QUIZ 7 !!! Musculoskeletal 3

43. A 4-year old sustains a fall at home and is brought to the emergency room by the mother. After an x-ray examination, the child is determined to have a fractured arm and plaster cast is applied. The nurse provides instructions to the mother regarding care for the child's cast. Which statement by the mother indicates a need for further instructions? a) the cast may feel warm as the cast dries b) I can use lotion or powder around the cast edges to relieve itching c) a small amount of white shoe polish can touch up a soiled white cast d) if the cast becomes wet, a blow drier set on the cool setting may be used to dry the cast

43) B - The mother needs to be instructed not to use lotion or powders on the skin around the cast edges or inside the cast. Lotions or powders can become sticky or caked and cause skin irritation. Options A, C, and D are appropriate instructions.

44. A nurse is providing instructions to the parents of a child with scoliosis regarding the use of a brace. Which statement by the parents indicates a need for further instruction? a) I will encourage my child to perform prescribed exercises b) I will have my child wear soft fabric clothing under the brace c) I should apply lotion under the brace to prevent skin breakdown d) I should avoid the use of powder because it will cake under the brace

44) C - The use of lotions or powders under a brace should be avoided because they can become sticky and cake under the brace, causing irritation. Options A, B, and D are appropriate interventions in the care of a child with a brace.

45. A 1-month old infant is seen in a clinic and is diagnosed with developmental dysplasia of the hip (DDH). The nurse assesses the infant, knowing that which of the following findings would be noted in this condition? a) limited range of motion in the affected hip b) an apparent lengthened femur on the affected side c) asymmetrical adduction of hte affected hip when the infant is placed supine with the knees and hips flexed d) symmetry of the gluteal skinfolds when the infant is placed prone and the legs are extended against the examining table

45) A - In DDH, the head of the femur is seated improperly in the acetabulum or hip socket of the pelvis. Asymmetrical abduction of the affected hip, when the child is placed supine with the knees and hips flexed, would be an assessment finding in DDH in infants beyond the newborn period. Other findings include an apparent short femur on the affected side, asymmetry of the gluteal skinfolds, and limited range of motion in the affected extremity.

46. A client is treated in physician's office for a sprained ankle after a fall. Radiographic examination has ruled out a fracture. Before sending the client home, the nurse plans to teach the client to avoid which of the following in the next 24 hours? a) resting the foot b) applying a heating pad c) applying an elastic compression bandage d) elevating the ankle on a pillow while sitting or lying down

46) B - Soft tissue injuries such as sprains are treated by RICE (rest, ice, compression, and elevation) for the first 24 hours after the injury. Ice is applied intermittently for 20 to 30 minutes at a time. Heat is not used in the first 24 hours because it could increase venous congestion, which would increase edema and pain.

47. A nurse is conducting health screening for osteoporosis. Which of the following client is at greatest risk of developing this disorder? a) a 25-year old woman who jogs b) a 36-year old man who has asthma c) a 70-year old man who consumes excess alcohol d) a sedentary 65-year old woman who smokes cigarettes

47) D - Risk factors for osteoporosis include female gender, postmenopausal, advanced age, low-calcium diet, excessive alcohol intake, being sedentary, and smoking cigarettes. Long-term use of corticosteroids, anticonvulsants, and/or furosemide (Lasix) also increases risk.

48. A nurse has given instructions to a client returning home after knee arthroscopy. The nurse determines that the client understands the instructions if the client states that he or she will: a) resume regular exercise the following day b) stay off the leg entirely for the rest of the day c) report fever or site inflammation to the physician d) refrain from eating food for the remainder of the day

48) C - After arthroscopy, the client usually can walk carefully on the leg once sensation has returned. The client is instructed to avoid strenuous exercise for at least a few days. The client may resume the usual diet. Signs and symptoms of infection should be reported to the physician.

49. A client with possible rib fracture has never had a chest radiograph. The nurse would plan to tell the client which of the following items about the procedure? a) the x-rays stimulate a small amount of pain b) removal of jewelry and any other metal objects is necessary c) the client will be asked to breathe in and out as the x-ray is taken d) the x-ray technologist will stand next to the client during the procedure

49) B - A radiograph is a photographic image of part of the body on a special film, which is used to diagnose a wide variety of conditions. Radiography itself is painless; any discomfort would arise from repositioning a painful part for filming. The nurse may want to premedicate a client who is at risk for pain. Any radiopaque objects such as jewelry or other metal must be removed. The client is asked to breathe in deeply and then hold the breath while the chest radiograph is taken. To minimize risk of radiation exposure, the x-ray technologist stands in a separate area protected by a lead wall. The client also wears a lead shield over his or her gonads.

5. Foods allowed in the diet of gout patient include: a) cheese b) beef c) sardines d) liver

5) A - preventive measures for gout: uric acid is formed from metabolism of purine. To prevent further formation and accumulation of uric acid, the patient must be advised to stick on a low purine diet. This means that the patient must avoid: sweet breads, yeast, heart, herring, sardines, anchovies, shellfish, heavy alcohol intake avoidance of excessive weight gain alkaline ash diet to increase the pH of urine to discourage precipitation of uric acid and enhance the action of drugs such as probenicid (Benemid)

50. A nurse is one of several persons who witness a vehicle hit a pedestrian at fairly low speed on a small street. The person is dazed and tries to get up. The leg appears fractured. The nurse would plna to: a) try to reduce the fracture manually b) assist the person to get up and walk to the sidewalk c) leave the person for a few moments to call an ambulance d) stay with the person and encourage the person to remain still

50) D - With a suspected fracture, the client is not moved unless it is dangerous to remain in that spot. The nurse should remain with the client and have someone else call for emergency help. A fracture is not reduced at the scene. Before the client is moved, the site of fracture is immobilized to prevent further injury.

51. A client has a fiberglass (nonplaster) cast applied to the lower leg. The client asks the nurse when the client will be able to walk using the casted leg. The nurse replies that the client will be able to bear weight on the casted leg: a) in 48 hours b) in 24 hours c) in about hours d) within 20 to 30 minutes of application

51) D - A fiberglass cast is made of water-activated polyurethane materials that are dry to the touch within minutes and reach full rigid strength in about 20 minutes. Because of this, the client can bear weight on the cast within 20 to 30 minutes.

52. A nurse has given a client with a leg cast instructions on cast care at home. The nurse would evaluate that the client needs further instruction if the client makes which of the following statements? a) I should avoid walking on wet, slippery floors b) I'm not supposed to scratch the skin underneath the cast c) it's okay to wipe dirt off the top of the cast with a damp cloth d) if the cast gets wet, I can dry it with a hair dryer turned to the warmest setting

52) D - Client instructions should include avoiding walking on wet slippery floors to prevent falls. Surface soil on a cast can be removed with a damp cloth. If the cast gets wet, it can be dried with a hair dryer set to a cool setting to prevent skin breakdown. If the skin under the cast itches, cool air from a hair dryer may be used to relieve it. The client should never scratch under a cast because of the risk of skin breakdown and ulcer formation.

53. A client with a hip fracture asks the nurse why Buck's extension traction is being applied before surgery. The nurse's response is based on the understanding that Buck's extension traction primarily: a) allows bony healing to begin before surgery b) provides rigid immobilization of the fracture site c) lengthens the fractured leg to prevent severing of blood vessels d) provides comfort by reducing muscle spasms and provides fracture immobilization

53) D - Buck's extension traction is a type of skin traction often applied after hip fracture before the fracture is reduced in surgery. Traction reduces muscle spasms and helps immobilize the fracture. Traction does not lengthen the leg for the purpose of preventing blood vessel severance. Traction also does not allow for bony healing to begin.

54. A client returns to the nursing unit following the application of skeletal leg traction. Upon assessment, the nurse notes a small amount of bleeding around the pin insertion sites. The nurse should take which action? a) notify the surgeon b) recheck the site in 1 hour c) check the client's vital signs d) place a small pressure dressing at the bleeding site

54) D - Following pin insertion for skeletal traction, a small amount of bleeding is expected. This can be controlled with small pressure dressings; however, bleeding that continues for more than 24 hours should be brought to the surgeon's attention. It is not necessary to notify the surgeon immediately. Rechecking the site in 1 hour delays necessary intervention. Although vital signs may be checked in the immediate post-operative period, this action is unrelated to the small amount of bleeding.

55. A nurse is evaluating the pin sites of a client in skeletal traction. The nurse would be least concerned with which of the following findings? a) inflammation b) serous drainage c) pain at a pin site d) purulent drainage

55) B - A small amount of serous oozing is expected at pin insertion sites. Signs of infection such as inflammation, purulent drainage, and pain at the pin site are not expected findings and should be reported to the physician.

56. A client with a fractured right ankle has a short leg cast applied in the emergency department. During discharge teaching, the nurse provides which information to the client to prevent complications? a) trim the rough edges of the cast after it is dry b) weigh-bearing on the right leg is allowed once the cast feels dry c) expect burning and tingling sensations under the cast for 3 to 4 days d) keep the right ankle elevated above the heart level with pillows for 24 hours

56) D - Leg elevation is important to increase venous return and decrease edema, which can cause compartment syndrome, a major complication of fractures and casting. Weight-bearing on a fractured extremity is prescribed by the physician during follow-up examination, after radiographs are obtained. Additionally, a walking heel or cast shoe may be added to the cast if the client is allowed to bear weight and walk on the affected leg. Although the client may feel heat after the cast is applied, burning and/or tingling sensations indicate nerve damage or ischemia and are not expected. These complaints should be reported immediately. Option 1 is incorrect. The client and/or family may be taught how to "petal" the cast to prevent skin irritation and breakdown, but rough edges, if trimmed, can fall into the cast and cause a break in skin integrity.

57. An older adult female client with a fractured left tibia has a long leg cast and is using crutches to ambulate. In caring for the client, the nurse assesses for which sign or symptom that indicates a complication associated with crutch walking? a) left leg discomfort b) weak biceps brachii c) triceps muscle spasms d) forearm muscle weakness

57) D - Forearm muscle weakness is a sign of radial nerve injury caused by crutch pressure on the axillae. When a client lacks upper body strength, especially in the flexor and extensor muscles of the arms, he or she frequently allows weight to rest on the axillae and on the crutch pads instead of using the arms for support while ambulating with crutches. Leg discomfort is expected as a result of the injury. Triceps muscle spasms may occur as a result of increased muscle use but is not a complication of crutch walking. Weak biceps brachii is a common physical assessment finding in older adults and is not a complication of crutch walking.

58. A nurse is caring for a client with Buck's traction and is monitoring the client for complications of the traction. Which assessment finding indicates a complication? a) weak pedal pulses b) drainage at the pin sites c) complaints of discomfort d) warm toes with brisk capillary refill

58) A - Weak pedal pulses are a sign of vascular compromise, which can be caused by pressure on the tissues of the leg by the elastic bandage or prefabricated boot used to secure this type of traction.

59. A client has fallen and sustained a leg injury. Which question would the nurse ask the cleint to help determine if the injury caused a fracture? a) is the pain a dull ache? b) is the pain sharp and continuous? c) does the discomfort feel like a cramp? d) does the pain feel like the muscle was stretched?

59) B - Fracture pain is generally described as sharp, continuous, and increasing in frequency. Bone pain is often described as a dull, deep ache. Strains result from trauma to a muscle body or to the attachment of a tendon from overstretching or overextension. Muscle injury is often described as an aching or cramping pain, or soreness.

6. The patient is placed on allopurinol (Zyloprim) therapy. To monitor effectiveness of the therapy, the nurse will monitor which the following serum laboratory values? a) uric acid b) fasting blood glucose c) serum calcium d) alkaline phosphatase

6) A - preventive therapy - prevention of future gout attacks is by placing the patient on daily medication that either promote uric acid excretion or prevent uric acid formation. To evaluate the effectiveness of the therapy, serum uric acid level of the patient must be monitored. The medication is effective when uric acid goes down to normal level below 6.9 mg/dl

60. The nurse is assessing the casted extremity of a client for signs of infection. Which of the following findings is indicative of infection? a) dependent edema b) diminished distal pulse c) coolness and pallor of the skin d) presence of a "hot spot" on the cast

60) D - Signs and symptoms of infection under a casted area include a musty odor or purulent drainage from the cast or the presence of "hot spots," which are areas on the cast that are warmer than others. The physician should be notified if any of these occur.

61. A nurse is performing pin site care on a client in skeletal traction. Which finding would the nurse expect to note when assessing the pin sites? a) loose pin sites b) clear drainage from the pin sites c) purulent drainage from the pin sites d) redness and swelling around the pin sites

61) B - A small amount of clear drainage ("weeping") may be expected after cleaning and removing crusting around the pin sites. Redness and swelling around the pin sites and purulent drainage may be indicative of an infection. Pins should not be loose, and, if this is noted, the physician should be notified.

62. A nurse is caring for a client who has been placed in Buck's extension traction while awaiting surgical repair of a fractured femur. The nurse prepares to perform a complete neurovascular assessment of the affected extremity and plans to assess: a) vital signs and bilateral lung sounds b) warmth of the skin and the temperature in the affected extremity c) pain level and for the presence of edema in the affected extremity d) color, sensation, movement, capillary refill, and pulse of the affected extremity

62) D - A complete neurovascular assessment of an extremity includes color, sensation, movement, capillary refill, and pulse of the affected extremity.

63. A client in the emergency department has a cast applied. The client arrives at the nursing unit, and the nurse prepares to transfer the client into the bed by: a) placing ice on top of the cast b) supporting the cast with the fingertips only c) asking the client to support the cast during transfer d) using the palms of the hands and soft pillows to support the cast

63) D - The palms or the flat surface of the extended fingers should be used when moving a wet cast to prevent indentations. Pillows are used to support the curves of the cast to prevent cracking or flattening of the cast from the weight of the body. Half-full bags of ice may be placed next to the cast to prevent swelling, but this action would be performed after the client is placed in bed. Asking the client to support the cast during transfer is inappropriate.

64. A nurse is caring for a client who has been placed in Buck's extension traction. The nurse provides for countertraction to reduce shear and friction by: a) using a footboard b) providing an overhead trapeze c) slightly elevating the foot of the bed d) slightly elevating the head of the bed

64) C - The part of the bed under an area in traction is usually elevated to aid in countertraction. For the client in Buck's extension traction (which is applied to a leg), the foot of the bed is elevated. An overhead trapeze or footboard is not used to provide countertraction. Option C provides a force that opposes the traction force effectively without harming the client.

65. The nurse is caring for a client who develops compartment syndrome from a severely fractured arm. The client asks the nurse how this can happen. The nurse's response is based on the understanding that: a) A bone fragment has injured the nerve supply in the area b) an injured artery causes impaired arterial perfusion through the compartment c) bleeding and swelling cause increased pressure in an area that cannot expand d) the fascia expands with injury, causing pressure on underlying nerves and muscles

65) C - Compartment syndrome is caused by bleeding and swelling within a compartment, which is lined by fascia that does not expand. The bleeding and swelling place pressure on the nerves, muscles, and blood vessels in the compartment, triggering the symptoms.

66. A client has undergone fasciotomy to treat compartment syndrome of the leg. The nurse prepares to provide which type of wound care to the fasciotomy site? a) dry sterile dressings b) hydrocolloid dressings c) wet sterile saline dressings d) one-half strength betadine dressings

66) C - The fasciotomy site is not sutured but is left open to relieve pressure and edema. The site is covered with wet sterile saline dressings. After 3 to 5 days, when perfusion is adequate and edema subsides, the wound is debrided and closed. A hydrocolloid dressing is not indicated for use with clean, open incisions. The incision is clean, not dirty, so there should be no reason to require Betadine. Additionally, Betadine can be irritating to normal tissues.

67. An older client admitted to the hospital with a hip fracture is placed in Buck's extension traction. The nurse plans to frequently monitor which specimen item? a) temperature b) mental state c) neurovascular status d) range of motion ability

67) C - The neurovascular status of the extremity of the client in Buck's extension traction must be assessed frequently. Older clients are especially at risk for neurovascular compromise because many older clients already have disorders that affect the peripheral vascular system. Although the client's temperature is monitored, it is not specific to the use of Buck's extension traction. Although clients in some types of traction do become depressed after a few days or weeks, Buck's extension traction is usually used preoperatively, which typically involves a few hours or 1 to 2 days, at the most. Range of motion of the involved leg is contraindicated in hip fractures.

68. Buck's extension traction is applied to an older client following a hip fracture. The nurse explains to the client that this type of traction is: a) traction involving the use of a cast b) skeletal traction involving the use of surgically inserted pins c) circumferential traction involving the use of a belt around the body d) skin traction involving the use of traction attached to the skin and soft tissues

68) D - Buck's extension traction is a form of skin traction and involves the use of a belt or boot that is attached to the skin and soft tissues. The purpose of this type of traction is to decrease painful muscle spasms that accompany fractures. The weight that is used as a pulling force is limited (usually 5 to 10 pounds) to prevent injury to the skin. Options A, B, and C are incorrect descriptions.

69. A client has Buck's extension traction applied to the right leg. The nurse plans which of the following interventions to prevent complications from the device? a) provide pin care once a shift b) massage the skin of the right leg with lotion every 8 hours c) inspect the skin on the right leg at least once every 8 hours d) release the weights on the right leg for range of motion exercises daily

69) C Buck's extension traction is a type of skin traction. The nurse inspects the skin of the limb in traction at least once every 8 hours for irritation or inflammation. Massaging the skin with lotion is not indicated. The nurse never releases the weights of traction unless specifically ordered by the physician. There are no pins to care for with skin traction.

7. A patient with rheumatoid arthritis asks the nurse why she is taking Prednisone (Deltasone) the nurse best response would be that it: a) enhance the immune system b) increase bone density c) decrease inflammation d) reduce peripheral edema

7) C - the main effect of corticosteroids is to supress inflammation. However, this same effect is also one of the main setback of corticosteroid therapy suppression of the inflammatory response also decreases the immune response making the patient susceptible to infection.

70. The nurse is caring for a client with a newly applied leg cast. The nurse prevents the development of compartment syndrome by: a) elevating the limb and applying ice to the affected leg b) elevating the limb and covering the limb with bath blankets c) keeping the leg horizontal and applying ice to the affected leg d) placing the leg in a slight dependent position and applying ice

70) A - Compartment syndrome is prevented by controlling edema. This is achieved most optimally with the use of elevation and the application of ice. The use of bath blankets or a dependent or horizontal leg position will not prevent this syndrome.

71. A client has sustained a closed fracture and has just has a cast applied to the affected arm. The client is complaining of intense pain. The nurse has elevated the limb, applied an ice bag, and administered an analgesic, which has provided very little pain relief. The nurse interprets that this pain may be caused by: a) infection under the cast b) the anxiety of the client c) impaired tissue perfusion d) the newness of the fracture

71) C - Most pain associated with fractures can be minimized with rest, elevation, application of cold, and administration of analgesics. Pain that is not relieved from these measures should be reported to the physician, because it may be caused by impaired tissue perfusion, tissue breakdown, or necrosis. Because this is a new closed fracture and cast, infection would not have had time to set in.

72. The client with a fractured femur experiences sudden dyspnea. A set of arterial blood gases reveal the following: pH is 7.32, PaCO2 is 43, PaO2 is 58, and HCO3 is 20. Which of the following components of the ABG results supports the nurse's suspicion of fat embolus? a) pH b) PaO2 c) HCO3 d) PaCO2

72) B - A key feature of fat embolism is a significant degree of hypoxemia with a Pao2 often less than 60 mm Hg. Other features that distinguish fat embolism from pulmonary embolism are an elevated temperature and the presence of fat in the blood with fat embolus.

73. The rehabilitation nurse is providing home care instruction for a client being discharged after above-the-knee amputation of the right lower limb with a fitted prosthesis. The nurse determines the client requires further teaching if the client makes which of the following statements? a) I will elevate the residual limb on a pillow b) I will change the residual limb sock everyday c) I will check the residual limb for skin irritation daily d) I will notify my prosthesis if my residual limb sock becomes stretched or ill-fitting

73) A - Clients must avoid elevation of the residual limb to prevent flexion contractures of the right hip. Additionally, sitting in a chair should be limited to 1-hour intervals to avoid the same. If there is no contraindication, clients should lie in the prone position three to four times a day to promote hip extension. Limb socks should be removed daily, laundered in mild soap, and replaced with a clean sock. When the sock is removed, the residual limb should be inspected for erythema and excoriation. As the edema resolves, the residual limb shrinks and the sock may not fit properly, leading to skin irritation. The prosthetist should be notified of the ill-fitting sock.

74. A client arrives at the clinic complaining of knee pain. On assessment the nurse notes that the knee area is swollen. The nurse interprets that the client's signs and symptoms likely indicate: a) osteoporosis b) a recent injury c) rheumatoid arthritis d) degenerative joint disease

74) B - Pain and swelling are associated with musculoskeletal inflammation, infection, or a recent injury. Degenerative joint disease, osteoporosis, and rheumatoid arthritis may be accompanied by pain, but swelling may or may not be present.

75. A client seeks treatment in the emergency department for a lower leg injury. There is visible deformity to the lower aspect of the leg, and the injured leg appears shorter than the other leg. The area is painful, swollen, and beginning to become ecchymotic. The nurse interprets that this client has experienced a: a) strain b) sprain c) fracture d) contusion

75) C - Typical signs and symptoms of fracture include pain, loss of function in the area, deformity, shortening of the extremity, crepitus, swelling, and ecchymosis. Not all fractures lead to the development of every sign. A strain results from a pulling force on the muscle. Symptoms include soreness and pain with muscle use. A sprain is an injury to a ligament caused by a wrenching or twisting motion. Symptoms include pain, swelling, and inability to use the joint or bear weight normally. A contusion results from a blow to soft tissue and causes pain, swelling, and ecchymosis.

76. The nurse is assessing the client who has just been measured and fitted for crutches. The nurse determines that the client's crutches are fitted correctly if: a) the top of the crutch is even with the axilla b) the elbow is straight when the hands is on the handgrip c) the client's axilla is resting on the crutch pad during ambulation d) the elbow is at a 30-degree angle when the hand is on the handgrip

76) D - For optimal upper extremity leverage, the elbow should be at approximately 30 degrees of flexion when the hand is resting on the handgrip. The top of the crutch needs to be two to three finger widths lower than the axilla. When crutch walking, all weight needs to be on the hands to prevent nerve palsy from pressure on the axilla.

77. The nurse is assigned to care for a client who is in traction. The nurse ensures a safe environment for the client by: a) making sure that the knots are at the pulleys b) checking the weights to be sure that they are off the floor c) making sure that the head of the bed is kept at a 90-degree angle d) monitor the weights to be sure that they are resting on a firm surface

77) B - To achieve proper traction, weights need to be free-hanging, with knots kept away from the pulleys. Weights are not to be kept resting on a firm surface. The head of the bed is usually kept low to provide countertraction

78. A client with a possible rib fracture has never had a chest x-ray. The nurse plans to tell the client which of the following about the procedure? a) the x-ray stimulates a small amount of pain b) the client will be asked to breathe in and out continuously during the x-ray c) the x-ray technologist will stand next to the client during the x-ray d) it is necessary to remove jewelry and any other metal objects from the chest area

78) D - An x-ray is a photographic image of a part of the body on a special film, which is used to diagnose a wide variety of conditions. Any radiopaque objects such as jewelry or other metal must be removed from the chest area because they will interfere with the interpretation of the results. The x-ray is painless, and any discomfort would arise from repositioning a painful part for filming. The nurse may premedicate a client, if prescribed, who is at risk for pain. The client is asked to breathe in deeply and then hold the breath while the chest x-ray is taken. To minimize the risk of radiation exposure, the x-ray technologist stands in a separate area protected by a lead wall. The client also wears a lead shield over the reproductive organs.

79. The nurse has an order to get the client out of bed to a chair on the first postoperative day following total knee replacement. The nurse plans to do which of the following to protect the knee joint? a) apply a compression dressing and put ice on the knee while sitting b) obtain a walker to minimize weigh-bearing by the client on the affected leg c) lift the client to the bedside chair, leaving the continuous passive motion (CPM) machine d) apply a knee immobilizer before getting the client up and elevate the client's surgical leg while sitting

79) D - The nurse assists the client to get out of bed on the first postoperative day after putting a knee immobilizer on the affected joint to provide stability. The surgeon orders the weight-bearing limits on the affected leg. The leg is elevated while the client is sitting in the chair to minimize edema. Ice is not used unless prescribed. A compression dressing should already be in place on the wound. A CPM machine is used only while the client is in bed

2. Which of the following guidelines should a nurse include in the teaching plan for a patient who has osteoarthritis? a) achieve ideal body weight b) increase daily calcium intake to 1500 mg c) maintain a high fiber diet d) sleep at least 10 hours each day

2) A - the primary cause of arthritis is not yet known but it is often-associated with obesity, aging, trauma, fractures, and infections. Osteoarthritis is a wear and tear disease of the joints. The more pressure it takes the more severe and the faster is the progression of the disease. Thus, one of the important aspects of management if the patient is obese is to lose weight to lessen the pressure on the joints

20. Which of the following will contribute to the development of primary gout? a) beer and wine b) eggs and milk c) vegetables and meat d) butter and fruits

20) A - beer and wine are purine-rich beverages. Gout is a metabolic disorder of purine. Other foods rich in purine are: organ meats, legumes, salted anchovies, shellfish, mushroom, sweetbreads, consomme, hearing fish.

21. Which of the following nursing interventions will best help alleviate the discomfort of the patient with rheumatoid arthritis? a) walking a mile each morning b) active range-of-motion exercises of joints c) application of hot or cold packs on the joints d) splinting the joint during waking hours

21) C - during acute phase of pain, cold application is recommended. Cold numbs nerve endings and therefore, relieves pain. After the acute phase of pain, heat application is done. This thins the synovial fluid and relieves joint stiffness. Heat also improves circulation to the area, improves oxygen supply and will relieve pain.

22. Which of the following instructions should the nurse include when giving health teachings on prevention of crutch palsy? a) assuming a tripod position when using crutches b) bearing the weight on the palms of the hands and elbows c) bearing the weight on the axillae d) placing the crossbar of the crutches so that the elbows are extended

22) B - during crutch-walking, the weight of the body should be borne by the hands and elbows, not by the axillae to prevent crutch palsy.

23. Which of the following should be included when giving client teaching to an obese woman, whose height is 5 feet and 2 inches, on prevention of progression of osteoporosis? a) bed rest b) avoid sunlight c) weight-bearing exercises and weight reduction d) limit intake of milk and dairy products

23) C - weight-bearing exercises promote calcium absorption in he bones. Weight reduction reduces strain at the cartilage of joints. These measures prevent progression of osteoporosis.

24. The best position for a child with myelomeningocele is a) prone b) supine c) semi-fowler's d) modified trendelenburg

24) A - prone position will prevent trauma to the sac at the lumbosacral area in a child with myelomeningocele.

25. Which of the following complications does the nurse suspect when a client had fracture of the femur and is now experiencing respiratory distress? a) sepsis b) fat embolism c) bleeding d) shock

25) B - fat embolism is a common complication of fracture of the long bones, like fracture of the femur. Yellow marrow is released into the circulation and reaches the pulmonary circulation. Acute respiratory distress syndrome may occur.

26. Which among these clients is at highest risk for developing low back pain? a) the man working with a drill hammer b) the man delivering mails in the building c) the salesman selling truck tires d) the man washing windows of a building

26) A - dealing with drill hammer puts strain at the back more than the other jobs mentioned.

27. The client had been diagnosed to have fracture of the tibia after a motorcycle accident. Few hours after, he complains of pain distal to the injury, with numbness and tingling sensation. The nurse notes pallor and coolness of the extremity with absent distal pulse. What complication of fracture does the nurse identify in this client?

27) Compartment Syndrome - compression and edema of the content of the compartment (blood vessels, nerves, and muscles) leads to five p's - pain, pallor, pulselessness, paresthesia, paralysis.

28. A man with cast will start to walk with crutches. What should the nurse check first? a) lying and sitting blood pressure b) pulse rate c) temperature d) respiratory rat

28) A - BP should be checked first before starting to ambulate to assess for potential postural hypotension

29. Which of the following is the primary reason for splinting the hands and wrists of client with rheumatoid arthritis? a) to improve the strength of the hands and wrists b) to prevent contractures c) to relieve muscle spasm d) to relieve pain

29) B - splinting of hands and wrists of the client with rheumatoid arthritis is done primarily to prevent contractures.

Situation: Maco, a newly registered nurse, works as a private duty nurse of a 55 year old female Canadian national who has gout. 3. Which of the following nursing diagnoses is a priority for a patient with gout? a) pain b) fatigue c) risk for infection d) risk for peripheral neurovascular dysfunction

3) A - Gouty arthritis is a metabolic disorder characterized by accumulation and deposition of uric acid crystals, called tophi, in tissues especially in joints that results in inflammatory response. It is caused by prolonged hyperuricemia due to problems in synthesizing purines or by poor excretion of uric acid by the kidney. This disorder is more common in men, with onset around age 50. The immediate problem of patient suffering from gout is the acute pain experienced on affected joints such as the great toe, feet, ankles, or knees. Other signs and symptoms include: malaise pruritus headache elevated serum uric acid presence of tophi positive monsodium urate crystals in synovial fluid inflammation of affected joint Nursing care during the acute phase when severe joint pain afflicts the patient includes: provide bed rest use bed cradle to support bed sheets and keep pressures of sheets off joint perform range of motion exercise gently carefully align joints so they are slightly flexed administer medications

30. Which of the following factors should concern the nurse most in a client who had undergone total hip replacement? a) the client has a small dog and a cat at home b) the client goes for a walk in the park each morning c) the client showers instead of having tub bath d) the client uses raised toilet seat

30) A - bending and stooping like taking care of a small dog and a cat, may cause dislodgement of the hip prosthesis.

31. The client is diagnosed to have fibromyalgia. Which of the following signs and symptoms is commonly experienced by the client? a) irritability b) headache c) fever d) lethargy

31) B - fibromyalgia is a chronic syndrome of musculoskeletal tissues characterized by chronic widespread pain. Assessment: painful muscles, fatigue, sleep disturbances, headache, restlessness leg syndrome, depression.

32. The client is being prepared for crutch-walking. Which of the following health teachings should be included? a) flex the arms at 90 degree angle with the crutches b) the axillae should rest on both crutches c) bear weight on the palms of the hands d) going up and down the stairs is not allowed when using crutches

32) C - when using crutches, the client should bear weight on the palms of the hands not on the axillae. This is to prevent crutch palsy

33. The nurse notes that the client on cast has diminished distal pulse. Which of the following is the most appropriate nursing action? a) check the client's vital signs b) get doppler and check for distal pulse c) elevate the affected feet d) notify the physician

33) D - diminished distal pulse in an extremity on cast indicates that the cast is too tight. This leads to circulatory impairment. Therefore, the physician should be notified. Bivalving/splitting of the cast will be done by the physician to prevent necrosis and gangrene formation.

34. The client will go electromyography (EMG). Which of the following information should be given when preparing the client for this procedure? a) a contrast medium will be injected into your vein b) you will be placed in a tunnel-like device c) electrode needles will be inserted into your muscles d) scalp electrodes will be applied and graphical recording of electrical activities of your brain will be done

34) C - in EMG, electrode needles will be inserted into the muscles. There will be mild discomfort.

35. X-rays confirm that a patient has a fractured femur. While the patient is in balanced skeletal traction, which of these measures is important? a) adjusting the weights when moving him up in bed b) supporting his affected leg in plantar flexion c) raising him up in bed whenever he slips down d) maintaining him in semi-fowler's position

35) C - raising the patient with traction, up in bed whenever he slips down maintains efficiency of the traction.

36. A patient was admitted and diagnosed with fibromyalgia. Which of the following is true of the disease? a) the disease is characterized by muscle weakness b) the signs and symptoms are relieved by steroids c) the disease is related to arthritis d) the disease is characterized by tender points in the different parts of the body and headache

36) D - fibromyalgia is characterized by muscle pain and tender points in the different parts of the body and headache. Treatment of choice is non-steroidal anti-inflammatory drugs.

37. The client with cervical spinal cord injury is on halo-vest traction. Which of the following emergency equipment is most important to keep readily available at the bedside? a) small wrench b) suction apparatus c) ambu bag d) tracheostomy tray

37) A - the small wrench taped over the vest will be used for untightening the screws of the traction if CPR needs to be done to the client with halo-vest traction.

38. The client had undergone total hip replacement. Which of the following crutch-walking gaits is most appropriate for the client? a) four-point gait b) two-point gait c) swing-to gait d) three-point gait

38) D - three point gait is the most appropriate crutch gait for the client who had undergone total hip replacement. It is a non-weight bearing crutch gait.

39. Which non-pharmacologic intervention should the nurse include in the care plan for a patient who has moderate rheumatoid arthritis? a) massaging inflamed joints b) avoiding range of motion c) selecting clothing that have Velcro fasteners d) using assistive devices at meal times

39) C - selecting clothing that have Velcro fasteners facilitates task of the client with rheumatoid arthritis. Joints of fingers of the client are the most commonly affected joint. This makes it difficult for the client to perform activities of daily living like dressing and grooming.

4. The nurse would instruct the patient which of the following to minimize complications? a) drinking a minimum of 3000 ml of fluid per day b) eating a minimum of 2500 calories per day c) walking at least three miles per day d) resting at least three hours per day

4) A - renal urate lithiasis (kidney stones) may result from precipitation of uric acid in the presence of low urinary pH. This can be avoided by allowing the patient liberal fluid intake to promote urinary excretion of uric acid.

40. A client with Paget's disease develops osteoporosis due to a) vitamin D deficiency b) inadequate calcium in diet c) bone resorption is rapid d) lack of pressure on the bones

40) C - paget's disease is characterized by very rapid bone resorption, followed by very rapid bone regeneration. However, the new bone tissues formed are weak. The client is prone to fracture.

41. A nurse is working with a nursing assistant on an orthopedic unit. The nurse observes the nursing assistant caring for a client after a left total hip replacement. The nurse will intervene if which of the following is observed? a) the nursing assistant stoops by bending at the hips and knees to pick up an object that the client dropped on the floor b) the nursing assistant keeps the client's bed in the low position when administering the bath c) the client is positioned with leg abducted slightly d) the head of the bed is elevated 30 degrees

41) B - during administration of bath, the nursing assistant should raise the bed to waist level to prevent bending and stooping. This prevents muscle strain and back injury.

42. A nurse has conducted preoperative teaching for a client scheduled for surgery in 1 week. The client has a history of arthritis and has been taking acetylsalicylic acid (aspirin). The nurse determines that the client needs additional teaching if the client states: a) aspirin can cause bleeding after surgery b) aspirin can cause my ability to clot blood to abnormal c) I need to discontinue the aspirin 48 hours before the scheduled surgery d) I need to continue to take aspirin until the day of surgery

42) D - anticoagulants alter normal clotting factors and increase the risk of bleeding after surgery. Aspirin has properties that can alter the clotting mechanism and should be discontinued at least 48 hours before surgery. Options A, B, and C are accurate client statements.

17. How do you position a client with left hip fracture in Buck's traction? a) head of bed raised at 45 degree angle b) left calf on pillow from knee to ankle c) position the left on affected side with pillows between legs d) position the left in the center of the bed with the leg extended

17) B - elevate the leg with pillow to relieve pressure from the heel of the foot and to improve the effectiveness of the countertraction.

18. A patient had hip surgery. On the second post-op day, the patient is agitated, is tremulous and confused. What should the nurse primarily assess? a) the surgical wound b) alcohol use before surgery c) peripheral circulation d) breathing pattern

18) B - the client's sign and symptoms indicate alcohol withdrawal.

19. A nurse is conducting a health screening among females at the mall to assess those who are at risk for developing osteoporosis. Which of the following questions is most appropriate to be asked by the nurse in relation to development of osteoporosis? a) at what age did you have your menstruation? b) did you have any fracture? c) are you taking corticosteroids? d) are you on the diet high in vitamin D?

19) C - corticosteroids promote calcium loss. This increases the risk for osteoporosis.

1. Mr. Alcasid asks the nurse, "What is osteoarthritis?" Which response from the nurse is correct? a) your bones are inflamed b) your weight bearing joints are inflamed c) you have inflammation in your joints d) there is shortening of your long bones

1) B - Osteoarthritis, also known as hypertrophic arthritis, osteoarthritis, senescent arthritis and degenerative joint disease is characterized by destruction of the articular cartilage, which becomes opaque, yellow, soft, weak and deteriorated. It is followed by thickening of bone under the cartilage and formation of osteophytes or bone spurs. Unlike RH, osteoarthritis is not a systemic disease and affects only the joint and its surrounding tissue. This disorder commonly occurs in the 50-70 year age group but women are more severely affected. The Signs and Symptoms of Osteoarthritis include: pain - worse with weight bearing, improves with rest may occur with paresthesia joint swelling and enlargement - may be from inflammatory exudates entering joint capsule causing an increase in synovial fluid or from fragments of osteophytes entering synovial cavity decreased ROM - depends on the amount of destroyed cartilage muscular atrophy - from disuse, joint instability and deformity crepitus - must be present on movement of the joint joint stiffness - worse in the morning and after a period of rest and disuse heberden's nodes - bony protuberances occurring on the dorsal surface of the distal interphalangeal joints of the fingers bouchard's nodes - bony protruberances occurring on the proximal interphalangeal joints of fingers coxaarthrosis - pain in the hip on weight bearing with pain progressing to include the groin and medial knee pain and limited range of motion varus (bowlegs) or valgus (knock kneed)

10. Before discharge, the nurse tells Karen that she should pace her activities. An example of pacing activities would be: a) doing all her household chores in the morning and resting in the afternoon b) taking a nap before going shopping c) hiring a helper to do the housework

10) B - pacing activities means alternating and balancing rest periods and activity in order to prevent excessive fatigue and over exertion. Rheumatoid arthritis is a chronic autoimmune disease characterized by inflammation and destruction of connective tissue within the joints that leads to eventual depletion of joint cartilage that weakens and cause dislocation of joint. This disease is characterized by periods of remissions and exacerbations. This disorder occurs three times more frequent in women until age 65 when both sexes have the same incidence. The most common joints affected are those of the hands, wrist, feet, ankles, elbows and knees. May also affect the heart, lungs and spleen late in the disease process.

11. Which type of medication is most commonly used to treat rheumatoid arthritis? a) glucocorticoids b) non-steroidal ant-inflammatory drugs (NSAIDs) c) antimalarial drugs d) gold salts

11) B - NSAID's are the first drugs of choice of RA. Its main action is to inhibit the inflammatory action of the mediators of inflammation; arachidonic acid and prostaglandins, etc to stop the disease process. It also provide pain relief. However it does not correct existing damage or bone deformity. below are the drugs used to treat RA. SALICYLATES: - ASA-Aspirin Anti-inflammatory and analgesic SIDE-EFFECTS take every 4-6 hours to maintain anti-inflammatory effect gastric irritation - take with food or milk toxicity - tinnitus, increase bleeding tendencies - instruct to report dark tarry stool hypersensitivity - rash NSAIAs (nonsteroidal) indomethacin (indocin) ibuprofen (motrin) tolmetin Na (tolectin) naproxen (naprosyn) fenoprofen (nalfon) sulindac (clinoril) diflunisal (dolobid) piroxicam (feldene) diclofenac Na (voltaren) SIDE-EFFECTS GIT irritation - take with food and milk, take with antacids headache and dizziness - discontinue and notify physician drowsiness - avoid driving do not use with salicylates or other anti-inflammatory agents do not crush enteric coated tablets Adrenocorticosteroids Prednisone Suppresses inflammatory reaction by the body SIDE-EFFECTS fluid retention - monitor weight increased susceptibility to infection - avoid exposure to persons with infection GIT irritation - take with food or antacid. Take in the morning if to be taken once a day decreased healing potential osteoporosis hirsutism adrenal crisis if abruptly withdrawn DM - do not stop, increase, decrease without doctor's order Antimalarials Hydroxychloroquine (plaquenil) Chloroquine (aralen) anti-inflammatory effect Quinacrine (atabrine) SIDE-EFFECTS effect expected after 6-12 months retinal edema that can lead to blindness - have an eye exam every 6 months yellow discoloration of the skin - may be stopped periodically to prevent deepening of skin discoloration Gold Salts: (IM) Gold Sodium Thimalate (myochrysine) Gold thioglucose (solganol) Gold (oral) Aurafin (ridaural) SIDE-EFFECTS effect after 3-6 months renal damage and hepatic damage - urinalysis and CBC before each injection dermatitis, ulcerations in mouth - report dermatitis and metallic taste and lesions in mouth to physician

12. Which assessment findings should the nurse expect for Karen? a) an asymmetrical pattern of affected joints b) a positive rheumatoid factor titer c) the presence of Herberden's nodes d) a positive antinuclear antibody titer

12) B - Signs and Symptoms: Begins as fatigue, musculoskeletal pain, low grade fever, lack of appetite and weight loss. Criteria for diagnosis of RA: The first four signs must be present for at least six weeks. Four of these signs and symptoms must be present at the same time to establish a diagnosis. stiffness after prolonged period of inactivity. Morning stiffness lasting at least one hour swelling of three or more joints swelling of the wrist, proximal interphalangeal (PIP) or metacarpophalangeal (MCP) joints symmetric joint swelling, same joint on each side of the body excluding the phalangeal joints positive rheumatoid factor rheumatoid nodules - painless and firm nodules found in subcutaneous tissue that develop during periods of exacerbation and most often in the wrist, carpal, knee, elbow and finger joints X-ray - decalcified areas of bone near joint margins Other Signs: - formation of pannus - fibrous scar tissue at the cartilage that eventually invades and erodes bones - hand deformities ulnar drift boutonniere deformity swan neck deformity - poor mucin precipitate in synovial fluid histological changes of synovium - presence of chronic inflammatory infiltrate

13. The nurse discussed to Karen the nature of RA. Which of the following statements by indicate a correct understanding of disease process? a) the nodules under my skin behind my forehead is part of RA b) I have to be careful because my bones have become brittle c) I have been working very hard lifting heavy things while selling in the market d) my disease is a normal aspect of my aging

13) A - the bones in rheumatoid arthritis do not become brittle as it is the joints that are affected not the bone. Brittle bone is characterized of osteoporosis. Overuse of joint is associated with osteoarthritis which is a wear and tear disease. Rheumatoid arthritis is not a part of normal aging as it is a disease process and occurs often in young women. Nodules which are firm and nontender may develop in the subcutaneous tissues of patients with RA.

14. The nurse should include which of the following client teachings for prevention of rapid progression of osteoporosis? a) avoid taking skim milk b) avoid taking protein-rich foods c) avoid calcium supplement d) avoid alcohol

14) D - avoiding alcohol and cigarette smoking will prevent rapid progression of osteoporosis. Skim milk is indicated among elderly because it is low in fats. Protein foods are necessary for calcium absorption. Calcium supplements help maintain integrity of the bones.

15. A client is brought to the emergency room with compound femur fracture. What is the first action the emergency room nurse should do? a) cover the open wound b) check the clients blood pressure c) assess the client's neurologic status d) prepare the client for X-ray

15) B - compound fracture of the femur may cause severe internal bleeding. Internal bleeding is characterized by hypotension.

16. A 3-year old in Bryant's traction is with foot foam. You found the child pulling out the foot foam. What is your most appropriate nursing action? a) remove the foot foam and assess the area b) reapply the foot foam at once c) call another nurse to maintain traction as you reapply the foot foam d) tell the child to stop removing the foot foam

16) C - maintain the traction as the foot foam is reapplied.

8. A patient under steroid therapy should be advised by the nurse to: a) limit carbohydrates in the diet b) take the medication on an empty stomach c) avoid individuals who have infections d) stop the medication when symptoms have subsided

8) C - Long Term Side Effects of Prednisone Therapy causes GI irritation so it must be taken with food. Patient may need antacid (must not contain sodium) to prevent ulcer. Give once-daily dose in the morning to lessen toxicity. Maybe diluted in juice or semi-solid food such as apple sauce causes sodium and water retention that results in cushinghoid appearance: moon face, buffalo hump, thinning of hair, hypertension and edema. Advise patient on low sodium diet that's high in potassium and protein avoid discontinuing abruptly as it can cause adrenal insufficiency and rebound inflammation. Reduce dosage gradually can cause glaucoma and cataract so monitor patient for visual disturbances and advise to have annual eye exam if on long term therapy increases cholesterol and glucose levels so diabetics must increase insulin dosage skin tests will be false-negative because it suppresses immune response avoid active immunization while under therapy because patient is immunosuppressed causes hypocalcemia and hypokalemia and increased urine calcium levels, causes osteoporosis so patient needs Vitamin D and calcium supplement will decrease iodine uptake and protein-bound iodine levels in thyroid function test tell patient to report: slow healing, exposure to infection, depression, insomnia, psychotic symptoms, weakness and fatigue, dizziness, joint pain, fever, anorexia and fainting always give by deep IM in gluteal muscle to prevent sterile abscess if given by subcutaneous and rotate injection sites route to prevent tissue atrophy always give the lowest dose to minimize toxicity

80. The nurse is conducting a health screening clinic for osteoporosis. The nurse determines that which client seen in the clinic is at the greatest risk of developing this disorder? a) a 25-year old female who jogs b) a 36-year old male who has asthma c) a 70-year old male who consumes excess alcohol d) a sedentary 65-year old female who smokes cigarettes

80) D - Risk factors for osteoporosis include being female, postmenopausal status, advanced age, low-calcium diet, excessive alcohol intake, sedentary lifestyle, and cigarette smoking. The long-term use of corticosteroids, anticonvulsants, and furosemide (Lasix) also increase the risk.

9. Which type of exercise should the nurse recommend to Cindy? a) jogging b) swimming c) bicycling d) skating

9) B - swimming is an ideal exercise for patient with arthritis because it allows ROM exercise for most of the joints of the body with less danger of injury.