EXAM 4

The nurse is teaching assistive personnel (AP) about the risk for osteoporosis associated with race or ethnicity. Which population typically has a decreased incidence of osteoporosis when compared to Euro-Americans?

African Americans

A postoperative client has just been admitted to the postanesthesia care unit (PACU). What assessment by the PACU nurse takes priority?

Airway

A nurse is assessing a community group for dietary factors that contribute to osteoporosis. In addition to inquiring about calcium, the nurse also assesses for which other dietary components? (Select all that apply.)

Alcohol Caffeine Carbonated beverages Vitamin D

A client who had a fractured ankle open reduction internal fixation (ORIF) 4 weeks ago reports burning pain and tingling in the affected foot. For which potential complication would the nurse anticipate?

Complex regional pain syndrome

A nurse assesses a client in the preoperative holding area and finds brittle nails and hair, dry skin turgor, and muscle wasting. What action by the nurse is best?

Consult the primary health care provider about a dietitian referral.

A client has arrived in the inpatient postoperative unit. What action by the inpatient nurse takes priority?

Participating in hand-off report

The nurse interviews an older client with moderate osteoarthritis and her husband. What psychosocial assessment question would the nurse include?

"Do you experience discomfort during sex?"

A nurse teaches assistive personnel (AP) about providing hygiene for a client in traction. Which statement would the nurse include as part of the teaching about this client's care?

"Ensure that the weights remain freely hanging at all times."

A nurse teaches a client who is at risk for carpal tunnel syndrome. Which health promotion activities would the nurse include in the health teaching? (Select all that apply.)

"Frequently assesses the ergonomics of the equipment being used." "Take breaks to stretch fingers and wrists during working hours." "Adjust chair height to allow for good posture."

The nurse assesses a client with diabetes and osteoarthritis (OA) during a checkup. The nurse notes the client's blood glucose readings have been elevated. What question by the nurse is most appropriate?

"Have you been taking glucosamine supplements?"

A nurse is caring for a client who is recovering from an above-the-knee amputation and reports pain in the limb that was removed. How would the nurse respond?

"How would you describe the pain that you are feeling?"

After teaching a client who is recovering from a vertebroplasty, the nurse assesses the patient's understanding. Which statement by the client indicates a need for additional teaching?

"I can drive myself home after the procedure."

The nurse is teaching a client who is planning to have a total hip arthroplasty. What statement by the client indicates a need for further teaching?

"I will receive IV heparin before surgery to decrease the risk of clots."

The nurse is teaching assistant personnel (AP) about care of an older ambulatory adult who has osteopenia. Which statement by the AP indicates understanding of the teaching?

"I will remind the client to take frequent walks to strengthen bones."

The nurse is teaching a client who had a left humeral biopsy about home care. Which statement by the client indicates understanding of the nurse's teaching?

"I will watch for tenderness and warmth around the biopsy site."

The nurse is teaching a client who is prescribed acetaminophen for control of osteoarthritic joint pain. What statement by the client indicates a need for further teaching?

"I won't take more than 5000 mg of this drug each day."

A client is prescribed celecoxib for joint pain. What statement by the client indicates a need for further teaching?

"I'll be sure to take this drug three times a day only on an empty stomach."

A client who had a recent total knee arthroplasty will be using a continuous passive motion (CPM) machine after discharge at home. What health teaching about the CPM machine will the nurse include? (Select all that apply.)

"Keep the machine padded well to prevent skin breakdown." "Ensure that your leg is placed properly on the machine." "Use the machine as prescribed but not at mealtime." "When the machine is not being used, do not store it on the floor." "Check that the cycle and range of motion is kept at the level prescribed."

A client has been prescribed denosumab. What health teaching about this drug is most appropriate for the nurse to include?

"Make appointments to come get your injection."

A client has a left knee arthrocentesis to remove excess joint fluid. What postprocedure health teaching will the nurse include?

"Monitor the site for bleeding or clear fluid leakage when you are home."

The nurse is teaching assistive personnel about postoperative care for an older adult who had a posterolateral total hip arthroplasty. What teaching will the nurse include? (Select all that apply.)

"Move the client slowly to prevent dizziness and a possible fall." "Encourage the client to deep breathe and cough at least every 2 hours." "Help the client use the incentive spirometer at least every 2 hours." "Keep the abduction pillow in place at all times while the client is in bed." "Let me know if the client has an elevated temperature or pulse." "Keep in mind that the client may be a little confused after surgery."

The nurse teaches assistive personnel (AP) about care of an older adult diagnosed with osteoporosis. What teaching would the nurse include?

"Osteoporosis places the client is at risk for fractures."

The nurse is teaching a client how to use a cane after a right surgical fractured fibula repair. What health teaching would the nurse include?

"Place the cane on your left side."

What information does the nurse teach a women's group about osteoporosis?

"Primary osteoporosis occurs in postmenopausal women due to lack of estrogen."

A nurse cares for a client placed in skeletal traction. The client asks, "What is the primary purpose of this type of traction?" How would the nurse respond?

"Skeletal traction will assist in realigning your fractured bone."

A nurse teaches a client about prosthesis care after amputation. Which statements would the nurse include in the health teaching? (Select all that apply.)

"The device has been custom made specifically for you." "Make sure that you wear the correct liners with your prosthetic." "I have scheduled a follow-up appointment for you."

The primary health care provider prescribes methotrexate (MTX) for a client with a new diagnosis of rheumatoid arthritis. The nurse provides health teaching about the drug. What statement by the nurse is appropriate to include about methotrexate?

"The drug can increase your risk for infection, so you should avoid crowds."

A nurse is caring for an older client who is recovering from a leg amputation surgery. The client states, "I don't want to live with only one leg. I should have died during the surgery." What is the nurse's best response?

"This is a big change for you. What support system do you have to help you cope?"

A client has long-term rheumatoid arthritis that especially affects the hands. The client wants to finish quilting a baby blanket before the birth of her grandchild. What response by the nurse is appropriate?

"Try a paraffin wax dip 20 minutes before you quilt."

The nurse is teaching a client with mild rheumatoid arthritis (RA) about how to protect synovial joints. Which health teaching will the nurse include? (Select all that apply.)

"Use both hands instead of one with holding objects." "When getting out of bed or a chair, use the palms of your hands." "Bend your knees instead of your waist and keep your back straight." "Do not use multiple pillows under your head to prevent neck flexion." "Use a device or rubber grip to open jars or bottle tops." "Use long-handled devices such as a hairbrush with an extended handle."

A nurse is giving a client instructions for showering the night before surgery. What instruction is most appropriate?

"Use the prescribed solution and wash the area where you will have surgery very thoroughly."

A nurse cares for a client who had a wrist cast applied 3 days ago. The client states, "The cast is loose enough to slide off." How would the nurse respond?

"You need a new cast now that the swelling is decreased."

A client had a bunionectomy with osteotomy. The client asks why healing may take up to 3 months. What explanation by the nurse is best?

"Your feet have less blood flow, so healing is slower."

The nurse is performing a neurovascular assessment for an older client who has an extremity fracture. How many seconds would the nurse expect for a capillary refill in it is within normal range?

5 seconds

A nurse is caring for several clients with fractures. Which client would the nurse identify as being at the highest risk for developing deep vein thrombosis?

A 74-year-old male who smokes and has a fractured pelvis

A client with chronic osteomyelitis is being discharged from the hospital. What information is important for the nurse to teach this client and family? (Select all that apply.)

Adherence to the antibiotic regimen. Eating high-protein and high-carbohydrate foods. Proper use of the intravenous equipment

A nurse assesses an older adult who was admitted 2 days ago with a fractured hip. The nurse notes that the client is confused and restless with an oxygen saturation of 88%. Which action would the nurse take first?

Administer oxygen via nasal cannula.

A nurse is teaching a client newly diagnosed with osteoarthritis (OA) about drugs used to treat the disease. For which drug does the nurse plan health teaching?

Acetaminophen

A client has a metastatic bone tumor in the left leg. What action by the nurse is appropriate?

Administer pain medication as prescribed.

1The post anesthesia care unit (PACU) charge nurse notes vital signs on four postoperative clients. Which client would the nurse assess first?

Client with a respiratory rate of 6 breaths/min

The nurse is caring for a client who just had a kyphoplasty. What nursing care is needed for the client at this time? (Select all that apply.)

Apply an ice pack to the surgical area to help relieve pain. Assess the client's pain level to compare it with pain before the procedure. Take vital signs, including oxygen saturation, frequently. Monitor for complications such as bleeding or shortness of breath. Perform frequent neurologic assessments and report major changes.

A client with osteoporosis is going home where the client lives alone. What action by the nurse is best?

Arrange a home safety evaluation.

A female client is preparing to have open magnetic resonance imaging (MRI) of the spine. What action(s) by the nurse is (are) most important to assess before the test? (Select all that apply.)

Ask if the client has a history of kidney disease. Ask the client if she could possibly be pregnant. Ensure that the patient has no metal or electronic implants. Assess the client for the ability to communicate.

A client has been advised to perform weight-bearing exercises to help slow bone loss, but has not followed this advice. What response by the nurse is appropriate at this time?

Ask the client about fear of falling.

An older client is distressed at body changes related to kyphosis. What response by the nurse is appropriate?

Ask the client to explain more about these feelings.

A client is admitted to the emergency department with a fractured femur resulting from a motor vehicle crash. What the nurse's priority action?

Assess airway, breathing, and circulation.

The nurse assesses a client after a total hip arthroplasty. The client's surgical leg is visibly shorter than the other one and the client reports extreme pain. While a co-worker calls the surgeon, what action by the nurse is appropriate?

Assess neurovascular status in both legs.

A clinic nurse is teaching a client prior to surgery. The client does not seem to comprehend the teaching, forgets a lot of what is said, and asks the same questions again and again. What action by the nurse is best?

Assess the client for anxiety.

A client with bone cancer is hospitalized for a limb salvage procedure. How can the nurse best address the client's psychosocial needs?

Assess the client's coping skills and support systems.

A client had an arthroscopy 1 hour ago on the left knee. The nurse finds the left lower leg to be pale and cool, with a 1+ pedal pulse. What action would the nurse perform first?

Assess the neurovascular status of the right leg.

The perioperative nurse manager and the postoperative unit manager are concerned about the increasing number of surgical infections in their hospital. What action by the managers is best?

Audit charts to see if the Surgical Care Improvement Project (SCIP) outcomes were met.

A postoperative client vomited. After cleaning and comforting the client, which action by the nurse is most important?

Auscultate lung sounds.

The nurse is caring for several clients with osteoporosis. For which client would bisphosphonates not be a good option?

Client with a spinal cord injury who cannot tolerate sitting up.

When assessing gait, what feature(s) would the nurse inspect? (Select all that apply.)

Balance Ease of stride Length of stride Steadiness

The nurse reviews a list of drugs that can cause secondary osteoporosis. Which drugs are most commonly associated with this health problem? (Select all that apply.)

Barbiturates Corticosteroids Loop diuretics

A nurse on the postsurgical inpatient unit is observing a client perform leg exercises. What action by the client indicates a need for further instruction?

Bends both knees, pushes against the bed until calf and thigh muscles contract.

The client's electronic health record indicates genu varum. What does the nurse understand this term to mean?

Bow-legged

A nurse is visiting a client discharged home after a total hip arthroplasty. What safety precautions would the nurse recommend to the client and family? (Select all that apply.)

Buy and install an elevated toilet seat. Install grab bars in the shower and by the toilet. Remove all throw rugs throughout the house. Use a shower chair while taking a shower.

The nurse is caring for a postoperative client who have a regional nerve blockade for a surgical tibial fracture repair this morning. What assessment finding would the nurse expect?

Client reports little to no pain.

A nurse assesses clients in an osteoporosis clinic. Which client would the nurse assess first?

Client taking raloxifene who reports unilateral calf swelling.

A nurse assesses a group of clients who have rheumatoid arthritis (RA). Which client would the nurse see first?

Client with a red, hot, swollen right wrist

The nurse is caring for an older client who had a total knee arthroplasty. Prior to surgery, the client lived alone independently. With which interprofessional health care team members will the nurse collaborate to ensure positive client outcomes? (Select all that apply.)

Case manager Physical therapist

The nurse is reviewing the laboratory profile for a client who has muscular dystrophy. Which laboratory value(s) would the nurse expect to be elevated? (Select all that apply.)

Creatine kinase (CK) Lactic dehydrogenase (LDH) Aspartate aminotransferase (AST) Aldolase (ALD)

A client who had a surgical fractured femur repair reports new-onset shortness of breath and increased respirations. What is the nurse's first action?

Place the client in a high-Fowler position.

The nurse is caring for an older client who has kyphosis and a widened gait. For which health problems is the client at risk?

Falls

The nurse assesses a client with long-term rheumatoid arthritis (RA) for late signs and symptoms. Which assessment findings will the nurse document as late signs and symptoms of RA? (Select all that apply.)

Felty syndrome Joint deformity Weight loss

A client has a great deal of pain when coughing and deep breathing after abdominal surgery despite having pain medication. What action by the nurse is best?

Demonstrate how to splint the incision.

An inpatient nurse brings an informed consent form to a client for an operation scheduled for tomorrow. The client asks about possible complications from the operation. What response by the nurse is best?

Do not have the client sign the consent and call the primary health care provider.

The nurse is assessing a client for chronic osteomyelitis. Which features distinguish this from the acute form of the disease? (Select all that apply.)

Draining sinus tracts Presence of foot ulcers

A nurse is planning postoperative care for a client following a total hip arthroplasty. What nursing interventions would help prevent venous thromboembolism for this client? (Select all that apply.)

Early ambulation Quadriceps-setting exercises Compression stockings/devices Anticoagulant drug therapy

The nurse is taking a history from an older client who reports having frequent falls. Which dietary habit could be contributing to the client's problem?

Eats few concentrated sweets.

A nurse plans care for a client who is recovering from open reduction and internal fixation (ORIF) surgery for a right hip fracture. Which interventions would the nurse include in this client's plan of care? (Select all that apply.)

Elevate heels off the bed with a pillow. Ambulate the client on the first postoperative day. Re-position the client every 2 hours.

A nurse plans care for a client who is recovering from a below-the-knee amputation of the left leg. Which intervention would the nurse include in this client's plan of care?

Encourage range-of-motion exercises

A client asks the nurse about what medications may be included for nonopioid multimodal analgesia following a total knee arthroplasty. What medications may be given to the client? (Select all that apply.)

Gabapentin Ketorolac Ketamine Bupivacaine

The postoperative nurse is caring for a client who reports feeling "something popped" after vomiting. What action by the nurse is best

Gather sterile nonadherent dressings.

A client who has rheumatoid arthritis is prescribed etanercept. What health teaching by the nurse about this drug is appropriate?

Giving subcutaneous injections

A client has rheumatoid arthritis (RA) and the nurse is conducting a home assessment. What options can the nurse suggest for the client to maintain independence in activities of daily living (ADLs)? (Select all that apply.)

Grab bars to reach high items Long-handled bath scrub brush Toothbrush with built-up handle

The nurse takes a history on a male client reporting chronic back pain. Which factor(s) in the client's history may have contributed to his pain? (Select all that apply.)

Had a motor vehicle crash 10 years ago. Played football in college and high school. Has installed carpet and other flooring for 30 years.

A client is getting out of bed into the chair for the first time after an uncemented total hip arthroplasty. What action by the nurse is appropriate?

Have adequate help to transfer the patient.

A nurse assesses a client with a pelvic fracture. Which assessment finding would the nurse identify as a complication of this injury?

Hematuria

A client with rheumatoid arthritis (RA) has an acutely swollen, red, and painful joint. What nonpharmacologic intervention does the nurse recommend?

Ice packs

The nurse is caring for a client who recently sustained a sports injury to his right leg. What nursing interventions are appropriate for this client? (Select all that apply.)

Immobilize the right leg. Use compression to support the leg. Obtain an x-ray to detect possible fracture. Elevate the right leg to decrease swelling.

A nurse is caring for a client recovering from an above-the-knee amputation of the right leg. The client reports pain in the right foot. Which prescribed medication would the nurse most likely administer?

Intravenous calcitonin

A nurse teaches a client with a fractured tibia about external fixation. Which advantages of external fixation for the immobilization of fractures would the nurse share with the client? (Select all that apply.)

It leads to minimal blood loss. It allows for early ambulation. It promotes healing.

A postoperative client has respiratory depression after receiving morphine for pain. Which medication and dose does the nurse prepare to administer?

Naloxone 0.4 to 2 mg

A hospitalized client's strength of the upper extremities is rated at a 4. What does the nurse understand about this client's ability to perform activities of daily living (ADLs)?

No difficulties are expected with ADLs.

An older client's serum calcium level is 8.7 mg/dL (2.18 mmol/L). What possible etiology(ies) does the nurse consider for this result? (Select all that apply.)

Normal age-related decrease in serum calcium Possible occurrence of osteoporosis or osteopenia

A client had a surgical procedure with spinal anesthesia. The client's blood pressure was 122/78 mm Hg 30 minutes ago and is now 138/60 and the client reports nausea. What action by the nurse is best?

Notify the primary health care provider.

The nurse is caring for a client who had a closed reduction of the left arm and notes a large wet area of drainage on the cast. What action is the most important?

Notify the primary health care provider.

After a total knee arthroplasty, a client is on the postoperative nursing unit with a continuous femoral nerve blockade. On assessment, the nurse notes the skin of both legs is pale pink, warm, and dry, but the client is unable to dorsiflex or plantarflex the surgical foot. What action would the nurse take next?

Notify the surgeon or anesthesia provider immediately.

A nurse cares for a client with a recently fractured tibia. Which assessment would alert the nurse to take immediate action?

Numbness in the extremity

A client asks the nurse about having a total knee arthroplasty to relieve joint pain. Which factor would place the client at the highest risk for impaired postoperative healing?

Obesity

An older client who fell at home is admitted to the emergency department and reports pain in her left groin and behind her left knee. What action would the nurse anticipate?

Obtain a left hip x-ray.

A nurse works on the postoperative floor and has four clients who are being discharged tomorrow. Which one has the greatest need for the nurse to consult other members of the health care team for post discharge care?

Older adult who lives alone at home despite some memory loss.

The nurse is assessing a client with long-term rheumatoid arthritis (RA) who has been taking prednisone for 10 years. For which complications of chronic drug therapy would the nurse assess? (Select all that apply.)

Osteoporosis Diabetes mellitus Glaucoma Hypertension Hypokalemia Decreased immunity

The nurse is caring for a client who has severe osteoarthritis. What primary joint problems will the nurse expect the client to report?

Pain

An older client with diabetes is admitted with a heavily draining leg wound. The client's white blood cell count is 38,000/mm3 (38 109/L) but the client is afebrile. Which nursing action is most appropriate at this time?

Place the client on Contact Precautions.

A client has a bone density score of -2.8. What intervention would the nurse anticipate based on this assessment?

Planning to teach about bisphosphonates

A nurse is caring for four clients. After the hand-off report, which client would the nurse see first?

Post-microvascular bone transfer client whose distal leg is cool and pale

A preoperative nurse is reviewing morning laboratory values on four clients waiting for surgery. Which result warrants immediate communication with the surgical team?

Potassium: 2.9 mEq/L (2.9 mmol/L)

A client is scheduled to have a total hip arthroplasty. What preoperative teaching by the nurse is most important?

Remind the client to have all dental procedures completed at least 2 weeks prior to surgery.

A nurse is caring for a client with diabetes mellitus who has fractured her arm. Which action would the nurse take first?

Remove the medical alert bracelet from the fractured arm.

The nurse is caring for a young client who has been diagnosed with osteopenia. Which risk factor in the client's history most likely contributed to the bone loss?

Rheumatoid arthritis

After teaching a client with a fractured humerus, the nurse assesses the client's understanding. Which dietary choice demonstrates that the client correctly understands the nutrition needed to assist in healing the fracture?

Roast beef with low-fat milk and a vitamin C supplement

A nurse plans care for a client who has an external fixator on the lower leg. Which intervention would the nurse include in the plan of care to decrease the client's risk for infection?

Scheduling for pin care to be provided every shift

A registered nurse (RN) is watching a new nurse change a dressing and perform care around a Penrose drain. What action by the new nurse warrants intervention?

Securing the drain's safety pin to the sheets

The nurse is performing an assessment of a client with possible plantar fasciitis in the right foot. What assessment finding would the nurse expect in the right foot?

Severe pain in the arch of the foot

A postoperative nurse is caring for a client who received a neuromuscular blocking agent during surgery. On assessment the nurse notes the client has weak hand grasps. What assessment does the nurse conduct next?

Signs of oxygenation

A nurse is providing education to a community women's group about lifestyle changes helpful in preventing osteoporosis. What topics does the nurse cover? (Select all that apply.)

Strengthening exercises are important. Take recommended calcium and vitamin D. Walk for 30 minutes at least three times a week

The postanesthesia care unit (PACU) nurse is caring for an older client following a lengthy surgery. The client's pulse is 48 beats/min which is 20 beats/min lower than the preoperative baseline. What assessment does the nurse make next?

Temperature

A postoperative client has an abdominal drain. What assessment by the nurse indicates that goals for the priority client problems related to the drain are being met?

There is no redness, warmth, or drainage at the insertion site.

The nurse assesses a client who is admitted with a pelvic fracture. Which assessments would the nurse monitor to prevent or detect a complication of this injury?

Urinary output Blood pressure Pupil reaction

A preoperative nurse is assessing a client prior to surgery. Which information would be most important for the nurse to relay to the surgical team

Use of multiple herbs and supplements

The nurse assesses a client with rheumatoid arthritis (RA) and Sjögren syndrome. What assessment would be most important for this client?

Visual acuity

A client who had a traumatic above-the-knee amputation states that he fears he will never have an intimate relationship again. What is the nurse's best response?

You think you won't be able to have sex again?"