Subtopic musculoskeletal system

One week after an above-the-knee amputation, a client refuses to go to physical therapy and tells the nurse, "I'll never be a whole person again!" What is the nurse's best response? 1 "You're still the same person you've always been. Just relax." 2 "You've lost a part of yourself. That must be very difficult for you." 3 "You may feel that way, but I'm sure your family considers you a whole person." 4 "You must go to physical therapy every day or you will develop muscle contractures."

2 "You've lost a part of yourself. That must be very difficult for you." The response "You've lost a part of yourself. That must be very difficult for you" acknowledges and reflects the client's feelings and encourages further communication. The response "You're still the same person you've always been. Just relax" negates the client's feelings. The nurse does not know how the client's family members feel; the response "You may feel that way, but I'm sure your family considers you a whole person" takes the focus off the client. The response "You must go to physical therapy every day or you will develop muscle contractures" is true, but telling the client this serves no therapeutic purpose at this time.

Three days after a cast is applied to a client's fractured tibia, the client reports that there is a burning pain over the ankle. The cast over the ankle feels warm to the touch, and the pain is not relieved when the client changes position. What is the nurse's priority action? 1 Obtain a prescription for an antibiotic. 2 Report the client's concern to the primary healthcare provider. 3 Administer the prescribed medication for pain. 4 Explain that this is typical after a cast is applied.

2 Report the client's concern to the primary healthcare provider. The client's concern indicates tissue hypoxia or breakdown and should be reported to the primary healthcare provider. Other data, such as elevated temperature or increased white blood cells, are not present to support the presence of an infection. Although administering the prescribed medication for pain will be done to provide relief of pain, the priority is to notify the primary healthcare provider. This is not a typical response to a cast and may indicate a complication.

A client with a history of a herniated nucleus pulposus is scheduled for total hip replacement surgery. To prevent the most common complication associated with this type of surgery, the nurse should instruct the client to perform which activity? 1 Straight-leg raises 2 Buerger-Allen exercises 3 Deep breathing and coughing 4 Plantar flexion and dorsiflexion exercises

4 Plantar flexion and dorsiflexion exercises Plantar flexion and dorsiflexion exercises promote venous return, which helps prevent venous thrombus formation, the most common complication after hip surgery. Straight-leg raises are contraindicated for a client who has a history of a herniated nucleus pulposus. Buerger-Allen exercises stimulate collateral circulation for clients with peripheral vascular disease; they are seldom used, because walking is considered a more effective exercise. Although deep breathing and coughing should be encouraged to prevent respiratory complications, thrombus formation is a more common complication than respiratory complications after a total hip replacement.

Which musculoskeletal system change is associated in older adult clients? 1 Decreased in height 2 Decreased neck rigidity 3 Increased fine-motor dexterity 4 Increased range of motion (ROM)

1 Decreased in height Loss of height and deformity and shortening of the trunk are common in older adults due to vertebral compression and degeneration. Rigidity in the neck, shoulders, back, hips, and knees increases with age due to loss of elasticity in ligaments, tendons, and cartilage. A decline in fine-motor dexterity occurs in the older adult due to slow impulse conduction along motor units. Range of motion (ROM) is limited in the older adult due to cartilage erosion, increased friction between the bones, and overgrowth of bone around joint margins.

Non-weight bearing with crutches has been prescribed for a client with a leg injury. The nurse provides teaching before ambulation is begun. To facilitate walking with crutches, what is the most important activity the nurse should teach the client? 1 Sit up in a chair to help strengthen back muscles. 2 Keep the unaffected leg in extension and abduction. 3 Exercise the triceps, finger flexors, and elbow extensors. 4 Use a trapeze frequently to strengthen the biceps muscles.

3 Exercise the triceps, finger flexors, and elbow extensors. The triceps, finger flexors, and elbow extensors are used in crutch walking and therefore need strengthening. Although back muscles keep the person erect, the most important muscles for walking with crutches are the triceps, elbow extensors, finger flexors, and the muscles in the unaffected leg. Keeping the unaffected leg in extension and abduction will do nothing to promote crutch walking. A pushing, not a pulling, motion is used with crutches; the triceps, not the biceps, are used.

Which term should the nurse use to describe synovial joint movement that moves away from the midline of the body? 1 Inversion 2 Extension 3 Pronation 4 Abduction

4 Abduction Abduction is a synovial joint movement that involves movement of a part away from the midline of the body. Inversion is turning of the sole inward toward the midline of the body. Pronation is a synovial joint movement that involves the turning of the palm downward. Extension is a synovial joint movement that involves a straightening of joint that increases the angle between two bones.

The nurse is caring for a client with rheumatoid arthritis. When should the nurse expect the client to experience the most pain and limited movement of the joints? 1 After assistive exercise 2 When the room is cool 3 During the evening hours 4 In the morning on awakening

4 In the morning on awakening Inactivity over an extended time increases stiffness and pain in joints. The client typically has morning stiffness, or gel phenomenon. Assistive exercises help maintain joint mobility. Whether the room is cool is not a factor; cold applications may decrease joint discomfort. The pain is not as severe in the evening as in the morning.

Which diagnostic test is used for the direct visualization of ligaments, menisci, and articular surfaces of joints? 1 Arthroscopy 2 Muscle biopsy 3 Ultrasonography 4 Electromyography

Arthroscopy is a diagnostic test that uses an arthroscope to directly visualize the ligaments, menisci, and articular surfaces of a joint. A muscle biopsy is conducted to diagnose atrophy and inflammation. An ultrasonography is used to view soft tissue disorders, traumatic joint injuries, and osteomyelitis. An electromyography may be performed to evaluate diffuse or localized muscle weakness.

Which type of cast will the nurse be caring for in a child with a fractured femur? 1 Cylinder 2 Hip spica 3 Prefabricated knee 4 Robert Jones

2 Hip spica A hip spica cast is now mainly used for femur fractures in children. A cylinder cast is used for knee fractures because it extends from the groin to the malleoli of the ankle. A prefabricated knee splint is a commonly used cast for lower extremity injuries. A Robert Jones dressing is composed of bulky padding materials, splints, and elastic wrap or stockinette used for lower extremity injuries.

Which condition is characterized by infection of a client's bone or bone marrow? 1 Osteomalacia 2 Osteomyelitis 3 Herniated disc 4 Spinal stenosis

2 Osteomyelitis Osteomyelitis is infection of bone or bone marrow. Osteomalacia is a condition characterized by softening of bones due to calcium or vitamin D deficiency. Herniated disc is caused by structural damage of the intervertebral discs in which the nucleus pulposus seeps through a torn or stretched annulus. Spinal stenosis is narrowing of the spinal canal.

Which hormone increases the rate of protein synthesis in a client? 1 Estrogen 2 Thyroxine 3 Parathormone 4 Vitamin D

2 Thyroxine Thyroxine increases the rate of protein synthesis in all the body tissues. Estrogen stimulates bone-building, which is known as osteoblastic activity. Parathormone promotes osteoclastic activity in a state of hypocalcemia. Vitamin D and its metabolites are produced in the body and transported in the blood to promote the absorption of calcium and phosphorus from the small intestine.

A nurse is caring for a client who just had an above-the-knee amputation. Which is the key factor in assessing how the client will cope with the body image change? 1 Extent of the change 2 Suddenness of the change 3 Obviousness of the change 4 Personal perception of the change

4 Personal perception of the change It is not the reality of a situation but the client's feeling or perceptions about the change that is the most important determinant of the client's ability to cope. The extent of change is not relevant; what is relevant whether the client perceives the change as enormous or less important. Although suddenness of the change may influence a person's coping ability, it is not the primary factor that influences coping with body image changes. Although obviousness of the change may influence a person's coping ability, it is not the primary factor that influences coping with body image changes.