Musculoskeletal System (Med/Surg)

Which musculoskeletal abnormality does the nurse suspect in a client who exhibits short steps and drags a foot? Torticollis Pes planus Spastic gait Steppage gait

Spastic gait Rationale Spastic gait is a musculoskeletal abnormality, caused by cerebral palsy, that results in short steps and dragging of the foot. Torticollis is a twisting of the client's neck to one side. Pes planus, also called flatfoot, is an abnormal flatness of the sole and arch of the foot. Steppage gait is an increase in hip and knee flexion to clear the foot from the floor; footdrop will be evident in the affected client.

A client has injured a short bone. Which is an example of a short bone? Multiple choice question Tibia Femur Tarsals Humerus

Tarsals Tarsals are short bones, unlike the tibia, femur, and humerus, which are long bones. Short bones do not have epiphysis and diaphysis.

Goniometer

The goniometer, a device used to measure the angle of a joint as shown in the image, is used to assess range of motion. An arthroscope is a small fiberoptic tube that can be inserted into a joint for visualization. Splints and orthoses (braces) are used to immobilize joints after fracture. External fixators are used to stabilize bone injuries.

A nurse is teaching a client with a non-weight-bearing long leg cast. Which statement indicates the need for the nurse to reinforce discharge teaching? <p>A nurse is teaching a client with a non&#x2013;weight-bearing long leg cast. Which statement indicates the need for the nurse to reinforce discharge teaching?</p> "The cast can be wrapped in plastic when I take a shower." "I called my office to let them know I will be back at work next week." "The physical therapist is going to teach me how to walk with crutches." "I am going to give myself a pedicure with red nail polish when I get home."

"I am going to give myself a pedicure with red nail polish when I get home." Rationale Red nail polish will interfere with the ability to assess the toes for capillary refill; effective capillary refill, after releasing compression of the toenail, confirms that the cast is not compromising circulation to the distal part of the extremity. Wrapping the cast in plastic is an effective way of protecting the long leg cast during a shower. Usual daily activities can be resumed after the application of a cast. Teaching the client how to use the crutches is the role of the physical therapist.

After teaching, the registered nurse is evaluating the statements of a licensed coworker about osteoporosis. Which statement made by the licensed coworker indicates the nurse needs to follow up? Multiple choice question "I should give milk to the client daily." "I should not allow the client to make movements." "I should give the pain killers only upon prescription." "I should ambulate the client in the sunlight."

"I should not allow the client to make movements." Because it may result in permanent immobility, clients with osteoporosis should not remain immobile. Therefore, the coworker's statement that the client should not be allowed to make movements indicates the need for follow up by the nurse to correct this misconception. Milk is rich in calcium and should be given to clients with bone disorders. Licensed personnel cannot give any medication to the client unless prescribed by the primary healthcare provider. Sunlight is a good source of vitamin D, which is required for calcium absorption; therefore ambulating the client in the sun would be beneficial.

The nurse is teaching a client undergoing intravenous gentamicin therapy for the treatment of acute osteomyelitis. Which statement by the client indicates effective learning? "I should drink lots of water if I retain urine." "I should use eyeglasses if I have vision problems." "I should stop the medication when the symptoms have subsided." "I should report any hearing loss to the primary healthcare provider."

"I should report any hearing loss to the primary healthcare provider." Rationale Acute oseteomyelitis is treated with antibiotics such as gentamicin. Gentamicin use can cause ear toxicity; therefore, the client should report any hearing loss to the primary healthcare provider. Gentamicin also causes urine retention, but increasing water intake can aggravate this condition; therefore, the client should report this issue to the primary healthcare provider instead of increasing water consumption. Gentamicin may cause visual disturbances and should be reported to the primary healthcare provider; use of inappropriate eyeglasses, or use of glasses without first consulting the primary healthcare provider, increases the risk. The client should not stop taking the medication without consulting the primary healthcare provider, even if the symptoms have subsided.

After a cervical neck injury, a client is placed in a halo fixation device with a body cast. Which statement indicates the client's concern about body image has been resolved successfully? "I hate having everyone else do things for me." "I've gotten used to the brace. I may even miss it when it's gone." "I've been keeping my daily calories low in an attempt to lose weight." "I can't get to sleep. However, I make up for it in the morning by sleeping later."

"I've gotten used to the brace. I may even miss it when it's gone." Rationale The client is demonstrating acceptance and is looking toward the future with the response "I've gotten used to but the brace. I may even miss it when it's gone." The response "I hate having everyone else do things for me" relates to low self-esteem, not body image disturbance. The response "I've been keeping my daily calories low in an attempt to lose weight" may indicate that the client may not accept the present body weight. Although the response "I can't get to sleep. However, I make up for it in the morning by sleeping later" may indicate adaptability, it is not related to body image.

A client with painful swelling of a distal joint of the ring finger is found to be in the early stages of rheumatoid arthritis (RA). A test for the rheumatoid factor is negative. The client asks about the reliability of the test, stating, "I don't think the result is accurate. I have been diagnosed with RA, and I am in so much pain." How should the nurse respond? "It might help if you try not to think about your discomfort." "Don't let that upset you; eventually the tests will be positive." "These tests will have to be repeated; they are complicated tests." "Laboratory tests often are negative in the early stages of the disease."

"Laboratory tests often are negative in the early stages of the disease." Rationale The antibody called rheumatoid factor is not definitive for RA; it is commonly absent in the early stages of the disease. The response "It might help if you try not to think about your discomfort" denies the client's discomfort and does not address the stated confusion. The response "Don't let that upset you; eventually the tests will be positive" denies the client's immediate feelings and blocks further communication of feelings. The response "These tests will have to be repeated; they are complicated tests" reinforces the client's confusion over negative test results and feeling discomfort.

A client with a fractured head of the right femur and osteoporosis is placed in Buck extension before surgical repair. What should the nurse do when caring for this client until surgery is performed? Remove the weights from the traction every 2 hours to promote comfort. Turn the client from side to side every 2 hours to prevent pressure on the coccyx. Raise the knee gatch on the bed every 2 hours to limit the shearing force of traction. Assess the circulation of the affected leg every 2 hours to ensure adequate tissue perfusion.

Assess the circulation of the affected leg every 2 hours to ensure adequate tissue perfusion. Rationale Arterial perfusion and the presence of hemorrhage must be assessed at least every 2 hours to prevent complications or to identify problems early. Removing the weights and turning the client from side to side will interfere with the pull of traction. Raising the knee gatch on the bed will alter the pull of traction and promote thrombus formation.

The nurse is planning care for an immobilized client who has suffered a stroke. The client has right-sided hemiparesis. Which activity takes priority for this client? Assess the client lung sounds every 8 hours. Assist the client in performing range-of-motion (ROM) exercises every 1 to 2 hours. Allow the client to sit upright in the chair for as long as tolerated. Have the nursing assistant turn and reposition the client every 2 to 3 hours.

Assist the client in performing range-of-motion (ROM) exercises every 1 to 2 hours. Rationale ROM exercises should be performed often to prevent muscle atrophy and contractures. Assessing the client's lung sounds every 8 hours is the minimum the nurse should assess lung sounds, and it is important, but it is not a priority in planning care for immobilization. The client should not be allowed to dangle in a chair for prolonged periods of time because of skin breakdown and venous return. The nursing assistant should be instructed to turn the client at least every 2 hours.

While assessing a client with a musculoskeletal disorder, the nurse gives the client a muscle strength rating of 2. What observation would correspond to this rating? Multiple choice question Can complete range of motion (ROM) against gravity No joint motion and slight evidence of muscle contractility Can complete ROM with gravity eliminated Can complete ROM against gravity with some resistance

Can complete ROM with gravity eliminated A muscle strength rating of 2 signifies a poor ROM. This rating is given if a client completes ROM with gravity eliminated. A rating of 3 is given if the client has a complete range of motion against gravity. A rating of 1 indicates no joint motion and slight evidence of muscle contractility. A rating of 4 is given to a client who has the ability to complete ROM against gravity with some resistance.

A nurse is reviewing the laboratory reports of four clients. Which client most likely has rheumatoid arthritis? Client A: Uric Acid = 8.5 mg/dL Client B: C-reactive protein (CRP) = 800 mcg/dL (8000 mcg/L) Client C: Anti-deoxyribonucleic acid (DNA) antibody = 90 IU/mL Client D: Erythrocyte sedimentation rate (ESR) = 65mm/hr

Client D: Erythrocyte sedimentation rate (ESR) = 65mm/hr Erythrocyte sedimentation rate (ESR) is a nonspecific index of inflammation. Its normal value is less than 30 mm/hr. Client D, who has elevated levels of ESR to 65 mm/hr, may present with rheumatoid arthritis, osteomyelitis, rheumatic fever, and respiratory tract infections. Uric acid is an end-product of purine metabolism. The normal range of uric acid is 2.3 to 7.6 mg/dL (137-452 μmol/L). An elevation in the uric acid value in client A to 8.5 mg/dl may result in gout. The normal value of C-reactive protein (CRP) is 6.8-820 mcg/dL (68-8200 mcg/L). Client B, who presents with a normal level of CRP at 800 mcg/dL (8000 mcg/L), will not have inflammatory diseases, infections, and active, widespread malignancy. The normal value of anti-deoxyribonucleic acid (DNA) antibody is less than 70 IU/mL; it helps to detect serum antibodies that react with DNA. Client D, who has elevated levels of anti-DNA antibody at 90 IU/mL, may be more susceptible to systemic lupus erythematosus (SLE).

Which drug is most appropriate for relieving a painful muscle spasm in the back of a client with osteoarthritis (OA)? Multiple choice question Tramadol Hyaluronate Diclofenac epolamine patch Cyclobenzaprine hydrochloride

Cyclobenzaprine hydrochloride Cyclobenzaprine hydrochloride is a muscle relaxant administered to relieve painful muscle spasms, especially those resulting from OA of the vertebral column. While tramadol is a weak opioid drug that may also be given to relieve pain in clients with OA, it is not as effective against painful muscle spasms. Hyaluronate is a specific injection for knee and hip pain associated with OA. The diclofenac epolamine patch is used in clients with signs and symptoms of knee OA.

The nurse is reviewing the blood test reports of a child whose blood sample was tested after receiving a general anesthetic. The nurse finds that the client has increased intracellular calcium levels. What medication would be beneficial to the client? Aspirin (Anacin) Naproxen (Aleve) Ibuprofen (Advil) Dantrolene (Dantrium)

Dantrolene (Dantrium) Rationale The administration of general anesthetic sometimes causes malignant hyperthermia in clients. Malignant hyperthermia is characterized by increased levels of intracellular calcium in the body. Dantrolene sodium (Dantrium) reduces the muscle tone and metabolism and thereby decreases the calcium levels in the body. Therefore dantrolene is used to antagonize the effects of malignant hyperthermia in this client. Aspirin (Anacin) should not be given to children because it increases the risk of Reye syndrome. Drugs such as naproxen (Aleve) and ibuprofen (Advil) may not reduce calcium levels in the body and thus may not be used to reverse the effects of malignant hyperthermia in the client.

A client had an above-the-knee amputation of the left leg because of trauma from a motor vehicle collision. The primary healthcare provider prescribes ambulation with crutches until the residual limb is healed and the client can be fitted with a prosthesis. What should be the nurse's initial action? Demonstrate the swing-through crutch walking gait. Determine whether the client has ever used crutches before. Introduce the client to another client who is using crutches. Provide a pamphlet that has information about using crutches.

Determine whether the client has ever used crutches before. Rationale Information about the client's experiential background will influence the teaching plan. A teaching plan should be formulated based on what a client does or does not know. Demonstrating the swing-through crutch walking gait may be done later. Also, the swing-through gait may be used initially. Introducing the client to another client who is using crutches may or may not be done later. The focus should be on the client at this time. Providing a pamphlet that has information about using crutches should be done eventually but is not the priority at this time.

A college basketball player complains of a "click" in the knee when walking. The client states that the knee occasionally gives way when running and sometimes locks. The client does not recall any specific injury. What does the nurse suspect that the diagnostic tests will reveal? Cracked patella Ruptured Achilles tendon Injured cartilage in the knee Stress fracture of the tibial plateau

Injured cartilage in the knee Rationale These adaptations are consistent with torn cartilage; this injury is common among basketball players. A fractured patella will cause pain and usually manifests itself at the time of the injury. A ruptured Achilles tendon is painful and prevents plantar flexion of the foot; adaptations usually are manifested at the time of the injury. A stress fracture is associated with pain, not with a clicking or locking of the knee.

A client who had a right total hip replacement is progressing from the use of a walker to the use of a cane. In which hand should the nurse teach the client to hold the cane? Left hand Right hand Stronger hand Dominant hand

Left hand Rationale A cane should be used on the unaffected side. Weight-bearing can be shared by a cane and an affected leg when they are advanced forward together. Teaching the client to use the right hand promotes leaning toward the affected side and does not permit sharing of weight by the stronger left side of the body. Teaching the client to use the stronger hand is unsafe; the stronger hand may not be the left hand. Teaching the client to use the dominant hand is unsafe; the dominant hand may not be the left hand.

A client sustains a complex comminuted fracture of the tibia with soft tissue injuries after being hit by a car while riding a bicycle. Surgical placement of an external fixator is performed to maintain the bone in alignment. Postoperatively it is most essential for the nurse to do what? Cleanse the pin sites with alcohol several times a day. Perform a neurovascular assessment of both lower extremities. Ambulate the client with partial weight bearing on the affected leg. Maintain placement of an abduction pillow between the client's legs.

Perform a neurovascular assessment of both lower extremities. Rationale A neurovascular assessment identifies early signs and symptoms of compartment syndrome. Compartment syndrome is increased pressure within a closed fascial space caused by a fracture or soft tissue damage that compresses circulatory vessels, nerves, and tissues, compromising viability of the limb. The nurse should monitor for the six Ps: unrelenting pain, pallor, paresthesia, pressure, pulselessness, and paralysis. In addition, the circumference of the extremity will increase, and the leg will feel hard and firm on palpation. Both legs are assessed for symmetry. There is no established standard of care associated with pin care; some primary healthcare providers believe that pin care is contraindicated, because it disrupts the skin's natural barrier to infection. Initially the client should use a wheelchair or walk without bearing weight on the affected extremity. As healing occurs, the primary healthcare provider will prescribe progressive weight bearing. Maintaining abduction of the leg is not necessary with an external fixation of the tibia.

A client visits a primary healthcare provider with a report of burning and a sharp pain in the sole of the foot that intensifies in the morning. Which abnormal condition does the nurse anticipate in the client? Multiple choice question Torticollis Pes planus Tenosynovitis Plantar fasciitis

Plantar fasciitis Plantar fasciitis is a condition associated with a burning sensation and sharp pain in the sole of the foot that worsens in the morning. Torticollis is a condition where the neck is twisted in an unusual position to one side. Pes planus is the abnormal flatness of the sole and arch of the foot. Tenosynovitis is a condition associated with a superficial swelling pain and tenderness along a tendon sheath.

A client who had an open reduction and insertion of a prosthesis for a fracture of the femoral neck is stable after surgery and is returned to the orthopedic unit. What is most important for the nurse to do when positioning this client? Maintain both legs in abduction. Keep both legs in functional body alignment. Avoid placing the client in the supine or prone position. Prevent adduction and external rotation of the affected extremity.

Prevent adduction and external rotation of the affected extremity. Rationale Adduction may cause dislocation of the new prosthesis, and external rotation increases tension on the suture line. Only the operated leg needs to be kept abducted. Keeping both legs in functional body alignment positions the affected leg too close to the midline and increases the danger of hip dislocation. The supine position is permitted as long as the affected leg is abducted and external rotation avoided, which help keep the prosthesis firmly in the acetabulum. The prone position is not advised, because it puts excessive stress on the operative site.

After an amputation, the client's residual limb is bandaged snugly throughout the postoperative period. Which goal should the nurse identify as the primary reason for this intervention? Promoting shrinkage Preventing injury to the area Preventing suture line infection Promoting drainage of secretions

Promoting shrinkage Rationale Wrapping of the residual limb applies pressure that prevents swelling and shapes it for the fitting of a prosthesis in the future. A sock is used to protect the residual limb from irritation and injury. Infection is not prevented in this manner; surgical asepsis should be maintained. Secretion drainage is not promoted by wrapping the limb; portable drainage systems are used for this purpose.

A client has an above-the-knee amputation of the left leg because of arterial insufficiency. To prevent a hip flexion contracture, in what position should the nurse periodically place this client? Prone position Sitting position Supine position with a pillow under the residual limb Right side-lying position with a pillow between the thighs

Prone position Rationale The prone position maintains the hips in extension, which helps to prevent flexion contractures of the hips. The sitting position flexes the hips and knees, which promotes hip and knee flexion contractures. The supine position with a pillow under the residual limb will flex the hip, promoting a hip flexion contracture. In the right side-lying position the left hip will be flexed, which will promote the development of a hip flexion contracture.

A nurse is caring for a client with pain due to muscle spasm. Which nursing action is beneficial for the client? Providing heat compresses at the site Providing a massage to the affected area Encouraging the client to perform isometric exercises Encouraging the client to do active-passive range-of-motion (ROM) exercises

Providing heat compresses at the site Rationale The nurse provides thermotherapy (heat) to a client with muscle spasm. Heat compresses at the site of pain comforts the client by relaxing the muscle. A massage may stimulate muscle tissue contraction that increases spasm and pain. The client with muscle spasm may not be able to perform isometric muscle-strengthening exercises. The client may be encouraged to perform active-passive range-of-motion (ROM) exercises when the pain subsides.

A client who has intermittently been having painful, swollen knee and wrist joints during the past 3 months is diagnosed with rheumatoid arthritis. What type of diet should the nurse expect the primary healthcare provider to prescribe? Salt-free, low-fiber diet High-calorie, low-cholesterol diet High-protein diet with minimal calcium Regular diet with vitamins and minerals

Regular diet with vitamins and minerals Rationale There are no dietary restrictions, but iron and vitamins should be encouraged to treat any underlying nutritional deficiencies. A salt-free, low-fiber diet is not indicated. A high-calorie diet will increase the client's weight; this is contraindicated because it will increase the strain on weight-bearing joints. A balanced diet should fulfill nutritional needs; there is no need to increase protein or restrict calcium.

A client reports pain, weakness, and numbness in the neck, back, and shoulders after working long hours at a computer. Which condition will the nurse most likely observe in the client's electronic medical record? Bursitis Meniscus injury Repetitive strain injury (RSI) Carpal tunnel syndrome (CTS)

Repetitive strain injury (RSI) Rationale Repetitive strain injury (RSI) is tiny tears and inflammation of the tendons, ligaments, and muscles due to prolonged force, repetitive movements, or awkward postures. It is common for a client working on a computer to have poor body posture and positioning. Bursitis is inflammation of the bursa, which results from repeated and excessive trauma such as gout, rheumatoid arthritis, and infection. It commonly occurs in the hands, knees, greater trochanters of the hip, shoulders, and elbows. A meniscus injury is a ligament sprain, commonly found in basketball, football, soccer, and hockey players. Carpal tunnel syndrome (CTS) is formed in the ligaments and bones due to compression of the median nerve of the hands.

The nurse provides self-care instructions to a client who is receiving external radiation therapy for metastasis to the bone. Which intended activity identified by the client demonstrates a need for further teaching? Avoiding exposing the area to the sun Wearing loose-fitting cotton clothing over the area Drying the area with a patting motion using a soft towel Rubbing on talcum powder after washing the area with water

Rubbing on talcum powder after washing the area with water Rationale Intending to use talcum powder indicates the client needs more teaching. Powders, lotions, creams, and ointments should not be applied to the area unless prescribed; some substances interfere with the path of the radiation and should not be used. The other intended actions are appropriate and do not need follow up. Sun rays, a form of radiation, can damage the skin further and should be avoided. Cotton is a natural fiber that is soft against the skin and allows air to circulate. The skin should be protected by patting dry with a soft towel.

Which information indicates a nurse has a correct understanding about skeletal muscles? Skeletal muscle accounts for about half of a human being's body weight. Skeletal muscle contraction propels blood through the circulatory system. Skeletal muscle contraction is modulated by neuronal and hormonal influences. Skeletal muscle occurs in the walls of hollow structures such as airways and arteries.

Skeletal muscle accounts for about half of a human being's body weight. Rationale Skeletal muscle is a type of striated voluntary muscle that accounts for about half of a human being's body weight. Cardiac muscle contraction propels blood through the circulatory system. Skeletal muscle contraction requires neuronal stimulation only. Smooth muscle, not skeletal, is found in the walls of hollow structures such as airways and arteries.

Which individual is at risk of developing carpal tunnel syndrome? Multiple choice question Housekeeper Software engineer Healthcare worker Professional athlete

Software engineer Carpal tunnel syndrome is a painful condition of the hands and fingers that is caused by repetitive movements that lead to compression of the medial nerve near the wrist. Computer-related jobs involve repetitive movement of the fingers and hand, thereby predisposing the individual to carpal tunnel syndrome. Musculoskeletal injuries can occur in clients whose jobs require manual labor, such as housekeepers and mechanics. Healthcare workers may be at risk of developing back injury due to prolonged standing and excessive lifting. Professional athletes experience acute musculoskeletal injuries, such as joint dislocations and fractures.

A client had a cerebrovascular accident (also known as a "brain attack"), and bed rest is prescribed. What can the nurse use to best prevent footdrop in this client? Splints Blocks Cradles Sandbags

Splints Rationale Various types of splints or boots are available to keep the foot in a position of functional alignment. Blocks elevate the frame of the bed and have no effect on the position of the feet. Although a cradle will keep the pressure of the linen off the client's feet, which otherwise may promote footdrop, the cradle does not maintain functional alignment of the ankle. Sandbags help prevent rotation of an extremity or the head; they are not used to prevent footdrop.

A client sustains a back injury after falling 20 feet (6 m). In which position should the nurse place the client? Lateral position with a pillow between the knees Any position that reduces pain and is comfortable Supine position while not allowing the spine to flex Sitting position with a pillow placed in the small of the back

Supine position while not allowing the spine to flex Rationale When caring for a client with a suspected back injury, the client should be positioned to keep the vertebral column in alignment (back straight) to prevent further spinal cord damage by vertebral (bone) movements. The lateral position with a pillow between the knees is contraindicated, because it may cause the spine to torque. To prevent additional damage to the spinal cord, the vertebral column should be kept horizontal with the spine in alignment. The comfortable position chosen by the client may be contraindicated, because it may not maintain the spine in alignment. The sitting position is contraindicated because it causes the spine to flex, which can precipitate additional injury.

A client with an above-the-knee amputation asks why the residual limb needs to be wrapped with an elastic bandage. The nurse explains the purpose is to do what? Limit the formation of blood clots. Decrease the phantom limb sensation. Prevent hemorrhage and cover the incision. Support the soft tissue and minimize swelling.

Support the soft tissue and minimize swelling. Rationale Pressure supports tissue, promotes venous return, and limits edema, thus promoting shrinkage of the distal part of the residual limb. Although it may limit clot formation, its primary purpose is to promote venous return, prevent edema, and shrink the distal part of the residual limb. Bandaging does not decrease the occurrence of phantom limb sensation. Although pressure may prevent hemorrhage, this is not its primary purpose.

A client who had a total hip replacement is receiving continuous regional analgesia. The nurse recognizes what as the benefit of this treatment over conventional methods? It is easy to adjust the dose. Neuropathic pain can be relieved. Systemic side effects are minimal. The need for parenteral medication is prevented.

Systemic side effects are minimal. Rationale Regional analgesia uses a local anesthetic to control pain; the local effect prevents systemic reactions. The dose adjustment involves the same level of complexity as conventional methods. The hip replacement involves somatic, not neuropathic, pain. Parenteral medication is used in conjunction with regional analgesia.

Which hormone increases the rate of protein synthesis in a client? Multiple choice question Estrogen Thyroxine Parathormone Vitamin D

Thyroxine Thyroxine increases the rate of protein synthesis in all the body tissues. Estrogen stimulates bone-building, which is known as osteoblastic activity. Parathormone promotes osteoclastic activity in a state of hypocalcemia. Vitamin D and its metabolites are produced in the body and transported in the blood to promote the absorption of calcium and phosphorus from the small intestine.

What does the nurse instruct a client to do while performing McMurray's test? Multiple choice question To raise the leg to 60 degrees To abduct the arm to 90 degrees To flex, rotate, and extend the knees To flex the knee to 30 degrees and pull the tibia forward

To flex, rotate, and extend the knees McMurray's test is done by flexion, internal rotation, and then extension of the knee. A straight-leg-raising test is performed by raising the leg to 60 degrees. Drop arm test is done by abducting the arm to 90 degrees. Lachman's test is performed by flexing the knee 30 degrees and pulling the tibia forward.

A client has a total hip arthroplasty. What should the nurse do when caring for this client after surgery? Use a pillow to keep the legs abducted. Elevate the client's affected limb on a pillow. Turn the client using the log-rolling technique. Place a trochanter roll along the entire extremity.

Use a pillow to keep the legs abducted. Rationale Using a pillow to keep the legs abducted ensures abduction of the leg to maintain position of the prosthesis and prevent dislocation. Elevating the client's affected limb on a pillow is not necessary as long as abduction of the limb is maintained. Turning the client using the log-rolling technique causes flexion of the hip; it is done only if prescribed by the primary healthcare provider. A trochanter roll at the ankle can cause damage to the peroneal nerve along the external malleolus.

To reduce a fracture of the hip, a client is placed in Buck traction before surgery. Because the client keeps slipping down in bed, increased countertraction is prescribed. What should the nurse do to increase countertraction? Add more weight to the traction. Elevate the head of the client's bed. Use a slight Trendelenburg position. Apply a chest restraint around the client.

Use a slight Trendelenburg position. Rationale Elevating the foot of the bed uses gravity and the client's weight for countertraction. Adding more weight to the traction will increase traction and requires a prescription; also it will cause more, not less, slipping down in bed. Elevating the head of the client's bed will decrease countertraction. Applying a chest restraint around the client will have no effect on countertraction.

During a follow-up visit, a nurse finds that flexion contractures have developed in a client with osteoarthritis (OA). Which factor may have led to this condition? Wearing shoes without insoles Elevating the legs 8 to 12 inches Using large pillows under the knees or head Placing a small pillow under the head in the supine position

Using large pillows under the knees or head Rationale The use of large pillows under the knees or head may result in flexion contractures that keep the client from straightening the knees fully. A client with OA will have severe pain in the affected joint during or after movement. In this case, the client should be taught to position the joints in the functional position. Wearing shoes without insoles may result in pressure on painful metatarsal joints. The legs may be elevated 8 to 12 inches (20 to 30 cm) to reduce back discomfort associated with OA. A small pillow can be used under the head when the client is in the supine position to reduce discomfort, but the use of other pillows should be avoided.

Which condition is characterized by infection of a client's bone or bone marrow? Multiple choice question Osteomalacia Osteomyelitis Herniated disc Spinal stenosis

Osteomyelitis Osteomyelitis is infection of bone or bone marrow. Osteomalacia is a condition characterized by softening of bones due to calcium or vitamin D deficiency. Herniated disc is caused by structural damage of the intervertebral discs in which the nucleus pulposus seeps through a torn or stretched annulus. Spinal stenosis is narrowing of the spinal canal.

What is the role of unlicensed assistive personnel (UAP) in caring for a client with a cast or in traction? Applying ice to the cast Positioning the casted extremity above heart level Marking the circumference of any drainage on the cast Looking for clinical manifestations of compartment syndrome Teaching range-of-motion exercises to the client and caregiver

Applying ice to the cast Positioning the casted extremity above heart level Rationale The role of unlicensed assistive personnel (UAP) in caring for the client with a cast or in traction involves applying ice to the cast and positioning the casted extremity above heart level. The licensed practical/vocational nurse (LPN/LVN) marks the circumference of any drainage on the cast. The registered nurse (RN) assesses the client for clinical manifestations of compartment syndrome and teaches the client and caregiver range-of-motion exercises.

While assessing a client with a musculoskeletal disorder, the nurse gives the client a muscle strength rating of 3. What observation would correspond to this rating? No evidence of muscle contractility Can complete range of motion (ROM) against gravity No joint motion and slight evidence of muscle contractility Can complete ROM against gravity with some resistance

Can complete range of motion (ROM) against gravity Rationale A muscle strength rating of 3 indicates that the client has a fair ROM and can complete ROM against gravity. No evidence of muscle contractility indicates that there is zero muscle strength. No joint motion and slight evidence of muscle contractility indicates trace muscle strength, which is a rating of 1. An ability to complete ROM against gravity with some resistance indicates good muscle strength, a rating of 4.

Which type of joint is present in between the client's tarsal bones? Pivot joint Hinge joint Saddle joint Gliding joint

Gliding joint Rationale The gliding joint is present in between the tarsal bones. The pivot joint is present in the proximal radioulnar joint. The hinge joint is present in the elbows and knees. The saddle joint is present in between the carpometacarpal joints of the thumb.

A client reports a burning, sharp pain along the sole of the foot that worsens in the morning. Which condition is suspected in the client? Kyphosis Pes planus Tenosynovitis Plantar fasciitis

Plantar fasciitis Rationale A burning, sharp pain on the sole of the foot that worsens in the morning is the manifestation of plantar fasciitis. It occurs during a chronic degeneration of the musculoskeletal system such as rheumatoid arthritis. Kyphosis is an exaggerated thoracic curvature due to poor posture, tuberculosis, arthritis, osteoporosis, or growth disturbance of the vertebral epiphyses. Pes planus is an abnormal flatness of the sole and arch of the foot due to hereditary, muscle paralysis, cerebral palsy, muscular dystrophy, or injury to the posterior tibial tendon. Tenosynovitis is a superficial swelling, pain, or tenderness along a tendon sheath due to inflammation from infection or injury.

The nurse is caring for a client with a long leg cast. Which clinical findings indicate compromised circulation? Foul odor Swelling of the toes Drainage on the cast Increased temperature Prolonged capillary refill

Prolonged capillary refill Swelling of the toes Rationale Constriction of circulation decreases venous return and increases pressure within the vessels. Fluid then moves into the interstitial spaces, causing edema. Impaired circulation is evidenced by prolonged capillary refill after the toes are compressed. A foul odor, drainage on the cast, or an increased temperature may indicate the presence of an infection.

A nurse is caring for a client with a fracture of the femoral neck. Which clinical indicator should the nurse expect to identify when assessing this client? Adduction with internal rotation Abduction with external rotation Shortening of the affected extremity with external rotation Lengthening of the affected extremity with internal rotation

Shortening of the affected extremity with external rotation

A nurse is caring for a client with compartment syndrome. Which nursing actions are appropriate? Multiple selection question Assisting with splitting the cast Assessing urine output Evaluating the pain on a scale Applying splints to the injured part Placing cold compresses to the affected area

-Assisting with splitting the cast -Assessing urine output -Evaluating the pain on a scale Compartment syndrome is increased pressure in a limited space, which compromises the compartmental blood vessels, nerves, and tendons. The cast may be split to reduce the external circumferential pressures. The nurse should assess urine output because the myoglobin released from damaged muscle cells may precipitate and cause obstruction in renal tubules. The nurse should evaluate the pain on a scale from 0 to 10; this helps to plan care. Application of external pressure by splints, casts, and dressing to the injured area may worsen the client's symptoms. Application of cold compresses may result in vasoconstriction and exacerbate the symptoms.

After a painful exacerbation of rheumatoid arthritis, a client is scheduled to begin a walking and exercise program. Which is an expected outcome for this client? Only when pain free, begin exercising as part of a formal activity program. Avoid exercising when there is a moderate amount of discomfort. Exercise and be active unless the discomfort becomes too great. Walk and exercise even when the pain is severe.

Exercise and be active unless the discomfort becomes too great. Rationale Some pain is to be expected, but the activity should not be continued when the pain becomes severe, because it can further traumatize the inflamed synovial membranes. It is unrealistic to expect the client to be pain free, so exercise would never begin. Some discomfort is expected; inactivity promotes the development of muscle atrophy and joint contracture. Activity should be curtailed when pain is severe.

A nurse cares for a client suspected of having atrial fibrillation. After reviewing the client's medical history, the nurse suspects that the medication may have been administered at a fast rate. Which medication might have caused this condition? Citracal Raloxifene Alendronate Zoledronic acid

Zoledronic acid Rationale Zoledronic acid may cause atrial fibrillation when it is infused too quickly into the body. Citracal may cause hypercalcemia, cardiac dysrhythmias, and urinary stones. Raloxifene may increase the risk of liver disease and liver thromboembolism. Alendronate may cause esophagitis, esophageal ulcers, and gastric ulcers.

While performing a musculoskeletal assessment, the nurse notices that the client can complete range of motion with gravity eliminated. Which grade would the nurse assign to the client? 1 2 3 4

2 Rationale When rating muscle strength, grade 2 indicates complete range of motion with gravity eliminated. Grade 1 indicates no joint motion and slight evidence of muscle contractility. Grade 3 is indicated by complete range of motion against gravity only. If there is complete range of motion against gravity with some resistance, then the grade would be 4.

The nurse is preparing a client for a myelogram to detect any subtle lesions or injuries. Which information does the nurse provide to the client before the procedure? Multiple choice question "You may have a severe headache after the procedure." "The machine will make loud noises during the procedure." "Electrodes will be applied to your skin during the procedure." "There may be some blood leakage on the dressing after the procedure."

"You may have a severe headache after the procedure." A myelogram is a sensitive test for nerve impingement that can detect subtle lesions and injuries. Spinal headache is common after a myelogram because it involves incision of the spinal roots. Diagnostic studies involving the use of magnetic resonance imaging produce loud noises. Electrodes are applied to the skin in somatosensory evoked potential studies. Leakage of blood on the dressing is observed after arthrocentesis.

Which concentration of a client's serum calcium level will stimulate the release of parathyroid hormone? 8.5 mg/dL (0.47 mmol/L) 9.0 mg/dL (0.5 mmol/L) 9.5 mg/dL (0.53 mmol/L) 10.0 mg/dL (0.56 mmol/L)

8.5 mg/dL (0.47 mmol/L) Rationale Hypocalcemia stimulates the release of parathyroid hormone. The normal levels of serum calcium range between 9.0 and 10.5 mg/dL (0.5-0.58 mmol/L). A serum calcium concentration of 8.5 mg/dL (0.47 mmol/L) suggests hypocalcemia and stimulates parathyroid hormone release. Serum calcium concentrations of 9.0 and 9.5 mg/dL (0.5-0.53 mmol/L) are normal findings. A serum calcium concentration of 10.0 mg/dL (.56 mmol/L) is a normal finding.

Which term should the nurse use to describe synovial joint movement that moves away from the midline of the body? Multiple choice question Inversion Extension Pronation Abduction

Abduction Abduction is a synovial joint movement that involves movement of a part away from the midline of the body. Inversion is turning of the sole inward toward the midline of the body. Pronation is a synovial joint movement that involves the turning of the palm downward. Extension is a synovial joint movement that involves a straightening of joint that increases the angle between two bones.

Which clinical manifestation can a client experience during a fat embolism syndrome (FES)? Multiple choice question Nausea Dyspnea Orthopnea Paresthesia

Dyspnea FES is clinically manifested by dyspnea because of low levels of arterial oxygen. Nausea and orthopnea are not seen in FES. However, tachypnea, headache, and lethargy are seen in clients with FES. Paresthesia occurs with compartment syndrome.

After a total knee replacement, a client is using a continuous passive motion device. The nurse concludes that teaching was effective when the client states that what is the goal of this therapy? Improve joint flexion. Maintain muscle tone. Prevent tissue breakdown. Prevent formation of a blood clot.

Improve joint flexion. Rationale A continuous passive motion device is used most commonly after knee replacement to gradually increase knee flexion without weight bearing or strain. Because it provides passive range of motion, muscle tone is not affected. A continuous passive motion device is not used to prevent tissue breakdown. Because muscles are not contracting, venous stasis is not prevented.

An older adult visits the primary healthcare provider because of joint pain. Which change in the joint may result in this condition? Loss of water from the discs Decreased muscle cells Loss of elasticity in the ligaments Increased cartilage erosion

Increased cartilage erosion Rationale Joint pain in an older adult is due to increased cartilage erosion. A loss in height and shortening of the trunk is due to a loss of water from the discs. A decrease in muscle cells causes a decrease in muscle strength. An increased rigidity in the neck, shoulders, back, hips, and knees is due to a loss of elasticity in the ligaments.

The nurse is preparing a care plan for a client who is to undergo an electromyography. Which nursing intervention should the nurse add to the care plan? Encourage the client to sleep quietly during the procedure Prepare the client to stay in a sitting position during the procedure Inform the client that the procedure is both painless and noninvasive Instruct the client to avoid drinking coffee or tea 24 hours before the procedure

Instruct the client to avoid drinking coffee or tea 24 hours before the procedure Rationale An electromyogram is a diagnostic procedure used to evaluate electrical potential associated with skeletal muscle contraction. The nurse should instruct the client to avoid drinking coffee or tea in the 24 hours before the procedure to prevent stimulatory reactions. During the procedure, the client should be kept awake and instructed to cooperate with voluntary movement. The client is placed in a supine position on the table during the procedure for effective results. An electromyogram is a painful procedure because it involves insertion of needles.

Which is a clinical manifestation of the Landouzy-Déjérine type of muscular dystrophy (MD)? Loss of hearing Cardiomyopathy Respiratory failure Mental impairment

Loss of hearing Rationale Loss of hearing is the clinical manifestation of Landouzy-Déjérine MD. Cardiomyopathy and respiratory failure are the clinical manifestations of both Duchenne and Becker MD. Duchenne MD is clinically manifested by mental impairment.

The laboratory reports reveal that a client has a serum calcium level of 7.9 mg/dL (.43 mmol/L). Which hormone would be elevated in the client? Estrogen Thyroxine Growth hormone Parathyroid hormone (PTH)

Parathyroid hormone (PTH) Rationale The normal range of serum calcium lies between 9 and 10.5 mg/dL (.5-.55 mmol/L). When serum calcium levels are lowered, secretion of PTH increases and stimulates bones to promote osteoclastic activity, which increases serum calcium levels. Estrogens stimulate osteoblastic (bone-building) activity and inhibit PTH. Thyroxine increases the rate of protein synthesis in all types of tissues, including bone tissues. Growth hormones secreted by the anterior lobe of the pituitary gland are responsible for increasing bone length until puberty.

The nurse provides moist heat to a client with cartilage degeneration. What is the rationale for this nursing intervention? To slow bone loss To prevent skin breakdown To increase muscle strength To increase blood flow to the area

To increase blood flow to the area Rationale Cartilage degeneration is a physiologic change of the musculoskeletal system that can be treated by providing moist heat, which increases blood flow to the area. Weight-bearing exercises are taught to slow bone loss. The client is instructed to prevent pressure on the bony prominences to prevent skin breakdown. The client is taught isometric exercises to increase muscle strength.

A nurse is caring for a client with scoliosis of the thoracic spine and lumbar spine. Which risk does the nurse suspect in the client? Osteoarthritis Muscle spasticity Intervertebral disc prolapse Cardiac function impairment

Cardiac function impairment Rationale Scoliosis can lead to cardiac function impairment. A client with an S-shaped thoracic and lumbar spine, and unequal shoulder and scapula height, may have scoliosis. A thoracic rib prominence in the lumbar spine deformity of 45 degrees indicates that the client is at a risk of lung and cardiac function impairment. Osteoarthritis is an inflammatory joint condition that is uncommon in a client with scoliosis of the thoracic spine and lumbar spine. Muscle spasticity, an increased muscle tone that may interfere with gait, movement, and speech, is uncommon in the client with scoliosis of the thoracic and lumbar spine. Passively raising the client's leg 60 degrees or less during a straight-leg-raising test indicates nerve root irritation due to intervertebral disc prolapse.

A client with osteomyelitis receiving ciprofloxacin therapy is taught about the pros and cons of the therapy. Which statement made by the client indicates effective learning? "I should go for a weekly change of dressing." "I should stop taking the medication once symptoms decrease." "I should not the remove soiled dressing without someone's assistance." "I should contact the primary healthcare provider in case of white patches in the mouth."

"I should contact the primary healthcare provider in case of white patches in the mouth." Rationale Ciprofloxacin causes adverse effects like formation of whitish-yellow or curd-like lesions in the mouth and itching in the perianal area. Therefore, the client's statement that the primary healthcare provider should be contacted in case of white patches in the mouth indicates effective learning. Dressings should be changed once soiled, not weekly. The client must take the antibiotic even after the symptoms have subsided and feels better. If the drug is abruptly discontinued, this may cause drug resistance. There are no restrictions as to who should change the dressing; the client can also change the dressing as needed.

The nurse is teaching a client about management of low back pain. Which statements made by the client indicate effective learning? Select all that apply. "I should sleep in a prone position." "I should sleep with my legs out straight." "I should keep a check on my body weight." "I should stop exercising if the pain gets severe." "I should exercise by leaning forward without bending the knees."

"I should keep a check on my body weight." "I should stop exercising if the pain gets severe." Rationale Increased body weight would put extra weight on the legs and back and thereby aggravate the pain; therefore keeping a check on body weight is beneficial. Pain during exercise suggests an injury; therefore exercise should be stopped if pain starts or becomes severe. Sleeping in a side-lying position with hips and knees bent would be beneficial. Sleeping with the legs out straight pulls the back muscles; this can cause pain. The client should not be allowed to exercise or walk by leaning forward without bending the knees because this may put pressure on the back.

After teaching the client about the precautions to be taken during bisphosphonate therapy, the nurse is evaluating the statements of the client. Which statement made by the client indicates the need for further teaching? "I should take the medication with water." "I should take the medication with a meal." "I should stop taking the medication abruptly." "I should remain upright for at least 30 minutes after taking the medication."

"I should take the medication with a meal." Rationale Bisphosphonates have the potential to cause erosive esophagitis and should therefore be taken with a large glass of water and the client should remain upright for at least 30 minutes after taking the medication to facilitate passage through the esophagus. They are poorly absorbed in the oral formulation, so should be taken on an empty stomach, first thing in the morning. Bisphosphonates should not be stopped abruptly unless on the orders of the primary healthcare provider.

A nurse provides discharge instructions to a client who had surgery for a left total hip replacement. Which should the nurse include when teaching the client about how to protect the affected hip when in the sitting position? "When sitting in a soft chair, the left leg should be elevated in a straight-out position." "When sitting in a firm armchair, the left foot should be flat on the floor's surface." "Sit in a firm armchair with the left leg elevated on a high stool." "Sit in a soft chair with pillows tucked under the left hip."

"When sitting in a firm armchair, the left foot should be flat on the floor's surface." Rationale Using a firm armchair with the left foot flat on the floor puts the least strain on the prosthesis. A soft chair permits hip flexion greater than 90 degrees, which is contraindicated. Elevation of the leg places increased strain on the prosthesis and is contraindicated. A soft chair, even with pillows, cannot ensure the prevention of hip flexion greater than 90 degrees, which is contraindicated.

A client's leg is placed in Buck extension to immobilize a fracture until surgery can be performed. When planning caring for this client, the nurse considers that Buck extension is which type of traction? Skeletal traction Cutaneous traction Halter transfixation Balanced suspension

Cutaneous traction Rationale Buck extension is an example of traction applied directly to the skin (cutaneous) by tape or by a foam boot. Skeletal traction is applied directly to the bony skeleton. There is no such intervention as halter transfixation. A halter (strap) may be used with cervical or pelvic traction. Balanced suspension traction keeps the affected extremity elevated off the bed.

A nurse is caring for a client who had a total hip replacement. Which is the priority assessment when monitoring the client for hemorrhage? Checking vital signs every 4 hours Examining the bedding under the client Measuring the circumference of the thigh Observing for ecchymosis at the operative site

Examining the bedding under the client Rationale Because of the recumbent position, drainage may flow under the client and not be noticed. Checking vital signs every 4 hours is too infrequent; however, the site is a more reliable indicator of hemorrhage. The girth of the thigh is not an indicator of hemorrhage. Dressings impede accurate assessment. There may be bruising from the surgery; it is not a reliable sign of hemorrhage.

On the second day after surgery, a client reports pain in the right calf. What should the nurse do first? Apply a warm soak. Document the symptom. Elevate the leg above the heart. Notify the primary healthcare provider.

Notify the primary healthcare provider. Rationale Calf pain may be a sign of thrombophlebitis, which can lead to pulmonary embolism. A postoperative client with pain in the calf should be confined to bed immediately and the primary healthcare provider notified. A prescription for application of heat may be given after a diagnosis is made; application of heat is a dependent nursing function. Documentation is not the priority; this is a potentially serious complication. The leg should not be elevated above heart level without a prescription; gravity may dislodge a thrombus, creating an embolism.

A client has a long leg cast. What instructions should the nurse give the client in preparation for crutch walking? Use the trapeze to strengthen the biceps. Keep the affected limb in extension and abduction. Sit up straight in a chair to develop the back muscles. Perform exercises in bed to strengthen the upper extremities.

Perform exercises in bed to strengthen the upper extremities. Rationale In crutch walking the client uses the triceps, trapezius, and latissimus muscles. A client who has been in bed may need to implement an exercise program to strengthen these shoulder and upper arm muscles before initiating crutch walking. Using the trapeze to strengthen the biceps does not strengthen muscles used in crutch walking. Keeping the leg in abduction alters the center of gravity, which impedes ambulation. Back muscles are not used in crutch walking.

Which joint surgery is used as a prophylactic measure and as a palliative treatment for clients with rheumatoid arthritis (RA)? Osteotomy Arthrodesis Synovectomy Debridement

Synovectomy Rationale Synovectomy is a type of joint surgery that involves the removal of thickened synovial membrane. It is used as a prophylactic measure and as a palliative treatment for rheumatoid arthritis (RA) because it prevents the serious destruction of joint surfaces. Osteotomy involves removing a wedge of bone to correct deformity and relieve pain. Arthrodesis is the surgical fusion of a joint. Debridement involves the surgical removal of degenerative debris from a joint.

While assessing a client, the nurse suspects that the client has acute osteomyelitis. Which symptoms in the client support the nurse's suspicion? Foot ulcer Temperature of 102° F Erythema of the affected area Tenderness of the affected area Drainage from the affected area

Temperature of 102° F Erythema of the affected area Tenderness of the affected area Rationale Osteomyelitis is the infection of bone caused by bacteria, viruses, or fungi. The symptoms of acute osteomyelitis are fever (temperature above 101° F), erythema, and tenderness near the affected area. The symptoms of chronic osteomyelitis are the presence of foot ulcers and drainage from the affected area.

A 52-year-old client reports fatigue and decreased strength in the limbs. Which suggestion given to the client will be most beneficial? "Include protein-rich food in your diet." "Drink two cups of milk daily." "Perform push-ups in the morning." "Give warm compresses to the limbs."

"Perform push-ups in the morning." Rationale Decreased muscle strength occurs with aging. This can be resolved by performing isometric exercises. Therefore suggesting the client perform push-ups in the morning would be most beneficial. Proteins help to provide energy to the client and will help with healing. Milk is rich in calcium, which is good for the overall health and especially the bones, but it will not increase bone strength. Warm compressions are given to reduce pain and inflammation caused by injury.

A client has a discectomy and fusion for a herniated nucleus pulposus (HNP). When getting out of bed for the first time, the client reports feeling faint and lightheaded. Which instruction should the nurse provide to the client? "Sit upright on edge of the bed." "Slide to the floor to prevent a fall and injury." "Bend forward to increase the blood flow to the brain." "Lie down immediately so a blood pressure can be obtained."

"Sit upright on edge of the bed." Rationale Sitting maintains alignment of the back and allows the nurses to support the client until orthostatic hypotension subsides. Sliding to the floor so the client will not fall and get hurt will induce flexion of the vertebrae, which can traumatize the spinal cord. Because it will increase the blood flow to the brain, bending forward will induce flexion of the vertebrae, which can traumatize the spinal cord. Rapid movement can flex the vertebrae, which can traumatize the spinal cord; taking the blood pressure at this time is not necessary.

A 70-year-old client is diagnosed with cartilaginous degeneration. Which action should the nurse take? Multiple choice question Advise the client to use moist heat Teach the client isometric exercises Provide the client with supportive armchairs Demonstrate weight-bearing exercises to the client

Advise the client to use moist heat Clients with cartilaginous degeneration are advised to take moist heat showers because they increase blood flow to the region. Isometric exercises are indicated for clients with muscular atrophy. Sitting in a supportive armchair provides support to bony structures and prevents further deformities in a client with kyphosis. Weight-bearing exercises are indicated in clients with decreased bone density.

A client's laboratory report shows altered serum calcium concentration. Which hormones are responsible for this condition? Calcitonin Thyroxine Glucocorticoids Growth hormone Parathyroid hormone

Calcitonin Parathyroid hormone Rationale Produced by the thyroid gland, calcitonin decreases the serum calcium concentration if it increases above the normal level. Parathyroid hormones increase and stimulate bones to promote osteoclastic activity and release calcium into the blood in response to low serum calcium levels. Thyroxine increases the rate of protein synthesis in all types of tissues. Glucocorticoids regulate protein metabolism to maintain the organic matrix of bone. Growth hormone helps to increase bone length and determine the amount of bone matrix formed before puberty.

A client who is undergoing treatment for osteomyelitis reports bloody, watery diarrhea. The client also has hives and mouth sores. Which medication will the nurse check for in the client's medication administration record? Cefazolin Neomycin Tobramycin Ciprofloxacin

Cefazolin Rationale Cephalosporin antibiotics, such as cefazolin, are used to treat osteomyelitis. Cefazolin can alter gastrointestinal function, resulting in adverse effects such as watery diarrhea, bloody stools, and mouth or throat sores. Cefazolin can also alter skin integrity and cause hives. Aminoglycoside antibiotics such as neomycin and tobramycin do not generally alter the gastrointestinal system; instead, they can cause ototoxicity and nephrotoxicity. Fluoroquinolones such as ciprofloxacin generally do not alter the gastrointestinal system and therefore do not cause watery, bloody stools. However, tendon rupture, especially of the Achilles tendon, can occur with the use of fluoroquinolones.

A client with osteomyelitis has a slow rate of healing. Which factors can contribute to reduced healing in the client? Diabetes Cataract Smoking Dermatitis Alcoholism

Diabetes Smoking Alcoholism Rationale Diabetes causes narrowing of blood vessels, thereby causing diminished blood supply to the affected organ or tissue; clients with diabetes have a slow healing rate. Intake of tobacco through smoking may reduce the blood supply to the affected area, thereby slowing down the healing process. Alcohol abuse reduces the amount of nutrients and vitamins required for muscle growth, thereby affecting the healing process. Cataract is a disease of the eye and does not affect the musculoskeletal system. Similarly, dermatitis is a skin condition that does not affect the musculoskeletal system.

While assessing a client's musculoskeletal system, the nurse identifies genu valgum. Which joint might have been palpated by the nurse? Hip joint Knee joint Temporomandibular joint Metacarpophalangeal joint

Knee joint Rationale Also known as knock knees, genu valgum is a condition in which the knees are poorly aligned. The knee joint should be assessed for any abnormalities or the presence of effusion. The hip joint is assessed to determine mobility and to find any hip pain experienced in the groin or pain that radiates to the knees. The temporomandibular joint is palpated to determine any weakness or pain in the face. The metacarpophalangeal joint is palpated to assess hand function based on the range of motion.

Where should the nurse place a pillow or sandbag to prevent external rotation of a lower extremity? Lateral to the client's affected hip Under the client's lower affected leg At the ankle of the client's affected leg On the side of the client's affected knee

Lateral to the client's affected hip Rationale Because external rotation involves the hip joint, support is necessary at that point to promote functional alignment. Placing it under the client's lower affected leg, at the ankle of the client's affected leg, or on the side of the client's affected knee will not prevent external rotation of the hip.

A client with osteoporosis is prescribed raloxifene. What should the nurse monitor in the client? Check serum creatinine Monitor urinary calcium Monitor liver function tests Observe for anxiety and drowsiness

Monitor liver function tests Rationale Raloxifene increases the risk for hepatic disease. Therefore the liver function test is monitored in a client who is prescribed this drug. Serum creatinine is checked in a client who is prescribed zoledronic acid. Urinary calcium is monitored in a client who is prescribed calcium supplements. Anxiety and drowsiness is observed in a client who is prescribed risedronate.

A nurse is caring for a client with a fracture of the head of the femur. The primary healthcare provider places the client in Buck extension. What explanation does the nurse give the client for why the traction is being used? Reduces muscle spasms Prevents soft tissue edema Reduces the need for cast application Prevents damage to the surrounding nerves

Reduces muscle spasms Rationale Buck extension is used to reduce the fracture, align the bone, and temporarily reduce muscle spasms. Edema occurs because of tissue trauma and will not be prevented by Buck extension. A fractured head of the femur is repaired via internal fixation; a cast is unnecessary. Damage already has occurred at the time of trauma and is not prevented by Buck extension.

The nurse is caring for a client who just had a posterior lumbar laminectomy. Which action is the priority? Encourage the client to cough. Reposition the client by log rolling. Assess the client for indications of peritonitis. Instruct the client to bend the knees when turning.

Reposition the client by log rolling. Rationale Log-rolling maintains the alignment of the vertebral column by turning as a unit. Coughing will increase the pressure of the cerebrospinal fluid (CSF) surrounding the spinal cord and intensify the pain; incentive spirometry and turning should be used to prevent respiratory complications. Peritonitis is not a danger, because the abdominal cavity was not opened. Flexion of the knees is avoided postoperatively, because it alters intervertebral pressure.

Which hormones are involved in building and maintaining healthy bone tissue? Multiple selection question Insulin Thyroxine Glucocorticoids Growth hormone Parathyroid hormone

-Insulin -Growth hormone Insulin works together with growth hormone to increase bone length, which helps to build and maintain healthy bone tissue. Thyroxine increases the rate of protein synthesis in all types of tissues. Glucocorticoids regulate protein metabolism to reduce or intensify the organic matrix of bone. Parathyroid hormone secretion stimulates bones to promote osteoclastic activity and release calcium into the blood when serum calcium levels are lowered.

Where are the central thermoreceptors located in the human body? Multiple selection question Skin Spinal cord Hypothalamus Throughout the body Abdominal organs

-Spinal cord -Hypothalamus -Abdominal organs Central thermoreceptors in the body provide skin and core temperature information to the hypothalamus and are located in the spinal cord, hypothalamus, and abdominal organs. Central thermoreceptors are not present in the skin; peripheral thermoreceptors are present in the skin. Central thermoreceptors are not present throughout the body; multiple thermoreceptors are present throughout the body.

On reviewing the x-ray report of a client with rheumatoid arthritis, the nurse learns that three small joints are involved. According to the diagnostic criteria for rheumatoid arthritis, which score will the nurse assign the client for joint involvement? 1 2 3 5

2 Rationale According to the diagnostic criteria for rheumatoid arthritis, involvement of one to three small joints (with or without large-joint involvement) is given a score of 2. Involvement of two to ten large joints is given a score of 1. Involvement of four to ten small joints (with or without large-joint involvement) is given a score of 3. Involvement of more than ten joints (and at least one small joint) is given a score of 5.

A nurse is demonstrating to a client how to manipulate the ankles through full range of motion. Which movements should the nurse use during this process? Select all that apply. version Inversion Abduction Dorsiflexion Plantar flexion

version Inversion Dorsiflexion Plantar flexion Rationale Eversion is turning the ankle inward toward the midline of the body. The ankle can evert. Inversion is turning the ankle outward away from the midline of the body. The ankle can invert. Dorsiflexion occurs when the toes and the distal part of the foot are bent upward toward the abdomen. The ankles can dorsiflex. Plantar flexion occurs when the toes and the distal part of the foot are bent downward away from the abdomen. The ankles can plantar flex. The ankle cannot be abducted; abduction is moving an extremity away from the midline of the body.

A client reports pain in the posterior leg while walking and running. Which condition does the nurse suspect? Crepitation Paresthesia Plantar fasciitis Achilles tendinitis

Achilles tendinitis Rationale Achilles tendinitis is marked by pain in the posterior leg while walking and running; this progresses to pain at rest. Achilles tendinitis is generally caused by cumulative stress on the Achilles tendon that results in inflammation. Crepitation is a frequent audible crackling sound with palpable grating that accompanies movement. Paresthesia is the feeling of numbness and tingling sensation in the lower extremities. Plantar fasciitis is a burning, sharp pain on the sole of the foot.

What are the diagnostic abnormalities present in a client with fat embolism syndrome? Multiple selection question Decreased PaO 2 Increased platelet count Increased fat cells in urine Decreased hematocrit level Decreased prothrombin time

-Decreased PaO 2 -Increased fat cells in urine -Decreased hematocrit level The diagnostic abnormalities present in a client with fat embolism syndrome are decreased PaO 2, increased fat cells in urine, decreased hematocrit level, decreased platelet count, and prolonged prothrombin time.

A client is scheduled for arthroscopic knee surgery and asks the nurse about the procedure. Which is the best response by the nurse? "It is surgical repair of a joint under direct visualization using a device with a tiny video camera attached to it." "It is a radiologic procedure in which dye is injected to help diagnose the extent of the knee injury." "The procedure will determine the type of treatments the primary healthcare provider will prescribe." "You will be anesthetized so that you do not remember anything about the procedure."

"It is surgical repair of a joint under direct visualization using a device with a tiny video camera attached to it." Rationale The response "It is surgical repair of a joint under direct visualization using a device with a tiny video camera attached to it" describes the procedure for arthroscopic surgery. Arthroscopic surgery is not a radiologic procedure and does not involve the injection of dye. This is a surgical procedure; the procedure is the treatment. Although the client will be anesthetized and will not remember anything about the procedure, this response evades the client's concern and does not describe the procedure.

A nurse is caring for a client with rheumatoid arthritis. Based on the client's diagnosis, the nurse should review the result of which laboratory test? Pancreatic lipase Bence Jones protein Antinuclear antibody Alkaline phosphatase

Antinuclear antibody Rationale An antinuclear antibody test may be positive in clients with autoimmune disorders such as rheumatoid arthritis and systemic lupus erythematosus. Pancreatic lipase is an enzyme that catalyzes the breakdown of lipids; this is a test used to diagnose pancreatic problems. Bence Jones protein is a urine test helpful in diagnosing multiple myeloma. Alkaline phosphatase is a blood test that determines phosphorus activity; it is used in diagnosing liver and biliary tract disorders and identifying periods of active bone growth or metastasis of cancer to bone.

A client admitted with a femur fracture 24 hours ago becomes confused. What should the nurse do immediately? Assess for petechiae on the neck and chest. Administer oxygen. Check for bilateral pedal pulses. Call the primary healthcare provider requesting a change in pain medication.

Assess for petechiae on the neck and chest. Rationale Clients with long bone fractures are at risk for fat embolism during the first 48 hours after the trauma occurred. Confusion is an early sign of a fat embolism. Unlike a pulmonary embolism, petechiae often occur with a fat embolism. The nurse needs to immediately perform an assessment of the client before any measures are done and then call the primary healthcare provider. If petechiae are present on the neck, upper arms, or chest, the primary healthcare provider will recognize this as a fat embolism and appropriate measures can be instituted without delay. Administering oxygen may be necessary, but assessment of the present oxygen status should be performed before applying oxygen. Assessing pedal pulses is important but unrelated to the present problem. Further assessment is required before requesting a change in pain medication.

A client is scheduled for a below-the-knee amputation. When should the nurse begin rehabilitation planning for the client? Before the surgery During the convalescent phase On discharge from the hospital When it is time for a prosthesis

Before the surgery Rationale Rehabilitation should begin immediately. This includes preoperative discussion of the nature of the operation and rehabilitation techniques. During the convalescent phase, on discharge from the hospital, and when it is time for a prosthesis are too late; valuable rehabilitation time has been wasted.

Which alternative therapy may be beneficial for the nurse to discuss with a client who has terminal bone cancer? Biofeedback Radiotherapy Bariatric therapy Radioactive implants

Biofeedback Rationale Biofeedback provides information about changes in body function; clients can learn to use this to control a variety of body responses, including pain. Radiotherapy is a part of standard medical regimens. Bariatrics is a type of therapy that focuses on the correction of obesity; it encompasses prevention, control, and treatment of the problem, which involves medications and surgery. Placement of radioactive sources into or in contact with tissues (brachytherapy) is part of standard medical treatment for cancer.

A nurse plans care to prevent deformities in a client with rheumatoid arthritis. Which intervention should be alternated with periods of rest? Active exercises Passive massage Bracing of joints Isometric exercises

Active exercises Rationale Active exercises, alternated with periods of rest, offer the best chance at preventing the joint deformities associated with rheumatoid arthritis, because they can move each involved joint through its full range of motion. Massage affects the muscles, not the joints, and will do little to prevent deformities. Immobilization of joints by bracing will promote the formation of contractures and deformities. Isometric exercises will promote muscle, not joint, function.

The nurse is caring for a client who has sustained blunt trauma to the forearm. The nurse assesses the client for which early sign of compartment syndrome? Warm skin at the site of injury Escalating pain in the fingers Rapid capillary refill in affected hand Bounding radial pulse in the injured arm

Escalating pain in the fingers Rationale Elevated tissue pressure restricts blood flow, causing increasing ischemia and increasing pain; it is the cardinal early symptom of compartment syndrome. The arm will feel cool, not warm, because of a decrease in circulation. Sluggish, not rapid, capillary refill is a sign of compartment syndrome. The pulse will be diminished, not bounding; increasing edema impairs circulation.

Which nursing action is contraindicated when caring for a client with a newly applied long leg cast? Elevating the cast on a pillow Drying the cast by using a fan Leaving the cast exposed to air Handling the cast with fingertips

Handling the cast with fingertips Rationale Handling the cast with fingertips before it is dried may create indentations that can cause pressure. Elevating the casted extremity on a pillow will help reduce edema. Drying the cast with a fan and leaving the cast exposed to the air will increase air flow that facilitates drying of the cast.

A client experiences an acute episode of rheumatoid arthritis. The nurse observes that the client's finger joints are swollen. The nurse concludes that this swelling most likely is related to which factor? Urate crystals in the synovial tissue Inflammation in the joint's synovial lining Formation of bony spurs on the joint surfaces Deterioration and loss of articular cartilage joints

Inflammation in the joint's synovial lining Rationale In rheumatoid arthritis, transformed autoantibodies attack synovium, producing inflammation. Urate crystals occur with gouty, not rheumatoid, arthritis. Formation of bony spurs on the joint surfaces is unrelated to rheumatoid arthritis. Deterioration and loss of articular cartilage in joints is osteoarthritis.

While assessing a client's joint for mobility, the primary healthcare provider moved the client's first and fifth metacarpals anteriorly from the flattened palm. Which type of synovial joint movement is this termed? Multiple choice question Flexion Extension Abduction Opposition

Opposition Opposition is a synovial movement that involves moving the first and fifth metacarpals anteriorly from the flattened palm (cupping position). Flexion involves bending the joint as a result of muscle contractions that result in decreasing the angle between two bones. Extension involves the straightening of the joint that increases the angle between two bones. Abduction involves the movement of a part away from the midline of the body.

Which synovial joint movement is involved in turning the client's palm downward? Multiple choice question Eversion Inversion Pronation Supination

Pronation Pronation is the movement involved in turning the palm inward. Eversion involves turning the sole outward away from the midline of the body. Inversion involves turning the sole inward towards the midline of the body. Supination involves turning the palm upward.

Which type of joint is present in the client's shoulders? Multiple choice question Pivotal Saddle Condyloid Spheroidal

Spheroidal The spheroidal joint is a ball and socket joint that provides flexion, extension, adduction, abduction, and circumduction in the shoulders and hips. The pivotal joint provides rotation in the atlas and axis, and at the proximal radioulnar joint. The saddle joint, which is at the carpometacarpal joint of the thumb, provides flexion, extension, abduction, adduction, and circumduction of the thumb-finger. The condyloid joint is a wrist joint between the radial and carpals; it provides flexion, extension, abduction, adduction, and circumduction.

Which term should the nurse use to describe a flat, poorly defined mass on the sole over a bony prominence caused by pressure? Multiple choice question Plantar wart Callus Ingrown nail Hypertrophic ungual labium

Callus In foot problems, callus is described as a flat, poorly defined mass on the sole over a bony prominence that is caused by pressure. Plantar wart is a painful papillomatous growth caused by a virus. A sliver of toenail penetrating the skin and causing inflammation results in ingrown nail. Hypertrophic ungual labium is described as chronic hypertrophy of the nail lip caused by improper nail trimming.

A client with severe chronic rheumatoid arthritis reports that pain lasts for 2 to 3 hours after exercising. What should the nurse should teach the client to do? Substitute isometric exercises for isotonic exercises. Stop the exercises for one day and then resume the exercises. Delay doing aerobic exercises until the pain subsides. Decrease the total time and number of repetitions of the exercise,

Decrease the total time and number of repetitions of the exercise, Rationale Exercise should be decreased to a level of tolerance. Isometric exercises promote muscle contraction, not joint movement. The exercise should not be stopped. The purpose of aerobic exercises is to improve cardiovascular functioning, not joint movement; there is no reason to interrupt aerobic exercises if they are tolerated.

The nurse is providing home care to an older adult client with decreased bone density. Which nursing intervention will be most beneficial for the client? Teaching isometric exercises Encouraging the client to do weight-bearing exercises Instructing the client to sit in supportive chairs with arms Providing moist heat such as shower or moist compresses

Encouraging the client to do weight-bearing exercises Rationale Older adults are at risk of developing decreased bone density. Elderly clients with decreased bone density should be encouraged to do weight-bearing exercises. Teaching isometric exercises would be beneficial for a client with muscular atrophy. A client with kyphotic posture should be instructed to sit in supportive chairs with arms. Providing moist heat would be beneficial for a client with cartilage degeneration.

Upon palpation, the nurse identifies spongy swelling caused by synovial fluid. Which joint was most likely palpated? Multiple choice question Biaxial joint Pivotal joint Synovial joint Temporomandibular joint

Temporomandibular joint The temporomandibular joint is palpated by asking the client to open his or her mouth; the nurse checks for any pain or weakness in the face. Common abnormal findings include tenderness, crepitus (a grating sound), and a spongy swelling caused by excess synovial fluid. Biaxial joints help in the gliding movement of the wrist. Pivot joints permit rotation in the radioulnar area. Synovial joints provide movement at the point of contact of articulating bones such as the hip, shoulders, and knees.nt

A client with dementia is admitted with a fractured hip after a fall at home. The client's family member witnessed the fall. Four hours after admission, the client's blood pressure increases to a moderately severe hypertensive level. The client pulls on the bedclothes continuously. The client's family member asks for pain medication for the client. What does the nurse concludes? The client has the need to go to the bathroom. The client may be in pain and unable to respond appropriately. The family member may be trying to keep the client overmedicated. The family member feels guilty about the fall and wants to keep the client pain free.

The client may be in pain and unable to respond appropriately. Rationale The client's dementia indicates that the client has problems with thought processes and may not be able to interpret or communicate the presence of pain. An increased blood pressure, caused by central nervous system stimulation, and pulling on the bedclothes suggest that the client is in pain. The client may have a need to go to the bathroom, but it is more likely that the client has pain that he or she is unable to communicate. There is no evidence that the family member wants the client overmedicated or has feelings of guilt.

While assessing the health of a 69-year-old client, the nurse finds an age-related change. Which finding in the client supports the nurse's conclusion? Big eyes, wide open Presence of facial hair A bruise on the elbow Walking with neck bent forward

Walking with neck bent forward Rationale Aging is associated with changes in gait. Walking with neck bent forward suggests a gait change, supporting the nurse's conclusion. Wide opening of eyes is not an age-related change. The release of sex hormones in both men and women causes growth of facial hair, which is normal. A bruise could be a result of an injury and does not occur with aging.

The nurse is caring for an elderly client who has a right hip fracture. Which priority intervention should be included in the plan of care? Oxygen therapy Cardiac monitoring Nutrition supplements Venous thromboembolism (VTE) prevention

Venous thromboembolism (VTE) prevention Rationale VTE is common after hip surgery and must be prevented; this is a component of core measures. Nutritional supplements, cardiac monitoring, and oxygen therapy may be necessary in some clients with hip fractures, but not in all.

Which hormone aids in regulating intestinal calcium and phosphorous absorption? Multiple choice question Insulin Thyroxine Glucocorticoids Parathyroid hormone

Glucocorticoids Adrenal glucocorticoids aid in regulating intestinal calcium and phosphorous absorption by increasing or decreasing protein metabolism. Insulin acts together with growth hormone to build and maintain healthy bone tissue. Thyroxine increases the rate of protein synthesis in all types of tissues. Parathyroid hormone secretion increases in response to decreased serum calcium concentration and stimulates the bones to promote osteoclastic activity.

Which diagnostic study is used to determine a client's bone density? Multiple choice question Diskogram Standard X-ray Computed tomography scan Magnetic resonance imaging

Standard X-ray A standard X-ray is used to determine bone density. A diskogram is used to visualize abnormalities of the intervertebral disc. A computed tomography scan is used to identify soft tissues, bony abnormalities, and various types of musculoskeletal trauma. Magnetic resonance imaging is used to diagnose avascular necrosis, disc disease, tumors, osteomyelitis, ligament tears, and cartilage tears.

A nurse is assessing a client with the diagnosis of osteoporosis. What part of the client's body should the nurse assess to identify osteoporotic changes? Long bones Facial bones Vertebral column Joints of the hands

Vertebral column Rationale Compression fractures of the vertebrae are the most common fractures in clients with osteoporosis; a gradual collapse of vertebrae may be asymptomatic and observed as kyphosis. Changes in the long bones or facial bones associated with osteoporosis are not observable to the naked eye. Observable changes such as inflammation in the hand joints and natural alignment of the bones are associated with arthritis, not osteoporosis.

A nurse teaches a client about osteoporosis. Which client statement supports the nurse's conclusion that the teaching is effective? "I know that certain illnesses can affect my body's calcium level." "I think I can eat all the calcium I need rather than taking medication." "I will begin to actively monitor my risk for this disease after menopause." "I'm glad that drinking a little wine every day is advised to maintain calcium levels."

"I know that certain illnesses can affect my body's calcium level." Rationale Medical conditions such as hyperthyroidism, hypothyroidism, malabsorption syndromes, chronic renal failure, acute pancreatitis, and other metabolic conditions aggravate bone loss and can lead to development of osteoporosis. Although it is advisable to eat calcium-rich foods, calcium supplements also are recommended to ensure that women consume the appropriate recommended amount. Women need to monitor their risk for osteoporosis and increase their calcium intake before menopause, because bone loss can occur at earlier ages. Women with osteoporosis need to make lifestyle modifications, such as avoidance of alcohol, cigarettes, and caffeine-containing substances.

A nurse is caring for a client with severe rheumatoid arthritis. What is most important in the nurse's approach to help this client achieve self-reliance and independence? A series of limited objectives A positive attitude toward the eventual outcome The understanding that little can be accomplished The recognition that a nursing home type of facility is needed

A positive attitude toward the eventual outcome Rationale A nurse's positive attitude can encourage and motivate a client. As many objectives as needed should be used. The attitude that little can be accomplished may discourage the client's attempts to attain the highest goals possible. The recognition that a nursing home type of facility is needed may discourage the client's attempts to attain the highest goals possible.

A client is placed into a whirlpool tub for range-of-motion exercises. The nurse should explain that rehabilitating exercises carried out underwater make use of what property of the water? Pressure Temperature Buoyant force Vapor production

Buoyant force Rationale Rehabilitating exercises carried out underwater minimize strain on the body. The buoyant force of the water enables the limbs to move more easily. Exercises are carried out near the surface of the water, where the water pressure will have little effect. Water temperature will not assist movement. Vapors are produced above water as a result of evaporation; they do not facilitate exercise.

The nurse assesses the musculoskeletal system of four different clients. Which client does the nurse anticipate to be diagnosed with pes planus? Client A: Pain in the posterior leg from heel to knee Client B: Flabby appearance of the muscles Client C: Abnormal flatness of the sole and arch of the foot Client D: General pain and tenderness in the muscles

Client C: Abnormal flatness of the sole and arch of the foot Rationale Client C has pes planus; symptoms of this condition include an abnormal flatness of the sole and arch of the foot. Client A has Achilles tendonitis, which is characterized by pain in the posterior leg. Client B has atrophy, which is characterized by a flabby appearance of the muscle. Client D has myalgia, which is characterized by general pain and tenderness in the muscles.

A nurse teaches an elderly client safety tip to prevent falls. Which physiologic change may have occurred in the client? Slowed movement Cartilage degeneration Decreased bone density Decreased range of motion (ROM)

Decreased bone density Rationale Teaching safety tips to prevent falls would best help a client with decreased bone density. If a client experiences slow movements, the nurse should not rush the client because the client may become frustrated if hurried. Providing a client with cartilage degeneration with a moist heat source such as a shower or a warm compress is beneficial because this action may increase blood flow to the area. A nurse should assess a client's ability to perform activities of daily living and mobility to help improve the self-care skills of clients with a decreased range of motion.

The nurse finds that a client undergoing treatment for osteomyelitis is showing signs of Achilles tendon rupture. Which medication does the nurse ask the primary healthcare provider to reconsider? Gentamycin Levofloxacin Acetaminophen Cyclobenzaprine

Levofloxacin Rationale Tendon rupture (especially the Achilles tendon) can occur with use of the fluoroquinolones (e.g., ciprofloxacin, levofloxacin). Aminoglycosides such as gentamycin do not cause rupture of the Achilles tendon; instead, gentamycin can cause ototoxicity and nephrotoxicity. Acetaminophen is a nonopioid analgesic used to manage pain; it does not cause rupture of the Achilles tendon. Cyclobenzaprine is a muscle relaxant; it does not cause tendon rupture.

What instructions should the nurse provide to a client after a long leg cast is removed? Elevate the extremity when sitting. Report discomfort or stiffness of the ankle. Perform full range-of-motion exercises of the leg once daily. Cleanse the leg by scrubbing with long, brisk motions.

Elevate the extremity when sitting. Rationale Elevation will help to control swelling that occurs after a leg cast is removed. Because the ankle has been immobilized, discomfort and stiffness are expected after cast removal. The leg should be put through full range-of-motion exercises more often than once daily. Because the skin was not exposed, it needs gentle washing to prevent skin trauma.

The nurse is assessing a client with severe nodule-forming rheumatoid arthritis for possible Felty syndrome. Which assessment findings are consistent with Felty syndrome? Itchy eyes Dry mouth Leukopenia Splenomegaly Photosensitivity

Leukopenia Splenomegaly Rationale Felty syndrome occurs most commonly in clients with severe nodule-forming rheumatoid arthritis; it is characterized by splenomegaly and leukopenia. Itchy eyes, dry mouth, and photosensitivity are all signs of Sjögren syndrome.

The nurse is teaching an elderly client isometric exercises. Which physiologic condition does the client have? Kyphosis Muscle atrophy Decreased bone density Decreased range of motion (ROM)

Muscle atrophy Rationale Muscle atrophy occurs due to muscular weakness; isometric exercises can help increase muscular strength. Kyphosis can be reduced by introducing the client to proper body mechanics and instructing the client to sit in supportive chairs with arms. Complications associated with decreased bone density can be reduced by teaching safety tips to prevent falls and by reinforcing the need to exercise. The nurse should assess the client's ability to perform activities of daily living and mobility in a client with a decreased ROM.

A client returns to work as a carpenter after surgery for carpal tunnel syndrome of the right hand. What instructions should the nurse give to help prevent further problems with the hands when the client returns to work? "Avoid carrying tools with the arms." "Learn to hammer with the left hand." "Do stretching exercises during breaks." "Avoid power tools such as cordless screwdrivers."

"Do stretching exercises during breaks." Rationale Stretching exercises will assist in keeping the muscles and tendons supple and pliable, thus reducing the traumatic consequences of repetitive activity. The problem is not caused by carrying articles in the arms but by repetitive-type trauma. Learning to hammer with the left hand is not a satisfactory alternative for a skilled carpenter. The use of power tools will not be a problem.

A registered nurse teaches a 70-year-old client with kyphosis about self-care measures. Which statement made by the client indicates effective learning? Multiple choice question "I should take moist heat baths." "I should do isometric exercises." "I should sit in supportive armchairs." "I should position myself quickly."

"I should sit in supportive armchairs." Sitting in a supportive armchair provides support to the bony structures and prevents further deformity in a client with kyphosis. Cartilaginous degeneration is prevented by taking moist heat baths. Isometric exercises are indicated for clients with muscular atrophy. Clients with kyphosis have a shift in the center of gravity and should not move quickly.

What is the main reason a nurse raises three of the four side rails on the bed of an 83-year-old client who had surgery for a fractured hip? As a safety measure because of the client's age Because clients older than 60 years of age should use side rails To be used as handholds to facilitate the client's ability to move in bed Because all older adults are disoriented for several days after anesthesia

As a safety measure because of the client's age Rationale The need to use side rails for safety is important with any older client because he/she could fall or try to get out of bed without assistance. Side rails are not always used on all clients over 60-years-old. Each individual must be evaluated based on his/her mental and physical status. The client may use the side rails to move around in bed, but safety is always first. Some older adults become disoriented for a few days after anesthesia, but not all older adults.

A client is on tobramycin therapy. Which assessment findings should be given priority? Select all that apply. Throat sores Blurred vision Watery diarrhea Hearing impairment Decreased sense of smell

Blurred vision Rationale The client may suffer blurred vision, hearing impairment, or decreased sense of smell as side effects associated with tobramycin. These findings should be given high priority, and measures to reverse the toxicity should be taken so as to prevent permanent damage. Excessive use of tobramycin is associated with side effects that include nephrotoxicity, neurotoxicity, and hearing deficit. Neurotoxicity results in damage to the nerves that affect the functioning of sensory organs (e.g., eyes, ears, nose, skin). Throat sores and watery diarrhea are the symptoms of cephalosporins such as cephazolin.

A client with multiple injuries from a motor vehicle accident now is permitted out of bed to a chair but is not permitted to bear weight on the lower extremities. When using a mechanical lift to transfer the client, it is essential that the nurse do what? Fold the client's arms across the chest. Place the sling so that the top is below the client's scapulae. Call the primary healthcare provider to secure a prescription to use a mechanical lift. Raise the lift so that the sling is at least 12 inches (30.5 cm) above the mattress.

Fold the client's arms across the chest. Rationale Folding the arms across the chest maintains both arms in a safe position during the transfer. During a safe transfer, the sling should extend from above the scapulae to the knees to provide appropriate support. The use of a mechanical lift is an independent function of the nurse. Raising the lift so that the sling is at least 12 inches (30.5 cm) above the mattress height is unsafe; during the transfer, the sling should be raised just high enough (3 to 4 inches [7.6 to 10.2 cm]) to clear the mattress.

The nurse enters a client's room and finds the client on the floor crying for help. It is obvious to the nurse that the client has sustained a hip fracture. Which action should the nurse take first? Administer pain medication. Place the affected extremity in traction. Immobilize the affected extremity. Notify the primary healthcare provider on call.

Immobilize the affected extremity. Rationale The nurse should immobilize the affected extremity first. Further damage and internal bleeding could occur if the extremity is not immobilized. Clients do experience pain with a hip fracture and will require pain medication; however, the emergency management for a fractured hip is to immobilize the extremity. The nurse will need to notify the client's primary healthcare provider, but the priority is to immobilize the extremity.

A client reports mild tenderness and swelling near the ankle while running. Which nursing instruction would best benefit the client? "Do vigorous endurance exercises." "Complete your activity with a balancing exercise." "Perform strengthening exercises in between your activity." "Do warm-up muscle exercises before performing an activity."

"Do warm-up muscle exercises before performing an activity." Rationale A client with mild tenderness and swelling at the ankle area has a first-degree (mild) sprain. Warming up muscles followed by stretching exercises before performing any vigorous activity may reduce the risk of sprains and strains. The sprain may be reduced when endurance exercises start at a low level of effort and progress gradually to a moderate level. Balancing exercises, which may overlap with some strengthening exercises, help to prevent falling but is not as important in a strain as is proper warm-up. Strengthening exercises must be done prior to an activity to build muscle strength and bone density.

While grading a client's muscle strength, the nurse records a score of 4. What does this indicate? No detection of muscular contraction A barely detectable flicker or trace of contraction Active movement against gravity and some resistance Active movement against gravity only, not against resistance

Active movement against gravity and some resistance Rationale According to the muscle-strength scale, a sore of 4 indicates active movement of the muscle against gravity and some resistance. A score of 0 indicates no muscular contraction. A score of 1 indicates a barely detectable flicker or trace of contraction. A score of 3 indicates active movement against gravity only, not against resistance.

A nurse is teaching a client with hemiparesis how to ambulate with a cane. What should the nurse instruct the client to do? Shorten the stride of the unaffected extremity. Lean the body toward the cane when ambulating. Advance the cane simultaneously with the affected extremity. Hold the cane in the hand on the side of the affected lower extremity.

Advance the cane simultaneously with the affected extremity. Rationale The cane is held on the unaffected side and is advanced at the same time as the affected extremity; this increases the base of support and provides stability. Shortening the stride of the unaffected extremity will produce an awkward gait and instability; regular ambulation should be approximated. Leaning the body will change the center of gravity and cause instability. Holding the cane in the hand on the side of the affected lower extremity does not provide for a wide base of support or stability.

A client returns from the postanesthesia care unit after a right rotator cuff repair. What should the nurse do when performing a neurovascular assessment? Monitor for a pulse deficit. Obtain hourly blood pressure readings. Assess for capillary refill in the nail beds. Place the shoulder through range-of-motion exercises.

Assess for capillary refill in the nail beds. Rationale Capillary refill and quality of the pulse in the affected arm reflect the status of circulation distal to the operative site. A pulse deficit is the difference between the apical and radial rates. Monitoring for a pulse deficit is related to monitoring the function of the heart, not peripheral circulation. Obtaining hourly blood pressure readings is unnecessary. Placing the shoulder through range-of-motion exercises is contraindicated immediately after surgery. In this situation, range-of-motion exercises require a primary healthcare provider's prescription.

An older client experiences urinary frequency and nocturia. While ambulating, the client develops severe back pain and is found to have a vertebral compression fracture. When planning care, the nurse will focus interventions on which type of fracture? Collapse of vertebral bodies Demineralization of the spinal cord Wear and tear of the spinous processes Bulging of the spinal cord from the vertebra

Collapse of vertebral bodies Rationale Osteoporotic vertebrae collapse under the weight of the upper body or by improper or rapid turning, reaching, or lifting. Bones, not the spinal cord, demineralize in osteoporosis. Wearing and tearing of the spinous processes occur in osteoarthritis. The spinal cord does not bulge; the nucleus pulposus bulges toward the spinal cord.

A nurse is caring for a client who is hospitalized because of injuries sustained in a major automobile collision. As the client is describing the accident to a friend, the client becomes very restless, and pulse and respirations increase sharply. Which factor is most likely related to the client's physical responses? Client's method of seeking sympathy Bleeding from an undiscovered injury Delayed psychological response to trauma Parasympathetic nervous system response to anxiety

Delayed psychological response to trauma Rationale Reliving the experience brings back the feelings, such as anxiety and fear, associated with it; the alterations described reflect sympathetic nervous system activity. There are not enough data present to determine the client's usual method of seeking sympathy. The increased pulse and restlessness may indicate bleeding; however, the other data presented support anxiety. Additional assessment is necessary to confirm bleeding. These changes are indicative of a sympathetic, not a parasympathetic, response.

Which nursing intervention is indicated for aging clients with decreased bone density? Teaching the client isometric exercises Advising the client to take a moist heat shower Providing supportive armchairs to the client Demonstrating weight-bearing exercises to the client

Demonstrating weight-bearing exercises to the client Rationale Decreased bone density leads to osteoporosis; weight-bearing exercises help to build and maintain bone density. Isometric exercises are indicated for clients with muscular atrophy. Clients with cartilaginous degeneration are advised to take moist heat showers to increase blood flow to the region. Correction of posture problems by sitting in a supportive armchair provides support to the bony structures for a client with kyphosis.

The registered nurse is evaluating the actions of a nursing student providing preoperative care to a client scheduled for a kyphoplasty. Which action of the nursing student does the nurse think needs correction? Establishing an intravenous line and taking vital signs Assessing the client's ability to lie prone for at least 1 hour Ensuring that anticoagulants are administered before surgery Ensuring the client's platelet count to be more than 100,000/mm 3

Ensuring that anticoagulants are administered before surgery Rationale A kyphoplasty is a procedure of inserting a small balloon into the fracture site and inflating it to contain the cement and to restore height to the vertebra. Anticoagulants should be discontinued before this procedure. Intravenous lines are established and vital signs are assessed to prevent complications. The client's ability to lie prone for at least 1 hour is assessed before the procedure. The client's coagulation laboratory results are assessed to ensure that platelet count is more than 100,000/mm 3.

A client is admitted to the hospital after falling and fracturing a hip. The primary healthcare provider applies a Buck boot with traction until surgery to replace the head of the femur with a prosthesis can be performed. What action can the nurse take to ensure that the Buck traction is being applied correctly? <p>A client is admitted to the hospital after falling and fracturing a hip. The primary healthcare provider applies a Buck boot with traction until surgery to replace the head of the femur with a prosthesis can be performed. What action can the nurse take to ensure that the Buck traction is being applied correctly?</p> Fit the spreader bar snugly around the foot. Position the boot so it extends 3 inches (7.6 cm) above the ankle. Hang the weight to apply traction, but limit it to 10 lb (4.5 kg). Cover the malleoli with tape to adequately secure the weights to the leg.

Hang the weight to apply traction, but limit it to 10 lb (4.5 kg). Rationale Eight pounds of weight commonly is applied to maintain adequate traction. Weight greater than 5 to 10 lb (2.3 to 4.5 kg) causes excessive tension on the skin, leading to damage. The spreader bar should be wide enough to keep materials away from the malleoli. The Buck boot should extend to the area just below the knee. Tape is unnecessary when a Buck boot is used.

On the third day after surgery for a fractured hip, a client appears angry and extremely restless and says, "I can't stand this another minute. There's a wrinkle in my sheet, and the water in my pitcher is warm." The client changes position frequently and does not maintain eye contact with the nurse. How should the nurse interpret the client's behavior? Severe discomfort in hip Increased levels of anxiety Anger with perceived poor nursing care Frustration with the need for leg abduction

Increased levels of anxiety Rationale When a client is anxious and has a decreased ability to cope, minor environmental irritants are magnified; eye contact is avoided to decrease additional stimuli. Pain is indicated by reports of discomfort, splinting, refusal to move, and alteration in vital signs. If the client is angry, eye contact will be maintained; prolonged eye contact may be used as a form of intimidation or aggression. If there is frustration with the need for leg abduction the client will verbalize about the need to continue the abduction, not about a variety of other annoyances.

A client with a femoral fracture associated with osteomyelitis is immobilized for 3 weeks. The nurse assesses for the development of renal calculi. What is the rationale for the nurse's assessment? The client has more difficulty urinating in a supine position. Lack of weight-bearing activity promotes bone demineralization. Fracture healing requires more calcium, which increases total calcium metabolism.

Lack of weight-bearing activity promotes bone demineralization. Rationale All clients who are confined to bed for any considerable period risk losing calcium from bones. Calcium precipitates in the urine, resulting in formation of calculi. There is no indication that the client's diet has changed. Although the client may have more difficulty urinating in a supine position because of an inability to assume the preferred anatomic position and the emotional effects of using a urinal, it usually does not predispose the client to developing renal calculi. The presence of a healing fracture does not increase total calcium metabolism; however, deposition of bone at the fracture site will be increased.

A registered nurse is teaching isometric exercises to an 80-year-old client. Which age change in the client necessitates the teaching of this exercise? Multiple choice question Kyphotic posture Muscular atrophy Decreased bone density Cartilaginous degeneration

Muscular atrophy Isometric exercises that increase muscle strength are indicated in older clients with muscular atrophy. Clients with kyphotic posture are taught exercises to maintain body mechanics. Clients with decreased bone density are taught weight-bearing exercises and safety tips to prevent falls. Clients with cartilaginous degeneration are advised to take moist heat showers because they increase blood flow to the region.

Which is the first line treatment for Paget disease? Multiple choice question Oral alendronate 1500 mg of calcium Intravenous pamidronate Intravenous zoledronic acid

Oral alendronate Oral alendronate, a bisphosphonate, is the first line treatment for Paget disease. 1500 mg of calcium is given as a supplement to reduce the risk for hypocalcemia. When oral drugs are not effective, pamidronate and zoledronic acid are administered intravenously.

A client's laboratory findings showed increase in serum alkaline phosphatase and urinary hydroxyproline levels. Which condition will the nurse most likely observe in the client's electronic medical chart? Osteomalacia Osteoporosis Osteomyelitis Osteitis deformans

Osteitis deformans Rationale In osteitis deformans, or Paget's disease, there will be an increase in serum alkaline phosphatase and urinary hydroxyproline levels. In osteomalacia, a decrease in vitamin D, calcium, and phosphorous levels is observed. In osteoporosis, there will be a decrease in calcium level and vitamin D; the alkaline phosphatase level is usually normal. Osteomyelitis is a bone infection in which there is an increase in white blood cell count and a blood culture test is performed to identify the infectious organism.

The registered nurse is evaluating the actions of a nursing student who is providing emergency care to a client with an extremity fracture. Which action of the nursing student does the registered nurse think needs a correction? Keeping the client warm Removing the shoes of the client Immobilizing the affected extremity Allowing the client to lie in supine position

Removing the shoes of the client Rationale A client with an extremity fracture has severe pain in the affected area. The client's shoes should not be removed because doing so can increase trauma in the client. The client with an extremity fracture should be kept warm and comfortable. The affected extremity should be immobilized to prevent further damage. The client with an extremity fracture should be allowed to lie in a supine position because this provides comfort.

The nurse is caring for a client 1 week after a client had an above-the-knee amputation. To control edema of the residual limb, the nurse should plan to take which action? Administer a diuretic as needed. Restrict the client's oral fluid intake. Rewrap the elastic bandage as necessary. Keep the residual limb elevated on a pillow.

Rewrap the elastic bandage as necessary. Rationale Elastic bandages compress the residual limb, preventing edema and promoting residual limb shrinkage and molding; the bandage must be rewrapped when it loosens. Administering a diuretic as needed and restricting the client's oral intake have a systemic effect on fluid balance; edema of the residual limb is a localized response to inflammation. Prolonged elevation of the residual extremity can lead to a flexion contracture of the hip.

The nurse is caring for a client who has undergone a total hip replacement. The nurse recognizes which clinical manifestations that indicate a pulmonary embolism? Select all that apply. Sudden chest pain Flushing of the face Elevation of temperature Abrupt onset of shortness of breath Pain rating increase from 2 to 8 in the hip

Sudden chest pain Abrupt onset of shortness of breath Rationale Sudden chest pain is caused by decreased oxygenation to pulmonary tissues. Because capillary perfusion is blocked by the pulmonary embolus, oxygen saturation drops and the client experiences shortness of breath, dyspnea, and tachypnea. Flushing of the face and fever are not classic signs of pulmonary embolus. The pain associated with pulmonary embolus generally is sudden in onset, severe, and located in the chest, not the hip.

The nurse is making rounds and stops to check a client who has had a total hip arthroplasty. Which action by the unlicensed assistive personnel (UAP) ([continuing care assistant (CCA]) will cause the nurse to intervene? The client's heels are kept off the bed. The UAP (CCA) elevates the client's affected leg on a pillow. The UAP (CCA) uses a pillow to keep the client's legs abducted. The client uses a walker when ambulating with the UAP (CCA).

The UAP (CCA) elevates the client's affected leg on a pillow. Rationale Using a pillow to elevate the affected leg would cause flexion of the hip, which is to be avoided; the nurse should intervene to correct this behavior. Keeping the heels off the bed is an important measure to prevent skin breakdown. The abduction pillow promotes proper position of the prosthesis and helps to prevent dislocation. Use of a walker is important to assist with ambulation and promote safety.

An x-ray film of a client's arm reveals a comminuted fracture of the radial bone. When determining an appropriate plan of care, the nurse considers that a comminuted fracture has what characteristics? Bone protrudes through a break in the skin. The bone has broken into several fragments, and the skin is intact. The bone is broken into two parts, and the skin may or may not be broken. Splintering has occurred on one side of the bone and bending on the other.

The bone has broken into several fragments, and the skin is intact. Rationale In a comminuted fracture, the bone is fragmented. When the bone protrudes through a break in the skin it is a compound fracture. When the bone is broken into two parts and the skin may or may not be broken it is a complete fracture. When splintering has occurred on one side of the bone and bending on the other it is a greenstick fracture.

Shoulder immobilization is prescribed after surgical repair of a client's rotator cuff. Which criterion should the nurse use to determine that appropriate alignment is achieved by the immobilizer device? Forearm moves freely. Upper arm is in abduction. Hand is lower than the elbow. Upper arm lies close to the chest.

Upper arm lies close to the chest. Rationale A shoulder immobilization device supports the upper arm in adduction, with the elbow bent to minimize tension in the operative area. The forearm is supported with the hand and elbow level to each other. There is limited motion in the forearm with a shoulder immobilization device in place. The upper arm is in adduction, not abduction. The forearm is kept horizontal, with the hand and elbow level to each other to prevent dependent edema.

A client with rheumatoid arthritis calls the outpatient clinic to report that pain with exercising has increased. What should the nurse suggest to the client to decrease pain? "For morning stiffness, take a tub bath rather than a hot shower." "Apply an ice pack directly to the involved joint for no more than 20 minutes at a time." "Decrease the number of repetitions of the exercises." "Cease exercising for a day."

"Decrease the number of repetitions of the exercises." Rationale Exercise should be performed to tolerance only; limiting the amount of exercise should decrease pain. To relax the joints, the client should take a hot shower versus a tub bath. Furthermore, it will be difficult for a client with stiff joints to get into a typical bathtub. Ice should never be placed against the skin without a layer of protection; further damage or frostbite could occur. Ceasing exercise for a day will increase stiffness.

A client with a fracture is found to have compartment syndrome. Which interventions will be contraindicated? Multiple selection question Splitting the cast in half Applying cold compresses Reducing the traction weight Loosening the client's bandage Elevating the extremity above heart level

-Elevating the extremity above heart level -Applying cold compresses Cold compresses and elevating above the heart level are contraindicated for compartment syndrome. Compartment syndrome is a condition in which swelling and increased pressure within a limited space (a compartment) press on and compromise the function of blood vessels, nerves, and tendons that run through that compartment. Application of cold compresses could result in vasoconstriction and exacerbate compartment syndrome. Elevating the extremity above heart level could lower venous pressure and slow arterial perfusion. Splitting the cast in half decreases pressure and is beneficial in treating compartment syndrome. Reducing traction weight is beneficial because it decreases external circumferential pressure. Loosening the bandage is beneficial because it decreases pressure.

Identify abnormal assessmenthe t findings in client's musculoskeletal system. Multiple selection question Joint crepitation Muscular atrophy Muscle strength of 5 Tenderness of the spine Full range of motion in joints

-Joint crepitation -Muscular atrophy -Tenderness of the spine Crepitation, a cracking and popping sound of the joint, is not a normal assessment finding. Muscular atrophy, wasting of the muscle, is also an abnormal finding. Spine tenderness on palpation of spine, joints, or muscles is not a normal finding on physical assessment of the musculoskeletal system. Muscle strength of 5 indicates active movement of the muscle against full resistance without evident fatigue, or normal muscle strength. Full range of motion in the joints is a normal finding.

A client diagnosed with Paget's disease is prescribed zoledronic acid. Which assessments should be performed before initiating therapy? . Multiple selection question Serum calcium Serum creatinine Liver function tests Dental examination Serum alkaline phosphatase

-Serum creatinine -Dental examination Zoledronic acid causes renal insufficiency, so serum creatinine levels are measured before initiating therapy. Dental examination should be performed before initiating drug therapy as this drug can cause jaw or maxillary osteonecrosis. Serum calcium level should be monitored in clients taking calcium supplementation as this therapy may cause hypercalcemia. Liver function tests are monitored if raloxifene is prescribed as this drug may increase liver enzymes. Serum alkaline phosphatase is measured to diagnose Paget's disease.

A client with terminal bone cancer is to receive 2 mg of hydromorphone intravenously (IV) every 4 hours as needed for severe breakthrough pain. The vial contains 10 mg/mL. When the client reports severe pain, how much solution of hydromorphone should the nurse administer? Record your answer using one decimal place. Include a leading zero if applicable.

0.2 mL

The nurse is providing postoperative care for a college student who has undergone a knee arthroscopy for a tendon repair. The client is scheduled to be discharged in a few hours and plans to return to the college dormitory and spend the weekend there before returning to class in 2 days. What is most important for the nurse to include in the client's discharge plans? Arrange for a taxi to return the client to the dormitory. Instruct the client to restrict activities for at least several days. Suggest the client spend the weekend in a motel near the hospital. Ask the client who is available in the dormitory to provide assistance.

Ask the client who is available in the dormitory to provide assistance. Rationale Before discharge, the nurse should ensure that a responsible person is available to assist the client if needed. Calling a taxi to take the client to the dormitory without a plan for follow-up care is unsafe nursing care. Instruction to restrict activities is inadequate, incomplete nursing care. Suggesting the client spend the weekend in a motel near the hospital is unsafe and may not be feasible or affordable.

Which drug is used in the treatment of a client with intervertebral disc disease? Etidronate Zoledronic acid Cyclobenzaprine Salmon calcitonin

Cyclobenzaprine Rationale Intervertebral disc disease often causes myalgia. Therefore, muscle relaxants, such as cyclobenzaprine, are used in its treatment. Etidronate, zoledronic acid, and salmon calcitonin are effective in the treatment of osteoporosis.

The medical history of a client with osteoporosis indicates renal calculi. Which medication would be contraindicated? Os-cal Raloxifene Ibandronate Zoledronic acid

Os-cal Rationale Os-cal (a calcium supplement) should not be prescribed to a client with osteoporosis with a history of urinary stones. Raloxifene may increase liver function test values and worsen hepatic disease. Ibandronate should not be prescribed to clients with gastric problems because of the risks of esophagitis and gastric ulcers. Zoledronic acid should not be prescribed to clients with poor oral hygiene because the medication may cause maxillary osteonecrosis.

In which part of the client's body is the amphiarthroidial joint located? Multiple choice question Pelvis Elbow Cranium Shoulder

Pelvis Amphiarthrodial joints are slightly movable joints located in the pelvis. The elbow joint is freely movable; it is referred to as a diarthrodial joint. The joint at the cranium is an immovable synarthrodial joint. The shoulder joint is movable (ball and socket) and is referred to as a diarthrodial joint.

A client who has degenerative joint disease of the vertebral column is taught to turn from the back to the side, while keeping the spine straight. In addition to crossing an arm over the chest, what should the nurse instruct the client to do? "Pull yourself to one side by using the night table." "Bend your top knee to the side to which you are turning." "Turn with both legs straight while your ankles are crossed." "Flex your bottom knee to the side to which you wish to turn."

"Bend your top knee to the side to which you are turning." Rationale Putting the upper arm and leg toward the side to which the client is turning uses body weight to facilitate turning; the spine is kept straight. Telling the client to pull to one side by using the night table is unsafe and will result in twisting of the spinal column. Turning with both legs straight while the ankles are crossed can be done if another person is turning the client; when turning alone in this position, the client will have no leverage, and turning probably will result in twisting of the spinal column. Flexing the bottom knee to the side to which the client wishes to turn will interfere with turning, because the bent leg becomes an obstacle and provides a force opposite to the leverage needed to turn.

A client is admitted to the hospital with lower back pain and a tentative diagnosis of a herniated nucleus pulposus. When assessing the client's back pain, which question should the nurse ask? "Is there any tenderness in the calf of your leg?" "Have you had any burning sensation on urination?" "Do you have any increase in pain during bowel movements?" "Does the pain progress from your flank around to your groin?"

"Do you have any increase in pain during bowel movements?" Rationale Using the Valsalva maneuver during defecation raises cerebrospinal fluid pressure, thereby causing pain for a client with a herniated nucleus pulposus. Calf tenderness is associated with thrombophlebitis. Dysuria is associated with urinary problems. Pain progressing from the flank around to the groin is not associated with intervertebral disk problems.

After teaching, the nurse is evaluating the statements of a client about intranasal use of calcitonin. Which statement made by the client indicates effective learning? "I should expect some nausea." "I should stop the medication if the symptoms subside." "I should not take calcium supplements when taking calcitonin." "I should not spray the medication into the same nostril on 2 consecutive days."

"I should not spray the medication into the same nostril on 2 consecutive days." Rationale Clients using a nasal form of calcitonin should spray the medication daily into alternate nostrils. Therefore the client's statement that the medication should not be sprayed into the same nostril on 2 consecutive days indicates effective learning. Nausea does not occur with the nasal spray. The spray should be used as directed and should not be stopped without informing the primary healthcare provider. Calcium supplements should be taken during the course of the therapy to prevent secondary hyperparathyroidism.

A registered nurse teaches a client about magnetic resonance imaging to diagnose osteomyelitis. Which statement made by the client indicates the need for further education? "I expect no pain from the procedure." "I can take an anti-anxiety agent if needed." "I should remain still throughout the procedure." "I will hear loud noises and alarms."

"I will hear loud noises and alarms." Rationale The nurse should explain to the client that the machine will make loud tapping noises intermittently; alarms will not go off during this procedure so the nurse needs to correct this misinformation. All the other statements are correct, and the client will need no further education. The procedure is painless. The client can take anti-anxiety agents if indicated. The client must remain still throughout the procedure.

A nurse develops a teaching plan for a client with rheumatoid arthritis. What should the nurse include in the plan about ways to reduce joint stress? "If experiencing pain after 1 to 2 hours of activity, actively take measures to address the pain." "When performing day-to-day tasks, use smaller muscles more frequently than large muscles." " Schedule all of the heavy tasks at one time, and then schedule a long rest period." "When the joints are swollen, an increase in exercise will help reduce swelling."

"If experiencing pain after 1 to 2 hours of activity, actively take measures to address the pain." Rationale Addressing and managing joint pain protects the joints, especially if the pain lasts more than 1 or 2 hours after a particular activity. The client should use large muscles, such as pushing doors open with arms rather than fingers. Doing heavy tasks at one time will increase joint stress; heavy and light tasks should be alternated. When the inflammatory process is active, the joint should be at rest as much as possible.

A 76-year-old male client asks the nurse about the chances of getting osteoporosis like his wife. Which is the best response by the nurse? "This is only a problem for women." "Exercise is a good way to prevent this problem." "You are not at risk because of your small frame." "You might think about having a bone density test."

"You might think about having a bone density test." Rationale Osteoporosis is not restricted to women; it is a potential major health problem of all older adults. Estimates indicate that half of all women have at least one osteoporotic fracture, and the risk in men is estimated between 13% and 25%; a bone mineral density (BMD) measurement assesses the mass of bone per unit volume or how tightly the bone is packed. Osteoporosis also can occur in men. Exercise may decrease the occurrence of, but will not prevent, osteoporosis; a regimen including weight-bearing exercises is advised. A small frame is a risk factor for osteoporosis.

A nurse is caring for a client who had an open reduction and internal fixation of a femoral neck fracture. The client has a prescription for ambulation with slight weight bearing on the affected extremity. During the physical assessment the nurse identifies that the client has kyphosis and strong upper arm strength. What assistive device does the nurse expect the primary healthcare provider to prescribe for this client? Crutches Quad cane Straight cane A standard walker

A standard walker A standard walker can be used by a client with partial weight bearing who has enough upper body strength to lift and move the walker forward. A standard walker with rubber tips is designed for those who need more support than a cane. Kyphosis is an exaggerated angulation of the posterior curve of the thoracic spine; it alters the client's center of gravity, making the use of crutches unsafe. A quad cane requires weight bearing on both legs. Partial weight bearing means that the client may put minimal weight on the affected extremity. A straight cane requires weight bearing on both legs.

A client reports pain in the posterior part of the leg while walking that worsens upon rest. Which musculoskeletal abnormality is present in the client? Crepitus Ankylosis Contracture Achilles tendonitis

Achilles tendonitis Rationale The Achilles tendon attaches the calf muscle to the heel. An inflammation to the Achilles tendon, Achilles tendonitis, may lead to pain in the posterior leg upon movement that worsens at rest. A frequent, audible crackling sound with palpable grating that accompanies movement is crepitus. Chronic joint inflammation and destruction resulting in stiffness is ankylosis. A contracture is a condition in which the muscles and joints become rigid due to fibrosis of the supporting soft tissues.

A nurse records a 3 for a client during an assessment of muscle strength. According to the muscle strength scale, what does a score of 3 indicate in the client? Absence of muscular contraction Active movement against full resistance Barely detectable contraction with palpation Active movement against gravity only, and not against resistance

Active movement against gravity only, and not against resistance Rationale The muscle-strength test is useful to grade the strength of a client's muscles during contraction. The presence of active movement against gravity and not against resistance receives a score of 3 as per the muscle-strength scale. The complete absence of muscular contraction is scored as 0. The active movement against full resistance without evident fatigue indicates normal muscle strength and is scored as 5. Barely detectable contraction indicates weak muscle tone and is scored as 1.

The nurse is caring for a client 4 hours after the client's hip replacement surgery. What should the nurse do when assisting the client out of bed? Tell the client that both legs must have equal weight bearing. Advise the client that the legs must continually be kept wide apart. Sit the client in a straight-back chair so that the hips are kept flexed. Transfer the client using a mechanical lift, because weight bearing on the leg is not allowed.

Advise the client that the legs must continually be kept wide apart. Rationale Abduction keeps the prosthesis firmly in place; adduction of the extremity may cause the prosthesis to dislocate. Only partial weight bearing on the affected leg is indicated initially. Sitting flexes the hips to 90 degrees; this is contraindicated initially, because it can cause the prosthesis to dislocate. Full weight bearing on the unaffected leg and partial weight bearing on the affected leg generally are permitted on the second or third postoperative day.

Nursing care of a client with a fractured hip should include the assessment of pedal pulses. The nurse should assess for which important characteristics of the pedal pulses? Contractility and rate Color of skin and rhythm Amplitude and symmetry Local temperature and visible pulsations

Amplitude and symmetry Rationale Assessment of the pedal pulse should include the strength of the pulse (amplitude). Symmetry, the correspondence of homologous parts on opposite sides of the body, indicates whether the pulses are equal. Contractility is not a characteristic of a pulse but of the heart; rate is not measured with pedal pulses. Color of skin is not a pulse characteristic; rhythm is important but symmetry and strength are more important. Local temperature is not a characteristic of the pedal pulse; pulsations are not visible in pedal pulses.

The nurse is getting a client out of bed to the chair for the first time since surgery 2 days ago. What assessment should the nurse should make first before moving the client? Assessment of appropriate foot wear Assessment of comfort and pain Assessment of wound and skin Assessment of urinary catheter

Assessment of comfort and pain Rationale Pain and comfort have to be assessed first before beginning to transfer the client. Assessment of foot wear, wound assessment, and catheter assessment are important after pain has been assessed and treated, if needed.

A spouse spends most of the day with a client who is receiving chemotherapy for inoperable bone cancer. The spouse asks the nurse, "What can I do to help?" How can the nurse best support the client's spouse? Assist the couple to maintain open communication. Offer the couple a description of the disease process. Instruct the spouse about the action of the medications. Meet privately with the spouse to explore personal feelings.

Assist the couple to maintain open communication. Rationale Clients and their families need to maintain honest, open interpersonal communication so that concerns can be shared and future problems addressed. Although an understanding of the disease is important, details will not assist the significant other in maintaining an active, caring role. The spouse may want to know about the action of the medications, but it will not help meet the needs of both the spouse and the client. Although the nurse may meet privately with the spouse to explore feelings, this does not address the spouse's immediate concern.

The nurse teaches a client who developed degenerative joint disease of the vertebral column positioning techniques, including turning from back to side, keeping the spine straight. The nurse explains that the least effort will be exerted if the client crosses the arm over the chest and does what? Uses the overbed table to pull the upper body up to assist with turning Bends the top knee to the side to which the client is turning Crosses the ankles while turning and keeps both legs straight Flexes the bottom knee to the side to which the client wishes to turn

Bends the top knee to the side to which the client is turning Rationale Putting the upper arm and leg toward the side to which the client is turning uses body weight to facilitate turning; the spine is kept straight. Using the overbed table to pull up will result in twisting the spinal column. This is unsafe; an overbed table has wheels and is not a stable object. Crossing the ankles while turning with both legs straight can be done if another person is turning the client; when turning alone in this position, the client will have no leverage and turning probably will result in twisting the spinal column. Flexing the bottom knee to the side to which the client wishes to turn will interfere with turning, because the bent leg becomes an obstacle and provides a force opposite to the leverage needed to turn.

Which medications are useful to relieve pain associated with muscle spasms? Cefazolin Carisoprodol Fondaparinux Methocarbamol Cyclobenzaprine

Carisoprodol Methocarbamol Cyclobenzaprine Rationale Central and peripheral muscle relaxants such as carisoprodol, methocarbamol, and cyclobenzaprine are used to reduce muscle spasm pain. Cefazolin is a bone-penetrating antibiotic used prophylactically before surgery. Fondaparinux is a low molecular weight heparin used to prevent venous thromboembolism (VTE) in client scheduled for orthopedic surgery.

A client who has an above-the-knee amputation (AKA) reports phantom limb sensations. What should the nurse do? Reassure the client that these sensations will pass. Explain the psychological component involved to the client. Encourage the client to get involved in diversional activities. Describe the neurologic mechanisms in language that the client understands. Rationale Explanation of the underlying mechanism usually helps calm anxiety about a phantom pain experience. Reassuring the client that these sensations will pass is false reassurance, because phantom limb sensations may not disappear. Explaining the psychological component involved to the client reinforces the idea that there is something psychologically wrong with the client. Encouraging the client to get involved in diversional activities may distract the client but does not foster awareness of the cause.

Describe the neurologic mechanisms in language that the client understands. Rationale Explanation of the underlying mechanism usually helps calm anxiety about a phantom pain experience. Reassuring the client that these sensations will pass is false reassurance, because phantom limb sensations may not disappear. Explaining the psychological component involved to the client reinforces the idea that there is something psychologically wrong with the client. Encouraging the client to get involved in diversional activities may distract the client but does not foster awareness of the cause.

A nurse is determining which tasks to delegate. Which actions should a registered nurse perform while caring for a client in traction? Padding traction connections Determining correct body alignment Assessing complications associated with immobility Teaching the client about range-of-motion (ROM) exercises Assisting the client with passive and active range-of-motion (ROM) exercises

Determining correct body alignment Assessing complications associated with immobility Teaching the client about range-of-motion (ROM) exercises Rationale The registered nurse (RN) has to assure that the client is in proper body alignment to maintain effectiveness of the traction. It is the responsibility of the RN to assess for complications associated with immobility such as wound infection, constipation, and deep vein thrombosis. The RN has to teach the client about range-of-motion (ROM) exercises to help foster faster recovery. The licensed practical nurse (LPN) should pad the traction connections to prevent skin irritation. Unlicensed assistive personnel (UAP) should assist the client with passive and active ROM exercises as directed by the RN.

What should a nurse assess after applying a body jacket brace to a client with severe spine injuries following a car accident? Pin sites Development of cast syndrome Signs of compartment syndrome Abdomen for decreased bowel sounds Areas of pressure over the bony prominences

Development of cast syndrome Abdomen for decreased bowel sounds Areas of pressure over the bony prominences Rationale A client with a severe spine injury due to an accident would benefit from application of a body jacket brace, which immobilizes and supports the thoracic and lumbar spine. After application of the brace, the nurse should assess the client for the development of cast syndrome. This condition occurs when a brace is tightly applied, compressing the superior mesenteric artery against the duodenum. A window in the brace may be left over the umbilicus. The nurse should monitor the reduction in bowel sounds to prevent abdominal pressure and pain. The nurse should assess the areas of pressure over the bony prominences such as the iliac crest and then adjust or remove the brace based upon any complications. A client with an external fixator will need pin sites assessed. A client with a lower extremity cast must regularly be assessed for signs of compartment syndrome and increased pressure at the heel, anterior tibia, head of the fibula, and malleoli.

A peripheral nerve or dorsal column stimulator is implanted to relieve a client's intractable pain. What discharge instructions should the nurse provide? Multiple choice question Disconnect the transmitter when taking a bath. Analgesics will no longer be necessary. The transmitter will be implanted and, therefore, not visible. The transmitter will interfere with electronic devices.

Disconnect the transmitter when taking a bath. Clients may bathe when the transmitter is disconnected. The client may need analgesics in conjunction with the transmitter. Electrodes are attached to sensory nerves or over the dorsal column; a transmitter is worn externally and, by electric stimulation, may be used to interfere with the transmission of painful stimuli as needed. The transmitter should not interfere with other electronic devices.

A client with rheumatoid arthritis arrives in the clinic stating, "I don't take any medications because they are too expensive." The client reports that family members are arranging for the medications to be obtained from another country. What is the nurse's best response? Discuss alternative solutions with the client. Encourage the client to use any method possible to obtain the medications. Contact the primary healthcare provider immediately to discuss the client's plan. Explain that medical regimens must be followed to continue to receive care in the clinic.

Discuss alternative solutions with the client. Rationale The nurse should discuss alternatives in terms of funding, such as Medicaid, research projects, and special aid. Standards outside the United States may be different, and purchasing medications in another country should not be encouraged. Eventually, the primary healthcare provider may be notified of this situation, but this is not the initial intervention. Explaining that medical regimens must be followed to remain in the clinic is a threatening comment; the nurse should be the client's advocate in this situation.

A client sustains a fracture of the femur after jumping from the second story of a building during a fire. The client is placed in Buck traction until an open reduction and internal fixation is performed. The client keeps slipping down in bed. What should the nurse do to alleviate this problem? Elevate the foot of the bed. Shorten the rope on the weights. Release the traction so the client can be repositioned. Move the client toward the head of the bed every couple of hours.

Elevate the foot of the bed. Rationale Elevating the foot of the bed provides slight countertraction, which will prevent sliding down in bed. Shorting the rope on the weights will have no effect. Releasing the traction so the client can be repositioned is unsafe; an interruption in the traction may result in disruption of bone alignment. Moving the client toward the head of the bed every couple of hours will not alleviate the cause of the problem, and it may be necessary more often than every couple of hours.

What should the nurse do to prevent deformities of the knee in a client with an exacerbation of arthritis? Encourage motion of the joint. Maintain a knee brace on the leg. Keep the client on a regimen of bed rest. Maintain joints in functional alignment when resting. Immobilize the joint with pillows until pain subsides.

Encourage motion of the joint. Maintain joints in functional alignment when resting. Rationale Exercise of involved joints is important to maintain optimal mobility and prevent buildup of calcium deposits. Functional alignment places the least strain on joints, muscles, and tendons. Immobilization causes loss of joint mobility and contractures. Immobility promotes the development of contractures. Immobilization with pillows promotes the development of contractures.

A nurse is caring for a client who had a total hip replacement. Which nursing action should be incorporated into the plan of care to prevent thrombus formation? Turning the client from side to side Encouraging the client to perform ankle exercises Elevating the knee gatch to 15 degrees for comfort Getting the client up to sit in a chair for as long as tolerated

Encouraging the client to perform ankle exercises Rationale Ankle movement, particularly dorsiflexion of the foot, allows muscle contraction, which compresses veins, reducing venous stasis and the risk for thrombus formation. Because the client is being turned, the client's muscles are not contracting to compress the veins and prevent venous stasis. The client must be turned at least every 2 hours to help prevent skin breakdown and pneumonia. Elevating the knee gatch will promote thrombus formation. Sitting for long periods is contraindicated, because pressure on the popliteal space and the dependent position of the lower extremities increase venous stasis.

Which assessment finding supports the nurse's conclusion that a prosthesis for a client with an above-the-knee amputation fits correctly? Skin that is cool to the touch Shrinking of the residual limb Absence of phantom limb pain Evenly darkened skin of the residual limb

Evenly darkened skin of the residual limb Rationale Even distribution of hemosiderin (iron-rich pigment) in the tissue in response to pressure of the prosthesis indicates a proper fit. Cool skin may indicate inadequate tissue perfusion, which may be caused by progression of the disease, inadequate wound healing, or excessive pressure from the prosthesis. Shrinking of the residual limb results in an improper fit. Absence of phantom limb pain is unrelated to a proper fit.

After reviewing the laboratory reports of a client with a severe joint injury, the nurse suspects fat embolism syndrome (FES). Which findings support the nurse's suspicion? Select all that apply. Fat cells in the urine PaO 2 value of 58 mm Hg (7.73 kPa) Hematocrit value of 30% (0.30) Platelet count of 160,000/µL (160 x 10 9/L) Prothrombin time of 12 seconds

Fat cells in the urine PaO 2 value of 58 mm Hg (7.73 kPa) Hematocrit value of 30% (0.30) Rationale Fat cells in the urine, PaO 2 of 58 mm Hg (7.73 kPa), and hematocrit of 30% (0.30) are all indicative of fat embolism syndrome (FES). FES is characterized by the presence of systemic fat globules, which are distributed into tissues and organs after a traumatic skeletal injury. The presence of fat cells in the urine indicates FES. Fat emboli in the lungs cause a hemorrhagic interstitial pneumonitis that produces signs and symptoms of acute respiratory distress syndrome (ARDS) and decreased partial pressure of arterial oxygen. The normal partial pressure of arterial oxygen is 80 to 100 mm Hg (10.6-13.33 kPa). The normal hematocrit value is 40% to 50% (0.40-0.50). Poor oxygen exchange decreases the hematocrit value in a client with FES. The normal platelet count is in the range of 150,000 to 450,000 platelets per µL of blood (150-450 x 10 9/L). The platelet count is decreased in FES. A platelet count of 160,000/µL (160 x 10 9/L) is a normal finding. Normal prothrombin time is in the range of 12 to 13 seconds. Prothrombin time is prolonged in FES, but a prothrombin time of 12 seconds is normal.

The nurse is caring for a client who is wearing a prosthesis after a single-leg amputation three months ago. Which crutch gait should the nurse teach the client to use? Tripod Four-point Three-point Swing-through

Four-point Rationale A four-point gait provides for weight bearing on all points that touch the floor and maximum support during ambulation. A tripod is for clients learning to do a swing-to gait pattern. A three-point gait is used when one extremity cannot bear weight. A swing-through gait does not simulate ambulation; it is used when the individual can bear weight but lacks the muscular control needed for ambulation without an assistive device.

A nurse is caring for a client who had an above-the-knee amputation. In what position should the nurse encourage the client to keep the hip to promote early and efficient ambulation? Functional alignment Extended and abducted Flexed and externally rotated Raised when moving the residual limb

Functional alignment Rationale Muscles that originate at the vertebrae or pelvic girdle and insert on the femur act to abduct, adduct, flex, extend, and rotate the femur. Functional body alignment should be maintained, because it facilitates safe and efficient use of muscle groups for balance and stability. Abduction of the residual limb will alter the center of gravity, which results in an unsteady gait. Hip flexion may contribute to a contracture; this will interfere with the ability to wear a prosthesis, which is necessary for nonassisted ambulation. External rotation does not promote functional alignment, which is needed for ambulation. Keeping the hip raised when moving the residual limb results in an unsteady gait. Muscles that originate at the vertebrae and pelvic girdle should be used to move the residual limb.

A client with a fractured hip is helped from the bed to a chair after surgery. The nurse instructs the client to bear most of the weight on the unaffected leg before sitting in a chair. What should the nurse explain that the benefit of bearing most of the weight on the unaffected leg is? Increasing circulation in the lower extremities Helping maintain the strength of the unaffected limb Providing the quickest method of getting the client to and from the bed Reducing the amount of help necessary to lift the client from the bed to the chair

Helping maintain the strength of the unaffected limb Rationale Weight bearing on the uninvolved leg helps maintain its muscle tone while limiting the stress on the involved extremity. When the legs are in a dependent position, venous return is reduced. Speed is not important when moving a client from the bed to a chair. Reducing the amount of help necessary to lift the client from the bed to the chair is an unacceptable rationale for care.

A client is admitted with a fracture of the neck of the femur. In what position should the nurse maintain the client's affected extremity? Internal rotation with flexion of the knee and hip External rotation with flexion of the knee and hip Internal rotation with extension of the knee and hip External rotation with extension of the knee and hip

Internal rotation with extension of the knee and hip Rationale A fracture in the neck of the femur will cause shortening of the femur and external rotation. To correct this misalignment, the client's leg should be extended and maintained in slight internal rotation. To reduce the fracture, it is necessary to maintain the leg in extension, counteracting the contraction of the quadriceps that may cause overriding of bone fragments. External rotation of the thigh as a result of muscle contraction tends to misalign the bone fragments; therefore, slight internal rotation or functional alignment is preferred.

A nurse is caring for a client who developed aseptic necrosis after a fracture of the head of the femur. The nurse prepares to administer care based on which factor? Infection at the site of the wound Weight-bearing before the fracture is healed Immobilization after reduction of the fracture Loss of blood supply to the head of the femur

Loss of blood supply to the head of the femur Rationale After a fracture, if blood supply is cut off or impaired, necrosis of the bone may occur from lack of oxygen and nutrient perfusion. The word aseptic indicates that infection is not present. Early weight-bearing at the fracture site may result in trauma to the bone; circulation is not impaired. Immobilization does not cut off circulation to the bone; it may cause contractures.

After an above-the-knee amputation of a right leg, a client reports pain in the right foot. The nurse should inform the client that phantom limb pain is the result of what? Tactile illusions associated with severed blood vessels Nerve endings in the limb that are still intact and react to stimuli An unconscious phenomenon to aid with grieving over the lost body part Hallucinations secondary to emotional symptoms associated with the distress of amputation

Nerve endings in the limb that are still intact and react to stimuli Rationale The neural endings that innervated the limb are still intact and may be stimulated (e.g., touch, environmental temperature, barometric pressure changes) within the residual limb. Severed blood vessels are not involved in phantom limb sensation. Although an individual must grieve over a lost body part, the grieving is unrelated to phantom limb sensation. Although phantom limb sensation is a hallucinatory-type experience, it is not part of a psychotic process.

As an acute episode of rheumatoid arthritis subsides, active and passive range-of-motion exercises are taught to the client's spouse. The nurse should teach that direct pressure should not be applied to the client's joints, because this may precipitate what? Pain Swelling Nodule formation Tophaceous deposits

Pain Rationale Palpation will elicit tenderness, because pressure stimulates nerve endings and causes pain. Pressure will not increase the swelling of already swollen joints. Nodules associated with rheumatoid arthritis are not caused by pressure; they occur spontaneously in about 25% of individuals with rheumatoid arthritis and are composed of collagen fibers, exudate, and cellular debris. Tophaceous deposits are present in gout, not rheumatoid arthritis; they are composed of sodium urate.

Considerations when caring for a client with a total hip replacement should include which interventions? Select all that apply. Maintain the affected hip in the adduction position when moving the client out of bed. Pain control should include regularly scheduled analgesics and may necessitate use of as needed medications as well. The client should sit in a chair at the correct height to encourage flexion of the joint. Frequent neurovascular assessment should be done distal to the surgical site and compared with the unaffected side. When turning, the client should be log rolled to prevent the leg from falling forward or backward.

Pain control should include regularly scheduled analgesics and may necessitate use of as needed medications as well. Frequent neurovascular assessment should be done distal to the surgical site and compared with the unaffected side. When turning, the client should be log rolled to prevent the leg from falling forward or backward. Rationale Pain control should include regularly scheduled analgesics, because decreased pain will aid in earlier mobilization. Assessing pain level is standard postoperative care, and pain must be managed accordingly. Frequent neurovascular assessment should be done when assessing vital signs to observe for circulatory compromise. When turning a client after a total hip replacement, the client should have an abductor pillow in place to ensure that the hip does not become adducted. Turning as a whole prevents the leg from moving out of alignment. The affected hip should not be in the adducted position, but rather the abducted position. The client should sit in a chair high enough to minimize flexion of the joint, particularly hyperflexion, which is bending forward more than 90 degrees.

The nurse is caring for a client with a distal femoral shaft fracture. For which clinical indicator unique to a fat embolus should the nurse assess the client? Oliguria Dyspnea Petechiae Confusion

Petechiae Rationale At the time of fracture or orthopedic surgery, fat globules may move from bone marrow into the bloodstream; also, increased catecholamines cause mobilization of fatty acids and the development of fat globules. In addition to obstructing vessels in the lung, brain, and kidneys with systemic embolization from fat globules, petechiae are noted in buccal membranes, conjunctival sacs, hard palate, chest, and anterior axillary folds; these indicators occur only with fat embolism. Oliguria is a clinical finding of an embolus but is not specific to a fat embolus. Dyspnea is not a clinical manifestation of a fat embolus, but an embolus. Confusion is a clinical manifestation of an embolus but is not specific to a fat embolus.

A stationary (nonrolling) walker has been prescribed for a client to aid in ambulation. What should the nurse teach the client to do to use the walker? Place the back legs of the walker about 10 inches (25.4 cm) in front of the feet, shift the body weight to the walker, and step forward. Move the walker about 8 inches (20.3 cm) forward while stepping forward to the walker, with body weight on the walker and both legs. Place the walker flat on the floor with the front legs about 12 inches (30.5 cm) in front of the feet, shift the body weight to the walker, and step forward to take initial steps. Move the walker about 10 inches (25.4 cm) in front of the feet with only the front legs of the walker on the floor, then step forward and put the walker flat.

Place the walker flat on the floor with the front legs about 12 inches (30.5 cm) in front of the feet, shift the body weight to the walker, and step forward to take initial steps. Rationale Placing the walker flat on the floor provides stability; putting weight on the walker equalizes weight bearing on the upper and lower extremities. Placing the back legs of the walker about 10 inches (25.4 cm) in front of the feet, shifting the body weight to the walker, and stepping forward places the walker too far in front of the client for safe transfer of body weight; also, all four legs should be flat on the ground. It is not possible to move the walker and have it bear weight at the same time; the walker should be flat on the ground when the client is stepping forward. All four points of the walker should be flat on the ground when the client is stepping forward.

The nurse is caring for a client who had surgery for a total hip replacement. Which action by the unlicensed assistive personnel (UAP) (continuing care assistant [CCA]) will cause the nurse to follow up? Places the client in supine position Places the client in lateral position Places the client in orthopneic position Places the client in semi-Fowler position

Places the client in orthopneic position Rationale The orthopneic position involves hip flexion greater than 90 degrees and requires the nurse to correct this behavior. This puts stress on the operative site and may dislodge the prosthesis. The supine, lateral, and semi-Fowler positions are acceptable, because little stress is placed on the operative site.

A primary healthcare provider schedules a bone scan for a client with osteoporosis. Which nursing actions are beneficial for the client? Placing the client in the supine position Verifying if the client has a shellfish allergy Ensuring that the client has no metal on the clothing Instructing the client to empty the bladder before the scan Informing the client that the postprocedure headache resolves in 2 days

Placing the client in the supine position Instructing the client to empty the bladder before the scan Rationale A bone scan is done to assess osteomyelitis, osteoporosis, primary and metastatic malignant lesions of bone, and certain fractures. The nurse has to place that client in the supine position for one hour for easy assessment while performing the bone scan. The nurse should instruct the client to empty the bladder before scanning. The client undergoing a computed tomography (CT) scan must be screened for a shellfish allergy to reduce the incidences of anaphylactic shock associated with the radiocontrast agent. Radio waves and a magnetic field are used during magnetic resonance imaging (MRI); therefore, the nurse should ensure that the client has no metal on the clothing before the procedure. The main risk of a myelogram is a spinal headache that usually resolves within 2 days of the procedure.

A client refuses to go to the twice-a-day prescribed sessions in physical therapy. How might the nurse best approach this problem? Having the client observe the progress of a more cooperative client with the same problem Being the client's advocate and asking the primary healthcare provider whether therapy can be decreased to once daily Ensuring that pain medication is administered to the client before the scheduled physical therapy sessions Planning a conference with the client, the physical therapist, and the nurse present to discuss the client's feelings

Planning a conference with the client, the physical therapist, and the nurse present to discuss the client's feelings Rationale Planning a conference with the client, the physical therapist, and the nurse present to discuss the client's feelings includes the client in the problem-solving process. Having the client observe the progress of a more cooperative client with the same problem, being the client's advocate and asking the primary healthcare provider whether therapy can be decreased to once daily, and ensuring that pain medication is administered to the client before the scheduled physical therapy sessions do not include the client in the problem-solving process; more data should be obtained from the client before deciding on an intervention, which may or may not be appropriate.

A client's laboratory report shows aldolase (ALD) as 9 units/dL. Which diseases may occur in the client? Select all that apply. Polymyositis Osteoporosis Muscle trauma Dermatomyositis Muscular dystrophy Metastatic cancers of the bone

Polymyositis Dermatomyositis Muscular dystrophy Rationale Polymyositis, dermatomyositis, and muscular dystrophy may occur due to the elevated levels of ALD. Note that the normal ALD levels range from 3 to 8.2 units/dL. Osteoporosis may occur due to elevated serum calcium. Muscle trauma may occur due to high levels of serum creatinine kinase. Metastatic cancers of the bone may occur due to high levels of alkaline phosphatase.

The nurse is caring for a client who may have Paget's disease and osteomalacia. Which laboratory tests can be conducted to confirm the nurse's suspicion? Aldolase Serum calcium Alkaline phosphatase Lactic dehydrogenase Aspartate aminotransferase

Serum calcium Alkaline phosphatase Rationale Serum calcium and alkaline phosphate tests are used for musculoskeletal assessment. Elevated levels of serum calcium and alkaline phosphate are symptoms of Paget's disease and osteomalacia. Elevated aldolase levels indicate polymyositis, dermatomyositis, and muscular dystrophy. Elevated levels of lactic dehydrogenase levels indicate skeletal muscle necrosis, extensive cancer, and progressive muscular dystrophy. Elevated aspartate aminotransferase levels indicate skeletal muscle trauma and progressive muscular dystrophy.

A client is admitted to the hospital with a diagnosis of a fractured hip after a fall. What clinical finding does the nurse expect to identify when assessing the client? Bruising over the affected hip Pain when moving the affected leg Shortening of the affected extremity Presence of crepitus when the affected leg is moved

Shortening of the affected extremity Rationale Shortening of the affected leg occurs because of the overriding of bone fragments. Crepitus with a fracture indicates grating of bones or entry of air in an open fracture. Although bruising may be present with a fracture because of soft tissue damage sustained during the fall, it is not necessarily present with all fractures of the hip. Pain can be expected because of trauma to bone and soft tissue; however, the affected leg should not be moved because it can cause further damage to nerves and blood vessels. The affected leg should not be moved to elicit crepitus, because it can cause further damage to nerves and blood vessels.

A client who had the left hand amputated after a traumatic injury is being fitted for a permanent prosthesis. What should the nurse teach the client about the most important factor for successful adaptation to the permanent prosthesis? Muscles in the upper arm must be developed. Dexterity in the other extremity must be achieved. Shrinkage of the residual limb must be completed. Adjustment to the altered body image must be accomplished.

Shrinkage of the residual limb must be completed. Rationale Shrinkage of the residual limb, resulting from reduction of subcutaneous fat and interstitial fluid, must occur for an adequate fit between the limb and the prosthesis. Although developed muscles in the upper arm and dexterity in the other extremity are desirable, it is the condition of the residual limb that is the most important factor in the fitting of a prosthesis. The prosthesis probably will facilitate an improved body image.

The nursing student is teaching a client who has undergone hip replacement surgery. Which instructions from the nursing student indicate a need for correction? Sit on chairs without arms. Use an elevated toilet seat. Cross legs at the knees or ankles. Use a pillow between legs for the first 6 weeks. Keep hips in a neutral, straight position when sitting.

Sit on chairs without arms. Cross legs at the knees or ankles. Rationale After hip replacement surgery, the client should not sit on chairs without arms because the client needs aid to rise to a standing position. The client should not cross legs at the ankles and knees because this may lead to severe pain. The client should use an elevated toilet seat for ease and comfort. The client should use a pillow between legs for the first 6 week after surgery to minimize pain and discomfort. The client should keep the hip in a neutral, straight position when sitting to avoid dislocation.

After an open reduction and internal fixation of a fractured hip, what assessments of the client's affected leg should the nurse make? Skin temperature Mobility of the hip Sensation in the toes Condition of the pins Presence of pedal pulse

Skin temperature Sensation in the toes Presence of pedal pulse Rationale Increased skin temperature may indicate the presence of an infection; decreased skin temperature suggests impaired circulation. Sensation in the toes assesses the neural integrity distal to the surgical site. Presence of a pedal pulse assesses the circulatory integrity distal to the surgical site. Flexion and abduction of the hip are contraindicated because they may dislodge the head of the femur from the acetabulum. No external pins are present with an internal fixation.

A client who has passed the acute phase of rheumatoid arthritis is permitted to be out of bed as tolerated. After assisting the client out of bed, where should the nurse place the client? Low, soft lounge chair Straight-back armchair Wheelchair with footrests Recliner chair with both legs elevated

Straight-back armchair Rationale A straight-back armchair allows the hips and shoulders to be against the back of the chair while fully supporting the thighs. A low, soft lounge chair permits the hips and knees to be flexed greater than 90 degrees, which can cause flexion contractures. The thighs are not fully supported in a wheelchair. A reclining chair with both legs elevated permits the hips to be flexed greater than 90 degrees, which promotes flexion contractures.

The nurse is reviewing a plan of care for a client who has experienced a traumatic amputation of a leg. The nurse recognizes that which intervention listed on the plan is of lowest priority? Teaching residual limb care Monitoring hemoglobin levels Maintaining the compression dressing Using therapeutic interviewing techniques

Teaching residual limb care Rationale Teaching residual limb care is not a priority at this point. The client is too traumatized to learn. It will assume priority as the client's recovery progresses. The nurse must closely monitor the hemoglobin level, because blood loss is a major problem. Maintaining a pressure dressing helps to prevent edema and bleeding and helps to shape the residual limb for a prosthesis. The client has experienced a major life event; the nurse will need to be empathetic and use interviewing skills to encourage expression of feelings.

A nurse administers an estrogen agonist to a client. Which nursing actions would be beneficial? Observing the client for signs of hypercalcemia Ensuring that the client has a dental examination before starting the drug Teaching the client about signs and symptoms of venous thromboembolism (VTE) Monitoring the client's liver function tests (LFTs) in collaboration with the primary healthcare provider Observing the client for central nervous system (CNS) adverse effects, such as drowsiness, anxiety, and agitation

Teaching the client about signs and symptoms of venous thromboembolism (VTE) Monitoring the client's liver function tests (LFTs) in collaboration with the primary healthcare provider Rationale Estrogen agonists may cause adverse effects that result in VTE; the client should be taught about the signs and symptoms of VTE that may occur in the first four months of estrogen agonist therapy. Monitoring LFTs in collaboration with the primary healthcare provider is also beneficial because this action may reduce the risk of hepatic disease. Clients taking calcium supplements should be observed for signs of hypercalcemia. Ensuring that the client has had a dental examination before starting bisphosphonate therapy would avoid jaw or maxillary osteonecrosis. Clients taking bisphosphonates should also be observed for CNS adverse effects, such as drowsiness, anxiety, and agitation.

A client that has a diagnosis of bone cancer is being prepared for the first radiation treatment. As the nurse begins the treatment, the client starts crying, stating, "I'm so discouraged." What is the nurse's best response? Tell the client, "It's difficult to deal with your diagnosis and treatment." Complete the preparation and tell the client, "We can talk about this later." Explain the therapy and reinforce that it will only cause a little discomfort. Allow the client to be alone for a few minutes so the client can regain composure.

Tell the client, "It's difficult to deal with your diagnosis and treatment." Rationale The correct response focuses on the client's feelings of despair and provides the opportunity to talk about them. Leaving the client alone abandons the client and leaves the client with no support. Avoiding a pressing problem misses an opportunity for discussion of feelings. Explaining the therapy and saying it will only cause a little discomfort focuses on the nurse's interpretation of the problem, not the client's.

A nurse is teaching crutch walking to a client who had arthroscopic surgery of the knee. The nurse should instruct the client to place weight on which part of the body? The upper arms The axillary region The palms of the hands Both lower extremities

The palms of the hands Rationale To prevent nerve damage in the axillary area, the palms should bear all the weight. Placing weight on the upper arms is unsafe and almost impossible to perform. Pressure in the axillary area causes nerve damage to the brachial plexus. Weight bearing on the affected lower extremity is initially contraindicated.

A nurse is caring for a client who had an open reduction internal fixation of a fractured hip. Which nursing assessment of the affected leg is most important after this surgery? Femoral pulse Toes for mobility Condition of the pin Range of motion of the knee

Toes for mobility Rationale Monitoring the mobility of the toes assesses neural integrity distal to the surgical site; this is part of a neurovascular assessment. The femoral artery is not assessed, because it is not distal to the surgical site. No pin is present with an open reduction and internal fixation of a fractured hip. An assessment of range of motion of the knee may cause flexion of the hip, which is contraindicated.

What should the nurse do to promote early and efficient ambulation after a client has a mid-thigh amputation? Keep the head of the bed elevated. Place the residual limb on a pillow. Turn the client to the prone position routinely. Encourage the client to lie on the unaffected side.

Turn the client to the prone position routinely. Rationale Flexion contracture of the hip can be prevented by routinely placing the client in a prone position to extend the hip. Lying with the head of the bed elevated does not allow for full extension of the hip. Placing the residual limb on a pillow and encouraging the client to lie on the unaffected side can cause flexion of the hip, which will result in a hip contracture.

A client has recently developed osteomyelitis. The client's laboratory reports show strains of Escherichia coli. What might be a possible reason for this condition? Sickle cell disease Intravenous drug use Urinary tract infections Joint replacements

Urinary tract infections Rationale Urinary tract infections, which can be caused by Escherichia coli, can predispose a client to developing osteomyelitis. Sickle cell disease also predisposes clients to osteomyelitis, but Salmonella is the causative microorganism. Intravenous drug use can predispose a client to osteomyelitis by increasing the risk of Salmonella infections. Insertion of indwelling prosthetic devices such as joint replacements can predispose a client to osteomyelitis by increasing the risk of Staphylococcus epidermidis infection.

What should a nurse explains to a client is the best way to achieve stimulation of calcium deposition in the bone after a distal femoral fracture? Resting the extremity Weight-bearing activity Normal aging processes Ingesting foods high in calcium

Weight-bearing activity Rationale Weight bearing and the use of antigravity muscles stimulate bone formation or osteoblastic function. Resting the extremity will result in bone demineralization, not calcium deposition in the bone. The aging process contributes to a gradual and progressive demineralization of bone. Calcium intake has a relationship to osteoclastic mechanisms in that it inhibits the withdrawal of calcium from bone.

During a follow-up office visit, an older client who has been undergoing treatment for the last 5 months for osteomyelitis notes perianal itching and diarrhea. Which other finding does the nurse correlate with this information? Whitish-yellow lesions in the oral cavity Presence of glucose and ketones in urine Flexion contracture of the lower extremities Overgrowth of genital wart-like lesions

Whitish-yellow lesions in the oral cavity Rationale Whitish-yellow lesions in the oral cavity is correlated to the perianal itching and diarrhea. The antibiotics that are effective against osteomyelitis may be used for as long as 6 months. Long-term antibiotic therapy can result in overgrowth of Candida albicans and Clostridium difficile in the gastrointestinal tract. This can in turn result in genitourinary changes such as perianal itching, diarrhea, and gastrointestinal tract changes such as whitish-yellow lesions in the oral cavity, especially in older adults. The presence of glucose and ketones is not a reason for perianal itching and diarrhea. Flexion contracture of the lower extremities does not cause perianal itching and diarrhea. While genital warts can cause itching and diarrhea, they are not the cause for this scenario. The prolonged use of antibiotics has disrupted the normal flora (biome).

A nurse is evaluating the actions of a caregiver for a client with a lower extremity cast. Which action of the caregiver indicates the nurse needs to follow up? Using a towel to dry the cast Moving joints above and below the cast regularly Elevating the injured part above heart level for 48 hours Wrapping the client's cast with a plastic cover for 36 hours

Wrapping the client's cast with a plastic cover for 36 hours Rationale Covering the cast in plastic for a prolonged period of time may lead to discomfort and need to be corrected by the nurse. All the other actions are correct. A towel may be used to blot dry the cast and prevent itching and infection. Moving joints above and below the cast daily prevents muscular atrophy. Elevation of the injured part above heart level for the first 48 hours helps to prevent edema due to fluid shift.