Ncsbn NCLEX Lesson 8 G-Musculoskeletal

The nurse should provide which dietary instruction to a client with osteoporosis? 1. "Eat more dairy products to increase your calcium intake." 2. "Eat more bananas to increase your potassium intake." 3. "Decrease your intake of foods that contain vitamin D." 4. "Decrease your intake of nuts and seeds."

1 Osteoporosis causes a reduction in skeletal bone mass, leading to porotic and brittle bones. To offset this reduction, the nurse should advise the client to increase calcium intake by consuming more dairy products, which provide about 75% of the calcium in the average diet. Decreasing vitamin D intake is incorrect as vitamin D helps facilitate calcium utilization. None of the other options would stop osteoporosis from worsening.

A 70-year-old male is recently diagnosed with osteoporosis. The nurse is teaching the client about this disease. Which of the following client responses requires further education by the nurse? (Select all that apply.) 1. "I don't believe the doctor because I heard that only women can get osteoporosis." 2. "Exercising in an aquatics class will make my bones much stronger." 3. "It sounds like I'll need to drink more milk and eat more cheese and yogurt." 4. "I should ask for help to clean the gutters instead of climbing a ladder."

1,2 Osteoporosis is commonly thought of as a "woman's problem", but after age 65 men and women are losing bone mass at about the same rate and calcium absorption decreases. Treatment for osteoporosis includes regular weight-bearing exercises, such as walking, in which bones and muscles work against gravity; aqua aerobics will not make bones stronger. The client needs adequate intake of calcium and vitamin D; while supplements may be needed, calcium is best absorbed from natural food sources. There is a direct link between tobacco use and decreased bone density.

The nurse is reviewing the medical record of a client who has been diagnosed with systemic lupus erythematosus. The nurse would expect which findings associated with this disease? Select all that apply. 1. Reports of pain in the hands and knees 2. A temperature of 100.6° F (38° C) 3. Polydipsia for the last month Generalized weakness 4. A red, raised rash on the face 5. A recent ten pound weight gain

1,2,3,4 Systemic lupus erythematosus (SLE) is an autoimmune, inflammatory disorder of the connective tissue. It can affect multiple organs. This disorder has remission periods and flare-ups. A client who was recently diagnosed often presents during an exacerbation. Common assessment findings during exacerbation include a red, raised, rash on the face, commonly known as the "butterfly rash" and generalized weakness that can be associated with the fever and joint inflammation that are also present. SLE most frequently affects small joints (such as the hands) and the knees. Clients tend to experience anorexia which often leads to reports of weight loss, not weight gain. Polydipsia (excessive thirst) is not associated with SLE.

The nurse is assessing a client after a traumatic femur fracture. Which of the following assessment findings of the affected area require the nurse's immediate action? (Select all that apply.) 1. Paresthesia. 2. Weak pulse. 3. Pallor. 4. Peristalsis. 5, Pain 6. Cyanosis

1,2,3,5 Compartment syndrome is a complication after a traumatic injury involving the long bones. It is defined as swelling (edema) within a defined space (compartment) such as an extremity, which will put pressure on nerves and blood vessels, possibly leading to irreversible muscle and nerve ischemia.One or more of the six Ps are often seen with compartment syndrome: Pain, (increasing) Pressure in the affected extremity/area, Paresthesia (numbness, tingling), Pallor (coolness and loss of color), Paralysis and weak, diminished or absent Pulse (pulselessness).Cyanosis is seen with hypoxia and occurs more systemically in nail beds, face, lips and mucus membranes.Peristalsis refers to the rhythmic waves of involuntary muscle contractions of the intestines or other parts of the gastrointestinal system.

A client is in the acute phase of RA. Which of the following should the nurse identify as highest priority in the plan of care? (Select all that apply.) 1. Relieving pain 2. Preserving joint function 3. Maintaining usual ways of accomplishing tasks 4. Preventing joint deformity 5. Assessing body image issues

1,2,4 Pain relief is a high priority during the acute phase because the pain is typically severe and interferes with the client's ability to function. Preserving joint function and preventing joint deformity are high priorities during the acute phase to promote an optimal level of functioning and reduce the risk of contractures. Maintaining usual ways of accomplishing tasks would be the lowest priority during the acute phase. Rather, the focus is on developing less stressful ways of accomplishing routine tasks.

The nurse is caring for a client with a femur fracture. Which assessment findings require the nurse's immediate action? Select all that apply. 1. Shortness of breath 2. Pain level of 5 (0 to 10 scale) 3. Blood pressure of 88/54 mm Hg 4. Allergy to penicillin 5. Palpable hard mass near fracture site 6. Absent pulse in affected extremity 7. History of deep vein thrombosis

1,3,5,6 Complications related to fractures, especially of the long bones such as the femur, can include fat embolism, compartment syndrome and hemorrhage. Findings seen with compartment syndrome will include worsening pain, paresthesia (numbness, tingling), pallor (coolness and loss of color) and weak, diminished or absent pulse. A fat embolism will typically travel to the pulmonary vasculature and cause respiratory symptoms. Hemorrhage near the fracture site will manifest with swelling, bruising/hematoma, hypotension and tachycardia. The other findings are important to note but are not life-threatening and should be addressed at a later time.

During a conversation with a client who has osteoarthritis, the client says, "I am so frustrated with this disease and my disabilities." What is the best response by the nurse? 1. "Can you tell me more about what is frustrating you?" 2. "Has your spouse been supportive of your diagnosis?" 3. "Do you use any assistive devices to help you walk?" 4. "What medications have you been taking for pain?"

1. Osteoarthritis (OA) is characterized by the progressive deterioration and loss of cartilage in one or more joints. OA is a chronic condition that may cause permanent changes in lifestyle. In this scenario, the nurse should collect more data about the specific cause of the client's frustration and disabilities to help develop an appropriate plan of care. The other options about pain medications, assistive devices and spousal support are relevant but the nurse first needs to collect more data about what specifically is frustrating the client.

A 85-year-old client fell while going to the bathroom. It appears he may have a bone fracture in his right leg. The nurse observes a deformity in the affected leg and the client is unable to move it. He is alert and oriented but in pain. Which is the FIRST nursing action to take after confirming the patient is safe and stable? 1. Apply an ice pack covered with a towel to the site 2. Immobilize the fracture with a splint 3. Administer pain medication 4. Elevate the extremity above heart level

2 After confirming the patient is safe and stable, the nurse will immobilize the fracture with a splinting device. This will prevent movement of the extremity by the client. Immobilization prevents further pain or bleeding along with decreasing the risk of more damage that can occur to the surrounding tissues. In addition, if a bone is not immobilized and the extremity is moved after it has been fractured, this can alter the way the bone heals.

The nurse manager is conducting rounds on the floor. Which of these findings would require immediate corrective action and further instruction to the assigned nurse about proper care? 1. The weights of a client in skin traction are hanging several inches above the floor 2. The legs of a client who underwent hip replacement surgery yesterday are adducted 3. The assigned staff nurse picks up the frame of an external fixation device to move a client's extremity 4. A client in skeletal traction states, "The other nurse said that clear, yellow and crusty drainage around the pin site is a good sign."

2 After having a total hip replacement, the client is positioned with an abduction wedge or pillow(s) between the legs. The abduction pillow helps prevent adduction and internal rotation of the affected leg, which could cause dislocation of the hip prosthesis. Some surgeons recommend clients use an abduction wedge for as long as 6-12 weeks postoperatively.

The nurse notices body outgrowths on the distal interphalangeal joints. The nurse documents these findings as: 1. Bouchard's Nodes 2. Heberden's Nodes 3. Neurofibromatosis 4. Dermatofibromas

2 Bony outgrowths found on the DISTAL interphalangeal joint (closest to the fingernail and furthest away from the body) are called Heberden's Nodes. If the bony outgrowth was found on the PROXIMAL interphalangeal joint (middle joint of the finger...closest to the body) they are called Bouchard's Nodes.

A nurse is assessing a 3-week-old infant for possible development dysplasia of the right hip. Which finding should the nurse expect with this condition? 1. Even right and left gluteal folds 2. Clicking sound from affected hip 3. Downward pelvic tip upon observation 4. Negative Barlow maneuver

2 Developmental hip dyspepsia will present with uneven gluteal folds and thigh creases. A nurse will be able to hear a clicking sound when when the infant is placed on their back, leg flexed and the affected hip is moved to abduction. This is typically seen in infants less than 4 weeks old and is refereed to as a positive Ortolani's sign. Additionally, the nurse will assess for a positive Barlow maneuver (abducting the hip while applying pressure on the knee will cause the hip to dislocate from the socket). Finally, a pelvic downward tip is not a finding a nurse will find with possible development dyspepsia.

A client is receiving an antibiotic infusion for acute osteomyelitis of the left femur. Which nursing intervention will be included in the plan of care? 1. Encourage weight-bearing exercise 2. Immobilization of the left leg 3. Limit the administration of NSAIDs 4. Maintain the left leg in a flexed position

2 Immobilization of the affected leg helps to decrease pain and reduce the risk for pathologic fractures. Weight-bearing exercise increases the risk for pathologic fractures. NSAIDs are frequently prescribed to treat pain. Avoid flexing the affected limb to prevent contractures.

The nurse is providing discharge teaching to a client who has just undergone total hip replacement surgery. Which statement by the client would indicate to the nurse the need for further teaching? "I cannot drive a car for probably six weeks." "I should not sit in one position for more than four hours." "I need to wear a support stocking on my unaffected leg." "I need to place a pillow between my knees when I lie down."

2 The client needs to be instructed to not sit continuously for more than one hour. The client should be instructed to stand, stretch and take a few steps periodically. The client cannot drive a car for six weeks after surgery unless allowed to do so by a physician. A support stocking should be worn on the unaffected leg. An Ace bandage usually is prescribed for the affected leg and should be worn until there is no swelling in the legs and feet and full activities are resumed. The legs are abducted by placing a pillow between them when the client lies down. Incorrect

A client with a fractured lower right leg is medicated for pain with meperidine (Demerol) 100 mg and hydroxyzine hydrochloride (Vistaril) 50 mg IM. One hour later the client reports the pain is getting worse. What should the nurse recognize as a potential reason for the unrelieved pain? 1. Osteomyelitis 2. Thromboembolic complications 3. Fatty embolism 4. Compartment syndrome

4 Increasing pain that is not relieved by narcotic analgesics may be an indication of compartment syndrome. The nurse should immediately inform the charge nurse and emergency intervention will be required. Thromboembolic complications include deep vein thrombosis and pulmonary embolism, which are not characterized by increasing pain at the site of injury. Both pulmonary embolism and fat embolism present with sudden respiratory findings. Osteomyelitis is a bone infection that could occur some time after the initial injury, usually after at least 48-72 hours.

A client who has osteoarthritis, affecting both knees, is reporting constant pain at a level of 4 on a 0 to 10 scale. Which nonpharmacological intervention should the nurse implement for this client to help alleviate the pain? 1. Position the client with the knee joints in a flexed position. 2. Provide opportunity for the client to participate in hydrotherapy. 3. Place the client on strict bedrest with bathroom privileges only. 4. Collaborate with physical therapy for paraffin dips to the knees.

2. Osteoarthritis (OA) means the degeneration of cartilage in the joints, primarily the weight-bearing joints. These degenerative changes lead to swelling and pain in the joint. To prevent joint stiffness, it is important to encourage the client to balance activity and rest. Strict bedrest would only increase joint stiffness and further decrease in joint mobility. Paraffin (a type of wax) dips are helpful for clients with OA in the hands, but are not usually used for OA in the knees. The joints should be placed in a neutral, not flexed, position to prevent contractures. Soaking in a hot bathtub or doing hydrotherapy with physical therapy provides warmth that will decrease pain. The buoyancy of the client's body in water decreases weight on the joints, which will also decrease pain.

A client has received education from the nurse about their new diagnosis of systemic lupus erythematosus. Which statement by the client indicates that additional teaching is needed? "I will monitor my body temperature carefully." "I will protect my skin from the sun when I'm outside." "I will avoid foods that contain high levels of vitamin K." "I may feel more tired and fatigued than I used to."

3 Systemic lupus erythematosus (SLE) is a chronic, progressive, inflammatory connective tissue disorder that can cause major body organs and systems to fail. Clients with SLE should avoid prolonged sun exposure. The nurse should instruct clients to wear long sleeves and a large brimmed hat when outdoors. They should use sun blocking agents with a sun protection factor (SPF) of 30 or higher on exposed skin surfaces. It is expected for clients with SLE to experience fatigue, so they should allow time to rest when needed. Clients with SLE should monitor their body temperature carefully because this is typically the first sign of an exacerbation, during which the client can become critically ill. There is no established diet recommendation for clients with SLE, except to eat a well-balanced diet. Avoiding foods that contain vitamin K is not necessary, so this statement should be followed up on.

The nurse is developing a plan of care for a client with acute rheumatoid arthritis. Which priority interventions should the nurse include? Select all that apply. 1. Establishing a weight loss goal 2. Managing stress 3. Relieving pain 4. Preventing joint deformity 5. Preserving joint function

3,4,5 Pain relief is a high priority during the acute phase of RA because the pain is typically severe and interferes with the client's ability to function. Preserving joint function and preventing joint deformity are high priorities during the acute phase to promote an optimal level of functioning and reduce the risk of contractures. Managing stress and establishing a goal for a healthy weight are also important, but can wait to be addressed until the acute episode has resolved.

The nurse notices bone growths on the distal interphalangeal joints of a client with osteoarthritis. How should the nurse document these findings? 1. Bouchard's nodes 2. Dermatofibromas 3. Neurofibromatosis 4. Heberden's nodes

4 Bony outgrowths found on the distal interphalangeal joint (closest to the fingernail and furthest away from the body) are called Heberden's nodes. If the bony outgrowth was found on the proximal interphalangeal joint (the middle joint of the finger, closest to the body), they would be Bouchard's nodes.

A client is admitted with severe pain in the knees. Which form of arthritis is characterized by urate deposits and joint pain, usually in the feet and legs, and occurs primarily in men? 1. Septic arthritis 2. Traumatic arthritis 3. Seasonal arthritis 4. Gouty arthritis

4 Gouty arthritis is characterized by urate deposits and pain in the joints, especially those in the feet and legs. Urate deposits don't occur in septic or traumatic arthritis. Septic arthritis results from bacterial invasion of a joint and leads to inflammation of the synovial lining. Traumatic arthritis results from blunt trauma to a joint or ligament. Seasonal arthritis is not a condition.

For a client with osteoporosis, the nurse should provide which dietary instruction to help slow the progression down? 1. "Decrease your intake of foods that contain vitamin D." 2. "Decrease your intake of nuts and seeds." 3. "Eat more bananas to increase your potassium intake." 4. "Eat more dairy products to increase your calcium intake."

4 Osteoporosis causes a severe, general reduction in skeletal bone mass. To offset this reduction, the nurse should advise the client to increase calcium intake by consuming more dairy products, which provide about 75% of the calcium in the average diet. Decreasing your vitamin D intake is incorrect as vitamin D helps facilitate calcium. None of the other options would stop osteoporosis from worsening. Correct!

A 70-year-old woman is evaluated in the emergency department for a wrist fracture of unknown cause. During the admission process, which of the following findings should the nurse identify as being the client's greatest risk factor for developing osteoporosis? 1. Inactive lifestyle for the past 10 years 2. History of menopause at age 50 3. Two glasses of red wine each day for the past 30 years 4. History of oral corticosteroid use for 20 years to treat chronic lung problems

4 The use of oral corticosteroids for a long period of time increases the risk for developing osteoporosis. Being postmenopausal and physically inactivity may also contribute, but are less significant. Other factors that increase the risk for osteoporosis and fracture include low bone mass and poor calcium absorption. However, long-term steroid treatment is the most significant risk factor.

The nurse is reviewing the chart of a client with suspected osteoporosis. Which diagnostic test to confirm the diagnosis should the nurse plan for? Positron-emission tomography scan Computerized axial tomography scan Magnetic resonance imaging scan Dual-energy X-ray absorptiometry scan

4. Osteoporosis is a metabolic disease in which bone mineralization results in decreased bone density. A dual-energy X-ray absorptiometry (DEXA) scan is a painless scan that measures bone mineral density (BMD) in the hip, wrist or vertebral column. It is the recommended test for the diagnosis of osteoporosis. Magnetic resonance imaging (MRI), computerized axial tomography (CAT) and positron-emission tomography (PET) scans are imaging tests used for evaluating a range of musculoskeletal diseases, but they are not typically used to diagnose osteoporosis.

The nurse in an urgent care clinic is evaluating a client's understanding of discharge instructions for a second-degree ankle sprain. Which statement by the client requires follow-up by the nurse? "I will apply ice intermittently for the first 24 to 48 hours." Incorrect "I will elevate my ankle to decrease pain and swelling." "I will apply a compression bandage and wear an ankle brace." "I will do gentle stretching and range of motion exercises daily." Correct Response

A sprain is excessive stretching of the ligament with tearing of the ligament fibers. Twisting motions from a fall or sports activity typically precipitate the injury. A second-degree sprain is classified as moderate. Second-degree sprains require immobilization with an elastic bandage and ankle brace, splint or cast. Recommendations for caring for a client with a sprain include rest, use of ice for the first 24 to 48 hours, application of a compression bandage for a few days to reduce swelling and provide joint support and elevation of the affected extremity (RICE). It is recommended not to stretch or use the sprained joint for approximately a week, sometimes longer, to allow it to heal properly. The nurse should follow up and advise the client not to perform stretching and range of motion exercises. Incorrect

The nurse is caring for a client who is recovering from a below-knee amputation. Which is the best way for the nurse to apply the prescribed elastic bandage to the stump? 1. Wrap the bandage in a figure-eight manner. 2. Wrap the bandage in a chevron manner. 3. Wrap the bandage in a simple spiral manner. 4. Wrap the bandage in a triangular manner.

An amputation is the removal of part of the body. The limb should be wrapped with an elastic bandage applied in a figure-eight manner. This approach reduces the risk of cutting off circulation to the stump area. Although wrapping a bandage in a simple spiral, chevron and triangular manner are appropriate techniques in other circumstances, they are not recommended for use on an amputation stump. Incorrect

A client who has been newly diagnosed with carpal tunnel syndrome asks the nurse why they are having pain and tingling in their fingers. Which is the best response from the nurse? 1. "The pain and tingling is caused by uric acid crystals collecting in the small joints of your fingers." 2. "The pain and tingling is caused by compression of the median nerve in your wrist." 3. "The pain and tingling is caused by the fluid build-up in the soft tissue of your fingers." 4. "The pain and tingling is due to sclerotic plaques along the nerves in your hand."

Carpal tunnel syndrome (CTS) is a common, repetitive motion-related condition in the wrist. The carpal tunnel is a rigid canal lying between the carpal bones and a fibrous tissue sheet called the flexor retinaculum. A group of nine tendons, enveloped by synovium, share space with the median nerve in the carpal tunnel. When the synovium becomes swollen or thickened, the median nerve is compressed. This causes pain, numbness and painful tingling in the client's fingers and hand. CTS typically does not cause soft tissue fluid build-up. Uric acid crystals collecting in small joints is seen with gout. Sclerotic plaques along nerve fibers tend to occur with multiple sclerosis (MS). Therefore, the best response includes information about the median nerve in the wrist being compressed.

The nurse in a rehabilitation facility is caring for a client who had a total left hip arthroplasty, using a posterior approach, three days ago. Which intervention should the nurse make sure to include in the client's plan of care? 1. Rest the client's heels flat on the bed, in line with the hip. 2. Keep the client's affected hip bent at least 90 degrees. 3. Instruct the client to cross their legs at their ankles only. 4. Apply an abduction pillow while the client is in bed.

Clients who have had a total hip arthroplasty (THA), i.e., hip replacement, are at risk for post-operative hip joint dislocation. An abduction pillow should be used to prevent the client from closing or crossing their legs while in bed, causing adduction beyond the midline of the body, which can lead to dislocation of the new joint. The client's heels should be elevated off the bed, not flat on the bed, to prevent pressure injury to the heels. The affected hip should not be flexed to 90 degrees. Even crossing the legs at the ankles should be discouraged and prevented with this type of hip surgery.

A client has received instructions for the management of osteoarthritis. Which statement by the client would indicate a need for additional teaching? 1. "It is important for me to balance my exercise and rest periods." 2. "I will avoid driving after I have taken cyclobenzaprine." 3. "Gradual weight loss may help my pain." 4. "Early surgical intervention is the preferred treatment."

Clients with osteoarthritis experience the erosion of cartilage in their joints, which leads to pain and swelling of the joints. Weight loss has shown to decrease pressure on the joints, which can decrease pain. Balancing exercise and rest periods allows the client to be active to help decrease joint stiffness while decreasing the likelihood of more inflammation in the joint. Cyclobenzaprine is a muscle relaxant used to manage pain and muscle spasms in clients with osteoarthritis. Cyclobenzaprine can cause drowsiness, fatigue and dizziness. For safety reasons, the client should not drive after taking cyclobenzaprine. Initial management of osteoarthritis includes physical therapy, medications and weight loss. Surgical management is typically not considered until all medical interventions have failed.

Osteoarthritis is an autoimmune disease that causes progressive loss of cartilage in the joints. T or F

F Osteoarthritis is typically the result of normal aging and wear and tear on the joints; it is not an autoimmune disease. With osteoarthritis, there is loss of cartilage in the joints. Eventually, the cartilage wears away and bones rub against each other, causing pain, swelling, and stiffness.

The nurse should use alcohol or iodine-based products to clean around the pins used in skeletal traction.

F Alcohol and iodine-based products can accelerate corrosion of the metal and can cause skin staining. Skeletal traction pins can be cleaned with normal saline, sterile water (or even plain soap and water.)

The client with Charcot's joint will benefit from regular aerobic exercise.

F Charcot's joint is a degenerative condition affecting one or more joints and results in joint instability and hypermobility, along with numbness and tingling or loss of sensation in the affected joints (usually in the feet). Treatment includes casting (for up to 12 weeks) and no weight-bearing on the foot followed by wearing a brace.

An overweight client, who is newly diagnosed with gout, should be advised to lose weight as quickly as possible.

F Clients diagnosed with gout and who are overweight should lose weight slowly. Quick weight loss may cause uric acid kidney stones to form.

Rheumatoid nodules are the same thing as Heberden's nodes.

F Firm, non-tender, subcutaneous nodules develop in some chronic active cases of rheumatoid arthritis. They are serious extra-articular manifestations found in the lungs, eyes, and blood vessels. Heberden's and Bouchard's nodes are bony enlargements of the joints involving the hand; these nodes are strongly familial (inherited) and are characteristic of osteoarthritis.

Estrogen, calcitonin, bisphosphonates, and bone-forming agents can reverse the damage of osteoporosis.

F Nothing can reverse the damage already done by osteoporosis. These drugs can sometimes slow or halt the progress of the disease.

Obesity is a risk factor for the development of rheumatoid arthritis.

F Obesity, because it stresses joints, is a risk factor in the development of traumatic osteoarthritis. Rheumatoid arthritis, although not fully understood, seems to be an autoimmune disorder.

An indication for total hip replacement is peripheral vascular disease associated with uncontrolled diabetes.

F Peripheral vascular disease might call for amputation, often of the foot, but reasons for total hip replacement include osteoarthritis, rheumatoid arthritis, trauma (such as fracture of the femoral head), failure of a prosthesis, or avascular necrosis of the femur due to steroid use.

When the nurse suspects compartment syndrome, the casted limb should be elevated about the level of the heart.

F When the nurse suspects compartment syndrome, the cast should be split and constrictive bandages released. The limb should not be elevated above the level of the heart because this compromises arterial perfusion, which compounds the ischemic problem.

Gout is a systemic disease in which urate crystals deposit in the joints and other body tissues, causing inflammation. High levels of uric acid in the blood are found in clients who have gout. Clients with gout should follow a low-purine diet. Purine-rich foods such as organ meats (liver), shellfish (shrimp), red meat and oily fish with bones (sardines) should be restricted. Vegetables and dairy, including eggs, do not need to be restricted or limited with gout.The nurse is reinforcing teaching for a client who has a diagnosis of gout. Which foods should be restricted in the client's diet? Select all that apply. 1. Shrimp 2. Vegetables 3. Eggs 4. Liver 5. Sardines

Gout is a systemic disease in which urate crystals deposit in the joints and other body tissues, causing inflammation. High levels of uric acid in the blood are found in clients who have gout. Clients with gout should follow a low-purine diet. Purine-rich foods such as organ meats (liver), shellfish (shrimp), red meat and oily fish with bones (sardines) should be restricted. Vegetables and dairy, including eggs, do not need to be restricted or limited with gout.

The nurse in an assisted living facility comes upon an 85-year-old client lying on the bathroom floor. The nurse observes a deformity in the left leg and the client is unable to move the leg. The client is alert and oriented but in severe pain. Which action should the nurse take first? 1. Administer pain medication. 2. Immobilize the fracture with a splint. 3. Apply an ice pack to the site. 4. Elevate the extremity above heart level.

It appears that the client suffered a bone fracture in the left leg. After confirming that the client's respiratory and neurologic status is stable, the nurse should immobilize the fracture with a splinting device. This will prevent movement of the extremity by the client and further pain or bleeding along the fracture into the surrounding tissues. Next, the nurse should notify the health care provider or call emergency medical services to transport the client to the nearest emergency room.

The nurse is reviewing the medical record of a client who has been diagnosed with osteoporosis. The nurse identifies which risk factors for this condition? Select all that apply. The client takes 10 mg of prednisone daily. Correct! The client is a 75-year-old Caucasian female. Correct! The client weighs 200 lbs. (90.7 kg) with a height of 5 feet 2 inches (157 cm). The client has a 30 pack per year smoking history. Correct! The client performs weight-bearing exercises six days a week.

Osteoporosis is the loss of bone density that leads to weakness of the bone. Risk factors for osteoporosis include being a postmenopausal woman (lack of estrogen), smoking, thin stature, steroid use, lack of weight-bearing exercise, such as prolonged immobility or a sedentary lifestyle, and ethnicity. Steroid use is associated with osteoporosis because it impacts the body's ability to rebuild new bone. Smoking is also associated with osteoporosis. Performing weight-bearing exercise increases bone strength and promotes bone development. A client who is 5 feet 2 inches (157 cm) in height and weighs 200 lbs. (90.7 kg) is considered obese and obesity is associated with osteoarthritis, not osteoporosis.

A progressive exercise routine is the best therapy for the client with chondromalacia patellae.

T Although this degenerative disorder cannot be cured, it can be traced to a trauma or repeated stress. Selective strengthening of the inner portion of the quadriceps muscle will help normalize the tracking of the patella. Cardiovascular conditioning can be maintained by stationary bicycling, pool running or swimming.

Clients diagnosed with systemic lupus erythematosus (SLE) should avoid exposure to sunlight and ultraviolet light.

T Clients with SLE often experience photosensitive rashes. Exposure to sunlight can also cause migraine headaches, nausea, and joint pain.

The nurse should assist the client with an above the knee amputation to lie in the prone position several times a day.

T Lying on the stomach will help stretch the hip flexor muscles. The client should lie in the prone position for about 20 minutes, 3 to 4 times a day.

Paget's Disease (neuropathic joint disease) is characterized by overactive osteoclasts.

T Paget's Disease attacks the mechanism that replaces old cells with new ones. The overactive osteoclasts rapidly restore bone cells and, as a result, the bone that is formed is abnormal, i.e., enlarged, not as dense, brittle, and prone to fractures.

A stress fracture is an example of a pathological fracture.

T Pathological means that a bone or joint was weakened by a disease process. Stress fractures are caused by the repetitive application of force (such as overuse) or by a condition that weakens the bone (osteoporosis). Stress fractures are most common in the weight-bearing bones of the lower leg and foot.

Complications of orthopedic surgery include deep vein thrombosis, fat embolism, pulmonary embolism, thrombophlebitis, hemorrhage, and wound infection.

T These are all potential complications of orthopedic surgery.

A woman is more likely to develop type 1 osteoporosis if she is postmenopausal, smokes, drinks alcohol, and is not taking hormone replacement therapy.

T Type 1 osteoporosis is related to decreased estrogen levels in postmenopausal women. Risk factors include a family history of osteoporosis, low body weight, smoking, and drinking a large amount of alcohol.

X-rays should be taken both before and after a closed reduction of a fracture.

T X-ray images are necessary to first show where the bone should be moved and afterward to show whether it is positioned for ideal healing.

Some symptoms of osteomalacia include kyphosis, difficulty walking, deformation of weight-bearing bones, and pain in the low back and hips.

T \Osteomalacia is softening of bone. It may be caused by poor dietary intake or poor absorption of calcium and other minerals; it is a characteristic feature of vitamin D deficiency in adults. Its more obvious effects may appear in major weight-bearing joints such as the back, hips, and legs.

The nurse in the outpatient clinic is following up on a client with a fractured arm. The client's arm was placed in a cast four hours ago. The client states, "my fingers are tingling and feel cold." Which action should the nurse take first? Notify the health care provider. Elevate the client's arm above the level of the heart. Apply an ice pack to the cast to reduce swelling. Check the capillary refill in the client's fingers. Correct!

The client with a cast on an extremity is at risk for development of compartment syndrome. Compartment syndrome occurs when the swelling underneath the cast becomes so great that it will decrease circulation and tissue perfusion to the extremity, distal to the cast. This is a medical emergency. Using the nursing process, the nurse should first collect more data by checking the client's capillary refill, which can support the possibility of compartment syndrome. After obtaining the additional information, the nurse can make the best decision about what to do next.

A client is admitted to the orthopedic nursing unit with a fractured right tibia. The client is complaining of pain. Which action should the nurse take first? Contact the health care provider. Place an ice pack on the fracture site to reduce edema. Check the pulse and capillary refill in the right foot. Correct! Administer acetaminophen 650 mg PO as ordered.

The nurse should first collect more data about the client's pain. Compartment syndrome is a potential complication with an acute fracture and the nurse should evaluate tissue perfusion in the affected extremity to make sure that the pain is solely related to the acute fracture. Signs of compartment syndrome include worsening pain, weak peripheral pulses, edema, slow capillary refill and paresthesia (i.e., numbness, tingling). If the nurse suspects that compartment syndrome is occurring, the health care provider (HCP) must be notified immediately. After ruling out compartment syndrome, the nurse can proceed with administering an analgesic and applying ice.

The nurse is reviewing the chart of a client who was admitted after having been found lying on the bathroom floor in their home. The client's family reports that the client could have been lying on the floor for over 12 hours. Which laboratory result should be of greatest concern to the nurse? 1. Serum white blood cell count of 14,000/mm3 2. Serum hemoglobin level of 10.8 g/dL 3. Serum creatinine level of 4.2 mg/dL 4. Serum glucose level of 162 mg/dL

When a person falls and lies immobile for an extended period of time, muscle tissue will start to break down. This is called rhabdomyolysis. Rhabdomyolysis leads to the release of myoglobin (muscle protein) into the bloodstream. Myoglobin breaks down into substances that will damage the kidneys, causing acute kidney injury (AKI) as evidenced by the client's severely elevated creatine level. (A normal range would be between 0.5 to 1.2 mg/dL). Although the client's other lab values are also outside of the normal range, the values are not as severely elevated or decreased as the creatinine level which represents the greatest concern to the client's condition at this time.