NURS 2210 Exam 3 - Iggy Ch's 49-51

Which of the following interventions should the nurse implement to prevent injury to the client with severe osteoporosis? A. Provide passive ROM to all weight-bearing joints. B. Use a lift sheet to reposition the client. C. Place a pillow between the client's knees when in the side-lying position. D. Position the client as upright as possible when sitting to promote lung expansion.

ANS: B Severe osteoporosis causes such bone density loss that pathologic fractures can easily occur when lifting or pulling a client. Use of a lift sheet when positioning reduces this risk.

A rock climber has sustained an open fracture of the right tibia after a 20-foot fall. The nurse plans to assess the client for which potential complications? Select all that apply. A. Acute compartment syndrome (ACS) B. Fat embolism syndrome (FES) C. Congestive heart failure D. Urinary tract infection (UTI) E. Osteomyelitis

A. Acute compartment syndrome (ACS) B. Fat embolism syndrome (FES) E. Osteomyelitis Rationale Congestive heart failure is not a potential complication for this client. Pulmonary embolism is a potential complication for venous thromboembolism, which can occur with fracture.

The client's left arm is placed in a plaster cast. Which assessment will the nurse perform before the client is discharged? A. Assess that the cast is dry. B. Ensure that the client has 4 × 4 gauze to take home for placement between the cast and the skin. C. Check the fit of the cast by inserting a tongue blade between the cast and the skin. D. Ensure that the capillary refill of the left fingernail beds is longer than 3 seconds.

A. Assess that the cast is dry. Rationale A. The cast must be dry and free of cracking and crumbling. B. The client should not place anything between the cast and the skin. C. In assessing fit, one finger should easily fit between the cast and the skin. D. Capillary refill longer than 3 seconds indicates impairment of the circulation in the extremity and requires the health care provider's immediate attention.

A client is admitted to the emergency department after a motorcycle accident with a compound fracture of the left femur. Which action will be most essential for the nurse to take first? A. Check the dorsalis pedis pulses. B. Immobilize the left leg with a splint. C. Administer the prescribed analgesic. D. Place a dressing on the affected area.

A. Check the dorsalis pedis pulses. Rationale A. The first action should be to assess the circulatory status of the leg because the client is at risk for acute compartment syndrome (ACS), which can begin as early as 6 to 8 hours after an injury. Severe tissue damage can also occur if neurovascular status is compromised. B. Immobilization will be needed, but the nurse must assess the client's condition first. C. The nurse needs to first assess the client before administering an analgesic. D. This should be done after the nurse has assessed the client.

The older adult client has had a right open reduction internal fixation (ORIF) of a fractured hip. Which intervention will the nurse implement for this client? A. Keep the client's heels off the bed at all times. B. Reposition the client every 3 to 4 hours. C. Administer preventive pain medication during deep-breathing exercises. D. Prohibit the use of antiembolic stockings.

A. Keep the client's heels off the bed at all times. Rationale A. Because the client is an older adult and is more at risk for skin breakdown because of impaired circulation and sensation, the client's heels must be kept off the bed at all times to avoid constant pressure on this sensitive area. B. Repositioning the older adult client must be done every 2 hours to prevent skin breakdown and to inspect the skin for any signs of breakdown. C. Pain medication would not be administered for deep-breathing exercises because this client typically would not experience pain on breathing. D. Antiembolic stockings are not contraindicated for older adults. They help prevent deep vein thrombosis.

The client has undergone an elective below-knee amputation of the right leg as a result of severe peripheral vascular disease. In postoperative care teaching, the nurse instructs the client to notify the health care provider if which change occurs? A. Observation of a large amount of serosanguineous or bloody drainage B. Mild to moderate pain controlled with prescribed analgesics C. Absence of erythema and tenderness at the surgical site D. Ability to flex and extend the right knee

A. Observation of a large amount of serosanguineous or bloody drainage Rationale A. A large amount of serosanguineous or bloody drainage may indicate hemorrhage or, if an incision is present, that the incision has opened. This requires immediate attention. B. Mild to moderate pain controlled with prescribed analgesics would be a normal finding for this client. C. Absence of erythema and tenderness of the surgical site would be normal findings for this client. D. The client should be able to flex and extend the right knee (limb) after surgery.

The nurse anticipates providing collaborative care for a client with a traumatic amputation of the right hand with which health care team members? Select all that apply. A. Occupational therapist B. Physical therapist C. Psychologist D. Respiratory therapist E. Speech therapist

A. Occupational therapist B. Physical therapist C. Psychologist Rationale The client has an amputation and does not have a respiratory condition that warrants collaborative care with a respiratory therapist.

Which intervention will the nurse suggest to a client with a leg amputation to help cope with loss of the limb? A. Talking with an amputee close to the client's age who has had the same type of amputation B. Drawing a picture of how the client sees himself or herself C. Talking with a psychiatrist about the amputation D. Engaging in diversional activities to avoid focusing on the amputation

A. Talking with an amputee close to the client's age who has had the same type of amputation Rationale A. Meeting with someone of a comparable age who has gone through a similar experience will help the client cope better with his or her own situation. B. Drawing a picture is not therapeutic and may cause more harm than good. C. Unless the client is having serious maladjustment problems or has a coexisting psychological disorder, meeting with a psychiatrist should not be necessary. D. Diversional activities do not help the client deal with loss of the limb.

The client has sustained a fracture of the left tibia. The extremity is immobilized using an external fixation device. Which postoperative instruction will the nurse plan to include in this client's teaching plan? A. Use pain medication as prescribed to control pain. B. Clean the pin site when any drainage is noticed. C. Wear the same clothing that is normally worn. D. Apply Neosporin (bacitracin, neomycin, and polymyxin

A. Use pain medication as prescribed to control pain. Rationale A. The client should be taught the correct use of prescribed pain medication to control pain adequately. B. Pin sites must be cleaned at least every 8 hours and as needed to reduce the risk for infection. C. The client will have to adjust the type of clothing that is worn while the fixation device is in place. D. If signs and symptoms of infection develop around the pin sites, the client must notify the health care provider immediately. Infection at the pin sites places the client at risk for osteomyelitis.

A client has been diagnosed with a primary bone tumor. What information in the client's history would lead the nurse to believe that this tumor is a chondrosarcoma? A. Dull pain and swelling of the affected area for a long period B. Pain and swelling of the affected area for a short period C. Local pain accompanied by muscle atrophy D. Local tenderness with a palpable mass

ANS: A A chondrosarcoma is characterized by dull pain and swelling of the affected area for a long period.

Which clinical manifestation would serve to alert the nurse that a client's osteomyelitis is chronic, rather than acute? A. Ulceration of the skin B. Temperature more than 101° F (38° C) C. Erythema of the affected area D. Swelling around the affected area

ANS: A Fever, swelling, and erythema are far less common in chronic osteomyelitis, whereas ulceration, sinus tract formation, and localized pain are more characteristic.

What maneuver should the nurse ask the client with carpal tunnel syndrome to perform to assess for early motor changes? A. Ask the client to pick up a coin. B. Ask the client to grasp his or her hand. C. Ask the client to pick up a 5-pound weight. D. Ask the client to place the backs of the hands together and flex the wrists.

ANS: A Motor changes begin with a weak pinch and progress to muscle weakness and wasting. Asking the client to pick up a coin is an example of testing the ability to pinch.

Clients with chronic, unremitting osteomyelitis may benefit from the use of hyperbaric oxygen (HBO). The purpose of HBO is to A. Increase tissue perfusion. B. Provide a bacteriocidal effect. C. Decrease the client's pain. D. Increase the client's mobility.

ANS: A The goal of hyperbaric oxygen therapy is to increase tissue perfusion with a high concentration of oxygen that infuses into tissues to promote healing.

A client has had a urinary pyridinium crosslinks assay to evaluate bone resorption. What outcome result would the nurse expect to find in a client with osteoporosis? Increased A. Urinary pyridinium level B. Serum calcium level C. Urinary calcitonin level D. Serum parathyroid hormone level

ANS: A A urinary pyridinium crosslinks assay measures urinary concentrations of pyridinium, a collagen substance found in bone and cartilage. If bone loss is present, urinary levels of pyridinium increase.

A client has been advised to take supplemental calcium carbonate. What instructions should be given to this client regarding this medication? A. "Take this medication with food." B. "These tablets should not be crushed." C. "Take this medication on an empty stomach." D. "The medication should not be swallowed with milk or other calcium products."

ANS: A Calcium carbonate should be taken with food, because gastric acid is necessary for absorption.

Which instruction is most important for the RN to provide to the nursing assistant assigned to care for a client with primary osteoporosis? a. "Clean up clutter in the room." b. "Encourage the client to bathe herself or himself." c. "Monitor urinary output." d. "Perform passive range-of-motion exercises."

ANS: A Clients with osteoporosis are at risk for fracture when they fall. Clutter in the room is a risk factor for falls. The other choices have nothing to do with prevention of bone fracture in a client with primary osteoporosis.

A client is prescribed alendronate (Fosamax). Which statement indicates that the client understands teaching about this drug? a. "I should take this drug with a full glass of water." b. "I need to lie down for 30 minutes after taking it." c. "This drug should be taken after a meal." d. "This drug needs to be taken at the same time as calcium."

ANS: A Fosamax needs to be taken on an empty stomach with a full glass of water for best absorption and to prevent esophagitis. After taking the drug, the client needs to stay upright for 30 minutes. Calcium can be taken, but not at the same time as Fosamax.

While caring for a client who has chronic osteomyelitis and wound drainage, which intervention is most important for the nurse to implement? a. Cover the wound with a dressing. b. Teach about the cause of the infection. c. Monitor the erythrocyte sedimentation rate (ESR). d. Prepare the client for hyperbaric oxygenation.

ANS: A If an open wound is present in the hospital or long-term care setting, the client's treatment usually includes Standard Precautions for limiting infection by covering the wound. Teaching about the cause of the infection could prevent further episodes of infection, but does not take care of the current problem. The ESR just tells the health care provider that an inflammatory process is going on. Hyperbaric oxygenation is used only for clients with chronic, unremitting osteomyelitis. Covering the wound would be the most important step for the nurse to take first.

Which nursing intervention is most effective in preventing transfer of an organism from the wound of a client with osteomyelitis to other clients? a. Contact Precautions b. Restriction of visitors c. Irrigating the wound as needed d. Leaving the wound open to air

ANS: A In the presence of wound drainage, Contact Precautions may be used to prevent the spread of the offending organism to other clients and health care personnel. Restricting visitors does not prevent transfer. One visitor could possibly transfer the bacteria to another surface. Irrigating the wound would not destroy the organism. The wound should be covered to prevent transfer of the organism.

The nurse is caring for a client with prostate cancer. Which laboratory finding indicates to the nurse that the cancer has metastasized to the bone? a. Serum calcium, 21.6 mg/dL b. Creatine kinase, 55 U/mL c. Alkaline phosphatase, 45 IU/mL d. Lactate dehydrogenase, 120 U/L

ANS: A Metastasis of tumor to bone results in release of calcium into the bloodstream, causing an elevation of the serum calcium level (normal range, 9 to 10.5 mg/dL). The other laboratory values are within normal limits and do not indicate metastasis to the bone.

Which client is at highest risk for the development of plantar fasciitis? a. Young adult runner b. Adolescent swimmer c. Older adult client who walks with a cane d. Adult client confined to a wheelchair

ANS: A Plantar fasciitis accounts for 10% of running-related injuries. Obesity is also thought to be a factor in the development of plantar fasciitis. It is often seen in middle-aged and older adults who are ambulatory, but plantar fasciitis is most common in athletes, especially runners.

A client diagnosed with primary bone sarcoma of the leg is scheduled for tumor removal. The client expresses fear of loss of function. Which is the nurse's best response? a. "It is normal to feel this way." b. "Physical therapy will assist you to regain function." c. "This surgery is better than an amputation." d. "This surgery is necessary to save your life."

ANS: A The client with bone cancer is expected to adjust to actual or impending loss with help. An expected outcome of nursing care includes the ability of the client to verbalize the reality of the loss and seek social support. The other responses do not reflect therapeutic communication techniques.

Which instruction does the nurse include in the discharge teaching plan of a client who has osteoporosis? a. "Avoid using scatter rugs." b. "Avoid weight-bearing exercises." c. "Use a cane when walking outside." d. "Reduce the amount of protein in your diet."

ANS: A To avoid falls, the client should keep a hazard-free environment, including avoiding scatter rugs, cluttered rooms, and wet floor areas. Weight-bearing exercises help prevent bone resorption. A cane is not needed unless the client has a physical disability. A protein deficiency should be avoided because it might cause a reduction in bone density.

The nurse is performing a medical history and physical assessment for a client. Which assessment findings lead the nurse to conclude that the client is at risk for development of osteoporosis? (Select all that apply.) a. Client is a white woman with a body mass index (BMI) of 19.4. b. Client fractured her wrist badly in a fall last year. c. Client drinks at least four cans of diet cola every day. d. Client does tai chi exercises for 45 minutes every morning. e. Client has smoked two packs of cigarettes a day for 40 years. f. Client has taken estrogen (Premarin) 0.625 mg daily since menopause.

ANS: A, B, C, E Risk factors for osteoporosis include white race, female gender, small body frame, large intake of caffeinated carbonated drinks, and smoking cigarettes. Recent fracture after a fall indicates that the client's bones may be soft and/or thin. Hormone replacement therapy, late onset of menopause, and regular exercise help reduce the risk of osteoporosis.

The nurse is performing a medical history and physical assessment on an older client. Which common findings in the older client are related to the musculoskeletal system? (Select all that apply.) a. Decrease in bone density b. Decrease in falls due to lack of activity c. Atrophy of the muscle tissue d. Decrease in bone prominence e. Degeneration of cartilage f. Reduced range of motion of the joints

ANS: A, C, E, F In the older adult, common findings include a decrease in bone density, atrophy of muscle tissue, cartilage degeneration, and a decrease in range of motion. In addition, falls increase as the result of kyphotic posture, widened gait, and an alteration in the center of gravity, creating an unsteady walking pattern. Increased bony prominences are observed in the older adult because less soft tissue is present to cushion the bone, and pressure ulcers are a threat.

The client is 8 hours postoperative from limb salvage surgery for a tumor of the left thigh. On assessment, the nurse notes that the toes of the left foot are more edematous than they were 1 hour before, cooler to the touch, and have a slower capillary refill. What is the nurse's priority action at this time? A. Elevate the left foot. B. Notify the physician. C. Loosen the pressure dressing. D. Apply ice to the distal extremity.

ANS: B A rapid deterioration in circulatory status of the affected extremity alerts the nurse to notify the physician immediately.

Which of the following diagnostic procedures can determine whether a bone tumor is benign or malignant? A. Bone scan B. Bone biopsy C. Computed tomography D. Magnetic resonance imaging

ANS: B Although different types of imaging can provide information associated with benign or malignant bone tumors, only a biopsy can confirm the tumor type.

Which of the following clients would be most at risk for the development of osteomalacia? A. 72-year-old man with congestive heart failure B. 55-year-old woman with Laënnec's cirrhosis C. 22-year-old woman with type 1 diabetes D. 45-year-old woman with asthma

ANS: B Clients with liver or pancreatic disease have decreased vitamin D metabolism.

A client with Paget's disease has been prescribed treatment with a 6-month course of etidronate (Didronel). What instructions would be most important for the nurse to provide to this client? A. "This medication may make you feel light-headed or sleepy." B. "Take this medication with water or juice 1 to 2 hours after breakfast." C. "This dosage will be increased over the course of therapy." D. "The medication may cause diarrhea."

ANS: B Etidronate (Didronel) is poorly absorbed from the small intestine. It should be taken on an empty stomach 1 to 2 hours after breakfast or at bedtime with water or juice.

A client is about to begin drug therapy for osteomyelitis. What information regarding this treatment would be most appropriate for the nurse to provide to the client? A. "You will need to remain in the hospital for the duration of the treatment." B. "You will need to undergo treatment with IV antibiotics for several weeks." C. "Only close family members may be permitted to visit while you are receiving treatment." D. "Once the IV medications are completed, the infection is considered cured, and no further treatment is needed."

ANS: B Typically, osteomyelitis requires treatment with IV antibiotics for several weeks. The client will leave the hospital with a central IV catheter for home infusion of the medication. Oral antibiotics for several more weeks usually follow the IV regimen.

To prevent bone density loss, which exercise should the nurse recommend to a client at risk for osteoporosis? A. High-impact aerobics 45 minutes once weekly B. Walking 30 minutes three times weekly C. Jogging 30 minutes four times weekly D. Bowling for 1 hour twice weekly

ANS: B Weight-bearing, nonjarring exercises have been proven to reduce or slow bone loss without causing vertebral compression

An adult client's susceptibility to osteoporosis is caused by which aspect of his or her history? a. Fractured arm at age 16 b. Active smoking c. Vitamin D supplements d. Weight lifting

ANS: B A history of smoking has been identified as a risk factor for osteoporosis. A history of low-trauma fracture after the age of 50 has been identified as a risk factor. Vitamin D and weight lifting are measures that can be used to prevent this disease.

The nurse is caring for a client with a lesion in the area of the tibia that is swollen and tender. Which client problem is the highest priority for nursing care? a. Need for increased calories related to increased metabolism b. Pain management related to physical injury c. Compromised self-care related to weakness d. Safety risk related to skeletal impairment

ANS: B A palpable mass and swelling in the area of the tibia are symptoms of osteochondroma, which is a common, benign bone tumor. Pain is the most common manifestation of a benign bone tumor. The other distractors are important, but pain management is the highest priority.

When providing care for a client who has had a débridement for osteomyelitis, which intervention is most important for the nurse to implement? a. Assess the white blood cell count. b. Assess circulation in the distal extremities. c. Administer pain medication. d. Monitor temperature.

ANS: B All the interventions would be completed during care of this client. However, after resection of infected bone, neurovascular assessments must be done frequently because the client experiences increased swelling, which could cause neurovascular compromise.

Two hours after limb salvage surgery for a client with left leg bone sarcoma, the nurse notes that the toes of the left foot are more edematous, are cooler to the touch, and have a slower capillary refill. Which action does the nurse take first? a. Apply ice to the distal extremity. b. Check the splint for proper placement. c. Elevate the left foot. d. Loosen the pressure dressing.

ANS: B Assessment of the neurovascular status of the affected extremity should be performed every 1 to 2 hours after surgery. Splinting or casting the limb may cause neurovascular compromise and needs to be checked for proper placement. Applying ice will cause vasoconstriction, which will further impair blood flow. Elevation of the foot will similarly decrease circulation to the area.

What is the pathophysiologic process leading to the development of osteoporosis? A. Lack of erythropoietin production by aging kidneys B. Rate of osteoclastic activity exceeding the rate of osteoblastic activity C. Insufficient intestinal absorption of calcium, magnesium, and phosphorus D. Atrophy of bone and skeletal muscle modeling processes as a result of disuse

ANS: B Bone health is a dynamic process throughout life, dependent on bone-forming osteoblastic activity in balance with bone resorption osteoclastic activity. As people age, osteoclastic activity occurs more rapidly than osteoblastic activity.

The mother of a 16-year-old client diagnosed with Ewing's sarcoma expresses concern that her son seems to be angry at everyone in the family. How does the nurse respond? a. "You need to set limits with your son." b. "This is a normal stage in the grieving process." c. "He will be back to normal when he leaves the hospital." d. "This is typical behavior for a teenager."

ANS: B Clients often experience loss of control over their lives when a diagnosis of cancer (e.g., Ewing's sarcoma) is made. Clients may progress through the grieving process, which includes denial, followed by anger. Setting limits without understanding the grieving process can make the client feel that he has no control. The behavior is not typical of a teenager without the disease. It is part of the grieving process. The mother should not expect the son to return to "normal" when he goes home.

The nurse is caring for a client with rheumatoid arthritis. For which condition does the nurse assess most carefully? a. Dupuytren's contracture b. Hallux valgus c. Morton's neuroma d. Plantar fasciitis

ANS: B Hallux valgus deformity is a common foot problem in which the great toe deviates laterally at the first metatarsophalangeal joint. This condition often occurs as a result of poorly fitted shoes, family history, osteoarthritis, and rheumatoid arthritis. The other responses are not applicable to rheumatoid arthritis.

A client newly diagnosed with Ewing's sarcoma is most likely to exhibit which laboratory finding? a. Elevated red blood cells (RBCs) b. Elevated alkaline phosphatase (ALP) c. Decreased erythrocyte sedimentation rate (ESR) d. Decreased serum lactate dehydrogenase (LDH)

ANS: B In Ewing's sarcoma, laboratory results typically would demonstrate elevated alkaline phosphatase because of higher osteoblastic activity. Red blood cells would be low indicating anemia, the ESR would be elevated owing to tissue inflammation, and the LDH would be elevated as the cancer progresses.

Which of the following clients is most at risk for secondary osteoporosis? A. 33-year-old man recovering from a fractured wrist B. 55-year-old woman taking prednisone for asthma C. 72-year-old man who resides in a nursing home D. 25-year-old woman taking oral contraceptives

ANS: B Osteoporosis is more prevalent in postmenopausal women, and certain medications, such as corticosteroids, increase the risk of secondary osteoporosis.

The nurse is caring for a client who is able to flex the right arm forward without difficulty or pain but is unable to abduct the arm because of pain and muscle spasms. Which condition does the nurse suspect based on these assessment findings? a. Dislocated elbow b. Lesion in the rotator cuff c. Osteoarthritis of the shoulder d. Atrophy of the supraspinatus muscle

ANS: B Rotator cuff lesions may cause limited range of motion and pain and muscle spasm during abduction, whereas forward flexion stays fairly normal. The assessment findings are not consistent with the other conditions.

An occupational therapist is treating a client with rheumatoid arthritis. Which assessment finding in the client does the nurse share with the occupational therapist? a. Difficulty sleeping because of pain in the knees and elbows b. Difficulty tying shoelaces and doing zippers on clothing c. Swollen knees with crepitus and limited range of motion d. Generalized joint stiffness that is worse in the early morning

ANS: B The functional assessment helps nurses and therapists measure how functional the client is with activities of daily living, including dressing. The occupational therapist can assist the client to explore clothing options that are easier to manage with arthritic fingers. The other findings would not necessarily need to be shared with the occupational therapist for the treatment plan.

A client is seen at the clinic with the medical diagnosis of osteomalacia. When taking the client's history, what does the nurse assess for? a. Arm and leg strength b. Dietary intake of vitamin D c. Dietary intake of calcium d. Exercise habits

ANS: B Vitamin D deficiency is the most important factor in the development of osteomalacia. Weak arm and leg strength may be seen, calcium deficiency plays a part in the disease process, and discomfort while exercising may be described. However, the most significant risk factor in this disease process is vitamin D deficiency.

Which exercise does the nurse recommend to a client at risk for osteoporosis? a. High-impact aerobics 45 minutes once weekly b. Walking 30 minutes three times weekly c. Jogging 30 minutes four times weekly d. Bowling for 1 hour twice weekly

ANS: B Weight-bearing, nonjarring exercises have been proved to reduce or slow bone loss without causing vertebral compression. High-impact aerobics, jogging, and bowling are activities that actually could cause fracture in a client with osteoporosis. Walking would be the best choice as an exercise.

A female client who is a carrier of the gene for Duchenne's muscular dystrophy asks whether any of her daughters will have this disease. Which is the nurse's best response? a. "Both parents must have the defective gene." b. "Your daughter cannot get the disease." c. "Your daughters have a 50% chance of developing the disease." d. "Your daughters will become carriers of the gene."

ANS: B Women who are carriers have a 50% chance of passing the gene to their daughter, who then are carriers, and to their sons, who then have the disease. This type of muscular dystrophy affects only males. The other responses are not accurate.

The nurse reviews the health history of a client with acute osteomyelitis. Which findings might have contributed to the diagnosis? (Select all that apply.) a. Recent dental work b. Urinary tract infection c. Pregnancy d. Age e. Hemodialysis f. Gastrointestinal infection

ANS: B, E, F Poor dental hygiene and gum infection (not necessarily recent dental work), urinary tract infection, hemodialysis, and Salmonella infection of the gastrointestinal tract can be sources of infection and, consequently, osteomyelitis. Pregnancy and advancing age are not necessarily precursors to osteomyelitis, even though urinary tract infection leading to osteomyelitis is common in older men.

A client diagnosed with Ewing's sarcoma of the right leg confides fears surrounding the loss of independence with the loss of the limb to the nurse. What is the nurse's best response? A. "Physical therapy will assist you to regain function once you are fitted with a prosthesis." B. "It is natural to feel this way, but you are young and will adjust to it." C. "Many people experience a feeling of grief and mourn this loss." D. "This surgery was necessary to save your life."

ANS: C Ewing's sarcoma typically strikes young adults. The client needs assurance that these feelings of loss and grief are normal and are part of making the transition to adapting to the illness. The nurse performs ongoing psychological assessments and can initiate referral to a professional counselor if needed.

A client with Paget's disease and severe hypercalcemia is receiving mithramycin intravenously. Which of the following should the nurse monitor for complications of this therapy? A. Pulse oximetry B. T3 and T4 levels C. Liver enzyme levels D. Heart rate and rhythm

ANS: C Mithramycin can affect kidney and liver function. It also can cause decreased numbers of platelets. The nurse monitors all these parameters. When liver enzyme levels become very high, treatment may be interrupted temporarily.

Which of the following signs alerts the nurse to the possibility of carpal tunnel syndrome? A. A positive Trousseau's sign B. A positive Cullen's sign C. A positive Phalen's maneuver D. A positive Turner's sign

ANS: C Phalen's maneuver produces paresthesia in the median nerve within 60 seconds. Eighty percent of individuals with CST have a positive Phalen's maneuver result

A client with osteoporosis has been prescribed raloxifene (Evista). What laboratory data would suggest an adverse effect of this drug? A. Decreased serum calcium level B. Elevated cholesterol level C. Elevated liver function tests D. Decreased serum potassium level

ANS: C Raloxifene (Evista) can cause liver function tests to rise or worsen pre-existing hepatic disease. The nurse should monitor the client's liver function tests.

Which radiographic finding is considered to be diagnostic for osteomalacia? A. The presence of vertebral bone chip fractures B. The presence of mineralized fractures C. The presence of Looser's lines D. The presence of a string sign

ANS: C The classic diagnostic finding on radiographs for osteomalacia is Looser's lines. These lines represent nonmineralized stress fractures.

A client recently diagnosed with Paget's disease of the bone asks the nurse how this disease was acquired. What is the rationale for the nurse's response? This disease A. Occurs in postmenopausal women who have a sedentary lifestyle. B. Is a chromosomal abnormality. C. Is thought to be the result of a latent viral infection. D. Can be acquired from intestinal parasites.

ANS: C The disease may be the result of a latent viral infection contracted in young adulthood and manifesting as disease 20 to 40 years later.

The nurse is assessing a client who reports severe knee pain after a fall. Which question does the nurse ask to determine the radiation of the pain? a. "What makes the pain better or worse?" b. "Are you able to bear any weight on the knee at all?" c. "Does the pain move to another area from your knee?" d. "How would you rate the pain on a scale of 1 to 10?"

ANS: C To determine radiation of the pain, the nurse asks the client if the pain moves to another area from the knee. The other questions address the amount, functional impact, and alleviating or aggravating factors of the pain.

While performing a physical assessment on a client with osteoporosis, the nurse notes that the client changes position slowly and there is tenderness to palpation of the spinal vertebra at T8. What conclusion can the nurse draw from this data? A. The client has phallophobia. B. The client is developing kyphosis. C. The client has a compression fracture. D. The client has scoliosis.

ANS: C A client with known osteoporosis accompanied by tenderness to spinal palpation should be evaluated for one or more compression fractures.

A client's susceptibility to osteomalacia is related to which risk factor? a. Calcium level of 11 mg/dL b. Diet high in milk and soy c. phosphate level of 1.0 mg/dL d. Taking vitamin D supplements

ANS: C A low serum phosphate level predisposes a client to osteomalacia. The normal range is 2.5 to 4.5 mg/dL. Vitamin D supplements, diets high in vitamin D (e.g., milk and soy), and high calcium levels are not risk factors for osteomalacia.

The nurse is assessing a client who is suspected of having muscular dystrophy. Which statement by the client indicates that more teaching may be needed about the creatine kinase (CK) test that the health care provider has ordered? a. "The Lasix that I took this morning may affect the test results." b. "The CK test is 90% accurate in demonstrating muscle trauma or injury." c. "The level of CK will be decreased with skeletal muscle disease." d. "When muscle is damaged, CK isoenzymes are released over time."

ANS: C All of the statements are correct, except that the level of creatine kinase will increase with any skeletal muscle damage.

The nurse is assessing a client with Paget's disease. Which assessment finding leads the nurse to notify the health care provider immediately? a. Client is 5 feet in height and weighs 130 pounds. b. Long bones of the legs and arms are bowing. c. Base of the skull is enlarged with changes in vital signs. d. Mild pain is present in the area of the hips and pelvis.

ANS: C It is common for the client with Paget's disease to be short in stature and to develop bowing of the long bones and mild to moderate pain, which often occurs in weight-bearing joints. When the skull becomes enlarged with basilar invagination, the brainstem may become damaged; this can threaten the vital sign center and life itself.

Which client does the nurse assess first at the start of the nursing shift? a. Client wanting to know information about a magnetic resonance imaging (MRI) test scheduled in 3 hours b. Client who is verbalizing mild discomfort after an electromyography (EMG) c. Client who reports increased pain and swelling after an arthroscopy d. Client who refuses to drink more fluids after a nuclear medicine scan

ANS: C The client who should be the first priority is the one who is reporting increased pain and swelling after arthroscopy; this could indicate complications from the surgery. The client with mild discomfort after an EMG should be assessed for pain, but mild discomfort is common for this procedure. Pain medication can then be administered. After a nuclear medicine scan, the client must increase fluids to flush out the radioisotope used in the scan. The nurse could then visit with the client who had questions about the upcoming MRI.

The nurse is caring for a client who presents with achy jaw pain. Which assessment technique does the nurse use to determine whether the client has inflammation of the temporomandibular joint (TMJ)? a. Checking for decayed, fractured, loose, or missing teeth b. Observing the jaw joint as the client chews a piece of food c. Palpating the joint during movement for tenderness or crepitus d. Observing for asymmetric joint protrusion when the client's mouth is closed

ANS: C The temporomandibular joints are best assessed by palpation while the client opens his or her mouth. The other assessment techniques are not effective for assessing possible TMJ inflammation.

What is the primary complaint of a client with severe Paget's disease? A. Visual disturbances B. Decreased energy C. Falls D. Pain

ANS: D Bone pain is the most common problem for symptomatic clients with Paget's disease.

Which clinical manifestation indicates therapy for osteomalacia is successful? A. A weight gain of 5 pounds B. A serum calcium level of 8.8 mg/dL C. An increased range of shoulder motion D. An increase in lower extremity muscle strength

ANS: D The hypophosphatemia associated with osteomalacia decreases the amount of adenosine triphosphate available for muscle contraction and causes muscle weakness. An increase in lower extremity muscle strength indicates that the condition is responding to the treatment.

A client has cancer and a pacemaker, and suffers from claustrophobia. Which diagnostic test is the best indicator of the client's bone metastasis? a. Magnetic resonance imaging (MRI) b. Arthrogram c. Ultrasound d. Thallium bone scan

ANS: D Because the client has a pacemaker and claustrophobia, MRI would not be an option as a diagnostic test. The arthrogram is an x-ray used to visualize bone chips and torn ligaments within a joint. Ultrasound is used to assess soft tissue disorders, traumatic joint injuries, and osteomyelitis. The thallium bone scan is ideal for obtaining information about the extent of bone cancer such as osteosarcoma or bony metastases.

Which postoperative order does the nurse clarify with the surgeon before discharging the client who just had arthroscopic surgery on the right knee? a. Keep the right leg elevated on a soft pillow for 12 hours. b. Maintain non-weight bearing by right leg for 48 hours. c. Use ice on the knee for 24 hours. d. Administer two tablets of oxycodone/APAP (Tylox) every 4 hours for pain.

ANS: D Each tablet of Tylox has 5 mg oxycodone with 500 mg acetaminophen. If the client took two tablets every 4 hours, the client would ingest a total of 6000 mg of acetaminophen, well over the safe maximum dose of 4000 mg in 24 hours. The rest of the orders are appropriate.

Which instruction does the nurse give to the client before he or she has electromyography (EMG)? a. "Make sure that you have someone to drive you home after the test." b. "Do not eat or drink anything for at least 6 hours before the test." c. "You will have to avoid heavy lifting for 24 hours following the test." d. "Do not take your cyclobenzaprine (Flexeril) on the 2 days before the test."

ANS: D Electromyography (EMG) testing measures nerve signal transmission to and through muscles. Skeletal muscle relaxants such as Flexeril can affect test results and should be avoided for at least 2 days before the test. The other instructions are not relevant before EMG testing.

Which client does the nurse assess more carefully for risk of developing primary osteoporosis? a. African-American client b. Resident of a nursing home c. Client who eats meat with every meal d. Client who drinks 6 cups of coffee daily

ANS: D Excessive consumption of caffeine and alcohol has been shown to be a risk factor for primary osteoporosis because of loss of calcium in the urine. Being white or Asian has been identified as causing a higher risk for developing osteoporosis at an earlier age compared with African-American ethnicity. Being a resident of a nursing home who is not exposed to sunlight could be a risk factor, but just being a resident does not predispose to osteoporosis. Meat is high in protein. Protein deficiency has been identified as a risk factor.

Which assessment finding relates most directly to a diagnosis of chronic osteomyelitis? a. Erythema of the affected area b. Swelling around the affected area c. Temperature higher than 101° F (38° C) d. Ulceration of the skin

ANS: D Fever, swelling, and erythema are far less common in chronic osteomyelitis, whereas ulceration, sinus tract formation, and localized pain are more characteristic.

The nurse is caring for a client who is to have a computed tomography (CT) scan of the leg. Which assessment question does the nurse ask the client before the procedure? a. "Do you have any metal clips, plates, or pins in your body?" b. "Have you had anything to eat or drink in the last 6 hours?" c. "Do you have someone to drive you home after the procedure?" d. "Do you have any allergies to shrimp, scallops, or other seafood?"

ANS: D IV contrast that contains iodine may be required for CT scans to rule out malignancy. The client should be assessed for allergy to shellfish, which contain high amounts of iodine. The other questions are not relevant when a CT scan is to be obtained.

When preparing to care for a client with a family history of Paget's disease, it is most important for the nurse to include education in which area? a. Avoidance of infections b. Exercise program c. Nutrition high in vitamin C d. Need for genetic testing

ANS: D Paget's disease has been noted in up to 30% of people with a positive family history. Clients who have a history of this disease in their family should be taught the importance of genetic counseling. An exercise program may be started with the help of a physical therapist, but exercise may be difficult because of pain and danger of fracture. The diet should be rich in calcium and vitamin D.

The nurse has educated a client on Paget's disease. Which statement by the client indicates good understanding of causative factors? a. "It is caused by lack of calcium in my diet." b. "I probably had a fracture that caused it." c. "This disease occurs because of lack of exercise." d. "I may have a genetic predisposition."

ANS: D Paget's disease has been noted in up to 30% of people with a positive family history. The other responses are not accurate as a cause of Paget's disease.

The RN has assigned a client with severe osteoporosis to an LPN. Which information about the care of the client is most important for the RN to provide the LPN? a. Provide passive range of motion (ROM) to all weight-bearing joints. b. Position the client upright to promote lung expansion. c. Place a pillow between the client's knees when in the side-lying position. d. Use a lift sheet to reposition the client.

ANS: D Severe osteoporosis causes such bone density loss that pathologic fractures can easily occur when lifting or pulling a client. Use of a lift sheet when positioning reduces this risk. Passive range of motion prevents contractures, but active weight-bearing exercise reduces bone resorption and is a better choice if possible. Positioning the client to promote lung expansion and positioning with a pillow for side-lying are important interventions for any client. The most important intervention for this client is to prevent bone fractures.

A client has severe Paget's disease. Which factor has the highest priority when the nurse intervenes in the care of this client? a. Dietary education b. Exercise program c. Genetic testing d. Relief of pain

ANS: D The primary intervention for Paget's disease is drug therapy with pain management as a priority. This can be accomplished with various drugs and complementary measures. All the other options are treatments for Paget's disease. Pain management is the priority.

The client is scheduled to have dual-energy x-ray absorptiometry scan (DEXA). What information regarding preparation for this test should be given to the client? A. "You will need to drink at least 500 mL of fluid 1 to 2 hours before the scan." B. "You will be given a sedative just prior to the scan to reduce any pain or anxiety." C. "You should consume increased amounts of calcium-rich foods for the 48 hours preceding the scan." D. "There is no special preparation required for this test."

ANS: D The test is a painless scan that requires no preparation or follow-up care.

A client who has been diagnosed with osteomyelitis is beginning antibiotic therapy. Which information does the nurse include in the client's teaching plan? a. Needing a consultation with a surgeon b. Continuing on Contact Isolation at home c. Remaining in the hospital for the rest of the treatment d. Receiving antibiotic treatment at home from the home health nurse

ANS: D Typically, osteomyelitis requires treatment with IV antibiotics for several weeks. The client will leave the hospital with a central IV catheter (PICC) for home infusion of the medication. Oral antibiotics usually follow the IV regimen for several more weeks. Surgical intervention is reserved for clients with chronic osteomyelitis if medication therapy is ineffective. Contact Isolation is needed only if the infection can be transmitted to another person when copious drainage is present.

After the administration of each dose of zoledronic acid (Zometa), it is most important for the nurse to determine which finding? a. Capillary refill b. Pain relief c. Level of consciousness d. Urine output

ANS: D Zoledronic acid is a bisphosphonate that helps protect bones and prevent fractures. Urine output and serum creatinine should be monitored because this drug can be toxic to the kidneys. Zometa does not relieve pain or affect capillary refill or level of consciousness.

Which statement indicates to the nursing instructor that the nursing student understands the normal healing process of bone after a fracture? A. "A callus is quickly deposited and transformed into bone." B. "A hematoma forms at the site of the fracture." C. "Calcium and vascular proliferation surround the fracture site." D. "Granulation tissue reabsorbs the hematoma and deposits new bone."

B. "A hematoma forms at the site of the fracture." Rationale A. In stage 4 of a healing fracture, callus is gradually reabsorbed and transformed into bone. B. In stage 1, within 24 to 72 hours after a fracture, a hematoma forms at the site of the fracture because bone is extremely vascular. This then prompts the formation of fibrocartilage, providing the foundation for bone healing. C. Stage 3 of bone healing occurs as a result of vascular and cellular proliferation. D. Stage 2 of bone healing occurs within 3 days to 2 weeks after the fracture, when granulation tissue begins to invade the hematoma.

A client has a new synthetic arm cast for a radial fracture. What health care teaching does the nurse include for the client's home care? Select all that apply. A. "Apply heat on the cast for the first 24 hours to increase blood flow for healing." B. "Keep your arm elevated, preferably above your heart, as much as possible." C. "Report severe numbness or inability to move your fingers to your physician." D. "Take your pain medication as needed according to the prescription directions." E. "Don't cover the cast with anything because it will stay wet for 24 hours."

B. "Keep your arm elevated, preferably above your heart, as much as possible." C. "Report severe numbness or inability to move your fingers to your physician." D. "Take your pain medication as needed according to the prescription directions." Rationale The nurse will need to provide some teaching to prepare the client for discharge home. The primary nursing concern is assessment and prevention of neurovascular dysfunction or compromise. The client should immediately report numbness or the inability to move the fingers. The client should be instructed to take pain medication for discomfort that may accompany the fracture. Elevate the fractured extremity higher than the heart, and apply ice for the first 24 to 48 hours as needed to reduce edema. The client should apply ice for the first 24 to 48 hours. Synthetic materials for casts are much more common and include fiberglass and polyester-cotton knit, which are lighter than plaster and require minimal drying time.

The nurse plans to refer a client with an amputation and the client's family to which community resource? A. American Amputee Society (AAS) B. Amputee Coalition of America (ACA) C. Community Workers for Amputees (CWA) D. National Amputee of America Society (NAAS)

B. Amputee Coalition of America (ACA) Rationale A. The AAS is not an organization that actually exists. B. The ACA is an available resource for clients with amputations and supports them and their families. C. The CWA is not an organization that actually exists. D. The NAAS is not an organization that actually exists.

The nurse admits an older adult client who sustained a left hip fracture and is in considerable pain. The nurse anticipates that the client will be placed in which type of traction? A. Balanced skin traction B. Buck's traction C. Overhead traction D. Plaster traction

B. Buck's traction Rationale A. Balanced skin traction is indicated for fracture of the femur or pelvis. B. Buck's traction may be applied before surgery to help decrease pain associated with muscle spasm. C. Overhead traction is indicated for fracture of the humerus with or without involvement of the shoulder and clavicle. D. Plaster traction is indicated for wrist fracture.

Which typical clinical manifestation does the nurse expect to observe for a client with a right tibial fracture? A. Flaccid extremity B. Crepitation of extremity C. Mild pain D. No evidence of edema

B. Crepitation of extremity Rationale A. The client with a fracture will typically have a decreased range of motion (ROM) in the affected extremity, but not flaccidity. B. On assessment, crepitation (a continuous grating sound created by bone fragments) may be heard when the affected extremity is moved. C. Clients with a fractured extremity usually report moderate to severe pain at the site of the fracture or in an adjacent or distal area. D. Swelling is commonly seen at a fracture site. It can occur rapidly and may result in marked neurovascular compromise.

Which information about a client who was admitted with pelvic and bilateral femoral fractures after being crushed by a tractor is most important for the nurse to report to the physician? A. Thighs have multiple oozing abrasions. B. Serum potassium level is 7 mEq/L. C. The client is describing pain at a level 4 (0 to 10 scale). D. Hemoglobin level is 12.0 g/dL.

B. Serum potassium level is 7 mEq/L. Rationale A. This finding is not unusual for a client with this history. B. The elevated potassium level may indicate that the client has rhabdomyolysis and acute tubular necrosis caused by the crush injury. Further assessment and treatment are needed immediately to prevent further renal damage or cardiac dysrhythmias. C. A pain level of 4 is not an unusual finding for a client with this condition. D. A hemoglobin level of 12.0 g/dL is a normal finding.

The client has a grade III compound fracture of the right tibia. To prevent infection, which intervention will the nurse implement? A. Applying Neosporin (bacitracin, neomycin, and polymyxin B) ointment to the site daily with a sterile cotton-tipped swab B. Using strict aseptic technique when cleaning the site C. Leaving the site open to the air to keep it dry D. Assisting the client to shower daily and pat the wound site dry

B. Using strict aseptic technique when cleaning the site Rationale A. Chlorhexidine (Hexicleans), 2 mg/mL solution, is the better cleansing solution for pin site care, not Neosporin ointment. B. Using aseptic technique is the best way to prevent infection. C. A wound of this type should be kept covered. D. The wound site of a compound fracture must not be exposed to a shower. This practice violates maintaining aseptic technique.

A client who had an elective below-the-knee amputation reports pain in the part of his leg that was amputated. What is the nurse's best response to his pain? A. "The pain will go away in a few days or so." B. "That's phantom limb pain and every amputee has that." C. "On a scale of 0 to 10, how would you rate your pain?" D. "The pain is not real, so we don't treat it."

C. "On a scale of 0 to 10, how would you rate your pain?" Rationale The nurse should recognize the client's phantom limb pain as real and treat it aggressively. A combination of drug therapy and complementary and alternative therapies is the best approach for pain management. The phantom limb pain may not subside in a few days. Not all clients who have experienced an amputation have phantom limb pain; it is more common in above-the-knee amputations.

The nurse is concerned that a client who had an open reduction, internal fixation of his tibia and fibula is at risk for complex regional pain syndrome. What assessment findings at the affected area are common when a client has this complication? Select all that apply. A. Dull, aching pain B. Decrease in sweating C. Muscle spasms D. Skin discoloration E. Paresis F. Edema

C. Muscle spasms D. Skin discoloration E. Paresis F. Edema Rationale Muscle spasms, skin discoloration, paresis, and edema are all manifestations that present in complex regional pain syndrome. The client experiencing this syndrome would have intense, unrelenting, burning pain rather than dull, aching pain, as well as excessive (not decreased) sweating due to dysfunction of the autonomic nervous system.

The client has sustained a rotator cuff tear while playing baseball. The nurse anticipates that the client will receive which immediate conservative treatment? A. Surgical repair of the rotator cuff B. Prescribed exercises of the affected arm C. Sling for the affected arm D. Patient-controlled analgesia with morphine

C. Sling for the affected arm Rationale A. Surgical intervention is not considered conservative treatment. B. Exercises are prohibited immediately after a rotator cuff injury. C. The conservative treatment for this client is to place the injured arm in a sling or immobilizer. D. The client with a rotator cuff injury is treated primarily with nonsteroidal anti-inflammatory drugs (NSAIDs) to manage pain.

The nurse is instructing a local community group about ways to reduce the risk for musculoskeletal injury. What information will the nurse include in the teaching plan? A. Avoid contact sports. B. Avoid rigorous exercise. C. Wear helmets when riding a motorcycle. D. Avoid driving in inclement weather.

C. Wear helmets when riding a motorcycle. Rationale A. Telling the general public to avoid contact sports is not realistic. B. Telling the general public to avoid rigorous exercise is not only unrealistic, it is also opposed to what many health care professionals recommend to maintain health. C. Those who ride motorcycles or bicycles should wear helmets to prevent head injury. D. Telling the general public to avoid driving in inclement weather is not realistic.

The client is in skeletal traction. Which nursing intervention ensures proper care of this client? A. Ensure that weights are attached to the bed frame or placed on the floor. B. Ensure that pins are not loose, and tighten as needed. C. Inspect the skin at least every 8 hours. D. Remove the traction weights only for bathing.

C: The client's skin should be inspected every 8 hours for signs of irritation, inflammation, or actual skin breakdown. Weights are not allowed to be placed on the floor; weights should hang freely at all times. Pin sites should be checked for signs and symptoms of infection and for security in their position to the fixation and the client's extremity. However, the nurse does not adjust the pins. Any loose pin site or alteration must be reported to the health care provider. Weights must never be removed without a request from the health care provider.

The client with a fracture asks the nurse about the difference between a compound fracture and a simple fracture. Which statement by the nurse is correct? A. "Simple fracture involves a break in the bone, with skin contusions." B. "Compound fracture does not extend through the skin." C. "Simple fracture is accompanied by damage to the blood vessels." D. "Compound fracture, grade I, involves minimal skin damage."

D. "Compound fracture, grade I, involves minimal skin damage." Rationale A. A grade II compound fracture involves a break in the bone, with skin contusions. B. A simple fracture does not extend through the skin. C. A grade III compound fracture is accompanied by damage to blood vessels. D. A grade I compound fracture involves minimal damage to the skin.

The client is recovering from an above-knee amputation resulting from peripheral vascular disease. Which statement indicates that the client is coping well after the procedure? A. "My spouse will be the only person to change my dressing." B. "I can't believe that this has happened to me. I can't stand to look at it." C. "I do not want any visitors while I'm in the hospital!" D. "It will take me some time to get used to this."

D. "It will take me some time to get used to this." Rationale A. The client is not coping effectively because he or she does not want to participate in self-care. B. The client is not coping effectively because he or she is unwilling to address what has happened. C. The client who does not want to receive visitors is having difficulty coping with the change in body image. D. This statement indicates that the client is expressing acceptance and effective coping.

The nurse prepares to perform a neurovascular assessment on the client with closed multiple fractures of the right humerus. Which technique will the nurse use? A. Inspect the abdomen for tenderness and bowel sounds. B. Auscultate lung sounds. C. Assess the level of consciousness and ability to follow commands. D. Assess sensation of the right upper extremity.

D. Assess sensation of the right upper extremity. Rationale

Which nursing action will the nurse on the orthopedic unit plan to delegate to unlicensed assistive personnel (UAP)? A. Remove the wound drain for a client who had an open reduction of a hip fracture 3 days ago. B. Assess for bruising on a client who is receiving warfarin (Coumadin) to prevent deep vein thrombosis. C. Teach a client with a right ankle fracture how to use crutches when transferring and ambulating. D. Check the vital signs for a client who was admitted after a total knee replacement 3 hours ago.

D. Check the vital signs for a client who was admitted after a total knee replacement 3 hours ago. Rationale A. Removing a drain requires broader education and is within the scope of practice of licensed nursing staff. B. Assessment requires broader education and is within the scope of practice of a licensed nurse. C. Client teaching requires broader education and is within the scope of practice of a licensed nurse. D. Vital sign assessment is a skill that is within the role of the UAP.

An older adult client has multiple tibia and fibula fractures of the left lower extremity after a motor vehicle accident. Which pain medication does the nurse anticipate will be requested for this client? A. Cyclobenzaprine (Flexeril) B. Ibuprofen (Advil, Motrin, Dolgesic, others) C. Meperidine (Demerol) D. Patient-controlled analgesia (PCA) with morphine

D. Patient-controlled analgesia (PCA) with morphine Rationale A. Muscle relaxants are effective for treating pain related to muscle spasms, but they are not adequate for this type of acute pain. B. Ibuprofen (Advil, Motrin, Dolgesic, others) is a nonsteroidal anti-inflammatory that is used to treat mild to moderate pain. Bone pain is very acute. C. Meperidine (Demerol) should never be used for older adults because it has toxic metabolites that can cause seizures. D. Morphine is an opioid narcotic analgesic; given through PCA, it is the most appropriate mode of pain management for this type of acute pain associated with multiple injuries.

The client is brought to the emergency department (ED) via ambulance after a motor vehicle accident. What condition will the nurse assess for first? A. Bleeding B. Head injury C. Pain D. Respiratory distress

D. Respiratory distress Rationale A. Bleeding is the second assessment priority in this case. B. Head injury is the third assessment priority in this case. C. Pain is the fourth assessment priority in this case. D. The client is first assessed for respiratory distress, and any oxygen interventions are instituted accordingly.

The nurse is assessing the patient's posture and gait, and notes that the patient shifts his shoulders from side to side while walking. How is this finding considered? a. Abnormality in the swing phase, called a lurch. b. Abnormality in the stance phase, called an antalgic gait. c. Normal and automatic gait d. Limp or other type of asymmetric body movement

a. Abnormality in the swing phase, called a lurch.

Which ethnic group has the least risk for developing osteoporosis? a. African American b. European American c. Asian American d. Hispanic American

a. African American

The nurse is caring for the adult patient with a recent increase in growth hormone and acromegaly. In assessing this patient, what does the nurse expect to find? a. Bone and soft-tissue deformities b. Pain that increases when flexing joints c. Unusually tall height for ethnic background d. Marked lateral curvature of the spine

a. Bone and soft-tissue deformities

Which factor is primarily responsible for regulating serum calcium levels? a. Calcitonin b. Vitamin D c. Glucocorticoids d. Growth hormone

a. Calcitonin

The nurse is reviewing laboratory results for the patient who was involved in an accident. There is no evidence of fracture or bone damage, but multiple soft tissue injuries were sustained. Which muscle enzymes are expected to be elevated because of the injuries? (Select all that apply.) a. Creatine kinase (CK) b. Aspartate aminotransferase (AST) c. Alkaline phosphatase (ALP) d. Lactic dehydrogenase (LDH) e. Aldolase (ALD)

a. Creatine kinase (CK) b. Aspartate aminotransferase (AST)

The patient who is currently on anticoagulant therapy is advised to undergo diagnostic testing for musculoskeletal weakness. Which diagnostic test is contraindicated because of the therapy? a. Electromyography b. Computed tomography c. Xeroradiography d. Magnetic resonance imaging

a. Electromyography

The patient has osteoarthritis that affects the most common joints. In doing a functional assessment of this patient, the home health nurse anticipates the patient is most likely to have problems with which activity? a. Going up and down the stairs b. Buttoning a shirt c. Lifting more than 15 pounds d. Getting an arm into a coat sleeve

a. Going up and down the stairs

The patient has an effusion of the right knee. Which assessment finding does the nurse expect to see in this patient? a. Limitations in movement and accompanying pain. b. Obvious appearance of genu valgum c. Crepitus and difficulty weight bearing d. Obvious redness and skin bearing

a. Limitations in movement and accompanying pain.

Which orthopedic conditions will require the patient to have neurovascular assessment performed at least every 4 hours? (Select all that apply.) a. Presence of a cast b. Crush injury to the forearm c. Multiple rib fractures d. Femoral angiogram assessment e. Recent hip surgery

a. Presence of a cast b. Crush injury to the forearm d. Femoral angiogram assessment e. Recent hip surgery

The patient reports pain in the left lower ankle. Which questions does the nurse ask to elicit relevant information about this patient's musculoskeletal problem? (Select all that apply.) a. "Do you have adequate calcium and vitamin D intake?" b. "What seems to make the pain worse?" c. "What measures seem to help alleviate the symptoms?" d. "What did your family doctor tell you?" e. "When did your pain start?" f. "Do you have a history of diabetes mellitus?"

b. "What seems to make the pain worse?" c. "What measures seem to help alleviate the symptoms?" e. "When did your pain start?"

The patient has a family history of Osteoporosis but currently denies pain or dysfunction. To plan health promotion interventions related to this finding, what does the nurse do? a. Ask the patient's age and assess for weight loss. b. Assess the dietary intake of calcium. c. Assess for kyphoscoliosis or other deformities. d. Assess for occult fractures of the long bones.

b. Assess the dietary intake of calcium.

The nurse is reviewing the laboratory results for the patient with severe diarrhea and hypocalcemia. What does the nurse find is present in bone and serum in inverse proportion to calcium? a. Estrogen b. Phosphorus c. Thyroxine d. Insulin

b. Phosphorus

The patient is at risk for a parathyroid hormone (PTH) imbalance related to a recent surgical procedure. Based on this information, which blood level must the nurse monitor in the patient? a. Blood glucose b. Serum calcium c. Serum potassium d. Serum magnesium

b. Serum calcium

In assessing the patient's functional ability and ROM, the patient is unable to actively move a joint through the expected ROM. Which technique does the nurse use to assess joint mobility? a. The patient relaxes the muscles in the extremity, then moves the joint through the fullest possible. b. The nurse holds the part with one hand above and one hand below the joint to be evaluated, and allows passive ROM to evaluate joint mobility. c. The patient moves the joints while the nurse applies gentle pressure. d. The patient moves the joint to the best of ability while the nurse palpates for crepitus.

b. The nurse holds the part with one hand above and one hand below the joint to be evaluated, and allows passive ROM to evaluate joint mobility.

Which group has the greatest risk for trauma resulting in injuries to muscles and bones? a. Older adult men related to occupational injuries b. Young men related to motor vehicle accidents c. Young women related to sports injuries d. Children who are not supervised during play

b. Young men related to motor vehicle accidents

The patient is recovering from a long bone fracture. Which lifestyle choice decreases the vitamins and nutrients required for bone and tissue growth? a. Smoking cigarette b. Vegetarian diet c. Excessive alcohol consumption d. Excessive caffeine consumption

c. Excessive alcohol consumption

Which instrument is used to assess joint ROM? a. Odometer b. Ergometer c. Goniometer d. Spectrometer

c. Goniometer

The nurse is assessing the patient who is obese, especially in the abdominal area. What is the most common musculoskeletal assessment finding in this patient? a. Scoliosis b. Crepitus c. Lordosis d. Kyophosis

c. Lordosis

Based on bone physiology and the dynamic process of formation and resorption, which group has the greatest risk for bone injury? a. Older adult men regardless of exercise habits b. Young adults who exercise frequently c. Older adult women regardless of exercise habits d. Children who never or very rarely exercise

c. Older adult women regardless of exercise habits

Which vitamin plays a key role in bone health? a. Vitamin A b. Vitamin B c. Vitamin D d. Vitamin E

c. Vitamin D

The 55-year-old woman with a small frame is aware of her increased risk for osteoporosis and loss of bone mass, although she currently reports no pain or loss of function. She asks the nurse to recommend a good type of exercise to counteract the risk. What does the nurse suggest? a. Swimming b. Deep breathing and isometric exercises c. Walking with arm weights d. Golfing

c. Walking with arm weights

The patient is an athletic young adult man who broke his leg during a sports accident. The cast, which has been in place for several weeks, is being removed for the first time and the patient is stunned by the appearance of his leg. What is the nurse's best response to this patient's surprise? a. "Don't worry; it looks crusty and withered but the strength and function are normal." b. "The cast compresses the tissue, but your leg will look normal in a couple of days." c. "Let's just wash off the dead skin and you will see that it is not as bad as it seems." d. "Without regular exercise muscles atrophy; strength can be restored with use."

d. "Without regular exercise muscles atrophy; strength can be restored with use."

While observing the patient performing range-of-motion exercises, the nurse notes the patient can move the leg outward from the side of the body. How does the nurse identify this movement? a. Flexion b. Extension c. Adduction d. Abduction

d. Abduction

Which laboratory result may indicate bone or liver damage, such as metastatic cancer of the bone? a. Serum calcium 9.5 mg/dL b. Serum calcium 8.2mg/dL c. Lactate dehydrogenase (LDH) 185 units/L d. Alkaline phosphatase 140 units/L

d. Alkaline phosphatase 140 units/L

The patient is a construction worker in his early 30s who was treated with oral antibiotics after stepping on a nail. The wound does not appear to be responding to antibiotic treatment as expected, despite the patient's compliance. The nurse suspects the patient may have a family history of which disorder? a. Renal disease b. Heart disease c. Skin or bone cancer d. Diabetes mellitus

d. Diabetes mellitus

What activity does the nurse ask the patient to perform when assessing ROM in the patient's hands? a. Wave the hand as though waving goodbye.'s b. Grip the nurse's hand as hard as possible. c. Rapidly move the hands into the palm-up and palm-down positions. d. Make a fist and then oppose each finger to thumb.

d. Make a fist and then oppose each finger to thumb.

Which assessment finding of the musculoskeletal system indicates an abnormality? a. Symmetry in the upper extremities and equal muscle mass b. Gait balance and a smooth and regular stride c. Flexion, extension, and rotation of the neck d. Opposition of three of four fingers to thumb

d. Opposition of three of four fingers to thumb