MedSurg: Ch 11 Musculoskeletal Disorders

The nurse is discharge teaching for a client with a short leg cast. Which statement indicates the client understands the discharge teaching? 1. "I need to keep my leg elevated on two pillows for the first 24 hours." 2. "I must wear my sequential compression device all the time." 3. "I can remove the cast for one (1) hour so I can take a shower." 4. "I will be able to walk on my cast and not have to use crutches."

1. "I need to keep my leg elevated on two pillows for the first 24 hours." 1. This is a correct intervention. The leg should be elevated for at least the first 24 hours. If edema is present, the client needs to keep it elevated longer. 2. Sequential compression devices work to prevent deep vein thrombosis and the client does not wear one of these at home. 3. The client will not be able to remove the cast for any reason. The cast must be cut off. 4. Clients with casts can only ambulate if they have a walking cast or boot. This information is not in the stem of the question.

Which statement by the client prescribed calcitonin, a thyroid hormone, indicates to the nurse the teaching has been effective? 1. "I should administer the mediation in a different nostril each day." 2. "I need to drink a lot of water when I take my medicine." 3. "I have to dilute the medication with vitamin D before I take it." 4. "This medication will help the calcium leave my bones."

1. "I should administer the mediation in a different nostril each day." 1. This medication is administered intranasally. Alternating nostrils will decrease the risk of nasal irritation. 2. This intervention should be implemented for Fosamax, a bisphosphonate, not calcitonin, thyroid hormone. 3. Clients do not dilute their medication. Vitamin D is not used as a diluent for medication. 4. Calcium should be retained in the bone to maintain bone strength; medications are not administered to encourage loss from the bone.

The occupational health nurse is teaching a class on the risk factors for developing osteoarthritis (OA). Which is a modifiable risk factor for developing OA? 1. Being overweight. 2. Increasing age. 3. Previous joint damage. 4. Genetic susceptibility.

1. Being overweight. 1. Obesity is a well-recognized risk factor for the development of OA and it is modifiable because the client can lose weight. 2. Increasing age is a risk factor, but there is nothing the client can do about getting older, except to die. 3. Previous joint damage is a risk factor, but it is not modifiable, which means the client cannot do anything to change it. 4. Genetic susceptibility is a result of family genes, which the client cannot change; it is a nonmodifiable risk factor.

Which interventions should be included in the discharge teaching for a client who had a total hip replacement? Select all that apply. 1. Discuss the client's weight-bearing limits. 2. Request the client demonstrate use of assistive devices. 3. Explain the importance of increasing activity gradually. 4. Instruct the client not to take medication prior to ambulating. 5. Tell the client to ambulate with open-toed house shoes.

1. Discuss the client's weight-bearing limits. 2. Request the client demonstrate use of assistive devices. 3. Explain the importance of increasing activity gradually. 1. Clients need to understand the amount of weight bearing to prevent injury. 2. Teaching the safe use of assistive devices is necessary prior to discharge. 3. Increases in activity should occur slowly to prevent complications. 4. Using medication therapy, including analgesics, anti-inflammatory agents, or muscle relaxants, should be taught so the client is comfortable while ambulating. 5. The client should ambulate with well-fitted, supported, closed-toed shoes such as a tennis shoe or walking shoe.

The 50-year-old female client is being evaluating for osteoporosis. Which data should the nurse assess? Select all that apply. 1. Family history of osteoporosis. 2. Estrogen or androgen deficit. 3. Exposure to secondhand smoke. 4. Level and amount of exercise. 5. Alcohol intake.

1. Family history of osteoporosis. 2. Estrogen or androgen deficit. 4. Level and amount of exercise. 5. Alcohol intake. 1. Clients are more prone to have osteoporosis if there is a genetic predisposition. 2. Clients who are deficient in either estrogen or androgen are at risk for osteoporosis. 3. Clients who smoke are more at risk for osteoporosis. Research does not show a correlation between osteoporosis and secondhand smoke. 4. Regular, weight-bearing exercise promotes healthy bones. 5. Clients who consume alcohol and have diets low in calcium are at a higher risk for osteoporosis.

The nurse is caring for a client with a right total knee repair. Which intervention should the nurse implement? 1. Monitor the continuous passive motion machine. 2. Apply thigh-high TED hose bilaterally. 3. Place the abductor pillow between the legs. 4. Encourage the family to perform ADLs for the client.

1. Monitor the continuous passive motion machine. 1. The CPM machine is used to ensure the client has adequate range of motion in the knee postoperatively. 2. The TED hose are only applied to the unaffected leg, not the leg with the incision. 3. Adductor pillows are used in clients with total hip replacements to maintain function hip alignment. 4. The client should perform as many ADLs as possible. The client should maintain independence as much as possible.

Which intervention is an example of a secondary nursing intervention when discussing osteoporosis? 1. Obtain a bone density evaluation test. 2. Perform non-weight-bearing exercises regularly. 3. Increase the intake of dietary calcium. 4. Refer clients to a smoking cessation program.

1. Obtain a bone density evaluation test. 1. This is an example of a secondary nursing intervention, which includes screening for early detection. 2. The client should perform weight-bearing exercises, which promote osteoblast activity helping to maintain bone strength and integrity. This is a primary nursing intervention. 3. Increasing dietary calcium may be a primary intervention to help prevent osteoporosis or a tertiary intervention, which helps treat osteoporosis. 4. Smoking cessation is a primary intervention, which will help prevent the development of osteoporosis.

The client is scheduled for a magnetic resonance imaging (MRI) scan. Which intervention should the nurse delegate to the unlicensed assistive personnel (UAP)? 1. Prepare the client by removing all metal objects. 2. Inject the contrast into the intravenous site. 3. Administer a sedative to the client to decrease anxiety. 4. Explain why the client cannot have any breakfast.

1. Prepare the client by removing all metal objects. 1. Metal objects such as jewelry and zippers can interfere with the magnetic imaging and pose a danger to the client as a result of the magnetic properties of the equipment. This intervention can be delegated to the UAP. 2. Injection of contrast is given in the radiology department. 3. UAPs are unable to administer medications in hospitals. 4. The nurse cannot delegate teaching to a UAP.

The nurse is teaching a class to pregnant teenagers. Which information is most important when discussing ways to prevent osteoporosis? 1. Take at least 1,200 mg of calcium supplements a day. 2. Eat foods low in calcium and high in phosphorus. 3. Osteoporosis does not occur until around age 50 years. 4. Remain as active as possible until the baby is born.

1. Take at least 1,200 mg of calcium supplements a day. 1. The National Institutes of Health (NIH) recommends a daily calcium intake of 1,200 to 1,500 mg/day for adolescents, young adults, and pregnant and lactating women. 2. The pregnant teenager should eat foods high in calcium. 3. Osteoporosis may not occur before age 50 years, but taking calcium throughout the life span will help prevent it. Remember, teenagers tend to focus on the present, not the future, so the most important intervention to teach them is to take calcium supplements. 4. Activity will not help prevent osteoporosis in the teenager; the teenager must take calcium supplements.

Two unlicensed assistive personnel (UAP) are using the transfer board to move the client from the bed to the wheelchair. Which action should the nursing take? 1. Take no action since this is the correct procedure for transferring a client. 2. Instruct the UAPs not to use a transfer board when moving the client. 3. Tell the UAPs to use the bed scale sling to move the client to the chair. 4. Request the UAPs to stop and come to the nurse's station immediately.

1. Take no action since this is the correct procedure for transferring a client. 1. The UAPs are transferring the client correctly and safely, so no action should be taken. The UAPs are adhering to the Patient Care Safety Standards by using approved equipment. 2. The nurse should encourage the use of appropriate equipment designed to protect the client and the staff from injury. 3. The bed scale sling is inappropriate to use when moving the client from the bed to a wheelchair. 4. There is no reason for the nurse to stop the UAPs since the task is being performed correctly.

The client is prescribed Fosamax, a bisphosphonate. Which information should the nurse teach? 1. Take this medication with a full glass of water. 2. Take with breakfast to prevent gastrointestinal upset. 3. Use sunscreen to prevent sensitivity to sunlight. 4. This medication increases calcium reabsorption.

1. Take this medication with a full glass of water. 1. The client needs to take this medication with a full glass of water and remain upright for at least 30 minutes to reduce the risk of esophagitis. 2. This medication should be taken before breakfast on an empty stomach. 3. This medication does not cause photosensitivity. 4. This medication decreases calcium reabsorption by decreasing the activity of osteoclasts.

Which signs/symptoms indicate to the nurse the client has developed osteoporosis? 1. The client has lost one (1) inch in height. 2. The client has lost 12 pounds in the last year. 3. The client's hands are painful to the touch. 4. The client's serum uric acid level is elevated.

1. The client has lost one (1) inch in height. 1. The loss of height occurs as vertebral bodies collapse. 2. Weight loss is not a sign of osteoporosis. 3. This may indicate rheumatoid arthritis but not osteoporosis. 4. This is a sign of gout.

The nurse is caring for the following clients. After receiving the shift report, which client should the nurse assess first? 1. The client with a total knee replacement who is complaining of a cold foot. 2. The client diagnosed with osteoarthritis who is complaining of stiff joints. 3. The client who needs to receive a scheduled intravenous antibiotic. 4. The client diagnosed with back pain who is scheduled for a lumbar myelogram.

1. The client with a total knee replacement who is complaining of a cold foot. 1. A cold foot in a client who has had surgery may indicate a neurovascular compromise and must be assessed first. 2. A client with osteoarthritis is expected to have stiff joints. 3. A routine medication is not priority over a potential complication of surgery. 4. A routine diagnostic procedure does not have priority over a potential complication of surgery.

The nurse is caring for the client who had a right shoulder replacement. Which data warrant immediate intervention? 1. The client's hemoglobin is 8.1 g/dL. 2. The client's white blood cell count is 9,000/mm3. 3. The client's creatinine level is 0.8 mg/dL. 4. The client's potassium level is 4.2 mEq/L.

1. The client's hemoglobin is 8.1 g/dL. 1. The client's hemoglobin is near 8 g/dL, which indicates the client requires a blood transfusion. This information warrants intervention by the nurse. 2. This white blood cell count is within normal limits, so it does not warrant immediate intervention. 3. The creatinine level is within normal limits and does not warrant intervention. 4. The potassium level is within normal limits and does not require intervention by the nurse.

The nurse is discussing the importance of an exercise program for pain control to a client diagnosed with OA. Which intervention should the nurse include in the teaching? 1. Wear supportive tennis shoes with white socks when walking. 2. Carry a complex carbohydrate while exercising. 3. Alternate walking briskly and jogging when exercising. 4. Walk at least 30 minutes three (3) times a week.

1. Wear supportive tennis shoes with white socks when walking. 1. Safety should always be discussed when teaching about exercises. Supportive shoes will prevent shin splints. Colored socks have dye and may cause athlete's foot, which is why white socks are recommended. 2. Clients with diabetes mellitus should carry complex carbohydrates with them. 3. Osteoarthritis occurs most often in weight- bearing joints. Exercise is encouraged, but jogging increases stress on these joints. 4. For exercising to help pain control, the client must walk daily, not three (3) times a week. Walking at least 30 minutes three (3) times a week is appropriate for weight loss.

Which foods should the nurse recommend to a client when discussing sources of dietary calcium? 1. Yogurt and dark-green, leafy vegetables. 2. Oranges and citrus fruits. 3. Bananas and dried apricots. 4. Wheat bread and bran.

1. Yogurt and dark-green, leafy vegetables. 1. The best dietary sources of calcium are milk and other dairy products. Other sources include oysters; canned sardines or salmon; beans; cauliflower; and dark-green, leafy vegetables. 2. These foods are high in vitamin C. 3. These foods are high in potassium. 4. These foods are recommended for a high-fiber diet.

Which psychosocial problem should the nurse identify for a client with an external fixator device? 1. Ineffective coping. 2. Alteration in body image. 3. Grieving. 4. Impaired communication.

2. Alteration in body image. 1. The client problem of ineffective coping is usually not indicated for a client with an external fixator device, unless the stem provides more information about the client. 2. Many clients with an external fixator have alterations in body image because the large, bulky frame makes dressing difficult and because of scarring which occurs from the trauma and treatment. The length of healing is prolonged, so returning to the client's normal routine is delayed. 3. The client problem of grieving is usually not indicated for a client with an external fixator device, unless the stem of the question provides more information about the client. 4. The client problem of impaired communication is usually not indicated for a client with an external fixator device, unless the stem provides more information about the client.

The client with a long arm cast is complaining of unrelenting severe pain and feeling as if the fingers are asleep. Which complication should the nurse suspect the client is experiencing? 1. Fat embolism. 2. Compartment syndrome. 3. Pressure ulcer under cast. 4. Surgical incision infection.

2. Compartment syndrome. 1. These are not signs/symptoms of a fat embolism. 2. These are the classic signs/symptoms of compartment syndrome. 3. Clients in casts rarely develop pressure ulcers and usually they are not painful. 4. Hot spots on the cast usually indicate an infection of the surgical incision under the cast.

The female client diagnosed with osteoporosis tells the nurse she is going to perform swim aerobics for 30 minutes every day. Which response is most appropriate by the nurse? 1. Praise the client for committing to do this activity. 2. Explain to the client walking 30 minutes a day is a better activity. 3. Encourage the client to swim every other day instead of daily. 4. Discuss with the client how sedentary activities help prevent osteoporosis.

2. Explain to the client walking 30 minutes a day is a better activity. 1. Swimming is not as beneficial as walking in maintaining bone density because of the lack of weight-bearing activity. 2. Weight-bearing activity, such as walking, is beneficial in preventing or slowing bone loss. The mechanical force of weight-bearing exercises promotes bone growth. 3. Swimming is not as beneficial in maintaining bone density because of the lack of weight-bearing activity. 4. A sedentary lifestyle is a risk factor for the development of osteoporosis.

The client is diagnosed with osteoarthritis. Which sign/symptom should the nurse expect the client to exhibit? 1. Severe bone deformity. 2. Joint stiffness. 3. Waddling gait. 4. Swan-neck fingers.

2. Joint stiffness. 1. Severe bone deformity is seen in clients diagnosed with rheumatoid arthritis. 2. Pain, stiffness, and functional impairment are the primary clinical manifestations of OA. Stiffness of the joints is commonly experienced after resting but usually lasts less than 30 minutes and decreases with movement. 3. A waddling gait is usually seen in women in their third trimester of pregnancy or in older children with congenital hip dysplasia. 4. Swan-neck fingers are seen in clients with rheumatoid arthritis.

Which client goal is most appropriate for a client diagnosed with OA? 1. Perform passive range-of-motion exercises. 2. Maintain optimal functional ability. 3. Client will walk three (3) miles every day. 4. Client will join a health club.

2. Maintain optimal functional ability. 1. This is an intervention, not a goal, and "passive" means the nurse performs the range of motion, which should not be encouraged. 2. The two main goals of treatment for OA are pain management and optimizing functional ability of the joints to ensure movement of the joints. 3. Most clients with OA are elderly, are overweight, and have a sedentary lifestyle, so walking three (3) miles every day is not a realistic or safe goal. 4.Joining a health club is an intervention, and the fact the client joins the health club doesn't mean the client will exercise.

Which intervention should the nurse include for a client diagnosed with carpal tunnel syndrome? 1. Teach hyperextension exercises to increase flexibility. 2. Monitor safety during occupational hazards. 3. Prepare for the insertions of pins or screws. 4. Monitor dressing and drain after the fasciotomy

2. Monitor safety during occupational hazards. 1. Treatment for carpal tunnel syndrome does not include hyperextension of the wrist. 2. The nurse should monitor for potential injuries resulting from the alterations in motor, sensory, and autonomic function of the first three digits of the hand and palmar surface of the fourth. 3. Surgery may be needed to release the compression of the medial nerve, but pins and screws are used to hold the position. 4. Fasciotomy refers to the surgical excision of strips of connective tissue. This is not applicable in clients with carpal tunnel syndrome.

The nurse is assessing the client who is postoperative total knee replacement. Which assessment data warrant immediate intervention? 1. T 99˚F, HR 80, RR 20, and BP 128/76. 2. Pain in the unaffected leg during dorsiflexion of the ankle. 3. Bowel sounds heard intermittently in four quadrants. 4. Diffuse, crampy abdominal pain.

2. Pain in the unaffected leg during dorsiflexion of the ankle. 1. These vital signs are within normal limits. 2. Pain with dorsiflexion of the ankle indicates deep vein thrombosis. This can be from immobility or surgery; therefore, pain should be assessed in both legs. 3. Bowel sounds are normally intermittent. 4. This type of pain should make the nurse suspect the client has flatus, which is not a life-threatening complication and does not warrant immediate intervention.

The nurse is caring for a client with a left fractured humerus. Which data warrant intervention by the nurse? 1. Capillary refill time is less than three (3) seconds. 2. Pain is not relieved by the patient-controlled analgesia. 3. Left fingers are edematous and the left hand is purple. 4. Warm and dry skin on left fingers distal to the elastic bandage.

2. Pain is not relieved by the patient-controlled analgesia. 1. This is a normal assessment finding and does not require immediate action. 2. Unrelieved pain should warrant intervention by the nurse. Pain may indicate a complication or the need for pain medication, but either way it warrants intervention. 3. Edema and a hematoma as a result of the injury are expected and do not warrant intervention by the nurse. 4. The fingers distal to the Ace bandage indicate adequate circulation and require no intervention.

The nurse is working on an orthopedic floor. Which client should the nurse assess first after the change-of-shift report? 1. The 84-year-old female with a fractured right femoral neck in Buck's traction. 2. The 64-year-old female with a left total knee replacement who has confusion. 3. The 88-year-old male post-right total hip replacement with an abduction pillow. 4. The 50-year-old postop client with a continuous passive motion (CPM) device.

2. The 64-year-old female with a left total knee replacement who has confusion. 1. This is a normal treatment of a fractured femoral neck. 2. This is an abnormal occurrence from this information. This client should be seen first because confusion is a symptom of hypoxia. 3. This is a common treatment of a total hip replacement. 4. This is a treatment used for total knee replacement.

The elderly client is admitted to the hospital for severe back pain. Which data should the nurse assess first during the admission assessment? 1. The client's use of herbs. 2. The client's current pain level. 3. The client's sexual orientation. 4. The client's ability to care for self.

2. The client's current pain level. 1. This is a question the admitting nurse asks all clients, but it is not the most important. 2. Pain assessment and management are the most important issues if the client is breathing and has circulation. Lack of pain management decreases the attention of the client during the admission process. Pain is called the fifth vital sign. 3. Sexual practices are included in the admission forms, but they are not as important as pain management. 4. Assessing the client's ability to perform activities of daily living and self-care is important to prepare this client for discharge, which begins on admission, but this is not the most important at this time.

The client is scheduled for a computed tomography (CT) scan. Which question is most important for the nurse to ask before the procedure? 1. "On a scale of 1 to 10, how do you rate your pain?" 2. "Do you feel uncomfortable in enclosed spaces?" 3. "Are you allergic to seafood or iodine?" 4. "Have you signed a permit for this procedure?"

3. "Are you allergic to seafood or iodine?" 1. The assessment of the pain is important so the client will be able to tolerate the procedure. Pain is not a life-threatening problem but is a quality-of-care issue. 2. This is an appropriate question for a client having a closed MRI, not a CT scan. 3. This is the most important information the nurse should obtain. Any client who is allergic to seafood cannot be injected with the iodine-based contrast. This contrast could cause an allergic response endangering the client's life. 4. The general consent for admission to the hospital covers this procedure. A separate informed consent is not required.

The clinic nurse assesses a client with complaints of pain and numbness in the left hand and fingers. Which question should the nurse ask the client? 1. "Do you smoke or use any type of tobacco products?" 2. "Do you have to wear gloves when you are out in the cold?" 3. "Do you do repetitive movements with your left fingers?" 4. "Do you have tremors or involuntary movements of your hand?"

3. "Do you do repetitive movements with your left fingers?" 1. Assessing for smoking is evaluation for Raynaud's disease. 2.Exposure to cold is appropriate to assess for Raynaud's disease. 3. Repetitive movements are appropriate to assess for carpal tunnel syndrome. Clients with this disorder experience pain and numbness. 4. Tremors or involuntary movements could indicate Parkinson's disease.

Which priority intervention should the day surgery nurse implement for a client who has had right knee arthroscopy? 1. Encourage the client to perform range-of-motion exercises. 2. Monitor the amount and color of the urine. 3. Check the client's pulses distally and assess the toes. 4. Monitor the client's vital signs.

3. Check the client's pulses distally and assess the toes. 1. The nurse should not encourage range of motion until the surgeon gives permission for flexion of the knee. 2. Urinary output is important postoperatively, but monitoring it is not priority over a neurovascular assessment. 3. Neurovascular assessment is priority because this surgery has two to three small incisions in the knee area. The nurse needs to make sure circulation is getting past the surgical site. 4. Vital signs should be assessed, but the priority is to maintain the neurovascular status of the limb.

Which intervention should the nurse implement for a client with a fractured hip in Buck's traction? 1. Assess the insertion sites for signs and symptoms of infection. 2. Monitor for drainage or odor from under the plaster covering the pins. 3. Check the condition of the skin beneath the Velcro boot frequently. 4. Take weights off for one (1) hour every eight (8) hours and as needed.

3. Check the condition of the skin beneath the Velcro boot frequently. 1. Skeletal traction has a pin, screws, tongs, or wires inserted into the bone. There is no insertion site in skin traction. 2. Plaster traction is a combination of skeletal traction using pins and a plaster brace to maintain alignment of any deformities. 3. In Buck's traction, a Velcro boot is used to attach the ropes to weights to maintain alignment. Skin covered by the boot can become irritated and break down. 4. Buck's traction is applied preoperatively to prevent muscle spasms and maintain alignment, and the weights should not be removed unless assessing for skin breakdown.

The client is being evaluated for osteoporosis. Which diagnostic test is the most accurate when diagnosing osteoporosis? 1. X-ray of the femur. 2. Serum alkaline phosphatase. 3. Dual-energy x-ray absorptiometry (DEXA). 4. Serum bone Gla-protein test.

3. Dual-energy x-ray absorptiometry (DEXA). 1. Osteoporotic changes do not occur in the bone until more than 30% of the bone mass has been lost. 2. This serum blood study may be elevated after a fracture, but it does not help diagnose osteoporosis. 3. This test measures bone density in the lumbar spine or hip and is considered to be highly accurate. 4. This test is most useful to evaluate the effects of treatment, rather than as an indicator of the severity of bone disease.

The nurse is discussing osteoporosis with a group of women. Which factor will the nurse identify as a nonmodifiable risk factor? 1. Calcium deficiency. 2. Tobacco use. 3. Female gender. 4. High alcohol intake.

3. Female gender. 1. Calcium deficiency is a modifiable risk factor, which means the client can do something about this factor—namely, increase the intake of calcium—to help prevent the development of osteoporosis. 2. Smoking is a modifiable risk factor because the client can quit smoking. 3. A nonmodiftable risk factor is a factor the client cannot do anything to alter or change. Approximately 50% of all women will experience an osteoporosis-related fracture in their lifetime. 4. The client can quit drinking alcohol; therefore, this is a modifiable risk factor.

The client one (1) day postoperative total hip replacement complains of hearing a "popping sound" when turning. Which assessment data should the nurse report immediately to the surgeon? 1. Dark red-purple discoloration. 2. Equal length of lower extremities. 3. Groin pain in the affected leg. 4. Edema at the incision site.

3. Groin pain in the affected leg. 1. Bruising is common after a total hip replacement. 2. When a dislocation occurs, the affected extremity will be shorter. 3. Groin pain or increasing discomfort in the affected leg and the "popping sound" indicate the leg has dislocated, which should be reported immediately to the HCP for a possible closed reduction. 4. Edema at the incision site is common, but an increase in edema or redness should be reported.

The client is taking calcium carbonate (Tums) to help prevent further development of osteoporosis. Which teaching should the nurse implement? 1. Encourage the client to take Tums with at least eight (8) ounces of water. 2. Teach the client to take Tums with the breakfast meal only. 3. Instruct the client to take Tums 30 to 60 minutes before a meal. 4. Discuss the need to get a monthly serum calcium level.

3. Instruct the client to take Tums 30 to 60 minutes before a meal. 1. There is no reason to take Tums with eight (8) ounces of water. Tums are usually chewed. 2. Tums should not be taken with meals. 3. Free hydrochloric acid is needed for calcium absorption; therefore, Tums should be taken on an empty stomach. 4. To determine the effectiveness of calcium supplements, the client must have a bone density test, not a serum calcium level measurement.

To which member of the health-care team should the nurse refer the client diagnosed with OA who is complaining of not being able to get in and out of the bathtub? 1. Physiatrist. 2. Social worker. 3. Physical therapist. 4. Counselor.

3. Physical therapist. 1. A physiatrist is a physician who specializes in physical medicine and rehabilitation, but the nurse should not refer the client to this person just because the client is having difficulty with transfers. 2. The social worker does not address this type of physical problem. Social workers address issues concerning finances, placement, and acquiring assistive devices. 3. The physical therapist is able to help the client with transferring, ambulation, and other lower extremity difficulties. 4. A counselor is not able to help the client learn how to get in and out of the bathtub.

A client sustained a fractured femur in a motor-vehicle accident. Which data require immediate intervention by the nurse? Select all that apply. 1. The client requests pain medication to sleep. 2. The client has eupnea and normal sinus rhythm. 3. The client has petechiae over the neck and chest. 4. The client has a high arterial oxygen level. 5. The client has yellow globules floating in the urine.

3. The client has petechiae over the neck and chest. 5. The client has yellow globules floating in the urine. 1. The client requesting something for sleep is expected and does not require notifying the HCP. 2. Normal respirations and heart rate do not require notifying the HCP. 3. Petechiae are macular, red-purple pinpoint bleeding under the skin. The appearance of petechiae is a classic sign of fat embolism syndrome. 4. The arterial oxygen level would be low, not elevated. This sign does not warrant immediate intervention. 5. Yellow globules in the urine are fat globules released from the bone as it breaks. This should be reported immediately.

The nurse finds small, fluid-filled lesions on the margins of the client's surgical dressing. Which statement is the most appropriate scientific rationale for this occurrence? 1. These were caused by the cautery unit in the operating room. 2. These are papular wheals from herpes zoster. 3. These are blisters from the tape used to anchor the dressing. 4. These macular lesions are from a latex allergy.

3. These are blisters from the tape used to anchor the dressing. 1. These are not burns from the cautery unit. Such burns are located in or near the incision site and are usually black. 2. Herpes simplex lesions occur in a linear pattern along a dermatome. 3. Fluid-filled blisters are from a reaction to the tape and usually occur along the margins of the dressing where the tape was applied. 4. Skin reactions to latex are local irritations or generalized dermatitis, not blisters.

The client diagnosed with OA is a resident in a long-term care facility. The resident is refusing to bathe because she is hurting. Which instruction should the nurse give the unlicensed assistive personnel (UAP)? 1. Allow the client to stay in bed until the pain becomes bearable. 2. Tell the UAP to give the client a bed bath this morning. 3. Try to encourage the client to get up and go to the shower. 4. Notify the family the client is refusing to be bathed.

3. Try to encourage the client to get up and go to the shower. 1. Clients with OA should be encouraged to move, which will decrease the pain. 2. A bed bath does not require as much movement from the client as getting up and walking to the shower. 3. Pain will decrease with movement, and warm or hot water will help decrease the pain. The worst thing the client can do is not move. 4. Notifying the family will not address the client's pain, and the client has a right to refuse a bath, but the nursing staff must explain why moving and bathing will help decrease the pain.

The client is complaining of joint stiffness, especially in the morning. Which diagnostic tests should the nurse expect the health-care provider to order to R/O osteoarthritis? 1. Full-body magnetic resonance imaging scan. 2. Serum studies for synovial fluid amount. 3. X-ray of the affected joints. 4. Serum erythrocyte sedimentation rate (ESR).

3. X-ray of the affected joints. 1. MRIs are not routinely ordered for diagnosing OA. 2. There is no serum laboratory test to measure synovial fluid in the joints. 3. X-rays reveal loss of joint cartilage, which appears as a narrowing of the joint space in clients diagnosed with OA. 4. An ESR is a diagnostic laboratory test for rheumatoid arthritis, not osteoarthritis.

The client diagnosed with rule-out osteosarcoma asks the nurse, "Why am I having a bone scan?" Which statement is the nurse's best response? 1. "You seem anxious. Tell me about your anxieties." 2. "Why are you concerned? Your HCP ordered it." 3. "I'll have the radiologist come back to explain it again." 4. "A bone scan looks for cancer or infection inside the bones."

4. "A bone scan looks for cancer or infection inside the bones." 1. This is a therapeutic technique, but the client is asking for information. When a client seeks information, the nurse should give information first. Discussion of feelings should follow. 2. This non therapeutic technique blocks communication between the client and the nurse. The nurse should avoid a response with the word "why," which asks the client to explain or justify feelings to the nurse. 3. When the client requests information, the nurse needs to provide accurate information, not pass the buck. 4. This statement answers the client's question.

The nurse is discharging a client who had a total hip replacement. Which statement indicates further teaching is needed? 1. "I should not cross my legs because my hip may come out of the socket." 2. "I will call my HCP if I have a sudden increase in pain." 3. "I will sit on a chair with arms and a firm seat." 4. "After three (3) weeks, I don't have to worry about infection."

4. "After three (3) weeks, I don't have to worry about infection." 1. Clients should not cross their legs because the position increases the risk for dislocation. 2. If the client experiences a sudden increase in pain, redness, edema, or stiffness in the joint or surrounding area, the client should notify the HCP. 3. Clients should sleep on firm mattresses and sit on chairs with firm seats and high arms. These will decrease the risk of dislocating the hip joint. 4. Infections are possible months after surgery. Clients should monitor temperatures and report any signs of infection.

The client diagnosed with osteoporosis asks the nurse, "Why does smoking cigarettes cause my bones to be brittle?" Which response by the nurse is most appropriate? 1. "Smoking causes nutritional deficiencies which contribute to osteoporosis." 2. "Tobacco causes an increase in blood supply to the bones, causing osteoporosis." 3. "Smoking low-tar cigarettes will not cause your bones to become brittle." 4. "Nicotine impairs the absorption of calcium, causing decreased bone strength."

4. "Nicotine impairs the absorption of calcium, causing decreased bone strength." 1. This is the rationale for heavy alcohol use leading to the development of osteoporosis. 2. Smoking decreases, not increases, blood supply to the bone. 3. Cigarette smoking has long been identified as a risk factor for osteoporosis, and it doesn't matter if the cigarettes are low tar. 4. Nicotine slows the production of osteoblasts and impairs the absorption of calcium, contributing to decreased bone density.

The school nurse is completing spinal screenings. Which data require a referral to an HCP? 1. Bilateral arm lengthening while bending over at the waist. 2. A deformity which resolves when the head is raised. 3. Equal spacing of the arms and body at the waist. 4. A right arm lower than the left while bending over at the waist.

4. A right arm lower than the left while bending over at the waist. 1. These are normal data and do not require intervention. 2. If the screener suspects the client has scoliosis while the client is bending over, the screener asks the client to raise the head. An abnormality caused by scoliosis will not resolve. 3. This indicates a normal occurrence and does not need to be referred. 4. Unequal arm length may indicate scoliosis, and further assessment is needed by an HCP.

The nurse is caring for the client diagnosed with fat embolism syndrome. Which HCP order should the nurse question? 1. Maintain heparin to achieve a therapeutic level. 2. Initiate and monitor intravenous fluids. 3. Keep the O2 saturation higher than 93%. 4. Administer an intravenous loop diuretic.

4. Administer an intravenous loop diuretic. 1. The HCP should prescribe heparin to treat a fat embolism. 2. The client should be hydrated to prevent platelet aggregation. 3. The nurse should monitor oxygen levels and administer oxygen as needed to prevent further complications. 4. The nurse should question this order. This will decrease the client's hydration and may result in further embolism.

The nurse is preparing to administer subcutaneous Lovenox, a low molecular weight heparin. Which intervention should the nurse implement? 1. Monitor the client's serum aPTT. 2. Encourage oral and intravenous fluids. 3. Do not eat foods high in vitamin K. 4. Administer in the anterolateral upper abdomen.

4. Administer in the anterolateral upper abdomen. 1. An aPTT {or PTT} is used to determine therapeutic levels of unfractionated heparin. Laboratory studies such as aPTT are not monitored when administering subcutaneous Lovenox, a low molecular weight heparin. A therapeutic level will not be achieved as a result of a short half-life. 2. Oral fluids do not need to be increased because of this medication. 3. Vitamin K is the antidote for warfarin (Coumadin), an oral anticoagulant. It does not affect Lovenox. 4. Administering the medication in the prescribed areas, the "love handles," ensures safety and decreases the risk of abdominal trauma.

The nurse is caring for a client in a hip spica cast. Which intervention should the nurse include in the plan of care? 1. Assess the client's popliteal pulses every shift. 2. Elevate the leg on pillows and apply ice packs. 3. Teach the client how to ambulate with a tripod walker. 4. Assess the client for distention and vomiting.

4. Assess the client for distention and vomiting. 1. The client's popliteal pulse will be under the cast and cannot be assessed by the nurse; circulation is assessed by the 6 Ps of the neurovascular assessment. 2. Elevation should be used with an arm cast or leg cast, but this is not possible with a spica cast. 3. Clients with spica casts will not be able to ambulate because the cast covers the entire lower half of the body. 4. The nurse should assess the client for signs and symptoms of cast syndrome—vomiting after meals, epigastric pain, and abdominal distention. This is caused by a partial bowel obstruction from compression and can lead to complete obstruction. The client may still have bowel sounds present with this syndrome.

The client has been diagnosed with OA for the last seven (7) years and has tried multiple medical treatments and alternative treatments but still has significant joint pain. Which psychosocial client problem should the nurse identify? 1. Severe pain. 2. Body image disturbance. 3. Knowledge deficit. 4. Depression.

4. Depression. 1. Pain is a physiological problem, not a psychosocial problem. 2.A client with OA does not have bone deformities; therefore, body image disturbance is not appropriate. 3.After seven (7) years of OA and multiple treatment modalities, knowledge deficit is not appropriate for this client. 4.The client experiencing chronic pain often experiences depression and hopelessness.

Which information should the nurse teach the client regarding sports injuries? 1. Apply heat intermittently for the first 48 hours. 2. An injury is not serious if the extremity can be moved. 3. Only return to health-care provider if the foot becomes cold. 4. Keep the injury immobilized and elevated for 24 to 48 hours.

4. Keep the injury immobilized and elevated for 24 to 48 hours. 1. Ice should be applied intermittently for the first 48 hours. Heat can be used later in the recovery process. 2. Severe injury can be present even with some range of motion. 3. The client needs to return if the injury does not improve and if the foot gets cold. 4. The leg should be iced, elevated, and immobilized for 48 hours.

The client diagnosed with OA is prescribed a nonsteroidal anti-inflammatory drug (NSAID). Which instruction should the nurse teach the client? 1. Take the medication on an empty stomach. 2. Make sure to taper the medication when discontinuing. 3. Apply the medication topically over the affected joints. 4. Notify the health-care provider if vomiting blood.

4. Notify the health-care provider if vomiting blood. 1. This medication should be taken with food to prevent gastrointestinal distress. 2. Glucocorticoids, not NSAIDs, must be tapered when discontinuing. 3. Topical analgesics are applied to the skin; NSAIDs are oral or intravenous medications. 4. NSAIDs are well known for causing gastric upset and increasing the risk for peptic ulcer disease, which could cause the client to vomit blood.

The 84-year-old client is a resident in a long-term care facility. Which intervention should be implemented to help prevent complications secondary to osteoporosis? 1. Keep the bed in the high position. 2. Perform passive range-of-motion exercises. 3. Turn the client every two (2) hours. 4. Provide nighttime lights in the room.

4. Provide nighttime lights in the room. 1. The bed should be kept in the low position. Preventing falls is a priority for a client diagnosed with osteoporosis. 2. Range-of-motion (ROM) exercises will help prevent deep vein thrombosis or contractures, but they do not help prevent osteoporosis. 3. Turning the client will help prevent pressure ulcers, but does not help prevent osteoporosis. 4. Nighttime lights will help prevent the client from falling; fractures are the number-one complication of osteoporosis.

The nurse is preparing the preoperative client for a total hip replacement (THR). Which intervention should the nursing implement postoperatively? 1. Keep an abduction pillow in place between the legs at all times. 2. Cough and deep breathe at least every four (4) to five (5) hours. 3. Turn to both sides every two (2) hours to prevent pressure ulcers. 4. Sit in a high-seated chair for a flexion of less than 90 degrees.

4. Sit in a high-seated chair for a flexion of less than 90 degrees. 1. The abduction pillow should be kept between the legs while in bed to maintain a neutral position and prevent internal rotation. 2. The client should deep breathe and cough at least every two (2) hours to prevent atelectasis and pneumonia. 3. The client will need to turn every two (2) hours but should not turn to the affected side. 4. Using a high-seated toilet and chair will help prevent dislocation by limiting the flexion to less than 90 degrees.

The nurse is caring for the client who has had a total hip replacement. Which data indicate the surgical treatment is effective? 1. The client states the pain is at a "3" on a 1-to-10 scale. 2. The client has a limited ability to ambulate. 3. The client's left leg is shorter than the right leg. 4. The client ambulates to the bathroom.

4. The client ambulates to the bathroom. 1. Minimal pain is expected in a postoperative client but it does indicate surgical treatment is effective. 2. The client should be able to ambulate with almost full mobility. 3. A shorter leg indicates a dislocation of the hip. 4. The hip should have functional motion and client should be able to ambulate to the bathroom.This indicates surgical treatment has been effective.

The client newly diagnosed with osteoporosis is prescribed calcitonin by nasal spray. Which assessment data indicate to the nurse an adverse effect of the medication? 1. The client complains of nausea and vomiting. 2. The client is drinking two (2) glasses of milk a day. 3. The client has a runny nose and nasal itching. 4. The client has had numerous episodes of nosebleeds.

4. The client has had numerous episodes of nosebleeds. 1. Nausea and vomiting may occur during initial stages of therapy, but they will disappear as treatment continues. 2. The client should be sure to consume adequate amounts of calcium and vitamin D while taking calcitonin. 3. Rhinitis (runny nose) is the most common side effect with calcitonin nasal spray along with itching, sores, and other nasal symptoms. 4. Nosebleeds are adverse effects and should be reported to the client's HCP.

The client is postoperative open reduction and internal fixation (ORIF) of a fractured femoral neck. Which long-term goal should the nurse identify for the client? 1. The client will maintain vital signs within normal limits. 2. The client will have a decrease in muscle spasms in the affected leg. 3. The client will have no signs or symptoms of infection. 4. The client will be able to ambulate down to the nurse's station.

4. The client will be able to ambulate down to the nurse's station. 1. Vital signs remaining stable is a short-term goal, not a long-term goal. 2. This is an expected short-term outcome for a preoperative client with a fractured femoral neck. 3. No signs/symptoms of infection is a short-term goal for the nurse to identify in the hospital. 4. The discharge goal or long-term goal for this client is to return the client to ambulatory status.

The client who had a total knee replacement is being discharged home. To which multidisciplinary team member should the nurse refer the client? 1. The occupational therapist. 2. The physiatrist. 3. The recreational therapist. 4. The home health nurse.

4. The home health nurse. 1. The occupational therapist addresses upper extremity activities of daily living, swallowing issues, and cognition. This is not an appropriate referral. 2. The physiatrist is a physician specializing in rehabilitation medicine who practices in a rehabilitation setting. 3. The recreational therapist is used in psychiatric settings, rehabilitation hospitals, and long-term care facilities. The discipline is not seen in the home. 4. The home health care nurse will be able to assess the client in the home and make further referrals if necessary.

The nurse is caring for a client six (6) hours postoperative right total knee replacement. Which data should the nurse report to the surgeon? 1. A total of 100 mL of red drainage in the autotransfusion drainage system. 2. Pain relief after using the patient-controlled analgesia (PCA) pump. 3. Cool toes, distal pulses palpable, and pale nail beds bilaterally. 4. Urinary output of 60 mL of clear yellow urine in three (3) hours.

4. Urinary output of 60 mL of clear yellow urine in three (3) hours. 1. Drainage in the first 24 hours can be expected to be 200 to 400 mL. When using an autotransfusion drainage system, the client's blood will be filtered and returned to the client. 2. Pain relief with the PCA does not require notifying the surgeon. 3. Bilateral coolness of toes is not concerning since both feet are cool. Circulation is not restricted if pulses are present. Seeing pale pink nailbeds indicates blood loss during surgery. 4. The urinary output is not adequate; therefore, the surgeon needs to be notified. This is only 20 mL/hr. The minimum should be 30 mL/hr.

A client recovering from a total hip replacement has developed a deep vein thrombosis. The health-care provider has ordered a continuous infusion of heparin, an anticoagulant, to infuse at 1,200 units per hour. The bag comes with 20,000 units of heparin in 500 mL of 0.9% normal saline. At what rate should the nurse set the pump? ______

Answer: 30 mL/hr Divide the amount of heparin by the volume of fluid to get the concentration: 20,000 units ÷ 500 mL 40 units of heparin per 1 mL Divide the dose ordered by the concentration for the amount of milliliters per hour to set the pump: 1,200 units/hr ÷ 40 units/mL 30 mL/hr

The client must take three (3) grams of calcium supplement a day. The medication comes in 500-mg tablets. How many tablets will the client need to take daily? _______

Answer: 6 tablets 1,000 mg is equal to one (1) gram. Therefore, three (3) grams is equal to 3,000 mg. If one (1) tablet is 500 mg, the client will need six (6) tablets to get the total amount of calcium needed daily: 3,000 ÷ 500 6

The emergency department nurse is caring for a client with a compound fracture of the right ulna. Which interventions should the nurse implement? List in order of priority. 1. Apply a sterile, normal saline-soaked gauze to the arm. 2. Send the client to radiology for an x-ray of the arm. 3. Assess the fingers of the client's right hand. 4. Stabilize the arm at the wrist and the elbow. 5. Administer a tetanus toxoid injection.

The order should be 4, 1, 3, 2, 5. 4. The nurse first should stabilize the arm to prevent further injury. 1. A compound fracture is one in which the bone protrudes through the skin. The nurse should apply sterile, saline-soaked gauze to protect the area from the intrusion of bacteria. 3. The nurse should assess the client's circulation to the part distal to the injury. This is done after the first two interventions because life-threatening complications could occur if stabilization and protection from infection are not addressed first. 2. An x-ray will be needed to determine the extent of the injury. 5. A tetanus toxoid injection should be administered, but this can be done last.