ATI Learning Systems Med-Surg: Musculoskeletal System
A nurse in a rehabilitation facility is caring for a client with multiple fractures of both the lower extremities following a motor vehicle accident. The nurse realizes that the factor which is most critical for the client's successful rehabilitation is the.. 1. nursing care plan reflects realistic nursing goals for the client. 2. health care team must meet weekly to discuss the client's progress. 3. client's family must be involved in decision making. 4. client must be an active participant in the program.he ..
..a client must be an active participant in the program Rehabilitation is a learning process in which the interdisciplinary rehabilitation team works closely with the client. Like any other learning process, the client must be motivated for learning to occur. The client and caregivers are actively involved in collaboratively setting goals, planning, and taking part in the treatment. This is the most important factor for successful rehabilitation.
A nurse is caring for a client who had a below the knee amputation for gangrene of the foot. The client knows that the foot has been amputated, but reports to the nurse severe pain in the toes of the injured foot. The nurse should recognize this as... 1. an actual pain sensation. 2. a delusional belief. 3. a referred postoperative incisional pain. 4. a defense mechanism of denial. this as ..
..an actual pain sensation The nurse should recognize that the client is reporting *phantom limb pain*. Phantom limb pain is related to severed nerve pathways and is a frequent complication in clients who experience limb pain prior to the amputation. Phantom limb pain occurs less frequently following traumatic amputation. The nurse should recognize the pain is real and manage it accordingly. It may be described as deep and burning, cramping, shooting, or aching. Symptoms may be managed with various medications, such as opioids, antispasmodics, antiepileptics, or beta blockers.
A client is discharged after having an open reduction and internal fixation of a fractured tibia with application of a plaster cast. The nurse teaches the client to evaluate for early signs of decreased circulation related to post surgical edema. The nurse demonstrates that the teaching was understood when the client identified a manifestation of decreased circulation as.. 1. coldness of the toes. 2. capillary refill of 3 seconds. 3. blanching of the nailbeds with pressure. 4. pain at the surgical site.
..coldness of the toes Decreased venous return from the constriction caused by a cast may lead to impaired circulation of the foot. Manifestations of impaired circulation include toes that are cold, numb, tingling, or swollen. 2, 3: assessments indicate adequate circulation. 4. assessment is normal following an open reduction & internal fixation of a fracture. while pain may be more severe in the client w/ impaired circulation, pain alone is not an adequate assessment to make this determination.
A client sustains an open fracture of the left femur. An intramedullary pin is inserted, and the client is placed in skeletal traction. While performing the initial assessment, the nurse finds the client has slipped down toward the foot of the bed and the traction weight is resting on the floor. The appropriate nursing action is to... 1. remove the weight and move the client to the correct alignment in bed. 2. check for movement of the toes in the left foot. 3. notify the attending orthopedic physician. 4. help the client use the trapeze to pull himself up in bed.
..help the client use the trapeze to pull himself up in bed. The traction is no longer effective when it is resting on the floor. Provided that nothing is out of alignment, the nurse should help the client resume his normal position in bed to reestablish traction. 1. besides causing pain, this could interfere with the correct alignment of the extremity. 2. checking the toes for movement is not an appropriate action at this time. 3. its not necessary to notify the orthopedic physician unless the traction is out of alignment or other assessments are not within normal range.
A nurse notes on a client's MAR that the client is to receive *alendronate sodium* (Fosamax). The nurse should know that for proper absorption of the medication the client must.. 1. schedule the medication between meals. 2. take the medication with a calcium supplement. 3. take the medication with food. 4. sit up for 30 min after administration.
..sit up for 30 minutes after administration. Alendronate sodium is a *bisphosphonate*, which is a classification of medications that prevent the development of osteoporosis. It must be given with a full glass of water first thing in the morning on an empty stomach at least 30 min prior to consuming any other food, beverage, or medication. After taking the med, the client must remain seated upright for a minimum of 30 min to prevent esophageal irritation. Administration Consideration: give with milk or antacids 30 min before meals. Adverse Reaction: may include hypocalcemia, hypophosphatemia, nausea, heartburn and gastric ulcer. Class: inhibitor osteoclast-mediated bone resorption. Contraindications: do not give to clients with hypocalcemia, severe renal disease or are lactating. Indications: usd to prevent or treat osteoporosis (thinning of the bone) in women after menopause & to treat osteoporosis in men. it may also be used to treat Paget's disease of the bone. Nursing Considerations: Use with hormone replacement therapy. Monitor for adverse reactions. Therapeutic Actions: Binds to bone, stopping bone resorption.
A client with a radial fracture reports itching under the casted area. The appropriate nursing action to relieve itching is to.. 1. use a hair dryer on a cool setting to blow air into the cast. 2. elevate the affected extremity. 3. provide a cotton swab to scratch the area. 4. explain to the client that itching is an indication the fracture is healing.
..use a hair dryer on a cool setting to blow air into the cast. The cool air will cause vasoconstriction and decrease neural transmission of sensation to the affected area. Objects should not be placed under the cast because they can break off and become lodged in the cast, causing an alteration in skin integrity.
A nurse is caring for a client who sustained a traumatic injury to the leg in a farming accident resulting in amputation. Following an above-the-knee amputation, which of the following is the highest priority in the client's immediate postoperative care? 1. Risk for hemorrhage 2. Complications of immobility 3. Inability to perform self-care 4. Altered body image
1. Risk for hemorrhage According to Maslow's hierarchy, physiological needs must be met first. Amputation following a traumatic injury to the leg will likely involve severing & repairing major blood vessels. The client is at a high risk for injury or hemorrhage. 2. Preventing complications of immobility are important, however, using the airway, breathing, circulation (ABC) priority setting framework, observing for hemorrhage is the highest priority. It also poses the greatest risk to the client at this time as complications of immobility are currently potential and not actual problems. 3. Many postoperative clients do have at least some impaired ability to perform self-care, but according to Maslow's, this is a higher level need. The client's physiological needs should be addressed first. 4. Clients who experience a traumatic injury or amputation will have body image disturbance, but according to Maslow's, this is a higher level need. The client's physiological needs should be addressed first.
An assisted personnel at an extended care facility asks a nurse the difference between rheumatoid arthritis and osteoarthritis. The nurse responds, "Osteoarthritis is... 1. autoimmune." 2. localized." 3. systemic." 4. bilateral."
2. localized." Osteoarthritis is a deterioration of cartilage & overgrowth of bone. Rheumatoid arthritis is the inflammation of a joint's connective tissues, such as the synovial membranes, which leads to the destruction of the articular cartilage. Osteoarthritis is a localized process associated with aging and can affect any joint. The cartilage of the affected joint is gradually worn down, eventually causing a bone to rub against another bone. Joints appear larger, are stiff and painful, and usually feel worse the more they are used throughout the day. 1. Rheumatoid arthritis is a systemic *autoimmune* disease in which the body's immune system attacks itself. The pattern of joints affected is usually *bilateral*, involving the hands and other joints, & is *worse in the morning*. 3. Rheumatoid arthritis is a systemic autoimmune disease, involving other body organs, whereas *osteoarthritis is limited to the joints*. 4. Osteoarthritis is a deterioration of cartilage & overgrowth of bone. RA is the inflammation of a joint's connective tissues which leads to the destruction of the articular cartilage. Rheumatoid arthritis usually affects the same joints bilaterally, while osteoarthritis affects a joint, independent of other joints.
Following shoulder surgery, a client is instructed to keep the arm adducted at all times. The nurse explains to the client that this means he must keep the arm.. 1. bent at the elbow. 2. positioned on two pillows. 3. close to the body. 4. with the shoulder at a 90º angle.
3. close to the body Adducted means to position the arm toward the midline, or adjacent part, of the body. By keeping the arm close to the body, the shoulder joint is properly kept adducted. 1. Bent at the elbow: This action refers to flexion. While it is possible that flexion of the elbow may also be prescribed, this does not explain adduction. 2. Positioned on two pillows: This action refers to elevation. This does not explain adduction. close to the body. 4. With the shoulder at a 90º angle. This action refers to abduction, moving the arm away from the midline of the body.
A client has been admitted to the orthopedic floor to have a right total knee arthroplasty performed. Which of the following statements demonstrates to the nurse that the client understands the preoperative teaching? "I will... 1. have my knee placed in a continuous passive motion machine for 24 hours a day." 2. ask for pain medicine whenever the pain gets bad." 3. wear elastic stockings on both legs until I am discharged." 4. have to stay in bed for a week after my surgery."
3. wear elastic socks on both legs until I am discharged." The purpose of elastic stockings is to prevent thrombophlebitis, which is a common complication following orthopedic surgery. Thromboemboli can occur up to 6 months after surgery, so it is possible that the client will wear them even after discharge. 1. a continuous passive motion machine is usually prescribed for a few hrs at a time for a total of 8 to 12 hr a day. 2. client should ask for pain medication before the pain becomes severe. this will lessen the amount needed and help keep them comfortable. 4. ambulation usually begins 48 hr following a total knee arthroplasty.
A diabetic client with a non-healing wound of the heel is diagnosed with osteomyelitis. The nurse anticipates that the client's treatment regimen will include.. 1. application of ice to the site to decrease the edema. 2. application of a short leg cast to limit movement of the involved ankle joint. 3. administration of glucocorticoids to decrease the inflammatory process. 4. insertion of a peripherally inserted catheter line for long-term IV antibiotics.
4. insertion of a peripherally inserted catheter-line for long term IV antibiotics. Osteomyelitis is an acute or chronic bone infection usually caused by bacteria. When the bone is infected, pus is produced within the bone, which may result in an abscess. The affected bone may have been predisposed to infection because of recent trauma and diabetes mellitus is also a risk factor for the development of osteomyelitis. Long-term IV antibiotic therapy is usually needed to eradicate osteomyelitis, which can be very resistant to treatment in diabetic clients, and the client may eventually require amputation. *The object of treatment is to eliminate the infection and prevent the development of chronic infection.* 1. application of ice is not advisable as it will limit circulation, which is an existing problem in this client that likely contributed to the current infection. 2. limiting movement will not accomplish this goal. 3. admin. glucocorticoids may mask further signs of infection and delay wound healing.
A night shift nurse is assigned to care for a client who is 12 hr postoperative following a total knee arthroplasty. The nurse finds the client's leg in a continuous passive motion machine, a drain attached to an evacuator unit is in place, and the client has a PCA device. The client reports to the nurse, "I am in so much pain." The nurse's first action at this time is to... 1. suggest that the client push the button for the PCA device. 2. reposition the client for increased comfort per the client's instruction. 3. complete the assessment of the client including the client's pain. 4. turn off the continuous passive motion machine until the pain improves.
Complete the assessment of the client including the client's pain A knee joint arthroplasty is surgery to replace a painful, damaged, or diseased knee joint with a prosthetic joint. The nurse should complete the client assessment before selecting a course of action regarding the pain. The nurse should determine the characteristics of the client's pain and the frequency with which the client is using the PCA device before deciding what the next best action is. When caring for clients, assessment always comes first, followed by analysis, planning, intervening, and finally evaluating.
During report, a nurse is told to assess a client who was recently casted for a radial fracture for compartment syndrome. For which of the following findings should the nurse assess? 1. Decreased range of motion of the fingers distal to the cast 2. Numbness and tingling 3. Cyanosis of the fingers distal to the cast 4. Elevated client temperature
Numbness and tingling Compartment syndrome involves the compression of nerves & blood vessels within an enclosed space, leading to impaired blood flow & nerve damage. Thick layers of tissue called fascia separate groups of muscles in the arms & legs from each other. Inside each layer of fascia is a confined space, called a *compartment*, that includes the muscle tissue, nerves, & blood vessels. Bc fascia do not expand, any swelling in a compartment will lead to increasing pressure in that compartment, which will compress the muscles, blood vessels, & nerves. If this pressure is high enough, blood flow to the compartment will be blocked, which can lead to permanent injury to the muscle & nerves. The *hallmark symptom* of compartment syndrome is *severe pain* that does NOT respond to elevation or pain medication. In more advanced cases, there may be numbness, tingling, weakness, & paleness of the skin.
On a health history form, a client being admitted to an outpatient surgery center for a knee arthroscopy indicates taking *celecoxib* (Celebrex) daily. Based on the medication, the nurse should expect that the client has a history of 1. infection. 2. depression. 3. rheumatoid arthritis. 4. seizures.
Rheumatoid arthritis Celecoxib is a nonsteroidal anti-inflammatory, cyclooxygenase-2 (COX-2) inhibitor, used to relieve some manifestations caused by rheumatoid arthritis in adults.
A client is 3 days postoperative following a right total hip arthroplasty. The client cries out in pain when transferred to a chair. Which of the following nursing observations should lead to the suspicion of a dislocated hip prosthesis? 1. Bulging in the right hip area 2. Shortening of the right leg 3. Adduction of the left leg 4. External rotation of the right leg
Shortening of the right leg One of the classic indicators of prosthetic dislocation is shortening of the affected leg, along with an inability to move it, abnormal rotation, and increased discomfort.
A client involved in a motor vehicle crash sustained maxillofacial trauma from striking the windshield. The client receives inter-maxillary fixation with interdental wiring. Postoperatively, the client vomits clear liquids. Which of the following actions is appropriate for the nurse to take? 1. Suction the emesis from the client's mouth using a tonsil tip suction. 2. Insert an NG tube to suction out any remaining stomach contents. 3. Immediately cut the wires to allow the client to expectorate the emesis. 4. Instruct the client to vomit in an emesis basin.
Suction the emesis from the client's mouth using a tonsil tip suction. Intermaxillary fixation is wiring of the teeth using the solid jaw to support the fractured jaw by holding the two together. The wires are usually left in place for around 6 weeks until the fracture is healed. Clear liquids that have been vomited can easily be removed from the oral cavity by suctioning in the buccal space (between the gums and teeth).
A nurse is admitting a client with a history of gout. Which of the following manifestations should the nurse expect to find on the client's admission physical assessment? 1. Fluctuant subcutaneous nodules 2. Heberden's nodes 3. Tophi 4. Boutonniere deformity
Tophi Acute gouty arthritis is a metabolic disease marked by uric acid deposits in the joints. The disorder causes painful gouty arthritis, especially in the joints of the feet & legs. Tophi are deposits of urate crystal deposits that occur on the hands, knees, feet, forearms, & the Achilles tendons in a client with chronic gout. 1. Fluctuant subcutaneous nodules are a swelling under the skin that contain fluid. 2. Heberden's nodes & enlarged joints are manifestations of osteoarthritis. Heberden's nodes are hard nodules or bony swellings, which develop around the distal interphalangeal joints. 4. A boutonniere deformity is an inflammation of the finger tendons seen in rheumatoid arthritis which results in a permanent deformity of the phalanges.
A client with an ankle sprain is being discharged from the emergency department. To promote tissue healing and relieve discomfort, the nurse instructs the client to.. 1. continue typical activities with the ankle immobilized. 2. keep the extremity in a dependent position. 3. keep a loose dressing on the affected area. 4. apply cold compresses to the affected area.
apply cold compress to the affected area. Cold minimizes swelling and erythema to the affected area. However, cold compresses should not be applied continuously for more than 30 min. 1. Activities should resume only when there is no pain on movement, & the absence of edema indicates healing has occurred. Even if the edema subsides, there could be damage to the muscles, tendons, & nerves if the normal activity level resumes too soon. 2. A dependent position causes excessive fluid accumulation in the area of injury. The extremity should be elevated. 3. A compression dressing should be applied because it will decrease swelling of the affected area, thereby increasing edema.
Two days after fracturing his tibia playing lacrosse, a college student is brought to the hospital accompanied by his roommate who reports the client is not acting like himself and seems confused. The nurse notes that the client has a long leg cast on the right leg and that the client is disoriented to time and place. Vital signs reveal that the client is tachycardic and tachypneic. The nurse should assess the client for other signs of.. 1. hypovolemic shock. 2. fat embolism. 3. thrombophlebitis. 4. bone malalignment.
fat embolism Fat embolism syndrome follows long bone fractures. Age also seems to be a factor as young men with fractures are at an increased risk. The classic presentation consists of an asymptomatic interval followed by pulmonary and neurologic manifestations, such as a fever and cutaneous petechiae of the neck, chest, and abdomen. These initial manifestations are probably caused by mechanical occlusion of multiple blood vessels in the lungs with fat globules that are too large to pass through the capillaries. 1. Loss of approximately one-fifth or more of the normal blood volume produces hypovolemic shock. The loss can be caused by multiple complications, including external bleeding (from cuts or injury), bleeding from the gastrointestinal tract, internal bleeding, or diminished blood volume resulting from excessive loss of other body fluids. Although confusion and tachycardia are seen with hypovolemic shock, the client's history does not indicate this complication. 3. Thrombophlebitis is vein inflammation related to a blood clot. The cardinal symptoms are pain & tenderness over the involved vein. 4. Malalignment of the bones causes severe pain. It does not cause the symptoms that the client is exhibiting.
A client is on bed rest following a pelvic fracture when he suddenly becomes dyspneic and reports feeling short of breath. The nurse assesses the client and finds that tachycardia, hypotension, and tachypnea are occurring. The client's oxygen saturation level is dropping rapidly. The nurse should identify that the client is exhibiting signs consistent with.. 1. pneumonia. 2. pulmonary embolus. 3. tension pneumothorax. 4. flail chest.
pulmonary embolus - A client who has had a fracture and is maintained on bed rest is at high risk for pulmonary emboli due to venous stasis & hypercoagulation. The typical presentation of a client with a blood clot in the arterial structure of the lung includes difficulty breathing, low blood pressure, & confusion. The clot occludes pulmonary arterial blood flow to the lung, resulting in *hypoxia*. 1. While *pneumonia* can be a complication of immobility following a pelvic fracture, it does not cause a sudden onset of difficult breathing or a rapid drop in the oxygen saturation rate. 3. *Tension pneumothorax* can produce sudden dyspnea, but the client hx given does not lead one to suspect a collapsed lung. Generally, clients with tension pneumothorax have a trachea that deviates away from the affected side & breath sounds are absent over the affected area. 4. *Flail chest* results from multiple rib fractures. The client will have rapid, shallow respirations, a rapid heart rate, & develop cyanosis. Paradoxical chest movements that result from rib fractures will be obvious on visual inspection.
