Musculoskeletal PrepU

The nurse provides teaching to a client with osteoarthritis (OA). Which statement(s) indicate that teaching about pain management and functional ability were effective? Select all that apply. - "I will need to lose some weight." - "I will spend more time resting." - "I will increase the amount of walking I do every day." - "I will take the pain medication after exercising." - "I will avoid using a cane to walk."

- "I will need to lose some weight." - "I will increase the amount of walking I do every day." Pain management and optimal functional ability are the major goals of nursing interventions. With those goals in mind, nursing management of the client with OA includes pharmacologic and nonpharmacologic approaches as well as education. Weight loss is an important approach to lessen pain and disability caused by OA. Exercises such as walking should be begin in moderation and gradually increase. A sedentary lifestyle contributes to the development of OA so resting would not be encouraged. Canes or other assistive devices for ambulation should be considered, and any stigma about the use of these devices should be explored. Clients should plan daily exercise for a time when the pain is least severe or plan to use an analgesic agent before exercising.

Which instruction should the nurse include when teaching the client following hip replacement surgery? (Select all that apply.) - "Use a raised toilet seat and high-seated chair." - "Avoid bending forward when sitting in a chair." - "You may cross your legs at the ankles only." - "It is okay to briefly flex the hip to put on your clothes." - "Place pillows between your legs when you lay on your side."

- "Use a raised toilet seat and high-seated chair." - "Avoid bending forward when sitting in a chair." - "Place pillows between your legs when you lay on your side." The client following post hip replacement should not cross the legs, even at the ankle. He or she should avoid bending forward when sitting in a chair, avoid flexing the hip when dressing, and use a raised toilet seat. A pillow should be placed between the legs when side-lying.

Which actions by the nurse demonstrate an understanding of caring for a client in traction? Select all that apply. - Assessing the client's alignment in the bed - Ensuring that the weights are hanging freely - Frequently assessing pain level - Removing skeletal traction to turn and reposition the client - Placing a trapeze on the bed

- Assessing the client's alignment in the bed - Ensuring that the weights are hanging freely - Frequently assessing pain level - Placing a trapeze on the bed The weights must hang freely, with the client in good alignment in the center of the bed. The nurse should frequently monitor pain, as uncontrolled pain may be a sign of a complication. The client will be able to assist with alignment and bed mobility if a trapeze is placed on the bed. Skeletal traction should never be interrupted.

Which of the following are the major hormonal regulators of calcium homeostasis? Select all that apply. - Thyroid - Growth hormone - Calcitonin - Parathormone - Cortisol

- Calcitonin - Parathormone Parathormone and calcitonin are the major hormonal regulators of calcium homeostasis. Excessive thyroid hormone production in adults can result in increased bone resorption and decreased bone formation. Increased levels of cortisol have the same effects. Growth hormone has direct and indirect effects on skeletal growth and remodeling.

The nurse is caring for a patient with a pelvic fracture. What nursing assessment for a pelvic fracture should be included? (Select all that apply.) - Checking the urine for hematuria - Palpating peripheral pulses in both lower extremities - Assessing pupillary response - Testing the stool for occult blood - Assessing level of consciousness

- Checking the urine for hematuria - Palpating peripheral pulses in both lower extremities - Testing the stool for occult blood In pelvic fracture, the nurse should palpate the peripheral pulses, especially the dorsalis pedis pulses of both lower extremities; absence of a pulse may indicate a tear in the iliac artery or one of its branches. To assess for urinary tract injury, the patient's urine is analyzed for blood.

A client is scheduled for a bone scan. A bone scan may be ordered to detect metastatic bone lesions, fractures, and certain types of inflammatory disorders. Which nursing considerations are correct in preparing a client for a bone scan? Select all that apply. - Encourage the client to drink fluids to help distribute and eliminate the isotope. - Ensure the client is NPO for 12 hours before the test. - Inform the client that the radiopaque isotope will be administered intravenously. - Ensure that the client does not have any allergies to the isotope.

- Encourage the client to drink fluids to help distribute and eliminate the isotope. - Inform the client that the radiopaque isotope will be administered intravenously. - Ensure that the client does not have any allergies to the isotope. Informing the client that the radiopaque isotope will be administered intravenously, ensuring that the client does not have any allergies to the isotope, and encouraging the client to drink fluids to help distribute and eliminate the isotope are all considered in preparing a client for a bone scan. The client does not need to be NPO for 12 hours before the test.

Which statements describe open reduction of a fracture? Select all that apply. - It is performed in the operating room. - The bone is surgically exposed and realigned. - The bone is restored to its normal position by external manipulation. - The client usually receives general or spinal anesthetic.

- It is performed in the operating room. - The bone is surgically exposed and realigned. - The client usually receives general or spinal anesthetic. Statements describing open reduction are the following: It is performed in the operating room, the bone is surgically exposed and realigned, and the client usually receives general or spinal anesthetic. The bone is restored to its normal position by external manipulation with closed reduction.

Which evaluation finding requires follow up by the nurse caring for a client with a total knee replacement? Select all that apply. - Client ambulates 10 feet by postoperative day 2 - Knee flexion at 30 degrees - Client reports pain rating of 2. - 650 ml bloody drainage in drain wound - Pedal pulses strong and equal bilaterally

- Knee flexion at 30 degrees - 650 ml bloody drainage in drain wound A suction drain removes fluid accumulating in the wound. Typical drainage ranges from 200 to 400 ml the first 24 hours after surgery and declines to fewer then 25 ml by 48 hours. Knee mobility is increased with a continuous passive motion (CPM) device. Initial settings of the CPM are usually 10 degrees of extension and 50 degrees of flexion with an ultimate goal of full extension (0 degrees) and 90 degrees of flexion by discharge. A pain rating of 2 is an indicator of effective pain management. Strong and equal pedal pulses are an expected finding. Progressive ambulation begins on the day after surgery; ambulating 10 feet on postoperative day would be expected.

A client arrives in the emergency room complaining of severe pain in her left hip after falling out of the bed. What indication upon assessment does the nurse recognize as a dislocated left hip? Select all that apply. - Limited range of motion of the left hip. - The skin of the lower left leg is pale. - The skin over the left hip is warm. - The client is able to bend the knee but not move toes. - The left leg is shorter than the right.

- Limited range of motion of the left hip. - The skin of the lower left leg is pale. - The left leg is shorter than the right. The leg may be shorter than its unaffected counterpart as a result of the displacement of one of the articulating ones. ROM is limited. Evidence of soft tissue injury includes swelling, coolness (not heat), numbness, tingling, and pale or dusky color of the distal tissue. The client will not be able to bend the knee but will be able to move the toes.

A client with a herniated lumbar disc has asked about nonsurgical strategies to help with mobility. What strategies will the nurse teach the client? Select all that apply. - Physical therapy - Muscle relaxants - Nonsteroidal anti-inflammatory medications - Positive feedback and attitude - Weight reduction - Hydrotherapy

- Physical therapy - Muscle relaxants - Nonsteroidal anti-inflammatory medications - Weight reduction Muscle spasm is prominent during the acute phase, and muscle relaxants will help, as will physical therapy exercises and nonsteroidal anti-inflammatory medications (NSAID)s. Weight reduction will assist the client as well. Hydrotherapy and providing positive feedback has not been proven to assist in this condition.

A client is placed in traction for a femur facture. The nurse would document which expected outcomes of traction? Select all that apply. - Decreased pedal pulse - Realignment of the fracture - Increased ability to bear weight - Reduction of deformity - Minimization of muscle spasms - Full range of motion to extremity

- Realignment of the fracture - Reduction of deformity - Minimization of muscle spasms Traction is used to minimize muscle spasms, to reduce, align, and immobilize fractures, and to reduce deformity. Traction does not allow for full range of motion or an increased ability to bear weight. The client is confined to the bed while in traction. A decreased pulse is a sign of circulatory compromise and should be investigated and reported.

A nurse is planning the care of an older adult client who will soon be discharged home after treatment for a fractured hip. In an effort to prevent future fractures, the nurse should encourage what actions? Select all that apply. - Use of falls prevention precautions - Regular bone density testing - A high-calcium diet - Use of corticosteroids as prescribed - Weight-bearing exercise

- Use of falls prevention precautions - Regular bone density testing - A high-calcium diet - Weight-bearing exercise Health promotion measures after an older adult's hip fracture include weight-bearing exercise, promotion of a healthy diet, falls prevention, and bone density testing. Corticosteroids have the potential to reduce bone density and increase the risk for fractures.

A nurse is teaching an educational class to a group of older adults at a community center. In an effort to prevent osteoporosis, the nurse should encourage participants to ensure that they consume the recommended intake of what nutrients? Select all that apply. - Calcitonin - Potassium - Vitamin D - Vitamin B12 - Calcium

- Vitamin D - Calcium A diet rich in calcium and vitamin D protects against skeletal demineralization. Intake of vitamin B12 and potassium does not directly influence the risk for osteoporosis. Calcitonin is not considered to be a dietary nutrient.

Red bone marrow produces which of the following? Select all that apply. - White blood cells (WBCs) - Red blood cells (RBCs) - Platelets - Corticosteroids - Estrogen

- White blood cells (WBCs) - Red blood cells (RBCs) - Platelets The red bone marrow located within the bone cavities produces RBC, WBCs, and platelets through the process of hematopoiesis. The red bone marrow does not produce estrogen or corticosteroids.

When is it advisable for the nurse to apply heat to a sprain or a contusion? a. After 2 days b. Do not apply at all c. Immediately d. Only after a week

a. After 2 days It is advisable to apply heat on a sprain or a contusion 2 days after a sprain or a contusion has occurred. This is because after 2 days swelling is not likely to increase and as a result heat application reduces pain and relieves local edema by improving circulation. Delaying the application of heat prolongs the pain and increased the risk of local edema.

A public health nurse is organizing a campaign that will address the leading cause of musculoskeletal-related disability. The nurse should focus on what health problem? a. Arthritis b. Hip fractures c. Lower back pain d. Osteoporosis

a. Arthritis The leading cause of musculoskeletal-related disability is arthritis.

Which action would be most important postoperatively for a client who has had a knee or hip replacement? a. Assisting in early ambulation. b. Providing crutches to the client. c. Encouraging expressions of anxiety. d. Using a continuous passive motion (CPM) machine.

a. Assisting in early ambulation. An anticoagulant therapy and early ambulation are important for clients who undergo a knee or hip replacement. A CPM machine or crutches may be provided when prescribed. It is important to encourage clients to express their feelings of anxiety or depression. This is more crucial for clients who undergo an amputation rather than for clients who undergo a replacement surgery.

A client who has sustained a fracture reports an increase in pain and decreased function of the affected extremity. What will the nurse suspect? a. Avascular necrosis b. Infection c. Hypovolemic shock d. Pulmonary embolism

a. Avascular necrosis Avascular necrosis refers to the death of the bone from insufficient blood supply, typically manifested by complaints of increased pain and decreased function. Fever or redness, purulent drainage, and swelling of the site would suggest infection. Respiratory distress would suggest a pulmonary embolism. Changes in vital signs, level of consciousness, and signs and symptoms of fluid loss would suggest hypovolemic shock.

The nurse is discussing an older adult's risk for skeletal fractures with a group of students assigned to the clinical area. Which of the following would the nurse most likely explain as the underlying reason for the increased risk? a. Bone resorption is more rapid than bone formation. b. Collagen formation decreases. c. No bone reformation occurs in the older adult. d. Aging leads to a deficiency of calcium.

a. Bone resorption is more rapid than bone formation. Older adults are more prone to skeletal fractures because bone resorption is more rapid than bone formation. Collagen formation increases resulting in fibrosis and loss of strength and flexibility. Increased risk for skeletal fractures is not always due to a calcium deficiency. The process of bone reformation does not stop with age. Age-related declines of estrogen and testosterone production cause bone loss. After age 35 years, people generally experience a loss of bone mass.

A client comes to the emergency department complaining of pain in the right leg. When obtaining the history, the nurse learns that the client has a history of obesity and hypertension. Based on this information the nurse anticipates the client having which musculoskeletal disorder? a. Degenerative joint disease b. Paget's disease c. Scoliosis d. Muscular dystrophy

a. Degenerative joint disease Obesity predisposes the client to degenerative joint disease. Obesity isn't a predisposing factor for muscular dystrophy, scoliosis, or Paget's disease.

The primary nursing intervention that will control swelling while treating a musculoskeletal injury is: a. Elevate the affected area. b. Immobilize the injured area. c. Apply cold (moist or dry). d, Apply an elastic compression bandage.

a. Elevate the affected area. Elevation is used to control swelling. It is facilitated by cold, immobilization, and compression. Refer to Box 42-1 in the text.

A client has been prescribed alendronate for the prevention of osteoporosis. Which is the highest priority nursing intervention associated with the administration of the medication? a. Have the client sit upright for at least 30 minutes following administration b. Encourage the client to get yearly dental exams c. Ensure adequate intake of vitamin D in the diet d. Assess for the use of corticosteroids

a. Have the client sit upright for at least 30 minutes following administration While all interventions are appropriate, the highest priority is having the client sit upright for 60 minutes following administration of the medication. This will prevent irritation and potential ulceration of the esophagus. The client should have adequate intake of vitamin D and obtain yearly dental exams. The concurrent use of corticosteroids and alendronate is link to a complication of osteonecrosis.

Which of the following describes failure of the ends of a fractured bone to unite in normal alignment? a. Nonunion b. Subluxation c. Malunion d. Delayed union

a. Nonunion Nonunion results from failure of the ends of a fractured bone to unite in normal alignment. Delayed union occurs when there is prolonged healing for union of the fracture. In malunion, there is flawed union of fractured bone. Subluxation is a partial dislocation of the articulating surfaces.

Which body movement involves moving toward the midline? a. Eversion b. Adduction c. Abduction d. Pronation

b. Adduction Adduction is moving toward the midline. Pronation is turning inward. Abduction is moving away from the midline. Eversion is turning outward.

A client is hospitalized for open reduction of a fractured femur. During the postoperative assessment, the nurse notes that the client is restless and observes petechiae on the client's chest. Which nursing action is indicated first? a. Elevate the affected extremity. b. Administer oxygen. c. Contact the health care provider. d. Contact the nursing supervisor.

b. Administer oxygen. The client is demonstrating clinical manifestations consistent with a fatty embolus. Administering oxygen is the top priority. Elevating the extremity won't alter the client's condition. Notifying the nursing supervisor may be indicated by facility policy after other immediate actions have been taken. The nurse should contact the health care provider after administering oxygen.

Which of the following is the first-line medication that would be used to treat and prevent osteoporosis? a. Anabolic agents b. Bisphosphonates c. Selective estrogen receptor modulators d. Calcitonin

b. Bisphosphonates Bisphosphonates, along with calcium and vitamin D supplements, are the first-line medications given to prevent/treat osteoporosis. The other medications are prescribed after these drugs are used.

An older, female client with osteoporosis has been hospitalized. Prior to discharge, when teaching the client, the nurse should include information about which major complication of osteoporosis? a. Negative calcium balance b. Bone fracture c. Loss of estrogen d. Dowager hump

b. Bone fracture Bone fracture is a major complication of osteoporosis that results when loss of calcium and phosphate increases the fragility of bones. Estrogen deficiencies result from menopause, not osteoporosis. Calcium and vitamin D supplements may be used to support normal bone metabolism, but a negative calcium balance is not a complication of osteoporosis. Dowager hump results from bone fractures. It develops when repeated vertebral fractures increase spinal curvature.

Which is a neurovascular problem caused by pressure within a muscle area that increases to such an extent that microcirculation diminishes? a. Remodeling b. Compartment syndrome c. Hypertrophy d. Fasciculation

b. Compartment syndrome Compartment syndrome is caused by pressure within a muscle area that increases to such an extent that microcirculation diminishes. Remodeling is a process that ensures bone maintenance through simultaneous bone resorption and formation. Hypertrophy is an increase in muscle size. Fasciculation is the involuntary twitch of muscle fibers.

A patient is having low back pain. What position can the nurse suggest to relieve this discomfort? a. Supine, with the bed flat and a firm mattress in place b. Supine, with the knees slightly flexed and the head of the bed elevated 30 degrees c. Prone, with a pillow under the shoulders d. High-Fowler's to allow for maximum hip flexion

b. Supine, with the knees slightly flexed and the head of the bed elevated 30 degrees A medium to firm, not sagging mattress (a bed board may be used) is recommended; there is no evidence to support the use of a firm mattress (National Guideline Clearinghouse, 2010). Lumbar flexion is increased by elevating the head and thorax 30 degrees by using pillows or a foam wedge and slightly flexing the knees supported on a pillow. Alternatively, the patient can assume a lateral position with knees and hips flexed (curled position) with a pillow between the knees and legs and a pillow supporting the head (Fig. 42-1). A prone position should be avoided because it accentuates lordosis.

A nurse is assessing a client for risk factors known to contribute to osteoarthritis. What assessment finding should the nurse interpret as a risk factor? a. The client has a 30 pack-year smoking history. b. The client's body mass index is 34 (obese). c. The client is 58 years old. d. The client has primary hypertension.

b. The client's body mass index is 34 (obese). Risk factors for osteoarthritis include obesity and previous joint damage. Risk factors of OA do not include smoking or hypertension. Incidence increases with age, but a client who is 58 years old would not yet face a significantly heightened risk.

A nurse is providing a class on osteoporosis at the local center for older adults. Which statement related to osteoporosis is most accurate? a. Secondary osteoporosis occurs in women after menopause. b. The use of corticosteroids increases the risk of osteoporosis. c. A non-modifiable risk factor for osteoporosis is a person's level of activity. d. High levels of vitamin D can cause osteoporosis.

b. The use of corticosteroids increases the risk of osteoporosis. Corticosteroid therapy is a secondary cause of osteoporosis when taken for long-term use. Adequate levels of vitamin D are needed for absorption of calcium. A person's level of physical activity is a modifiable factor that influences peak bone mass. Lack of activity increases the risk for the development of osteoporosis. Primary osteoporosis occurs in women after menopause.

The nurse teaches the client with a high risk for osteoporosis about risk-lowering strategies, including which action? a. Increase fiber in the diet b. Walk or perform weight-bearing exercises outdoors c. Reduce stress d. Decrease the intake of vitamin A and D

b. Walk or perform weight-bearing exercises outdoors Risk-lowering strategies for osteoporosis include walking or exercising outdoors, performing a regular weight-bearing exercise regimen, increasing dietary calcium and vitamin D intake, smoking cessation, and consuming alcohol and caffeine in moderation.

A nurse is planning discharge teaching regarding exercise for a client at risk for osteoporosis. Which exercise would the nurse be most likely to suggest? a. Bicycling b. Walking c. Swimming d. Yoga

b. Walking Weight-bearing exercises should be incorporated into the client's lifestyle activities. Walking is a low-impact method of weight-bearing exercise and would be the most universal or most likely form of exercise for the nurse to recommend. Bicycling, and swimming are not weight-bearing exercise and will not increase bone density. Yoga may or may not be weight-bearing exercise depending on the yoga poses being performed; it is not as likely as walking to be recommended by the nurse.

Which client would the nurse identify as having the greatest risk for osteoporosis? a. A 16-year-old male with a history of asthma b. A 40-year-old overweight African American woman c. A small-framed, thin 45-year-old white woman d. A 20-year-old male athlete with repeated injuries

c. A small-framed, thin 45-year-old white woman Small-framed, thin white women are at greatest risk for osteoporosis. African American women have a greater bone density and thus are less susceptible to osteoporosis. Men have an increased bone mass and do not have hormonal changes, and do not acquire osteoporosis as frequently and get it at a later age. Asthma does not increase the risk for osteoporosis.

A patient had a total hip replacement. What recommended leg position should the nurse ensure is maintained to prevent prosthesis dislocation? a. Flexion b. Adduction c. Abduction d. Internal rotation

c. Abduction The nurse educates the patient about protective positioning, which includes maintaining abduction and avoiding internal and external rotation, hyperextension, and acute flexion.

A client is transported to the emergency department for a femur fracture following a motor vehicle crash. What action by the nurse is the highest priority? a. Administer pain medication per orders. b. Assess pedal pulses. c. Assess vital signs and level of consciousness. d. Assess the diameter of the thigh every 15 minutes.

c. Assess vital signs and level of consciousness. Femur fractures can lead to hypovolemic shock due to blood loss in the tissue. By assessing the vital signs and level of consciousness, the nurse can assess for shock. Assessing the pedal pulses and measuring the diameter of the thigh are appropriate interventions for someone with a femur fracture, but assessing for hypovolemic shock would be a priority. Pain medication should be safely administered per orders to help control pain. Many pain medications lower blood pressure (BP). If the client is in shock, BP may be too low to administer the pain medication safely.

Which medication directly inhibits osteoclasts, thereby reducing bone loss and increasing bone mass density (BMD)? a. Teriparatide b. Vitamin D c. Calcitonin d. Raloxifene

c. Calcitonin Calcitonin directly inhibits osteoclasts, thereby reducing bone loss and increased BMD. Raloxifene reduces the risk of osteoporosis by preserving BMD without estrogenic effects on the uterus. Teriparatide has been recently approved by the FDA for the treatment of osteoporosis. Vitamin D increases the absorption of calcium.

The nurse is caring for a client who underwent surgery to remove a spinal cord tumor. When conducting the postoperative assessment, the nurse notes the presence of a bulge at the surgical site. The nurse suspects the client is experiencing what complication from the surgery? a. Infection at the surgical site b. Impaired tissue healing c. Cerebrospinal fluid leakage d. Growth of a secondary tumor

c. Cerebrospinal fluid leakage Bulging at the incision may indicate a contained cerebrospinal fluid (CSF) leak. The site should be monitored for increasing bulging, known as pseudomeningocele, which may require surgical repair. Infection at the surgical site should be suspected if the surgical dressing is stained. The bulge does not indicate growth of secondary tumor, this can only be identified using diagnostic imaging. Impaired tissue healing would be indicated if the nurse assessed redness, swelling and warmth at the surgical site during a dressing change. The bulge at the site warrants further assessment of a postsurgical leak of CSF.

Which of the following type of fracture is associated with osteoporosis? a. Simple b. Stress c. Compression d. Oblique

c. Compression Compression fractures are caused by compression of vertebrae and are associated frequently with osteoporosis. Stress fractures occur with repeated bone trauma from athletic activities, most frequently involving the tibia and metatarsals. An oblique fracture runs across the bone at a diagonal angle of 45 to 60 degrees. A simple fracture (closed fracture) is one that does not cause a break in the skin.

An older adult female has a bone density test that reveals severe osteoporosis. What does the nurse understand can be a problem for this client due to the decrease in bone mass and density? a. Cardiac disease b. Hypertension c. Compression fractures d. Diabetes

c. Compression fractures In osteoporosis, loss of bone substance exceeds bone formation. The total bone mass and density is reduced, resulting in bones that become progressively porous, brittle, and fragile. Compression fractures of the vertebrae are common. Diabetes, hypertension, and cardiac disease may occur in response to the aging process but are not the result of osteoporosis.

The nurse is asked to explain to the client the age-related processes that contribute to bone loss and osteoporosis. What is the nurse's best response? a. Decrease in parathyroid hormone b. Increase of vitamin D c. Decrease in estrogen d. Increase in calcitonin

c. Decrease in estrogen Age related processes that contribute to loss of bone mass and osteoporosis are decreases in estrogen, calcitonin, and vitamin D and an increase in parathyroid hormone.

The nurse is caring for a patient postoperatively following orthopedic surgery. The nurse assesses an oxygen saturation of 89%, confusion, and a rash on the upper torso. What does the nurse suspect is occurring with this patient? a. Pneumonia b. Polyethylene-induced infection c. Fat emboli syndrome d. Disseminated intravascular coagulation

c. Fat emboli syndrome Fat embolism syndrome (FES) (see Chapter 43) may occur with orthopedic surgery. The nurse must be alert to any signs and symptoms that may suggest the development of FES. These may include respiratory distress; onset of delirium or any acute change in level of consciousness; and development of unusual skin rashes, especially a papular rash on the upper torso.

A male client who has undergone a cervical discectomy is being discharged with a cervical collar. Which of the following would be most appropriate to include the client's discharge plan? a. Removing the entire collar when shaving b. Moving the neck from side to side when the collar is off c. Keeping the head in a neutral position d. Wearing the cervical collar when sleeping

c. Keeping the head in a neutral position After a cervical discectomy, the client typically wears a cervical collar. The client should be instructed to keep his head in a neutral position and wear the collar at all times unless the physician has instructed otherwise. The front part of the collar is removed for shaving and the neck should be kept still while the collar is open or off.

Pulselessness, a very late sign of compartment syndrome, may signify a. Diminished arterial perfusion b. Venous congestion c. Lack of distal tissue perfusion d. Nerve involvement

c. Lack of distal tissue perfusion Pulselessness is a very late sign that may signify lack of distal tissue perfusion. The other answers do not apply.

A client's fracture was reduced by surgically exposing the bone and realigning it. What type of treatment does the nurse identity this as? a. Internal fixation b. Buck's traction c. Open reduction d. Skeletal traction

c. Open reduction In an open reduction, the bone is surgically exposed and realigned. Buck's traction is a type of skin traction that provides pulling on the structures. Skeletal traction is applied directly to the bone using a wire, pin, or cranial tongs. Internal fixation involves the use of metal screws, plates, rods, nails or pins to stabilize a reduced fracture.

Which is a hallmark sign of compartment syndrome? a. Edema b. Weeping skin surfaces c. Pain d. Motor weakness

c. Pain A hallmark sign of compartment syndrome is pain that occurs or intensifies with passive range of motion.

A client diagnosed with osteoporosis is being discharged home. Which priority education should the nurse should provide? a. Participate in weight-bearing exercises b. Increase calcium and vitamin D in the diet c. Remove all small rugs from the home d. Classify medications

c. Remove all small rugs from the home A client with osteoporosis is at risk for fractures related to falls. The home environment needs to be evaluated for safety issues, such as rugs and other objects that could cause a fall. All other education is important in educating the client, but the risk for injury from a fall and potential for a fracture makes safety in the home environment a priority.

Which is a strategy for lowering risk for osteoporosis? a. Low initial bone mass b. Increased age c. Smoking cessation d. Diet low in calcium and vitamin D

c. Smoking cessation Risk-lowering strategies include increased dietary calcium and vitamin D intake, smoking cessation, alcohol and caffeine consumption in moderation, and outdoor activity. Individual risk factors include low initial bone mass and increased age. A lifestyle risk factor is a diet low in calcium and vitamin D.

A client with low back pain is being seen in the clinic. In planning care, which teaching point should the nurse include? a. Sleep on the stomach to alleviate pressure on the back. b. A soft mattress is most supportive by conforming to the body. c. Use the large muscles of the leg when lifting items. d. Avoid twisting and flexion activities.

c. Use the large muscles of the leg when lifting items. The large muscles of the leg should be used when lifting.

A client has just returned from surgery after undergoing a lumbar laminectomy. Which of the following would be most important to do when positioning the client in bed? a. Allowing the client to sit up at the edge of the bed b. Maintaining full knee flexion when lying on the side c. Using a logrolling motion to change positions d. Keeping the knees flat with the head on a pillow

c. Using a logrolling motion to change positions After a laminectomy, logrolling is used to change the client's position. When in bed, a pillow is placed under the client's head and the knee rest is elevated slightly to relax the back muscles. When lying on his or her side, extreme knee flexion is avoided. Sitting is discouraged except for defecation.

A health care provider diagnoses primary osteoporosis in a client who has lost bone mass. For which client is primary osteoporosis most common? a. young menstruating woman b. elderly man c. elderly postmenopausal woman d. young child

c. elderly postmenopausal woman Although the cause of primary osteoporosis is unknown, an important contributing factor may be faulty protein metabolism resulting from estrogen deficiency and a sedentary lifestyle. Typically, these conditions occur in elderly postmenopausal women.

The nurse is conducting a medication reconciliation with a client admitted with a fracture. What medication predisposes a client for a risk for fractures? a. metoprolol b. furosemide c. prednisone d. digoxin

c. prednisone Prednisone, a corticosteroid, causes increased bone resorption and decreased bone formation, resulting in increased risk for fractures. Furosemide, digoxin, and metoprolol do not interfere with bone resorption or predispose clients to fractures.

The nurse is providing instructions to the client who is being prepared for skeletal traction. Which statement by the client indicates teaching was effective? a. "A belt will go around my pelvis and weights will be attached." b. "The traction can be removed once a day so I can shower." c. "I will wear a boot with weights attached." d. "Metal pins will go through my skin to the bone."

d. "Metal pins will go through my skin to the bone." In skeletal traction, metal rods or pins are used to apply continuous traction directly to the bone. Weights are used to apply the traction. Casts, external fixators, or splints are used when the traction is discontinued.

The nurse is educating a group of women on the prevention of osteoporosis. The nurse recognizes the education as being effective when the group members make which statement? a. "Estrogen deficiency increases bone density." b. "We need to increase aerobic exercise." c. "We need to consume a low-calcium, high-phosphorus diet." d. "We need an adequate amount of exposure to sunshine."

d. "We need an adequate amount of exposure to sunshine." The only accurate statement is related to getting an adequate amount of exposure to sunshine. Aerobic exercise, such as swimming, does not prevent osteoporosis. The exercise needs to be weight bearing. A diet low in calcium and high in phosphorus will increase the risk for osteoporosis. Estrogen deficiency is linked to decreased bone mass.

A client presents at a clinic reporting back pain that goes all the way down the back of the leg to the foot. The nurse should document the presence of what type of pain? a. Bursitis b. Tendonitis c. Radiculopathy d. Sciatica

d. Sciatica Sciatica nerve pain travels down the back of the thigh to the foot of the affected leg. Bursitis is inflammation of a fluid-filled sac in a joint. Radiculopathy is disease of a nerve root. Tendonitis is inflammation of muscle tendons.

With fractures of the femoral neck, the leg is a. adducted and internally rotated. b. shortened, abducted, and internally rotated. c. abducted and externally rotated. d. shortened, adducted, and externally rotated.

d. shortened, adducted, and externally rotated. With fractures of the femoral neck, the leg is shortened, adducted, and externally rotated.