Musculoskeletal questions
Rest is an essential component of bone healing.
A client has a hip fracture repair with a prosthetic implant placed. On the day after the implant, the nurse finds the client surrounded by papers from his briefcase and planning a phone meeting. The nurse plans to discuss activities with the client and should base the discussion on which information? Rest is an essential component of bone healing. 2. Setting limits on a client's behavior is a mandated nursing role. 3. Not keeping up with his job will increase the client's stress level. 4. Involvement in his job will keep the client from becoming bored.
Presence of warm areas on the cast
The nurse is assessing the casted extremity of a client for signs of infection. Which finding is indicative of the presence of an infection? Dependent edema 2. Diminished distal pulse 3. Coolness and pallor of the skin 4. Presence of warm areas on the cast
Checking the weights to be sure that they are off the floor
The nurse is assigned to care for a client who is in traction. Which intervention by the nurse should ensure a safe environment for the client? Making sure that the knots are at the pulleys sites 2.Checking the weights to be sure that they are off the floor 3.Making sure that the head of the bed is kept at a 90-degree angle 4.Monitoring the weights to be sure that they are resting on a firm surface
Bleeding and swelling cause increased pressure in an area that cannot expand.
The nurse is caring for a client who develops compartment syndrome as a result of a severely fractured arm. When the client asks why this happens, how should the nurse respond? A bone fragment has injured the nerve supply in the area. 2.An injured artery causes impaired arterial perfusion through the compartment. 3.Bleeding and swelling cause increased pressure in an area that cannot expand. 4.The fascia expands with injury, causing pressure on underlying nerves and muscles.
Muscle fibers are inflamed.
A client has been experiencing muscle weakness for a period of several months. The health care provider suspects polymyositis, and the client asks the nurse about the disorder. The nurse explains to the client that which occurs in this disorder? There is an increase in fibrous tissue. 2.Muscle fibers are inflamed. 3.Muscle fibers are thickened. 4.There is a decrease in elastic tissue.
Keep the right ankle elevated above the heart level with pillows for 24 hours.
A client who experienced a fractured right ankle has a short leg cast applied in the emergency department. During discharge teaching, which information should the nurse provide to the client to prevent complications? Trim the rough edges of the cast after it is dry. 2.Weight bearing on the right leg is allowed once the cast feels dry. 3.Expect burning and tingling sensations under the cast for 3 to 4 days. 4.Keep the right ankle elevated above the heart level with pillows for 24 hours.
"If the cast gets wet, I can dry it with a hair dryer turned to the hot setting."
The nurse has given the client with a nonplaster (fiberglass) leg cast instructions regarding cast care at home. The nurse determines that the client needs further teaching if the client makes which statement? "I should avoid walking on wet, slippery floors." 2."I'm not supposed to scratch the skin underneath the cast." 3."It's all right to wipe dirt off of the top of the cast with a damp cloth." 4."If the cast gets wet, I can dry it with a hair dryer turned to the hot setting."
Monitoring for blanching ability of toe nail beds
The nurse is caring for a client who had an orthopedic injury of the leg that required surgery and the application of a cast. Postoperatively, which nursing assessment is of highest priority to assure client safety? Monitoring for heel breakdown 2.Monitoring for bladder distention 3.Monitoring for extremity shortening 4.Monitoring for blanching ability of toe nail beds
Slightly elevating the foot of the bed
The nurse is caring for a client who has been placed in skin traction. Which action by the nurse provides for countertraction to reduce shear and friction? Using a footboard 2.Providing an overhead trapeze 3.Slightly elevating the foot of the bed 4.Slightly elevating the head of the bed
Reorient the client to time, place, and person frequently.
The nurse is caring for an older client who has been placed in Buck's extension traction after a hip fracture. During the assessment of the client, the nurse notes that the client is disoriented. Which is the most appropriate nursing intervention for this client? Apply restraints to the client. 2.Ask the family to stay with the client. 3.Ask the laboratory to perform electrolyte studies. 4.Reorient the client to time, place, and person frequently.
2.Clear drainage from the pin sites
The nurse is performing pin-site care on a client in skeletal traction. Which normal finding should the nurse expect to note when assessing the pin sites? Loose but intact pin sites 2.Clear drainage from the pin sites 3.Purulent drainage from the pin sites 4.Redness and swelling around the pin sites
"I can cross my legs if it is more comfortable for me when I sit."
The nurse is teaching a client who is preparing for discharge from the hospital after a total hip arthroplasty. Which statement by the client indicates the need for further teaching? "I need to avoid twisting my body when I am standing." 2."I need to check my incision every day for signs of infection." 3."I should not sit in one position for a prolonged period of time." 4."I can cross my legs if it is more comfortable for me when I sit."
Capillary refill greater than 6 seconds
The nurse performs a neurovascular assessment on a client with a newly applied cast. The nurse should determine that there is a need for close observation and a need for follow-up if which is noted? Palpable pulses distal to the cast 2.Capillary refill greater than 6 seconds 3.Blanching of the nail bed when it is depressed 4.Sensation when the area distal to the cast is pinched
Numbness and tingling are felt in the fingers.
A client with a compound (open) fracture of the radius has a plaster cast applied in the emergency department. The nurse provides home care instructions and tells the client to seek medical attention if which finding occurs? Numbness and tingling are felt in the fingers. 2.The cast feels heavy and damp after 24 hours of application. 3.The entire cast feels warm during the first 24 hours after application. 4.Slightly bloody drainage is noted on the cast during the first 6 hours after application.
First applying a knee immobilizer and then elevating the affect leg while sitting
The nurse has a prescription to get the client out of bed to a chair on the first postoperative day after total knee replacement surgery. Which action is most appropriate for the nurse to plan to implement to protect the knee joint? Applying both ice and a compression dressing to the knee while sitting 2. Obtaining a walker to minimize weight-bearing by the client on the affected leg 3. First applying a knee immobilizer and then elevating the affect leg while sitting 4. Lifting the client to the bedside chair, leaving the continuous passive motion (CPM) machine in place
Use a mirror to inspect all areas of the residual limb each day.
The nurse has taught a client with a below-the-knee amputation about home care and about monitoring for and preventing complications related to prosthesis and residual limb care. The nurse determines that the client has understood the instructions if the client stated that which action should be taken? Wear a clean nylon sock over the residual limb every day. 2.Use a mirror to inspect all areas of the residual limb each day. 3.Toughen the skin of the residual limb by rubbing it with alcohol. 4.Prevent cracking of the skin of the residual limb by applying lotion daily.
everything except joint deformities
The nurse performs an assessment on a client newly diagnosed with rheumatoid arthritis. The nurse expects to note which early manifestations of the disease? Select all that apply. Fatigue 2.Anorexia 3.Weakness 4.Low-grade fever 5.Joint deformities 6.Joint inflammation
Using the palms of the hands and soft pillows to support the cast
The nurse prepares to transfer the client with a newly applied arm cast into the bed using which method? Placing ice on top of the cast 2. Supporting the cast with the fingertips only 3. Asking the client to support the cast during transfer 4. Using the palms of the hands and soft pillows to support the cast
Pulse in the affected extremity 4.Level of pain in the affected leg 5.Skin color of the affected extremity 6.Capillary refill of the affected toes
The nurse, caring for a client who has been placed in Buck's extension traction while awaiting surgical repair of a fractured femur, should perform a complete neurovascular assessment of the affected extremity that include which interventions? Select all that apply. Vital signs 2. Bilateral lung sounds 3. Pulse in the affected extremity 4. Level of pain in the affected leg 5. Skin color of the affected extremity 6. Capillary refill of the affected toes
Weak pedal pulses
The nurse, caring for a client with Buck's traction, is monitoring the client for complications of the traction. Which assessment finding indicates a complication of this form of traction? Weak pedal pulses 2.Drainage at the pin sites 3.Complaints of leg discomfort 4.Toes demonstrating a brisk capillary refill