury Increased temperature Development of wound infection

Acute kidney injury Crush injuries can cause hemorrhage and decreased perfusion to major organs; therefore, the nurse will monitor for acute kidney injury. Shearing and friction damage skin integrity which may develop wound contamination. Acceleration or deceleration injuries cause direct trauma when an organ is moved from its fixed location (e.g., the brain).

After the client has been seen, which order will the nurse need to discuss with the health care provider? Give morphine Elevate right extremity Administer meperidine Apply ice packs to the right ankle

Administer meperidine Meperidine should not be used with older adults. Elevation, morphine, and ice packs are appropriate and do not need to be discussed at this time.

The nurse measures a 65-year-old female client who has come to the provider's office for an annual physical. She was measured as standing 65 inches last year. The nurse observes that the client now measures 64 inches. She has mild kyphosis. 1. What assessment questions should the nurse ask at this time?

Are you experiencing pain in your back or neck? Difficulty lifting or bending? Diet? -calcium/vit D Have you broken many bones when you have fallen? Ask the client if she feels she has gotten shorter. Ask if she experiences pain with lifting, bending, or stooping. Ask if the pain is worse with activity and relieved by rest

While conducting a community health fair, which client does the nurse identify at the highest risk for osteoporosis?

Asian American female Osteoporosis occurs most often in older, lean-built Euro-American and Asian women, particularly those who do not exercise regularly.

What teaching will the nurse provide to a client who has been prescribed methotrexate? Select all that apply. Hair loss may occur. Do not take with grapefruit juice Take with Vitamin C to enhance effects Report a fever to the health care provider Use methods of birth control while on this drug

Hair loss may occur. Report a fever to the health care provider Use methods of birth control while on this drug The nurse will teach that hair loss is a side effect of this drug; that any signs of fever or infection should be reported, as this drug suppresses the immune system; and that pregnancy is not recommended while taking methotrexate because birth defects are possible (and thus, the client should use methods of birth control). Folic acid, not Vitamin C, is often given with methotrexate to help decrease some of the drug's side effects. Grapefruit juice does not affect methotrexate.

Which assessment data does the nurse anticipate in a client with osteoarthritis? Morning stiffness Elevation in ANA and ESR Involvement of weight-bearing joints Symmetric appearance of disease process

Involvement of weight-bearing joints Osteoarthritis affects weight-bearing joints. It can affect unilateral, single joints. In osteoarthritis, the ANA is normal. The ESR may be normal or just slightly elevate. Rheumatoid arthritis is characterized by morning stiffness, elevation in both the ANA and ESR, and a symmetric appearance of the disease process.

The nurse is caring for a client who sustained a knee injury at work. The nurse explains that which diagnostic test best demonstrates soft tissue damage in the area of the injury? Knee x-ray Electromyography (EMG) Computed tomography (CT) Magnetic resonance imaging (MRI)

Magnetic resonance imaging (MRI) MRI is useful in determining the amount of soft tissue damage that may have occurred with the fracture. Standard x-rays and CT are helpful in determining simple and complex bone fractures. EMG assists with diagnosis problems associated with muscles.

An ankle fracture is confirmed via x-ray and a fiberglass cast is applied. Which nursing intervention is appropriate after the cast is applied? (Select all that apply.) You must pick all the correct answer(s). Monitor for signs of infection. Assess peripheral capillary refill. Ask the client if he will jog in the future. Keep the cast uncovered for air-drying over several hours. Ensure that a finger can be easily inserted between the skin and the cast.

Monitor for signs of infection. Assess peripheral capillary refill. Ensure that a finger can be easily inserted between the skin and the cast. A synthetic cast such as fiberglass will dry within 10 to 15 minutes and can bear weight 30 minutes after application. Assessing capillary refill and inserting a finger into the space between the skin and the cast allows the nurse to assure that the client's circulation is not compromised by swelling of the tissue or tightness of the cast. Monitoring for signs of infection are always important. Asking about future jogging is not a necessary intervention at this time. Teaching about safety can ta

The client also asks why she can't just take the calcium once a day. How will the nurse respond?

Morning and Night allows for a more continuous supply -calcium peaks halfway through the day Too much at one time could create stone A third of the daily dose should be given at bedtime because calcium is most readily utilized by the body when the client is fasting and immobile.

A 60-year-old man is brought to the ED with a deformed right ankle. He states that he was jogging close to the edge of a hillside, and that he tripped and fell down the hill. There are no open wounds. The right foot is pale and cool to palpation, and a pulse is not detected. The client rates his pain as an "8" on a 0-to-10 scale. 1. What is the priority nursing action at this time? Prepare for reduction. Administer pain medication. Obtain a Doppler of the right foot pulse. Notify the health care provider of the lack of pulse.

Obtain a Doppler of the right foot pulse. The nurse should obtain a Doppler reading to see if any pulse can be detected at all. Then, subsequent actions could include notifying the health care provider, administering pain medication, and preparing for reduction.

The health care provider orders oral calcium twice daily. The client asks why she must drink extra fluids. What is the appropriate nursing response?

Reduce risk of hypercalcemia = healthy blood transportation through the body prevent risk of kidney stones

The client is diagnosed with possible osteoporosis. 2. Which diagnostic test does the nurse anticipate will be ordered? (Select all that apply.) Sodium Phosphorus Serum calcium Thyroid function tests Dual x-ray absorptiometry (DXA)

Serum calcium Thyroid function tests Dual x-ray absorptiometry (DXA)

The client is diagnosed with osteoporosis. Which intervention by the nurse would be appropriate? Teach about smoking reduction. Suggest walking 30 minutes, 3-5 times weekly. Recommend a high calcium, low vitamin D diet. Confirm that high-impact activities build strength.

Suggest walking 30 minutes, 3-5 times weekly. The single most effective exercise for osteoporosis is walking 30 minutes three to five times a week. Clients should include increased vitamin D along with calcium in the diet. Smoking should be avoided (not just reduces), as should high-impact exercises, which may cause vertebral compression fractures.

The nurse is assessing a 38-year old client with a cast on the lower left extremity. Which early finding alerts the nurse to compartment syndrome? Toe numbness Left leg paralysis Decreased pulse in LLE More intense pain than expected from injury

The classic sign of acute compartment syndrome is pain, and the pain is more intense than what would be expected from the injury itself. Other symptoms include tingling or burning sensations (paresthesias) in the skin. Decreased pulses and numbness or paralysis are late signs of compartment syndrome.

The primary health care provider prescribes a prednisone taper for the client, and recommends that she continue taking hydroxychloroquine as usual. What teaching will the nurse provide to the client regarding prednisone?

The nurse will show/explain how to take the prednisone taper. More pills are taken initially, and the number of pills are reduced daily over the course of the taper. The nurse will teach that prednisone may cause a burst in energy or sleeplessness, so it should be taken in the morning.

Just prior to having arthroscopy for surgical repair, what question will the nurse ask the client? -select all that apply -when did you last eat or drink -when was your physical therapy consultation -have you completed your exercise for the day -do you understand the post-care information I shared with you -have you signed the informed consent form

when did you last eat or drink do you understand the post-care information I shared with you have you signed the informed consent form