Prep U Musculoskeletal Chapter 53

A nurse is caring for a client who's experiencing septic arthritis. This client has a history of immunosuppressive therapy and the client's immune system is currently depressed. Which assignment is the most appropriate for the nurse caring for this client?

The nurse is caring for the client in the intensive care unit Rationale: This client is critically ill; the client's diagnosis and immunosuppression place them at a high risk for infection. The most appropriate place for this client is in an intensive care unit, where the nurse can focus exclusively on health promotion.

A client with osteoarthritis asks for information concerning activity and exercise. When assisting the client, which concept should be included?

Exercising at least 1 hour after awakening allows the client to participate in exercise after some of the morning-related stiffness has subsided.

When developing a care plan for a client newly diagnosed with scleroderma, which nursing diagnosis has the highest priority?

Impaired skin integrity

After a person experiences a closure of the epiphyses, which statement is true?

No further increase in bone length occurs

The nurse is planning care with an older adult who is at risk for falling because of postural hypotension. Which intervention will be most effective in preventing falls in this client?

Instruct the client to sit, obtain balance, dangle legs, and rise slowly

A client is taking methotrexate for severe rheumatoid arthritis. The nurse instructs the client that it will be necessary to monitor:

Complete blood count (CBC) with differential and platelet count Rationale: This client should be monitored for blood dyscrasias, evidenced by decreased platelet count and white blood cell count with changes in the CBC differential

A nurse is teaching a client who was recently diagnosed with carpal tunnel syndrome. Which statement should the nurse include?

"Ergonomic changes can be incorporated into your workday to reduce stress on your wrist."

A client has a total hip replacement. Which of the following client statements indicates a need for further teaching before discharge?

"I can't wait to go home and get in the bath tub" Rationale: The client will need to avoid extremes of motion in the hip to avoid dislocation. The hip should not be flexed more than 90 degrees, internally rotated, or legs crossed. It is not possible to safely sit in the bathtub without flexing the hip beyond the recommended 90 degrees.

A nurse is assisting a client with range-of-motion exercises. The nurse moves the client's leg out and away from the midline of the body. What movement does the nurse document?

Abduction

A client in skeletal traction spills coffee in bed. Which action(s) should the nurse take to change this client's linens? Select all that apply.

Ask the client to raise the buttocks while the sheet is slid under the buttocks. Ask the client to raise the torso by using the trapeze. Change the lower part of the linen with the client resting supine.

A nurse is caring for a client placed in traction to treat a fractured femur. Which nursing intervention has the highest priority?

Assessing the extremity for neurovascular integrity

What are important nursing priorities on the first postoperative day for a client who has had an open reduction and internal fixation (ORIF) after a right hip fracture?

Assessing the neurovascular status in the right leg, providing pain control, encouraging position changes, and early ambulation

A nurse monitors a client receiving enoxaparin 30 mg subcutaneously BID after hip replacement surgery. Which adverse reaction is the client most likely to experience?

Bleeding

Passive range-of-motion (ROM) exercises for the legs and assisted ROM exercises for the arms are part of the care regimen for a client with a spinal cord injury. Which observation by the nurse would indicate a successful outcome of this treatment?

Free, easy movement of the joints Rationale: ROM exercises help preserve joint motion and stimulate circulation. Contractures develop rapidly in clients with spinal cord injuries, and the absence of this complication indicates treatment success. Range of motion will keep the ankle joints freely mobile

The nurse is counseling a client with osteoporosis about dietary choices to slow bone loss. What foods should the nurse teach the client to avoid?

Foods and beverages high in caffeine Rationale: Caffeine may decrease calcium absorption and contribute to bone loss so should be avoided in high amounts

During a scoliosis screening in a college health center, a student asks the public health nurse about the consequences of untreated scoliosis. The nurse identifies one of the direct complications as

Impingement on pulmonary function

A client is brought to the emergency department after injuring their right arm in a bicycle accident. The orthopedic surgeon tells the nurse that the client has a greenstick fracture of the arm. What does this mean?

One side of the bone is broken and the other side is bent.

A diet plan is developed for a client with gouty arthritis. The nurse should advise the client to limit his intake of

Organ meats Rationale: Gouty arthritis is a disorder of purine metabolism. High-purine foods include organ meats, anchovies, sardines, shellfish, and meat extracts.

Which cells are involved in bone resorption?

Osteoclasts

The nurse is evaluating the pin insertion site of a client's skeletal traction. Which finding indicates a complication?

Pin moves slightly at insertion site

A client is in balanced suspension traction to maintain alignment of a fractured tibia. Which activities are safe for the client?

Raise the hips using the trapeze Can use fracture bedpan

To prevent external rotation of the client's hips while lying on the back, it would be best for the nurse to place:

Trochanter rolls alongside the legs from ilium to midthigh

To prevent external rotation of the client's hips while lying on the back, it would be best for the nurse to place:

Trochanter rolls alongside the legs from ilium to mid thigh

A client suspected of having systemic lupus erythematosus (SLE) is being scheduled for testing. The client asks which of the tests ordered will determine if the client is positive for the disorder. Which statement by the nurse is most accurate?

"The diagnosis won't be based on the findings of a single test but by combining all data found."

A client recovering from hip replacement surgery questions the need for admission to a rehabilitation center because there are family members available at home to provide care. Which response by the nurse is best?

"The rehabilitation staff can evaluate your progress and help you recover without risking injury."

When the client who has had a hip replacement is lying on the side, the nurse should place pillows or an abductor splint between the legs to prevent:

Adduction of the hip joint Rationale: Places the hip in proper alignment. Dislocation of the hip can occur if the leg on the affected side is allowed to adduct.

A nurse is caring for a client with a spinal cord injury. The client is experiencing blurred vision and has a blood pressure of 204/102 mm Hg. What should the nurse do first?

Check the client's bladder for distention Rationale: The client is experiencing autonomic dysreflexia, which is a medical emergency. The nurse should immediately evaluate the client for bladder distention and be prepared to catheterize the client.

The nurse should closely monitor the client with an open fracture for which complication?

Osteomyelitis

A client has a plaster cast applied to the lower extremity that is still wet to touch. In which way should the nurse move the casted limb to elevate it on a pillow?

Place the palms on both sides of the cast Rationale: When moving a client with a wet plaster cast, only the palms of the hands should be used so that indentations in the cast from the fingers may be prevented

Which goal is the priority for a client with a fractured femur who is in traction?

Prevent effects of immobility while in traction.

After a laminectomy, the client states, "The doctor said that I can do anything I want to." Which activity that the client intends to do indicates the need for further teaching?

Sweeping the front porch Rationale: Sweeping causes a twisting motion, which should be avoided because twisting can cause undue stress on the recently ruptured disc site, muscle spasms, and a potential recurrent disc rupture.

An allergy to which antibiotic or antibiotic class necessitates cautious use of penicillin?

Cephalosporins

On a visit to the family physician, a client is diagnosed with a bunion on the lateral side of the great toe, at the metatarsophalangeal joint. Which statement should the nurse include in the teaching session?

"Some bunions are congenital; others are caused by wearing shoes that are too short or narrow."

A nurse is teaching a client with osteomalacia how to take ordered vitamin D supplements. Which adverse effects should the nurse instruct the client to report?

GI upset and metallic taste (early s/sx of vitamin D toxicity)

A client has a leg immobilized in traction. Which observation by the nurse indicates that the client understands actions to take to prevent muscle atrophy?

The client performs isometric exercises to the affected extremity three times per day Rationale: Isometric contractions increase the tension within a muscle but do not produce movement. Repeated isometric contractions make muscles grow larger and stronger.

A client undergoes hip-pinning surgery to treat an intertrochanteric fracture of the right hip. The nurse should include which intervention in the postoperative care plan?

Keep a pillow between the legs at all times

Which condition should the nurse assess when completing the history and physical examination of a client diagnosed with osteoarthritis?

Local joint pain

A client is 4 days postoperative from a tibia fracture and has a long leg cast. The nurse is conducting initial teaching for walking with crutches. What is the most important activity for the nurse to encourage the client to do prior to discharge from the hospital?

Conduct exercises in bed to strengthen the upper extremities, as this will assist the client in crutch use

A nurse is caring for a client who had hip pinning surgery 6 hours ago to treat intertrochanteric fracture of the right hip. What assessment finding requires further investigation by the nurse?

Client anxious and confused Rationale: The client is anxious and confused is the appropriate answer. Postoperative complications of hip fractures include hemorrhage, pulmonary emboli, and fat emboli. Anxiety and confusion may be indicative of hypoxia as a result of any of these complications and needs further investigation.

A client who has skeletal traction to stabilize a fractured femur has not had a bowel movement for 2 days. The nurse should:

Encourage fluid intake of 3,000ml per day

The nurse is going to lunch and is conducting a "hand-off of care" to the charge nurse. Which information should the nurse communicate to the charge nurse during the "hand-off of care" communication?

Give the charge nurse information about what care should be given while the nurse is at lunch.

A client has been diagnosed with osteoporosis after a bone density test and is asking what has caused it. Discussion of risk factors would include:

Heavy smoking, sedentary lifestyle, and high intake of carbonated drinks (d/t high phosphate levels)

The client returns from surgery for a below-the-knee amputation with the residual limb covered with dressings and a woven elastic bandage. At first, the bandage was dry. Now, 30 minutes later, the nurse notices a small amount of bloody drainage. The nurse should first:

Mark the area of drainage Rationale: The nurse should mark the bloody drainage and observe it again in 10 minutes to assess if the bleeding is continuing.

When assessing an older adult as a candidate for crutch walking, the nurse should take into account that for some elderly people, crutch walking is an impractical goal primarily because of decreased:

Motor coordination

The nurse is caring for a client who is 30 years of age with a fracture of the right femur and left tibia. Both legs have casts. The nurse assesses the following: respirations are 30 per minute and are rapid and shallow; there is presence of faint expiratory wheeze; and coughing produces thin pink sputum. The client is yelling at the nurse and wants to be released from the hospital; this is behavior unlike that previously reported. The last pain medication was administered 3 hours ago. What should the nurse do first?

Notify the HCP Rationale: The nurse's first action is to notify the HCP because the client is likely experiencing a fat embolus

The nurse is caring for an adult with a grade III compound fracture of the right femur; the client has been placed in skeletal traction. What is the intended outcome of the traction?

Reduce and immobilize the fracture

The nurse is creating a plan of care for an older adult client with osteoarthritis. Which nursing diagnosis is most appropriate?

Risk for injury r/t impaired immobity

When caring for a client with acute osteomyelitis in the right tibia, which measure is mostappropriate to implement when repositioning the client's leg?

Support the leg above and below the affected area when positioning.

The initial postoperative assessment is completed on a client who had an arthroscopy of the knee. Which information is not necessary to obtain every 15 minutes during the first postoperative hour?

Urinary output Neurovascular assessment, pain, and vital signs should be monitored during the first hour every 15 minutes

A home care nurse visits a client with muscular dystrophy. Which comment by the client indicates that more information about an advance directive is needed?

"I don't ever want a feeding tube when the time comes that I can't eat." Rationale: The client states a desire not to have a feeding tube but does not say that this wish is formally documented. There may be a need for teaching about advance directives. When the client says that a specific relative will make decisions and that this intent is documented, it is unlikely that further teaching is needed. Statements about a new brace or a sore relate to the client's condition and care plan and are not relevant to advance directives

The nurse has instructed the client about the correct positioning of the leg and hip following hip replacement surgery. Which statement indicates that the client has understood these instructions?

"I should avoid bending over to tie my shoes." Rationale: Acute flexion and adduction of the hip should be avoided after hip replacement surgery and the client should not bend over to tie the shoes.

A client recovering from lumbar surgery is fitted for a contour splint. What should the nurse explain to the client about this device?

"The splint immobilizes the body part in a functional position."

What is the most important assessment for the nurse to make when assessing peripheral pulses on a client who is post limb fracture?

Amplitude and symmetry of both extremities

A male client underwent a lumbar spinal fusion yesterday. Which nursing assessment should alert the nurse to the development of a possible complication?

Clear, yellowish fluid on the dressing Rationale: Clear yellowish fluid on the dressing may be cerebrospinal fluid (CSF). This fluid must be tested for glucose to determine whether it is CSF. If so, the client is at great risk for an infection of the central nervous system, which has a high mortality rate

A nurse suspects that a client with a recent fracture has compartment syndrome. Assessment findings may include

Inability to perform active movement and pain with passive movement

The nurse is caring for a client with a fractured fibula who has skeletal traction and skeletal pins. What would the nurse instruct the unlicensed assistive personnel (UAP) to report immediately?

The traction weights are on the floor

A client undergoes a total hip replacement. Which statement made by the client indicates to the nurse that the client requires further teaching?

"I don't know if I'll be able to get off that low toilet seat at home by myself."

Which behavior would demonstrate that the client has an understanding of proper residual limb care? The client:

Washing and thoroughly drying the residual limb daily are important hygiene measures to prevent infection

Following a boating accident, a client with multiple fractures is admitted to a semiprivate room in a progressive care unit. The client, who was piloting the boat, is unaware that the client's partner's 9-year-old son was killed in the accident. The client's parents instruct the nurse to prohibit phone calls and to withhold information about the accident. During an assessment of the client, the nurse notices that the television is on and the news is starting. What should the nurse do?

Allow the client to view the television and deal with any questions as they come Rationale: The nurse-client relationship is built on trust, so the nurse can't withhold information from the client. The nurse may refer the client to another source for the information, but the nurse can't prohibit the client from seeking information. It would be most appropriate for the nurse to deal with the client's questions as they come. Turning the television off, changing the channel, and distracting the client are all deceitful practices, which can damage a therapeutic nurse-client relationship