CUSTOM: MUSCLE-SKELETAL/ REP LORETTA
A nurse is teaching a group of newly licensed nurses on effective techniques for counseling clients about sexually transmitted infections (STIs). Which of the following statements should the nurse include in the teaching? "Use closed-ended questions when obtaining the health history." "A client's reproductive health history is not needed for counseling purposes." "Ask about the client's exposure to any past or present STIs." "Refer the client to genetic counseling if he has had a STI."
"Ask about the client's exposure to any past or present STIs." The nurse should assess the client exposure to any past or present STIs and any treatment taken.
A nurse in a medical clinic is providing teaching to an older adult client who has osteoarthritis that is affecting her knees. Which of the following client statements indicates an understanding of the teaching? "I can use either heat or ice to help relieve the discomfort." "Ibuprofen is the first step in medication therapy for osteoarthritis." "I should limit physical activity to prevent further injury." "I will elevate my legs by placing two pillows under my knees when I go to bed."
"I can use either heat or ice to help relieve the discomfort." The nurse should reinforce that different treatment modalities, such as heat or cold therapy, can be tried to determine which one is more effective for the client. Heat application can help with muscle relaxation in the area around the affected joint. The application of cold numbs nerve endings and decreases joint inflammation.
A nurse is teaching a client who has vulvodynia about self-care measures to alleviate symptoms. Which statement by the client indicates an understanding of the teaching? "I should increase oxalates in my diet." "I should take baths instead of showers." "I should avoid the use of any lubricants." "I should wear cotton undergarments."
"I should avoid the use of any lubricants." The nurse should recommend the use of natural oils such as olive oil for lubricant and avoid lubricants containing propylene glycol.
A nurse is teaching a client about preventing osteoporosis. Which of the following statements by the client indicates a need for further teaching? "I will reduce my intake of sodium." "I will decrease my intake of caffeine." "I will limit my intake of soft drinks." "I will reduce my intake of vitamin K-rich foods."
"I will reduce my intake of vitamin K-rich foods." Vitamin K is necessary for bone health. The nurse should instruct the client to increase her intake of vitamin K-rich foods—such as green, leafy vegetables—to promote bone health.
A nurse is providing teaching to a client who has a new diagnosis of fibromyalgia. Which of the following client statements indicates an understanding of the teaching? "I should increase my caffeine intake." "I will take my duloxetine in the morning, so I have more energy to accomplish tasks." "Low-impact aerobics can help reduce episodes of pain." "A course of chemotherapy treatment should provide a cure."
"Low-impact aerobics can help reduce episodes of pain." The nurse should reinforce that clients who have fibromyalgia can help reduce pain through regular low-impact aerobics, such as walking, swimming, and biking.
A nurse is providing discharge instructions to a client who has rheumatoid arthritis and a prescription for oral betamethasone. Which of the following statements should the nurse make about how to take this medication? "Take the medication between meals." "Take the medication with orange juice." "Take the medication with milk." "Take the medication on an empty stomach."
"Take the medication with milk." Betamethasone should be administered with milk or food to prevent gastric irritation.
A nurse is providing teaching for a client who is preparing for a below the knee amputation. Which of the following statements is true regarding the postoperative placement of a prosthesis? "You will do special exercises in advance of getting your prosthesis." "You will be fitted for your prosthesis at the time of surgery." "A special pressure dressing will remain on to cushion your prosthesis." "The prosthesis will be adjustable depending on what shoe you are wearing."
"You will do special exercises in advance of getting your prosthesis." The physical therapist will teach muscle strengthening exercises to prepare the client for prosthesis use.
A nurse is caring for a client who asks to be screened for cervical cancer because a relative has been diagnosed with it. Which of the following tests should the nurse expect the provider to use? A serum prolactin level A Papanicolaou test A vaginal ultrasound An endometrial biopsy
A Papanicolaou test A Papanicolaou test involves sampling cells from the cervix to detect abnormal cells and growth. The nurse should recommend the client have an annual Pap test between ages 21 to 29, and every 5 years from ages 30 to 65.
A nurse is providing teaching to a client who has had a total abdominal hysterectomy and bilateral salpingo-oophorectomy for uterine cancer. Which of the following instructions should the nurse include in the teaching? A Papanicolaou (Pap) test should be performed every 6 months. Artificial lubrication can be used to treat vaginal itching and dryness. Increased vaginal drainage typically occurs 5 days following surgery. Resume sexual intercourse in 2 to 3 weeks.
Artificial lubrication can be used to treat vaginal itching and dryness. The nurse should instruct the client that atrophic vaginal changes occur due to the loss of estrogen postoperatively and can also cause pain and dryness during sexual intercourse. Artificial lubricants can reduce the manifestations associated with diminished mucous production.
A client is starting celecoxib to treat osteoarthritis. The nurse should instruct the client to watch for and report which of the following adverse effects? Black, tarry stools Bone pain Dry mouth Polyuria
Black, tarry stools Celecoxib can cause gastrointestinal bleeding. The client should watch for and report black, dark-colored, or bloody stools, abdominal pain, or coffee-ground emesis. The nurse also should instruct the client to take celecoxib with food to reduce gastric irritation.
A nurse is teaching a client at high risk for osteoporosis about dietary measures she can take to increase her calcium level. Which of the following foods should the nurse advise the client to increase in her diet? Carrots Broccoli Cabbage Potatoes
Broccoli Broccoli is high in calcium. Most vegetables contain considerably less calcium, except for kale, collard greens with stems, and turnip greens, which are also good sources of calcium.
A nurse is teaching a client following a cystoscopy about his new prescription for tamsulosin. Which of the following adverse effects should the nurse include in the teaching? Temporary loss of libido. Dizziness. Bradycardia Burning with urination
Dizziness. Lightheadedness or dizziness is likely with the first several doses. Clients should be taught to rise slowly and carefully from lying or sitting positions until the sensation disappears.
A nurse is teaching a client who has a prosthetic limb due to a right below-the-knee amputation about prosthesis and stump care. Which of the following instructions should the nurse include in the teaching? Keep the prosthesis in direct contact with the residual limb. Apply a moisturizing lotion or oil to the stump daily. Dry the prosthesis socket completely before applying it to the limb. Expect some skin irritation from the prosthesis.
Dry the prosthesis socket completely before applying it to the limb. The client should dry the prosthesis socket thoroughly with a clean cloth. Moisture between the socket and the stump can put the client at risk for fungal or bacterial infection and skin breakdown.
A nurse is caring for an older adult client who has rheumatoid arthritis (RA) and is taking aspirin 650 mg every 4 hours. Which of the following diagnostic tests should the nurse monitor to evaluate the effectiveness of this medication? White blood cell (WBC) count Rheumatoid factor (RF) Antinuclear antibody (ANA) Erythrocyte sedimentation rate (ESR)
Erythrocyte sedimentation rate (ESR) Rheumatoid arthritis is a chronic inflammatory disease. ESR is useful in detecting and monitoring tissue inflammation in clients with RA. As the disease improves the ESR decreases.
A nurse is caring for an older adult client who had a femoral head fracture 24 hr ago and is in skin traction. The client reports shortness of breath and dyspnea. The nurse should suspect that the client has developed which of the following complications? Pneumonia Fat embolism Pneumothorax Airway obstruction
Fat embolism The nurse should suspect that client has fat embolism syndrome. This complication develops within 12 to 48 hr of a fracture and can cause dyspnea, respiratory distress, alterations in mental status, tachycardia, and other manifestations. Older adults who have hip fractures are at greater risk.
A nurse is caring for a client who has benign prostatic hyperplasia (BPH). Which of the following medications should the nurse plan to administer? Danazol Finasteride Fluoxymesterone Methyltestosterone
Finasteride Finasteride, a 5-alpha-reductase inhibitor, is used in the treatment of BPH to prevent the conversion of testosterone and to decrease prostate size.
A nurse is caring for a client who is experiencing menopausal symptoms and asks the nurse about menopausal hormone therapy (HT). The nurse should inform the client that HT is not recommended due to which of the following findings in the client's medical history? History of dermatitis History of breast cancer Multiple hospitalizations for COPD Concurrent treatment for GERD
History of breast cancer Women with a history of breast cancer should be counseled against using HT.
A nurse is caring for a client who has endometriosis and will receive depot injections of leuprolide. The client asks about the effects of this medication. Which of the following information should the nurse give the client? Menstruation will become regular. Vaginal secretions will increase. Hot flashes are common. Hair loss is common.
Hot flashes are common. Hot flashes, headache, and mood changes are common adverse effects of this medication.
A nurse is caring for a client who has an unrepaired femur fracture of the midshaft. Which of the following techniques should the nurse use when performing an assessment of the client's neurovascular status? Measure the circumference of the thigh. Palpate the femoral pulse. Monitor the client's calf for edema. Instruct the client to wiggle his toes.
Instruct the client to wiggle his toes. The nurse should observe the client's ability to move his toes when collecting data regarding neurovascular status distal to the fracture. Other means of evaluating neurovascular status include assessing skin color and temperature, sensation, pain, and capillary refill.
A nurse in a clinic is teaching information about cervical polyps with a client who has a new diagnosis. Which of the following information should the nurse include in the teaching? Avoid using tampons during menstruation. Cervical polyps are a precursor to the development of cervical cancer. Cervical polyps affect women before the age of 40. Postcoital bleeding may occur.
Postcoital bleeding may occur. The client may experience postcoital bleeding, because the polyps are soft, fragile, and bleed when touched.
A nurse is planning care for a client who is postoperative following a total hip arthroplasty. Which of the following interventions should the nurse include in the plan of care? Instruct the client to avoid movement of the affected leg. Prevent hip flexion of the affected extremity Position the lower extremities so that they are touching. Ensure that the client's heels are touching the bed.
Prevent hip flexion of the affected extremity The nurse should implement measures to prevent hip flexion of the affected extremity beyond 90 degrees due to the risk of dislocation. Raised toilet seats and reclining chairs help prevent hyper-flexion.
A nurse is teaching an assistive personnel (AP) about the purpose of a footplate on the bed of a client whose leg is in Buck's traction. Which of the following statements indicates the AP understands the teaching? "The footplate works to anchor the traction." "The footplate helps to prevent foot drop." "The footplate keeps the client from sliding down in bed." "The footplate prevents pressure sores on the heel."
The footplate helps to prevent foot drop." The purpose of a footplate is to prevent foot drop by providing support and a surface for isometric resistance exercises.
A nurse is caring for a client who is 4 hr postoperative following a hip replacement. The nurse should instruct the client to avoid which of the following activities? Placing a large pillow between legs when turning Putting on shoes and socks Using a raised toilet seat Using a walker
Putting on shoes and socks The client should not bend over to put on shoes and socks. It increases the risk of dislocation of the prosthesis to create more than 90° of flexion at the hip.
A nurse is teaching a client about medications that prevent osteoporosis. The nurse should instruct the client that which of the following medications is prescribed to prevent osteoporosis? Levothyroxine Calcitonin Raloxifene Allopurinol
Raloxifene Raloxifene is prescribed for the prevention and treatment of osteoporosis in postmenopausal women.
A nurse is providing discharge teaching to a client who has a fracture of the right tibia and a fiberglass cast. Which of the following instructions should the nurse include in the teaching? Use a blow dryer on a moderate heat setting to dry the cast after showering. Use a cotton swab to relieve itching under the cast. Report any worsening or unrelieved pain. Avoid moving the affected leg.
Report any worsening or unrelieved pain. Pain can be a sign of complications such as compartment syndrome or skin breakdown. The client should report it to the provider.
A nurse is caring for a client following a right total hip arthroplasty. Postoperatively the nurse should maintain the right leg in which of the following positions? Adduction. External rotation. Internal rotation. Abduction.
Abduction. When caring for a client following a total hip arthroplasty, the nurse should abduct the affected extremity to prevent dislocation, positioning the legs away from the midline.
A nurse in a clinic is talking with a client who has a new diagnosis of osteoarthritis. The nurse should anticipate that the client will require teaching about which of the following medications? Acetaminophen Celecoxib Cyclobenzaprine Ibuprofen
Acetaminophen According to the American Pain Society, acetaminophen is the primary drug of choice for treating osteoarthritis. The provider would likely begin with this medication.
A nurse is teaching an older adult client who has an intracapsular fracture of the right hip following a fall about the purpose of Buck's extension traction. The nurse should include which of the following information in the teaching? Buck's extension traction will reduce the fracture. Buck's extension traction will relieve muscle spasms. Buck's extension traction will maintain alignment of the pins. Buck's extension traction will allow supported movement of the extremity.
Buck's extension traction will relieve muscle spasms. Buck's extension traction immobilizes the fractured bone to relieve associated muscle spasms and thereby relieve pain. Any movement of the fractured extremity will aggravate severe muscle spasm and trigger pain.
A nurse in a clinic is caring for a client requiring a hysterectomy who states that she has decided to delay having this surgery for several months. Which of the following statements should the nurse make? "This type of surgery is very easy and should not cause a major disruption in your activities." "Most women don't have any problems during their recovery." "Can you elaborate on your reasons for delaying the surgery?" "If this happened to one of my family members, I would tell them to go ahead and not wait."
Can you elaborate on your reasons for delaying the surgery?" This is an appropriate statement that provides a general lead for the client and facilitates client communication.
A nurse is assessing a client who has a cast in place for a fractured tibia. Which of the following actions should the nurse take first? Checking capillary refill Discussing cast care Managing pain Performing range of motion
Checking capillary refill The priority action the nurse should take when using the airway, breathing, and circulation (ABC) approach to client care is to check the client's capillary refill. Musculoskeletal injuries can cause changes in the neurovascular system, usually distal to the injury. Capillary refill provides data about the client's circulation.
A nurse is reviewing the laboratory test results of an older adult client who is scheduled for elective removal of uterine fibroid tumors. When noting an erythrocyte sedimentation (ESR) rate of 28 mm/hr, the nurse should take which of the following actions? Ask the client if she has been sick with a fever. Request an antipyretic prescription. Ask the provider about postponing the surgery. Continue reviewing the preoperative test results.
Continue reviewing the preoperative test results. This ESR is below 30 mm/hr, as expected for a female older than 50 years, thus there is no need for the nurse to take any specific action. For women younger than 50, the ESR should be below 20 mm/hr. An increased ESR indicates inflammation or infection and might suggest a need to postpone elective surgery.
A nurse is caring for a client who is postoperative following a laminectomy with spinal fusion. Which of the following actions should the nurse take? Monitor sensory perception of the lower extremities. Assist the client into a knee-chest position to manage postoperative discomfort. Maintain strict bed rest for the first 48 hr postoperative. Position the client in a high-Fowler's position if clear drainage is noted on the dressing.
Monitor sensory perception of the lower extremities. The nurse should perform neurologic assessments focusing on sensory perception of the lower extremities every 4 hr. Any decrease in sensation by the client requires immediate notification of the provider.
A nurse in a clinic is caring for a female client who was exposed to gonorrhea. Which of the following actions should the nurse take? Instruct the client about preventing reinfection by using a diaphragm. Tell the client to expect some joint pain. Obtain information about the client's recent sexual experiences. Collect a urine specimen from the client.
Obtain information about the client's recent sexual experiences. The nurse should obtain information from the client about the types of sexual exposure the client may have had in order to thoroughly assess the client.
A nurse is assessing a client following the application of a leg cast for the treatment of a fracture. If the cast is too tight, which of the following findings should the nurse expect to observe first? Change in temperature of the toes. Pallor of the toes. Edema of the toes. Inability to move toes.
Pallor of the toes. If a cast is too tight it will increase pressure on the blood vessels, impairing circulation. When this occurs, pallor of the toes is the initial finding. The nurse should immediately report this finding to the provider.
A nurse is caring for a client who has had a spinal cord injury at the level of the T2-T3 vertebrae. When planning care, the nurse should anticipate which of the following types of disability? Paresthesia Hemiplegia Quadriplegia Paraplegia
Paraplegia Paraplegia, or paralysis of both legs, is seen after a spinal cord injury below T1.
A nurse is caring for an adolescent client who has a newly applied fiberglass cast for a fractured tibia. Which of the following is the priority action for the nurse to take? Perform a neurovascular assessment. Explain the discharge instructions to the client and parents. Provide reassurance to the client and parents. Apply an ice pack to the casted leg.
Perform a neurovascular assessment. The greatest risk to the client is neurovascular injury. Therefore, the priority action is to perform a neurovascular assessment. This consists of assessing the involved extremity (the lower leg) at the most distal point (the foot) for circulation (color), motion (movement), and sensation, and can be remembered by the acronym "C-M-S check."
A nurse is caring for a client who is postoperative following an open reduction and internal fixation of a fractured femur. Which of the following actions is the most important for the nurse to complete in the postoperative period? Medicate the client for pain. Instruct the client on use of crutches. Perform neurovascular checks of the extremities. Direct the client to perform exercises of the ankle and toes.
Perform neurovascular checks of the extremities. The priority action the nurse should take when using the airway, breathing, circulation approach to client care is the performance of neurovascular checks. These are a vital aspect of care for the client who has a sustained a fracture and should be monitored every hour for the first 24 hr. Circulation can easily become impaired due to constriction, which develops as the extremity swells from edema. This may cause nerve damage and tissue anoxia.
A nurse is caring for a client who is postoperative following a total hip arthroplasty. The nurse assists the client into a supine position. Which of the following actions is appropriate to prevent dislocation of the hip? Place a wedge pillow between the legs. Elevate the head of the bed to a Fowler's position. Position the legs in alignment with the spine. Place a footboard on the bed.
Place a wedge pillow between the legs. The nurse places a wedge pillow or other abduction device between the legs to prevent adduction which can lead to possible dislocation.
A nurse is caring for a client who has a prescription for balanced skeletal traction with a Thomas splint for the treatment of a fractured femur. Which of the following interventions should the nurse implement to prevent pressure points from developing around the edges of the splint? Apply lotion to the skin under the edges of the splint. Reposition the client to keep him from staying in the same position in bed. Remove the weights for a few minutes each hour. Apply a foot plate to the bed.
Reposition the client to keep him from staying in the same position in bed. The nurse should assist in the prevention of pressure points by keeping the client properly and frequently positioned in bed. Balanced suspension traction with a Thomas splint allows for increased movement.
A nurse is teaching a client about risk factors for osteoporosis. Which of the following factors should the nurse include in the teaching? (Select all that apply.) Sedentary lifestyle Obesity Aging Caffeine intake Secondhand smoke
Sedentary lifestyle is correct. Immobility depletes bone. Aging is correct. Women lose bone due to estrogen depletion after menopause. Caffeine intake is correct. Excessive caffeine intake causes calcium loss in the urine. Secondhand smoke is correct. Smoking is a risk factor for osteoporosis, both active and passive (secondhand) smoking.
A nurse is caring for a client who is postoperative and in skeletal traction. When assessing the client, the nurse should expect which of the following findings? (Select all that apply.) Slight pain at the insertion site Serous drainage on the dressing Movement of the pin at the insertion site Elastic bandages secure around the traction ropes Minimal edema around the pin
Slight pain at the insertion site is correct. The nurse should monitor the client's pain reports and implement the appropriate pain management strategies. Serous drainage on the dressing is correct. In the early postoperative period, the nurse should expect serous drainage and should report bleeding. Minimal edema around the pin is correct. In the early postoperative period, the nurse should expect slight edema and report significant edema.
A nurse is caring for a client who reports low back pain and asks the nurse for specific exercise recommendations. Which of the following activities should the nurse suggest? Tennis Canoeing Swimming Rowing
Swimming Some exercises, such as swimming and walking, can help clients who have low back pain because they strengthen back muscles.
A nurse is caring for a client who is postoperative following a right-sided mastectomy and has a drain connected to a portable drainage evacuator. Which of the following actions should the nurse? Dangle the operative limb for 5 min every hour. Place the head of the client's bed at a 15° angle. Keep the wound drain evacuator fully expanded at all times. Take blood pressures on the client's non-affected arm.
Take blood pressures on the client's non-affected arm. The nurse should plan to only take blood pressures, give injections, or perform venipuncture on the client's non-affected arm to avoid compromising circulation. The nurse should instruct other staff to follow these precautions as well.
A nurse is caring for a client who is receiving cisplatin for treatment of ovarian cancer. The client's most recent complete blood count (CBC) is shown in the table below. It is important for the nurse to consider which of the following for the client?WBC 1,400/mm3 RBC 4.3 x 10¹² /LHgb 12.1 g/dLHct 36.5%Platelets 170,000/mm3Albumin 4.5 g/dL The client has an increased risk for bleeding. The client should receive a diet with increased protein. The client has an increased risk of infection. The client should receive an erythropoiesis stimulating agent.
The client has an increased risk of infection. The low white blood cell count (expected range is 5,000 - 10,000/mm³) places the client at increased risk for infection. The nurse should assess the client's skin and mucous membranes, lung sounds, and venous access sites every 8 hr for signs of infection.
A nurse is planning a teaching session about hysterosalpingography for a client who has a diagnosis of infertility. The nurse should include which of the following information in the teaching plan? The client might experience shoulder pain following the procedure. The client should anticipate scheduling the procedure 5 days prior to menstruation. The client might experience diarrhea as a result of the procedure. The client should be on a liquid diet for 1 day following the procedure.
The client might experience shoulder pain following the procedure. Shoulder pain can occur due to phrenic nerve irritation cause by the contrast media.
A nurse is caring for a female client who has rheumatoid arthritis and a new prescription for methotrexate. The client tells the nurse she is planning a pregnancy. Which of the following instructions should the nurse give the client? Dietary modifications occur during pregnancy when taking this medication. The medication should be discontinued 3 months prior to a planned pregnancy. Dosage of the medication will be reduced during pregnancy. The client can breast feed when taking this medication.
The medication should be discontinued 3 months prior to a planned pregnancy. Methotrexate should be discontinued 3 months prior to planning a pregnancy because of the risk of birth defects.
A nurse is teaching a client about the causes of osteoporosis. The nurse should include which of the following types of medication therapy as a risk factor for osteoporosis? Anticoagulants NSAIDs Cardiac glycosides Thyroid hormones
Thyroid hormones Long-term use of synthetic thyroid hormone, such as levothyroxine, can accelerate bone loss.
A nurse is teaching a client who is scheduled for dual-energy x-ray absorptiometry (DXA) to screen for osteoporosis. Which of the following instructions should the nurse include in the teaching? "You will need to remove all jewelry before the test." "You will need to lie flat for 4 hours following the test." "You will need to empty your bladder before the test." "You will need to fast for 12 hours before the test."
You will need to remove all jewelry before the test." The nurse should instruct the client to remove all jewelry or metal objects that can interfere with the test. A DXA scan is the mostly commonly used screening and diagnostic tool for measuring bone mineral density.
