Musculoskeletal

A nurse is assigned a client with an acute exacerbation of rheumatoid arthritis (RA). Which medical facts about RA are essential in developing a plan of care? Select all that apply. 1. Onset is acute and usually occurs between ages 20 and 40. 2. The client experiences stiff, swollen joints bilaterally. 3. The client may not exercise once the disease is diagnosed. 4. Erythrocyte sedimentation rate (ESR) is elevated, and x-rays show erosions and decalcification of involved joints. 5. Inflamed cartilage triggers complement activation, which stimulates the release of additional inflammatory mediators. 6. The first-line treatment is gold salts and methotrexate.

2,4,5

A nurse is putting groceries in the car when an older adult client falls off of a curb. The nurse assesses the client and has a bystander call for an ambulance. Which assessment findings provide data of a suspected right hip fracture? Select all that apply. 1. The right leg is longer than the left leg. 2. The right leg is shorter than the left leg. 3. The right leg is abducted. 4. The right leg is adducted. 5. The right leg is externally rotated. 6. The right leg is internally rotated.

2,4,5

The nurse is assisting the client in filling a pillbox. A client has been prescribed indomethacin for the treatment of gouty arthritis. The orders state 25 mg t.i.d. for first 5 days and then increase by 25 mg per dose at weekly intervals until the daily dose reaches a maximum of 250 mg. The client is on week 3 of treatment and has tolerated the medication without any incident thus far. By week 3, what would the daily dose of medication be? Record your answer as a whole number.

225

A nurse is preparing discharge instructions for an above-the-knee amputation client. Which instructions would be a priority for home care? Select all that apply. 1. Massage the residual limb in a motion away from the suture line. 2. Avoid using heat application to ease pain. 3. Immediately report twitching, spasms, or phantom limb pain. 4. Avoid exposing the skin around the residual limb to excessive perspiration. 5. Be sure to perform the prescribed exercises. 6. Rub the residual limb with a dry washcloth for 4 minutes three times daily if the limb is sensitive to touch.

4,5,6

A client is scheduled for an open reduction internal fixation of the right hip. Place the following nursing interventions in chronological order to show the sequence in which the nurse would perform them. All options must be used. 1. Initiate a home care teaching plan. 2. Complete a preoperative checklist. 3. Encourage coughing, turning, and deep breathing. 4. Make sure the client has signed an informed consent form. 5. Monitor vital signs every 15 minutes x 4, every 30 minutes x 2, and every hour x 2. 6. Complete a history and physical examination.

6,4,2,5,3,1

The nurse is instructing a client following right knee replacement on how to use crutches. Which instructions are included? Select all that apply. 1. Let your armpits support your weight. 2. Have your elbows bent when holding the crutch handles. 3. Place crutches 1 foot in front of you. 4. Step forward first on your right leg. 5. Pivot on your left leg. 6. Swing your left leg forward.

2,3,5,6

A client is admitted to the trauma center with a spinal cord transection at T4. Which of the physical limitations does the nurse anticipate when planning care? Select all that apply. 1. The client will need ventilator support. 2. The client will be unable to independently ambulate. 3. The client will have no control of the bladder. 4. The client will need assistance with feeding. 5. The client will be unable to speak. 6. The client will be cognitively impaired.

2,3

A client is being discharged to a rehabilitation care facility following a hip replacement using the posterior surgical approach. When reporting to the licensed practical/ vocational nurse (LPN/VN), which nursing actions would the orthopedic nurse stress as essential? Select all that apply. 1. Place the client in high Fowler's position. 2. Avoid any hip flexion exercises. 3. Place two pillows between the client's knees. 4. Place a raised toilet seat in the bathroom. 5. Keep the client's feet elevated. 6. Maintain the client on bed rest until the incision heals.

2,3,4

A nurse is caring for a client newly diagnosed with osteoporosis. Which statements would the nurse include when teaching the client about the disease? Select all that apply. 1. Osteoporosis is common in females after menopause. 2. Osteoporosis is a degenerative disease characterized by a decrease in bone density. 3. Daily medication is needed to cure the disease. 4. Osteoporosis can cause pain and injury. 5. Passive ROM exercises can promote bone growth. 6. Limit weight bearing and repetitive exercises.

1,2,4

A client is admitted with a possible diagnosis of osteomyelitis. Based on the documentation below, which laboratory result is the priority for the nurse to report to the health care provider? 1. rheumatoid factor 2. blood culture 3. alkaline phosphatase 4. ESR

2