Chapter 18 Bone and Joint Problems (EVOLVE ch 49/51 med/surg)

A client recently had an amputation of the right hand. Which statement by the client, who was right-handed, indicates that he or she is coping effectively? A. "I can learn to write with my left hand." B. "I'll need help with all of my personal care." C. "Clothing will cover my missing hand." D. "People will look at me differently."

A. "I can learn to write with my left hand."

A client has a new synthetic leg cast for a tibial fracture. What health care teaching does the nurse include for the client's self-management at home? Select all that apply. A. "Keep your leg elevated, preferably above your heart, as much as possible." B. "Apply ice on the cast for the first 24 hours to increase blood flow for healing." C. "Report severe numbness or inability to move your toes to your health care provider." D. "Take your pain medication as needed according to the prescription directions." E. "Don't cover the cast with anything because it will stay wet for 24 hours."

A. "Keep your leg elevated, preferably above your heart, as much as possible." C. "Report severe numbness or inability to move your toes to your health care provider." D. "Take your pain medication as needed according to the prescription directions."

A client has sustained a fracture of the left tibia. The extremity is immobilized using an external fixation device. Which postoperative instruction does the nurse include in this client's teaching plan? A. "Use pain medication as prescribed to control pain." B. "Clean the pin site when any drainage is noticed." C. "Wear the same clothing that is normally worn." D. "Apply bacitracin (Neosporin) if signs or symptoms of infection develop around pin sites."

A. "Use pain medication as prescribed to control pain."

A rock climber has sustained an open fracture of the right tibia after a 20-foot fall. The nurse plans to assess the client for which potential complications? (Select all that apply.) A. Acute compartment syndrome (ACS) B. Fat embolism syndrome (FES) C. Congestive heart failure D. Urinary tract infection (UTI) E. Osteomyelitis

A. Acute compartment syndrome (ACS) B. Fat embolism syndrome (FES) E. Osteomyelitis

A 65-year-old female client has chronic hip pain and muscle atrophy from an arthritic disorder. Which musculoskeletal assessment finding does the nurse expect to see in the client? A. Antalgic gait B. Midswing gait C. Narrow-based stance D. No lurch in gait

A. Antalgic gait

A client's left arm is placed in a plaster cast. Which assessment does the nurse perform before the client is discharged? A. Assess that the cast is dry. B. Ensure that the client has 4 × 4 gauze to take home for placement between the cast and the skin. C. Check the fit of the cast by inserting a tongue blade between the cast and the skin. D. Ensure that the capillary refill of the left fingernail beds is longer than 3 seconds.

A. Assess that the cast is dry.

The nurse is concerned that a client who had an ankle open reduction and internal fixation is at risk for complex regional pain syndrome. What assessment findings at the affected area are common when a client has this complication? Select all that apply. A. Burning pain B. Increase in sweating C. Muscle weakness D. Absent pedal pulse E. Edema

A. Burning pain B. Increase in sweating E. Edema

A client with a compound fracture of the left femur is admitted to the emergency department after a motorcycle crash. Which action is most essential for the nurse to take first? A. Check the dorsalis pedis pulses. B. Immobilize the left leg with a splint. C. Administer the prescribed analgesic. D. Place a dressing on the affected area.

A. Check the dorsalis pedis pulses.

An older adult client has had an open reduction and internal fixation of a fractured right hip. Which intervention does the nurse implement for this client? A. Keep the client's heels off the bed at all times. B. Re-position the client every 3 to 4 hours. C. Administer preventive pain medication before deep-breathing exercises. D. Prohibit the use of antiembolic stockings.

A. Keep the client's heels off the bed at all times.

A diabetic older adult client who had arthroscopic surgery on the right knee the previous day has a red, swollen, and painful right knee. The nurse anticipates that the health care provider will request which medication? A. Levofloxacin (Levaquin) B. Enoxaparin (Lovenox) C. Oxycodone (Roxicodone) D. Prednisone (Deltasone)

A. Levofloxacin (Levaquin)

When assessing a female client, the nurse learns that the client has several risk factors for osteoporosis. Which risk factor will be the priority for client teaching? A. Low calcium intake B. Postmenopausal status C. Positive family history D. Previous use of steroids

A. Low calcium intake

A client returns to the same-day surgical unit after having an ankle open reduction internal fixation (ORIF). What is the nurse's priority action when caring for this client? A. Monitor the client's vital signs frequently. B. Assess the client's abdomen for bowel sounds. C. Keep the client's affected leg on a pillow. D. Encourage the client to drink fluids.

A. Monitor the client's vital signs frequently.

A client has undergone an elective below-the-knee amputation of the right leg as a result of severe peripheral vascular disease. In postoperative care teaching, the nurse instructs the client to notify the health care provider if which change occurs? A. Observation of a large amount of serosanguineous or bloody drainage B. Mild to moderate pain controlled with prescribed analgesics C. Absence of erythema and tenderness at the surgical site D. Ability to flex and extend the right knee

A. Observation of a large amount of serosanguineous or bloody drainage

The nurse anticipates providing collaborative care for a client with a traumatic amputation of the right hand with which health care team members? (Select all that apply.) A. Occupational therapist B. Physical therapist C. Psychologist D. Respiratory therapist E. Speech therapist

A. Occupational therapist B. Physical therapist C. Psychologist

Loss of bone mineral density and structure describes which one of the following vocabulary words? A. Osteopenia B. Crepitus C. Bone mineral density D. Osteophyte

A. Osteopenia

Which intervention does the nurse suggest to a client with a leg amputation to help cope with loss of the limb? A. Talking with an amputee close to the client's age who has had the same type of amputation B. Drawing a picture of how the client sees him- or herself C. Talking with a psychiatrist about the amputation D. Engaging in diversional activities to avoid focusing on the amputation

A. Talking with an amputee close to the client's age who has had the same type of amputation

Which aspect of a musculoskeletal assessment will the physical therapist and the nurse plan to collaborate on? A. The need for ambulatory devices B. Medication that the client is currently taking C. Nutritional intake of the client before admission D. Current list of the client's medical conditions

A. The need for ambulatory devices

Which statement indicates to the nursing instructor that the nursing student understands the normal healing process of bone after a fracture? A. "A callus is quickly deposited and transformed into bone." B. "A hematoma forms at the site of the fracture." C. "Calcium and vascular proliferation surround the fracture site." D. "Granulation tissue reabsorbs the hematoma and deposits new bone."

B. "A hematoma forms at the site of the fracture."

You realize your client does not understand her diagnosis of osteoporosis when she makes which one of the following statements? A. "I have removed all the throw rugs in my house so I will not trip and fall." B. "I am going to have to quit smoking sometime." C. "I have signed up at the YMCA to do water exercises twice a week." D. "I have asked my son to put grab bars in my bathtub and handrails in the hallway."

B. "I am going to have to quit smoking sometime."

The client has sustained a traumatic amputation of the left arm after a machine accident. In what order should the following nursing actions be taken? 1. Apply direct pressure to the amputated site. 2. Elevate the extremity above the client's heart. 3. Assess the client for breathing problems. 4. Examine the amputation site. A. 2, 4, 3, 1 B. 3, 4, 1, 2 C. 1, 4, 3, 2 D. 4, 1, 2, 3

B. 3, 4, 1, 2

The nurse refers a client with an amputation and the client's family to which community resource? A. American Amputee Society (AAS) B. Amputee Coalition of America (ACA) C. Community Workers for Amputees (CWA) D. National Amputee of America Society (NAAS)

B. Amputee Coalition of America (ACA)

The nurse admits an older adult client who sustained a left hip fracture and is in considerable pain. The nurse anticipates that the client will be placed in which type of traction? A. Balanced skin traction B. Buck's traction C. Overhead traction D. Plaster traction

B. Buck's traction

Which diagnostic test requires the nurse to know whether the client is allergic to iodine-based contrast? A. Arthroscopy B. Computed tomography (CT) C. Electromyography (EMG) D. Tomography

B. Computed tomography (CT)

Care of the older adult may be affected by which physiologic change in the musculoskeletal system? A. Regeneration of cartilage B. Decreased range of motion (ROM) C. Increased bone density D. Narrower gait

B. Decreased range of motion (ROM)

The nurse plans to use which tool to measure joint range of motion (ROM)? A. Doppler device B. Goniometer C. Reflex hammer D. Tonometer

B. Goniometer

A client is suspected of having muscular dystrophy (MD). Which laboratory test result does the nurse anticipate with this disease? A. Decreased serum creatine kinase (CK) level B. Moderately elevated aspartate aminotransferase (AST) C. Decreased alkaline phosphatase (ALP) D. Decreased skeletal muscle creatine kinase (CK-MM) level

B. Moderately elevated aspartate aminotransferase (AST)

Which information about a client who was admitted with pelvic and bilateral femoral fractures after being crushed by a tractor is most important for the nurse to report to the health care provider? A. Thighs have multiple oozing abrasions. B. Serum potassium level is 7 mEq/L. C. The client is describing pain as level 4 (0-to-10 scale). D. Hemoglobin level is 12.0 g/dL.

B. Serum potassium level is 7 mEq/L.

A nurse is performing a musculoskeletal assessment on an older adult living independently in a senior housing apartment. What normal physiologic changes of aging does the nurse expect? Select all that apply. A. Muscle contractures B. Slowed movement C. Lordosis D. Antalgic gait E. Decreased coordination

B. Slowed movement E. Decreased coordination

A client has a grade III compound fracture of the right tibia. To prevent infection, which intervention does the nurse implement? A. Apply bacitracin (Neosporin) ointment to the site daily with a sterile cotton swab. B. Use strict aseptic technique when cleaning the site. C. Leave the site open to the air to keep it dry. D. Assist the client to shower daily and pat the wound site dry.

B. Use strict aseptic technique when cleaning the site.

The nurse is completing an admission assessment on a client scheduled for arthroscopic knee surgery. Which information will be most essential for the nurse to report to the health care provider? A. Knee pain at a level of 9 (0-to-10 scale) B. Warm, red, and swollen knee C. Allergy to shellfish and iodine D. Previous surgery on the other knee

B. Warm, red, and swollen knee

A client experiencing kyphosis appears withdrawn and does not initiate any conversation with the nurse when medications are given each day. Which statement by the nurse is most supportive of this client? A. "It is normal to feel depressed at times about your condition. You have my support." B. "You could exercise more often to build up your strength and endurance." C. "How do you feel about the pain in your spine? I am here if you want to talk." D. "What does your family say to you? Try talking to them."

C. "How do you feel about the pain in your spine? I am here if you want to talk."

A client who had an elective above-the-knee amputation (AKA) reports pain in the foot that was amputated. What is the nurse's best response to the client's pain? A. "The pain will go away in a few days or so." B. "That's phantom limb pain and every amputee has that." C. "On a scale of 0 to 10, how would you rate your pain?" D. "The pain is not real, so we don't treat it."

C. "On a scale of 0 to 10, how would you rate your pain?"

The nurse is instructing a local community group about ways to reduce the risk for musculoskeletal injury. What information does the nurse include in the teaching plan? A. "Avoid contact sports." B. "Avoid rigorous exercise." C. "Wear helmets when riding a motorcycle." D. "Avoid driving in inclement weather."

C. "Wear helmets when riding a motorcycle."

The nurse is using a common scale to grade a client's muscle strength. The client is able to complete range of motion (ROM) with gravity eliminated. Which grade does the nurse document in this client's record? A. 0 B. 1 C. 2 D. 3

C. 2

A client has sustained a rotator cuff tear while playing baseball. The nurse anticipates that the client will receive which immediate conservative treatment? A. Surgical repair of the rotator cuff B. Prescribed exercises of the affected arm C. Immobilizer for the affected arm D. Patient-controlled analgesia with morphine

C. Immobilizer for the affected arm

A client is in skeletal traction. Which nursing intervention ensures proper care of this client? A. Ensure that weights are attached to the bed frame or placed on the floor. B. Ensure that pins are not loose, and tighten as needed. C. Inspect the skin at least every 8 hours. D. Remove the traction weights only for bathing.

C. Inspect the skin at least every 8 hours.

Your client has a history of arthritis. After assessing her condition and finding stiffness with inactivity, pain relieved by rest, and crepitus, you realize she has which one of the following types of arthritis? A. Rheumatic arthritis (RA) B. Gout C. Osteoarthritis (OA) D. Polymyalgia rheumatica (PMR)

C. Osteoarthritis (OA)

Which client information is most essential for the nurse to report to the health care provider before a client with knee pain undergoes magnetic resonance imaging (MRI)? A. Daily use of aspirin B. Swollen and tender knee C. Presence of a permanent pacemaker D. History of claustrophobia

C. Presence of a permanent pacemaker

A client is scheduled to undergo closed magnetic resonance imaging (MRI) without contrast medium. Which information does the nurse give to the client before the test? A. "It will be important to lie still in a reclined position for 20 minutes." B. "Do not eat or drink for 8 hours before the test." C. "You can have the MRI if you have an internal pacemaker." D. "All jewelry and clothing with zippers or metal fasteners must be removed."

D. "All jewelry and clothing with zippers or metal fasteners must be removed."

A client with a fracture asks the nurse about the difference between a compound fracture and a simple fracture. Which statement by the nurse is correct? A. "Simple fracture involves a break in the bone, with skin contusions." B. "Compound fracture does not extend through the skin." C. "Simple fracture is accompanied by damage to the blood vessels." D. "Compound fracture involves a break in the bone, with damage to the skin."

D. "Compound fracture involves a break in the bone, with damage to the skin."

A nursing student is studying the skeletal system. Which statement indicates to the nursing instructor that the student understands a normal physiologic function of the skeletal system? A. "Volkmann's canals connect osteoblasts and osteoclasts." B. "In the deepest layer of the periosteum is the cortex, which consists of dense, compact bone tissue." C. "The matrix of the bone is where deposits of calcium and magnesium are present." D. "Hematopoiesis occurs in the red marrow, which is where blood cells are produced."

D. "Hematopoiesis occurs in the red marrow, which is where blood cells are produced."

A client is recovering from an above-the-knee amputation resulting from peripheral vascular disease. Which statement indicates that the client is coping well after the procedure? A. "My spouse will be the only person to change my dressing." B. "I can't believe that this has happened to me. I can't stand to look at it." C. "I do not want any visitors while I'm in the hospital." D. "It will take me some time to get used to this."

D. "It will take me some time to get used to this."

The nurse prepares to perform a neurovascular assessment on a client with closed multiple fractures of the right humerus. Which technique does the nurse use? A. Inspect the abdomen for tenderness and bowel sounds. B. Auscultate lung sounds. C. Assess the level of consciousness and ability to follow commands. D. Assess sensation of the right upper extremity.

D. Assess sensation of the right upper extremity.

A client returns to the postanesthesia care unit (PACU) after an arthroscopy for a shoulder rotator cuff tear. What is the nurse's priority when caring for this client? A. Perform passive range-of-motion exercises. B. Keep the affected arm immobilized. C. Ensure that the patient uses the patient-controlled analgesia (PCA) pump. D. Check the neurovascular status of the affected arm.

D. Check the neurovascular status of the affected arm.

Which nursing action does the nurse on the orthopedic unit plan to delegate to unlicensed assistive personnel (UAP)? A. Remove the wound drain for a client who had an open reduction of a hip fracture 3 days ago. B. Assess for bruising on a client who is receiving warfarin (Coumadin) to prevent deep vein thrombosis. C. Teach a client with a right ankle fracture how to use crutches when transferring and ambulating. D. Check the vital signs for a client who was admitted after a total knee replacement 3 hours ago.

D. Check the vital signs for a client who was admitted after a total knee replacement 3 hours ago.

You are taking care of a female older adult client with a loss of height and kyphosis. She is also postmenopausal. Which one of the following diagnostic tools would you order? A. Computed tomography (CT) scan of her bones B. Magnetic resonance image (MRI) of her bones C. Bone scan D. Dual-energy x-ray absorptiometry (DEXA) scan

D. Dual-energy x-ray absorptiometry (DEXA) scan

The nurse is conducting a musculoskeletal history in an older adult client who requires a caregiver to perform all activities of daily living (ADLs). Which level of functioning does the nurse record in the client's history using Gordon's Functional Health Patterns? A. Level 0 B. Level II C. Level III D. Level IV

D. Level IV

The ambulatory surgery postanesthesia care unit (PACU) nurse has just received report about clients who had arthroscopic surgery. Which client will the nurse plan to assess first? A. Young adult client who has been in the PACU for 30 minutes after left knee arthroscopy under local anesthesia B. Adult client who had a synovial biopsy of the right knee under local anesthesia and has been in the PACU for 20 minutes C. Adult client who has multiple right knee incisions for repair of torn cartilage and arrived in the PACU an hour ago D. Middle-aged adult client who returned to the PACU 25 minutes ago after left knee arthroscopic surgery under epidural anesthesia

D. Middle-aged adult client who returned to the PACU 25 minutes ago after left knee arthroscopic surgery under epidural anesthesia

The charge nurse in the hospital-based day surgery center is making client assignments for the staff. Which client is most appropriate to assign to a nurse who has floated from the general surgical unit? A. Young adult who has just been admitted for surgery after sustaining an ankle fracture B. Adult who needs teaching about quadriceps-setting exercises after knee arthroscopy C. Middle-aged adult who will require a pneumatic tourniquet applied before knee surgery D. Older adult who has undergone arthroscopic surgery of the shoulder under local anesthesia

D. Older adult who has undergone arthroscopic surgery of the shoulder under local anesthesia

An older adult client has multiple tibia and fibula fractures of the left lower extremity after a motor vehicle crash. Which pain medication does the nurse anticipate will be requested for this client? A. Cyclobenzaprine (Flexeril) B. Ibuprofen (Advil) C. Meperidine (Demerol) D. Patient-controlled analgesia (PCA) with morphine

D. Patient-controlled analgesia (PCA) with morphine

The nurse is reviewing the medication history for a client scheduled for a left total hip replacement. The nurse plans to contact the health care provider if the client is taking which medication? A. Acetaminophen (Tylenol) for pain relief B. Bupropion (Wellbutrin) for smoking cessation C. Magnesium hydroxide (Milk of Magnesia) to treat heartburn D. Prednisone (Deltasone) to treat asthma

D. Prednisone (Deltasone) to treat asthma

Your older adult client has recently been diagnosed with gout. You will need to teach him which one of the following EXCEPT: A. Side effects of medications B. How to decrease the likelihood of another attack C. Care of the joint D. Reassurance that this is a one-time occurrence

D. Reassurance that this is a one-time occurrence

A client is brought to the emergency department via ambulance after a motor vehicle crash. What condition does the nurse assess for first? A. Bleeding B. Head injury C. Pain D. Respiratory distress

D. Respiratory distress