Muskulo Prob 2

A nursing student is providing health maintenance education to a client with osteitis deformans (Paget's disease). Which statement by the client indicates a need for further education?

"Because I have no symptoms, my disease is not progressing." It is a chronic disease, and most persons who are affected by it are asymptomatic. Even though there may be no symptoms, excessive bone loss may have occurred.

The nurse is preparing instructions for a client who is diagnosed with osteomalacia who is at risk for skeletal injury. Which information would the nurse include in the teaching?

"Ensure adequate intake of foods fortified with vitamin D." Rationale: A common cause of osteomalacia is vitamin D deficiency, so the client needs to include adequate dietary intake of vitamin D-fortified foods.

The nurse teaches a client who is going to have a plaster cast applied to treat a fracture about the procedure. Which statement by the client indicates a need for further teaching?

"I can bear weight on the cast in one-half hour." Rationale: A plaster cast can tolerate weight bearing once it is dry, which takes from 24 to 72 hours, depending on the nature and thickness of the cast.

A client has had a bone scan done. The nurse determines that the client demonstrates understanding of postprocedure care when the client makes which statement?

"I need to drink plenty of water for 1 to 2 days after the procedure." Rationale: No special restrictions are necessary after a bone scan. The client is encouraged to drink large amounts of water for 24 to 48 hours to flush the radioisotope from the system.

The nurse has provided discharge instructions to a client after a total hip replacement. Which statement by the client indicates a need for further instruction?

"I need to sit in my recliner when I get home." client would be instructed to keep the legs apart while sitting or lying to prevent disruption of the hip re‐ placement; this may be accomplished by placing a blanket or a pillow between the legs. The use of an elevated toilet seat will prevent discomfort and pressure at the operative site.

A client is being discharged to home after spinal fusion with insertion of instrumentation (rod). The unit nurse would consult with the continuing care nurse regarding the need for modification of the home environment if the client makes which statement?

"My bedroom and bathroom are on the second floor of my home." Rationale: Stair climbing may be restricted or limited for several weeks after spinal fusion with instrumentation.

The nurse has provided instructions to a client with a diagnosis of rheumatoid arthritis about measures to protect the joints. Which statement by the client indicates a need for further instruction?

"Pain or fatigue is expected, and I would try to continue with the activity if this occurs." Rationale: The client needs to be instructed to use pain or fatigue as an indicator and guide to increase, maintain, or decrease an activity level.

A client with a fractured foot who is learning to use a cane is afraid it will slip with ambulation, causing a fall. The nurse provides the client with the most reassurance by making which statement?

"The cane has a flared tip with concentric rings to give stability."

Diagnostic studies are prescribed for a client with suspected Paget's disease. In reviewing the client's record, the nurse would expect to note that the primary health care provider has prescribed which laboratory study?

Alkaline phosphatase. Diagnostic laboratory findings for Paget's disease include an ele‐ vated serum alkaline phosphatase level and elevated urinary hydroxyproline excretion.

The nurse is planning to teach a client with a muscle ligament injury how to stand on crutches. The nurse will incorporate into written instructions that the client would be told to place the crutches in what manner?

6 inches (15 cm) to the front and side of the toes. Rationale: The classic tripod position is taught to the client before instructions on gait are given. The crutches are placed 6 inches (15 cm) in front and to the side of the client. This placement provides an adequate base of support to the client and improves balance.

The community health nurse is providing a teaching session on osteoporosis. The nurse informs these community residents that which is a risk factor for this disorder?

A diet low in vitamin D. Rationale: Some of the risk factors related to osteoporosis are a small skeletal frame and elevated thyroid hormone. Low dietary intake of calcium and vitamin D also constitutes a risk factor for osteoporosis.

A client is admitted to the nursing unit after a left below-the-knee amputation after a crush injury to the foot and lower leg. The client tells the nurse, "I think I'm going crazy. I can feel my left foot itching." How would the nurse interpret this client statement?

A normal response that indicates the presence of phantom limb sensation. Rationale: Phantom limb sensations are felt in the area of the amputated limb. These sensations can include itching, warmth, and cold. The sensations are caused by intact peripheral nerves in the area of the amputation.

A client is being transferred to the nursing unit from the postanesthesia care unit after spinal fusion with rod insertion to treat spinal instability from severe arthritis. The nurse would prepare to transfer the client from the stretcher to the bed by using which best method?

A transfer (slider) board and the assistance of three people. the client is transferred from the stretcher to the bed using a transfer (slider) board and the assistance of three people, with one at the head to pro‐ tect or support the client's head and neck. This strategy permits optimal stabilization and support of the spine while allowing the client to be moved smoothly and gently.

The nurse in the hospital emergency department is caring for a client with a fractured arm and is preparing the client for a reduction of the fracture that will be done in the casting room in the emergency department. The nurse would take which actions? Select all that apply

Administer a prescribed analgesic. Explain the procedure to the client. Obtain informed consent for the procedure. ​

A client with rheumatoid arthritis who had a total knee arthroplasty tells the nurse that there is pain with extension of the knee. The nurse would perform which action?

Administer an analgesic. Rationale: Pain with knee extension is a common complaint of clients after knee arthroplasty; therefore, administering an analgesic would be the appropriate action.

The nurse is giving a client with a left leg cast crutch-walking instructions using the three- point gait. The client is allowed touch-down of the affected leg. The nurse would tell the client to perform which action?

Advance the crutches along with the left leg, and then advance the right leg. Rationale: A three-point gait requires good balance and arm strength. The crutches are advanced with the affected leg, and then the unaffected leg is moved forward.

The nurse is performing an assessment on a client after a closed reduction of a fractured right humerus and application of a plaster cast. To assess for signs of compartment syndrome, the nurse would perform which action?

Assess capillary refill, temperature, color, and amount of pain in the right hand.

The nurse provides instructions to a client with bilateral deformities of the joints of the fingers due to rheumatoid arthritis. When providing teaching about the disease process, the nurse would inform the client that the changes are most likely due to what type of response?

Autoimmune. Rationale: The most likely cause for rheumatoid arthritis is activation of an autoimmune response. This is thought to trigger antigen-antibody responses and release of lysosomes from phagocytic cells, which ultimately attack the cartilage and synovia, with resultant synovitis.

A client has several fractures of the lower leg, which has been placed in an external fixation device. The client is upset and anxious about the appearance of the leg, which is edematous. The nurse documents which client problem in the plan of care?

Body image alteration. Rationale: The client experiences an altered image of the body related to a change in the structure and function of the affected leg.

The nurse is performing an assessment on a client with suspected Paget's disease. On assessment the nurse would expect the client to report which as the most common symptom of this disease?

Bone pain. The pain is related to progressive enlargement and deformity of the bone. Hearing loss, numbness of the face, or (more rarely) blindness can occur when the thickened bone of Paget's disease compresses vital nerves in the skull.

The nurse is evaluating goal achievement for a client in traction with impaired physical mobility. The nurse determines that the plan of care needs to be revised if which outcome is noted?

Bowel movement every 4 days. Rationale: A bowel movement every 4 days is insufficient. The client would be having a bowel movement a minimum of every other day.

The nurse is preparing a plan of care for a client who is scheduled to return from the recovery room after a left total knee arthroplasty. The nurse includes in the plan of care an assessment of the client's neurovascular status through the monitoring of which parameter?

Capillary refill, sensation, color, and pulse of the left foot.

The nurse is caring for a client who has just had a plaster leg cast applied to treat a fracture. The nurse would plan to prevent the development of compartment syndrome by performing which action?

Elevate the limb slightly. Elevation of the extremity may lower venous pressure and slow arterial perfusion; thus, the extremity should not be elevated above the heart.

The nurse is assessing an older client who sustained a fall and exhibits a shortened, adducted, and externally rotated left leg. On the basis of this finding, which condition would the nurse anticipate?

Fracture of the femoral neck. Rationale: Typical signs after femoral neck fracture include shortening of the affected leg, adduction, and external rotation. The client may report slight groin pain or pain in the medial side of the knee.

A client seeks treatment in the hospital emergency department for a lower leg injury. Deformity of the lower portion of the leg is evident, and the injured leg appears shorter than the other. The area is painful, swollen, and beginning to become ecchymotic. The nurse interprets that this client has experienced which injury?

Fracture. Rationale: Typical signs and symptoms of fracture include pain, loss of function in the area, deformity, shortening of the extremity, crepitus, swelling, and ecchymosis.

The nurse provides instructions to a client diagnosed with osteoporosis. Education about prevention of which complication is the most important?

Fractures.

An older client is diagnosed with osteoporosis. The nurse plans to teach the client about self-care measures, knowing that the client is most at risk for which problem as a result of this disorder of the bones?

Fractures. Rationale: The client is most at risk for fractures as a result of osteoporosis. Although other complications can occur, fracture is the greatest concern.

The nurse witnesses a client sustain a fall and suspects that the right leg may be broken. The nurse would take which priority action?

Immobilize the right leg before moving the client. Rationale: When a fracture is suspected, it is imperative that the area be splinted before the client is moved.

A client is complaining of knee pain. The knee is swollen, reddened, and warm to the touch. The nurse interprets that the client's signs and symptoms are compatible with which conditions? Select all that apply.

Infection. Recent injury. Inflammation. Rationale: Redness and heat are associated with musculoskeletal inflammation, infection, or a recent injury.

A client has skeletal traction applied to the right leg and has an overhead trapeze available for use. The nurse would assess which area as high risk for pressure and breakdown?

Left heel. Rationale: Common areas that are under pressure and are at risk for breakdown include the elbows (if they are used for repositioning instead of a trapeze) and the heel of the good leg (which is used as a brace when pushing up in bed).

client who had a body cast applied 2 days earlier begins to complain of anorexia, nausea, and abdominal discomfort. The nurse would take which immediate action?

Notify the primary health care provider. This results from pressure on the mesenteric artery and can lead to intestinal obstruction. The immediate action is to report the client's complaints to the primary health care provider (PHCP).

A hospitalized client has been diagnosed with osteomyelitis of the left tibia. The nurse determines that this condition is most likely a result of which event in the client's recent history?

Open trauma to the left leg. Rationale: Osteomyelitis is a bone infection and may be caused by direct contamination of bone through an open wound. Bacteria invade the bone tissue and produce inflammation. Ischemia and necrosis of the bone tissue may follow if not treated.

The nurse is planning measures to increase bed mobility for a client in skeletal leg traction. Which item would the nurse consider to be most helpful for this client?

Overhead trapeze. Rationale: The use of an overhead trapeze is extremely helpful for a client to move about in bed and to get on and off the bedpan.

The nurse has suggested specific leg exercises for a client immobilized in right skeletal lower leg traction. The nurse determines that the client needs further instruction if the nurse observes the client performing which action?

Performing active range of motion to the right ankle and knee. Rationale: Active range of motion to the right ankle and knee would disrupt skeletal traction of the right lower leg.

The nurse is caring for a client who is an athlete and has sustained an injury to the anterior cruciate ligament. The nurse is providing education to the client regarding the potential treatment measures for this injury. What would the nurse include in the teaching? Select all that apply.

Physical therapy. Knee immobilizer. Anti-inflammatory medications. ​

client who has experienced nonunion of a fracture is scheduled for bone grafting using cadaver bone. The client appears restless and anxious about the procedure. After determining that the client understands the surgical procedure, the nurse would explore which item next?

Potential worry about contracting hepatitis or possibly human immunodeficiency virus infection. To ease their fear, clients need reassurance and information about the donor screening that is done

A client has been diagnosed with osteomalacia, or adult rickets. The nurse would anticipate that the primary health care provider will include a new prescription for which vitamin supplement?

Rationale: Osteomalacia technically refers to bone softening that results from demineralization of bone matrix and failure to calcify. A common cause is vitamin D deficiency in the diet.

The home health nurse visits a client who is having an acute attack of gout. The nurse determines that the client needs further instruction regarding the treatment of gout if the client states to take which action?

Restricting fluids. Rationale: Ample fluid intake is encouraged to promote the excretion of uric acid. The client is placed on bed rest during an acute attack until the pain subsides. A diet low in purine normally is prescribed.

The nurse is caring for a client admitted for a fractured hip that was sustained from a fall at home. On assessment of the client's affected lower extremity, which signs/symptoms would most likely be noted?

Shortening and external rotation. Rationale: Signs of a hip fracture include shortening and deformity. The affected leg externally rotates as a result of discontinuation of the femur and loss of alignment and muscle control.

A client is fearful about having an arm cast removed. Which action by the nurse would be the most helpful?

Showing the client the cast cutter and explaining how it works. ​

A client has been placed in Buck's extension traction. The nurse can provide for countertraction to reduce shear and friction by performing which action?

Slightly elevating the foot of the bed. Rationale: The part of the bed under an area in traction usually is elevated to aid in countertraction. For the client in Buck's extension traction (which is applied to a leg), the foot of the bed is elevated.

The clinic nurse is performing an assessment on a client with a diagnosis of rheumatoid arthritis (RA). The nurse checks for which assessment finding that is associated with RA?

Systemic symptoms such as fatigue, anorexia, and weight loss. Rationale: In clients diagnosed with RA, systemic symptoms such as fatigue, anorexia, weight loss, and nonspecific aching and stiffness may appear before joint manifestations.

A client has just been admitted to the hospital with a fractured femur and pelvic fractures. The nurse would plan to carefully monitor the client for which signs/symptoms?

Tachycardia and hypotension. This can occur with closed fractures as well as open fractures. Signs of hypovolemic shock include tachycardia and hypotension.

The nurse in the hospital emergency department is assessing a client with an open leg fracture. The nurse would inquire about the last time the client had which done?

Tetanus vaccine. The nurse assesses for the date of the last tetanus immunization to ensure that the client has tetanus prophylaxis.

The nurse is obtaining a health history from a client and is assessing for risk factors associated with osteoporosis. The nurse would be most concerned if which data were obtained? Select all that apply.

The client reports that they don't exercise much at all. The client reports that they smoke a few cigarettes a day. The client reports that they are taking phenytoin to treat a seizure disorder. The client reports that they take a daily low dose of prednisone to treat a chronic respiratory condition.

The nurse is planning to teach proper use of a thoracolumbosacral orthosis to a client who has had spinal fusion with instrumentation. The nurse would include which teaching point in the discussion with the client?

The device is applied before getting out of bed in the morning.

A client is having a plaster cast placed on the lower extremity that will extend from midthigh to the center of the foot. Which instruction would be given to the client before hospital discharge?

The need to notify the primary health care provider immediately if the client notices numbness or swelling or if the foot becomes cold and pale. Rationale: Numbness, swelling, and cool, pale skin are findings that indicate a state of neurovascular compromise. This can lead to significant problems and potential loss of the limb.

The nurse is planning to teach the client with below-the-knee amputation about care to prevent skin breakdown. Which point would the nurse include in developing the teaching plan?

The socket of the prosthesis must be dried carefully before it is used.

A client is complaining of pain underneath a cast in the area of a bony prominence. The nurse interprets that this client may need which intervention?

To have a window cut in the cast. Rationale: A window may be cut in a dried cast to relieve pressure in an area of a bony prominence, to as‐ sess pulses, to relieve discomfort, or to remove drains.

The nurse has taught a client with a below-the-knee amputation about prosthesis and residual limb care. The nurse determines that the client has understood the instructions if the client makes which statement?

Use a mirror to inspect all areas of the residual limb each day. Rationale: Following amputation, the client needs to inspect all surfaces of the residual limb daily for irritation, blisters, or breakdown