Skin / Mobility Prep U Leukhardt
What instructions should the nurse include in the discharge teaching for the client following an arthroscopy? "Numbness and tingling in the foot are expected the first 24 hours." "It is normal to feel hot spots over the puncture site." "Keep the leg in the dependent position as much as possible." "The pain should be well-controlled with Tylenol."
"The pain should be well-controlled with Tylenol." Explanation: Mild analgesics are sufficient for pain control. The leg should be elevated with ice applied. The client should be taught the signs and symptoms of infection (such as heat) and neurovascular compromise (such as numbness and tingling) and instructed to contact the physician if they occur.
Which assessment findings indicate to the nurse that a client may have peripheral neurovascular dysfunction? Select all that apply. Cool skin Pain Redness of the skin Weakness in motion Capillary refill of 4 to 5 seconds Absence of feeling
Absence of feeling Capillary refill of 4 to 5 seconds Cool skin Pain Weakness in Motion Explanation: Indicators of peripheral neurovascular dysfunction include pale, cyanotic or mottled skin with a cool temperature, capillary refill greater than 3 seconds, weakness or paralysis with motion, and paresthesia, unrelenting pain, pain on passive stretch, or absence of feeling.
A client is hospitalized 3 days prior to a total hip arthroplasty and reports a high level of pain with ambulation. The client has been taking warfarin at home, which is now discontinued. To prevent the formation of blood clots, which action should the nurse take? Have the client limit physical activity. Encourage a diet high in vitamin K. Monitor partial thromboplastin (PTT) time. Administer the prescribed enoxaparin (Lovenox).
Administer the prescribed enoxaparin (Lovenox). Explanation: Clients who are prescribed warfarin at home and need to have a major invasive procedure stop taking warfarin prior to the procedure. Low molecular weight heparin, such as enoxaparin, may be used until the procedure is performed. The client will continue with a diet that has a daily consistent amount of vitamin K. The client needs to ambulate frequently throughout the day. Prothrombin (PT) time is monitored, not PTT, when warfarin had been administered.
A nurse is caring for an elderly female client with osteoporosis. When teaching the client, the nurse should include information about which major complication? Loss of estrogen Negative calcium balance Bone fracture Dowager's hump
Bone fracture Explanation: Bone fracture is a major complication of osteoporosis; it results when loss of calcium and phosphate increases the fragility of bones. Estrogen deficiencies result from menopause — not osteoporosis. Calcium and vitamin D supplements may be used to support normal bone metabolism, but a negative calcium balance isn't a complication of osteoporosis. Dowager's hump results from bone fractures. It develops when repeated vertebral fractures increase spinal curvature.
A client is seen in the orthopedic clinic for complaints of severe pain in the left hip. After a series of diagnostic tests, the client is diagnosed with severe degenerative joint disease of the left hip and suggested to have the hip reconstructed. What procedure will the nurse schedule the client for? Left hip arthroscopy Closed reduction of the left hip. Left hip arthroplasty Open reduction and internal fixation of the left hip.
Left hip arthroplasty Explanation: Clients with arthritis, trauma, hip fracture, or a congenital deformity may have an arthroplasty, or reconstruction of the joint. This procedure uses an artificial joint that restores previously lost function and relieves pain. An arthroscopy is not used to reconstruct a diseased hip. A closed reduction is not an invasive surgical procedure and would not be used to reconstruct the hip. An open reduction and internal fixation is not the treatment for reconstruction of the hip related to a diseased hip.
Which statement reflects the progress of bone healing? The age of the client influences the rate of fracture healing. Serial x-rays are used to monitor the progress of bone healing. Adequate immobilization is essential until ultrasound shows evidence of bone formation with ossification. All fracture healing takes place at the same rate no matter the type of bone fractured.
Serial x-rays are used to monitor the progress of bone healing. Explanation: Serial x-rays are used to monitor the progress of bone healing. The type of bone fractured, the adequacy of blood supply, the surface contact of the fragments, and the general health of the client influence the rate of fracture healing. Adequate immobilization is essential until x-ray shows evidence of bone formation with ossification.
The majority of bone infections are caused by which organism? Staphylococcus aureus Proteus Pseudomonas
Staphylococcus aureus Explanation: Over 50% of bone infections are caused by Staphylococcus aureus.
A client has severe osteoarthritis in the left hip and is having surgery to replace both articular surfaces of the hip. What type of surgical procedure will the nurse prepare the client for? Arthrodesis Total arthroplasty Osteotomy Hemiarthroplasty
Total arthroplasty Explanation: A total arthroplasty is a replacement of both articular surfaces within one joint. An arthrodesis is a fusion of a joint for stabilization and pain relief and is usually done on a wrist or knee. A hemiarthroplasty is the replacement of one of the articular surfaces in a joint, such as the femoral head but not the acetabulum. An osteotomy is the cutting and removal of a wedge of bone to change the bone's alignment, thereby improving function and relieving pain.
The nurse is preparing an education program on risk factors for musculoskeletal disorders. Which risk factors are appropriate for the nurse to include in the teaching program? Select all that apply. menopause age calcium-rich diet current cigarette smoking bed rest
age menopause bed rest current cigarette smoking Explanation: Increasing age, menopause, immobility (such as bed rest), and current cigarette smoking increase the risk for musculoskeletal disorders. A diet rich in calcium is beneficial in maintaining bone and muscle.
Fracture healing occurs in four areas, including the external soft tissue. fascia. bursae. cartilage.
external soft tissue. Explanation: Fracture healing occurs in four areas, including the bone marrow, bone cortex, periosteum, and the external soft tissue, where a bridging callus (fibrous tissue) stabilizes the fracture. Cartilage is special tissue at the ends of bone. The bursae are fluid-filled sacs found in connective tissue, usually in the area of joints. Fascia is fibrous tissue that covers, supports, and separates muscles.
A nurse is teaching a client with osteoporosis about dietary selections. What client statement indicates the teaching was effective? "I will eat more dairy products to increase my calcium intake." "I will decrease my intake of red meat." "I will decrease my intake of popcorn, nuts, and seeds." "I will eat more fruits to increase my potassium intake."
"I will eat more dairy products to increase my calcium intake." Explanation: Osteoporosis causes a severe, general reduction in skeletal bone mass. To offset this reduction, the nurse should advise the client to increase calcium intake by consuming more dairy products for improved calcium intake. Decreasing red meat will help with increased cholesterol and triglycerides. Clients with osteoporosis do not need to decrease popcorn, nuts or seeds. The client will osteoporosis does not need more potassium.
A nurse is performing discharge teaching for an elderly client diagnosed with osteoporosis. Which statement about home safety should the nurse include? "Most falls among the elderly occur outside the home. Clients should confine themselves to their homes as much as practical." "Most falls among the elderly occur in the home. These clients should remove throw rugs and install bathroom grab bars." "Most accidental injuries among the elderly are automobile-related. Elderly clients should have vision testing every 6 months while they're still driving." "Because of the increase in home burglaries involving the elderly, these clients should have burglar bars on every window in the home."
"Most falls among the elderly occur in the home. These clients should remove throw rugs and install bathroom grab bars." Explanation: Falls in the home cause most injuries among the elderly. Elderly clients should take measures to decrease the clutter that can contribute to falls, such as removing objects such as throw rugs from the floor. Elderly clients should also install grab bars in the shower and next to the toilet. The threat of fire makes burglar bars on every window impractical.
A client is being prepared for a total hip arthroplasty, and the nurse is providing relevant education. The client is concerned about being on bed rest for several days after the surgery. The nurse should explain what expectation for activity following hip replacement? "Our goal will actually be to have you walking normally within 5 days of your surgery." "The physical therapist will likely help you get up using a walker the day after your surgery." "Actually, clients are only on bed rest for 2 to 3 days before they begin walking with assistance." "For the first 2 weeks after the surgery, you can use a wheelchair to meet your mobility needs."
"The physical therapist will likely help you get up using a walker the day after your surgery." Explanation: Clients post-THA begin ambulation with the assistance of a walker or crutches within a day after surgery. Wheelchairs are not normally utilized. Baseline levels of mobility are not normally achieved until several weeks after surgery, however.
An older adult patient had a hip replacement. When should the patient begin with assisted ambulation with a walker? 24 hours 72 hours 1 week 2 to 3 weeks
24 hours Explanation: Following hip arthroplasty (total hip replacement), patients begin ambulation with the assistance of a walker or crutches within a day after surgery.
A nurse is performing a nursing assessment of a client suspected of having a musculoskeletal disorder. Which assessment should the nurse prioritize for a client who has a musculoskeletal disorder? Range of motion Strength Activities of daily living Gait
Activities of daily living Explanation: The nursing assessment is primarily a functional evaluation, focusing on the client's ability to perform activities of daily living. The nurse also assesses strength, gait, and range of motion, but these are assessed to identify their effect on functional status rather than to identify a medical diagnosis.
A client has recently been admitted to the orthopedic unit following total hip arthroplasty. The nurse assesses that the indwelling urinary catheter was removed one hour ago in the post-anesthesia care unit and that the client has not yet voided. Which action should the nurse take? Ask if the client needs to void. Obtain an order to reinsert the indwelling urinary catheter. Perform intermittent catheterization. Inform the primary provider promptly.
Ask if the client needs to void. Explanation: Since the indwelling urinary catheter was removed one hour earlier, the client would be expected to void within the next five hours (six hours after removal of the catheter). The nurse should ask the client if there is an urge to void. If the client does not feel the urge to void, the nurse should check periodically over the next 5 hours. Since not voiding within one hour of catheter removal is within normal, the nurse does not need to inform the health care provider, perform intermittent catheterization, or obtain an order to insert an indwelling catheter.
A client will be undergoing a total hip arthroplasty later in the day and it is anticipated that the client may require blood transfusion during surgery. How can the nurse best ensure the client's safety if a blood transfusion is required? Prime IV tubing with a unit of blood and keep it on hold. Keep the blood on standby and warmed to body temperature. Ensure that the client has had a current cross-match. Check that the client's electrolyte levels have been assessed preoperatively.
Ensure that the client has had a current cross-match. Explanation: Few clients undergoing an elective procedure require blood transfusion, but those undergoing high-risk procedures may require an intraoperative transfusion. The circulating nurse anticipates this need, checks that blood has been cross-matched and held in reserve, and is prepared to administer blood. Storing the blood at body temperature or in IV tubing would result in spoilage and potential infection.
The nurse uses the Fracture Risk Assessment Tool during an assessment of an older adult. Which information indicates to the nurse that the client is at risk for a fracture? Select all that apply. Smokes cigarettes Abstains from alcohol Female gender Takes calcium supplements Body mass index 27
Female gender Smokes cigarettes The Fracture Risk Assessment Tool (FRAX®) predicts a client's 10-year risk of fracturing a hip or other major bone, which includes the spine, forearm, or shoulder. Validated risk factors for a fracture include female gender and current cigarette smoker. The risk for a fracture is increased for a low body mass index and daily alcohol intake. A body mass index of 27 and abstaining from alcohol are not risk factors for a fracture according to this tool. This tool does not identify dietary supplements as a risk factor.
A nurse is caring for a client who is postoperative day 1 following a total arthroplasty of the right hip. How should the nurse position the client? Avoid flexion of the right hip. Turn the client on the surgical side. Keep the right hip adducted at all times. Place a pillow between the legs.
Place a pillow between the legs. Explanation: The hips should be kept in abduction by a pillow placed between the legs. When positioning the client in bed, the nurse should avoid placing the client on the operated hip. The right hip should not be flexed more than 90 degrees to avoid dislocation. The right hip should be maintained in an abducted position.
The client is postoperative for a total hip arthroplasty and denies pain when asked by the nurse. The client remains still in the bed and refuses to move. She finally reports feeling pressure at the site upon continued questioning by the nurse. The best nursing intervention is to Re-educate the client to use the word pain instead of pressure. Use the term "pressure" when asking the client about pain. Wait to medicate the client until the client reports pain. Use a 0 to 10 numeric pain intensity scale to measure pain.
Use the term "pressure" when asking the client about pain. Explanation: It is best for the nurse to use the client's terminology when assessing pain. Though the nurse may want to medicate this client, the nurse can only choose from the options present, and medicating is not there. The nurse does not wait for the client to use the word pain. Information in the stem of the question indicates that the client is experiencing pain. The client may have difficulty using a pain scale, because the client denies pain. The nurse does not re-educate the client to use the word pain instead of pressure.
Each bone is composed of cells, protein matrix, and mineral deposits. Which type of bone cell works to repair a bone fracture? osteomytes osteoclasts osteoblasts osteocytes
osteocytes Explanation: During times of rapid bone growth or bone injury, osteocytes function as osteoblasts to form new bone.
