Care of Musculoskeletal Patients

After application of a synthetic cast, the client asks the nurse how long he must wait until the cast is completely dry and he can tolerate weight-bearing. The nurse's most appropriate response is ~ 10 minutes. ~ 20 minutes. ~ 30 minutes. ~ 60 minutes.

30 minutes ~ Synthetic casts are dry to the touch in a few minutes but require about 30 minutes to set and allow weight-bearing

An older woman is admitted after falling down the stairs. Which assessment findings require immediate intervention? (Select all that apply.) a. Blood pressure, 80/50 mm Hg b. Potassium, 6.0 mEq/L c. Dark brown urine d. Heart rate, 90 beats/min e. Urine output, 50 mL/hr

A, B, C ~ Low blood pressure could indicate hypovolemia, which occurs with crush syndrome. Hyperkalemia and dark brown urine also may indicate crush syndrome. A heart rate of 90 beats/min is within normal limits; urine output of 50 mL/hr is also a normal finding.

A nurse cares for a client with a fracture injury. Twenty minutes after an opioid pain medication is administered, the client reports pain in the site of the fracture. Which actions should the nurse take? (Select all that apply.) a. Administer additional opioids as prescribed. b. Elevate the extremity on pillows. c. Apply ice to the fracture site. d. Place a heating pad at the site of the injury. e. Keep the extremity in a dependent position.

A, B, C ~ The client with a new fracture likely has edema; elevating the extremity and applying ice probably will help in decreasing pain. Administration of an additional opioid within the dosage guidelines may be ordered. Heat will increase edema and may increase pain. Dependent positioning will also increase edema.

The assessment that would alert the nurse to the possibility of cast syndrome in a client with a spica cast is ~ abdominal distention. ~ diminished pulses in the foot ~ "hot spot" felt on cast. ~ musty, unpleasant odor to cast.

Abdominal distention ~ Abdominal distention and persistent vomiting result when the duodenum is compressed between major vessels and vertebral bodies because of constriction on the spica cast

Which risk factor is shared by clients who have osteoporosis or osteomalacia? High alcohol intake A history of smoking Inadequate exposure to sunlight Homelessness

High alcohol intake ~ High alcohol intake is a risk factor for both osteoporosis and osteomalacia. A history of smoking is a risk factor for osteoporosis only. Inadequate exposure to sunlight and homelessness are risk factors for osteomalacia only.

After the cast on a client's fractured ulna has been changed to a bivalve cast, the nurse will alter the approach to care by ~ omitting vascular checks to the extremity. ~ preventing pinching the extremity between the two halves. ~ taking off both halves of the cast when x-ray films are ordered. ~ taping the halves together with paper tape

preventing pinching the extremity between the two Palves ~ The bivalve cast allows for removal of the top half for wound care or x-ray films and for ease in assessing tissue perfusion or pressure areas. When the top half is reapplied, the nurse must take precaution not to pinch the client's extremity between the two halves as they are secured together with an Ace wrap

A client who has undergone repair of the anterior cruciate ligament complains that the use of the continuous passive motion (CPM) machine causes pain and asks how long he is expected to use the machine. The nurse's most appropriate response would be ~ "I will give you pain medication to make you comfortable, since you should use the machine at least 8 hours out of 24." ~ "Try using the machine for 1 hour of every 4 hours, and see if that schedule re-duces your discomfort." ~ "You do not have to use the machine for the next few days. You can resume after the pain subsides." ~ "You should use the machine continuously. I will ask the physician to increase your dose of analgesics."

"I will give you pain medication to make you comfortable, since you should use the machine at least 8 hours out of 24." ~ The CPM machine should be used at least 8 hours a day or until full range of motion is achieved

A client with bone cancer is scheduled for a right upper extremity amputation. Which statement by the client's husband indicates an effective coping strategy? ~ "I'll have to find ways to help my wife focus on positive aspects of her body." ~ "The family will avoid direct discussion of my wife's amputation." ~ "I'll try to limit her visitors." ~ "My family will use diversional methods to help her not focus on the amputation."

"I'll have to find ways to help my wife focus on positive aspects of her body." ~ Planning to help the client focus on positive aspects of her body illustrates that the husband is coping with the change in his wife's body image in a positive way. Planning to have the family avoid direct discussion of the amputation does not allow the client the opportunity to discuss her feelings about the loss of a limb. Visitors could be a source of comfort and may provide a way for the client to express her feelings, so visitors should not be limited. Using diversional methods to help the client not focus on the amputation is not an effective coping strategy; it limits the chance for the client to discuss feelings about the amputation.

An older adult client is discharged from the hospital for treatment of osteoporosis. What does the nurse include in client teaching related to the client's home safety? ~ "Use area rugs on tile floors." ~ "Keep walkways free of clutter." ~ "Walk slowly on wet floor areas after mopping." ~ "Keep light low to prevent glare."

"Keep walkways free of clutter." ~ Walkways in the home must be clear of clutter and obstacles to help prevent falls. Clients with metabolic bone problems should not use area rugs at home because they may cause tripping or falling. Clients with metabolic bone problems must not walk on wet floors because the potential for falling is too great. Keeping the lights low would not allow the client to see adequately to walk safely or avoid an object on the floor.

The nurse is caring for a client with bone cancer of the right hip who has undergone radical resection of the tumor and has received a prosthetic implant. Which client statement indicates effective coping after the procedure? ~ "After I recover, I'll be just as strong as I was before the surgery." ~ "I won't be able to go out in public like I did before." ~ "Physical therapy and counseling will help me adjust to my prosthesis." ~ "I'll be able to return to work and drive without assistance."

"Physical therapy and counseling will help me adjust to my prosthesis." ~ The client stating that physical therapy and counseling will help him or her to adjust to the prosthesis illustrates effective coping and acceptance. The client expecting to be just as strong as before the surgery or expecting to return to work and drive without assistance reveals that the client is in denial of how surgery will affect his or her prognosis and activity. Avoiding going out in public suggests that the client is having difficulty coping and adjusting to his or her changed body image.

The nurse assesses an 85-year-old client who has fallen and finds crepitus and swelling below the right elbow. The nurse interprets these findings as ~ a closed fracture. ~ a dislocation. ~ manifestations of degenerative joint disease. ~ normal variations related to age.

A closed fracture. ~ Crepitus and swelling are caused by motion in the middle of a bone or by bone fragments rubbing together

Two days after an accident in which a client sustained multiple injuries, including fractures, the client becomes confused and dyspneic and has a fever of 103.4° F. The nurse assesses that the client has developed ~ a fat embolism. ~ a pulmonary embolism. ~ compartment syndrome. ~ wound infection

A fat embolism. ~ Manifestations of confusion, hypoxia, and fever may indicate a fat embolism in a client with multiple fractures

An emergency department nurse triages a client with diabetes mellitus who has fractured her arm. Which action should the nurse take first? a. Remove the medical alert bracelet from the fractured arm. b. Immobilize the arm by splinting the fractured site. c. Place the client in a supine position with a warm blanket. d. Cover any open areas with a sterile dressing.

A ~ A clients medical alert bracelet should be removed from the fractured arm before the affected extremity swells. Immobilization, positioning, and dressing should occur after the bracelet is removed.

A nurse notes crepitation when performing range-of-motion exercises on a client with a fractured left humerus. Which action should the nurse take next? a. Immobilize the left arm. b. Assess the clients distal pulse. c. Monitor for signs of infection. d. Administer prescribed steroids.

A ~ A grating sound heard when the affected part is moved is known as crepitation. This sound is created by bone fragments. Because bone fragments may be present, the nurse should immobilize the clients arm and tell the client not to move the arm. The grating sound does not indicate circulation impairment or infection. Steroids would not be indicated.

A home health nurse assesses a client with diabetes who has a new cast on the arm. The nurse notes the clients fingers are pale, cool, and slightly swollen. Which action should the nurse take first? a. Raise the arm above the level of the heart. b. Encourage range of motion. c. Apply heat to the affected hand. d. Bivalve the cast to decrease pressure.

A ~ Arm casts can impair circulation when the arm is in the dependent position. The nurse should immediately elevate the arm above the level of the heart, ensuring that the hand is above the elbow, and should re-assess the extremity in 15 minutes. If the fingers are warmer and less swollen, the cast is not too tight and adjustments do not need to be made, but a sling should be worn when the client is upright. Encouraging range of motion would not assist the client as much as elevating the arm. Heat would cause increased edema and should not be used. If the cast is confirmed to be too tight, it could be bivalved.

The home care nurse is visiting a client with diabetes who has a new cast on the arm. On assessment, the nurse finds the clients fingers to be pale, cool, and slightly swollen. Which is the nurses first intervention? a. Elevate the arm above the level of the heart. b. Encourage active and passive range of motion. c. Apply heat to the affected hand. d. Place a window or bivalve the cast.

A ~ Arm casts can impinge on circulation when the arm is in the dependent position. The nurse should immediately elevate the arm above the level of the heart, ensuring that the hand is above the elbow, and should reassess the extremity in 15 minutes. If the fingers are warmer and less swollen, the cast is not too tight and adjustments do not need to be made, but a sling should be worn when the client is upright. Heat would cause increased edema and should not be used. Encouraging range of motion would not assist the client as much as elevating the arm. If the cast is assessed to be too tight, it could be bivalved.

After teaching a client who is recovering from a vertebroplasty, the nurse assesses the clients understanding. Which statement by the client indicates a need for additional teaching? a. I can drive myself home after the procedure. b. I will monitor the puncture site for signs of infection. c. I can start walking tomorrow and increase my activity slowly. d. I will remove the dressing the day after discharge.

A ~ Before discharge, a client who has a vertebroplasty should be taught to avoid driving or operating machinery for the first 24 hours. The client should monitor the puncture site for signs of infection. Usual activities can resume slowly, including walking and slowly increasing activity over the next few days. The client should keep the dressing dry and remove it the next day.

A nurse reviews prescriptions for an 82-year-old client with a fractured left hip. Which prescription should alert the nurse to contact the provider and express concerns for client safety? a. Meperidine (Demerol) 50 mg IV every 4 hours b. Patient-controlled analgesia (PCA) with morphine sulfate c. Percocet 2 tablets orally every 6 hours PRN for pain d. Ibuprofen elixir every 8 hours for first 2 days

A ~ Meperidine (Demerol) should not be used for older adults because it has toxic metabolites that can cause seizures. The nurse should question this prescription. The other prescriptions are appropriate for this clients pain management.

A nurse cares for a client placed in skeletal traction. The client asks, What is the primary purpose of this type of traction? How should the nurse respond? a. Skeletal traction will assist in realigning your fractured bone. b. This treatment will prevent future complications and back pain. c. Traction decreases muscle spasms that occur with a fracture. d. This type of traction minimizes damage as a result of fracture treatment.

A ~ Skeletal traction pins or screws are surgically inserted into the bone to aid in bone alignment. As a last resort, traction can be used to relieve pain, decrease muscle spasm, and prevent or correct deformity and tissue damage. These are not primary purposes of skeletal traction.

The nurse is instructing a client who has been prescribed calcium citrate (Citracal). Which instruction does the nurse include? A ~ "Take Citracal with food." B ~ "For best absorption, take Citracal with a carbonated beverage." C ~ "One third of the daily dose is best taken during the day." D ~ "Milk of Magnesia (MOM) should be taken with Citracal."

A ~ Take Citracal with food." ~ Calcium supplements can cause gastric upset; taking Citracal with food can minimize gastric upset. Calcium citrate should be taken with 6 to 8 ounces of water, not carbonated beverages. One third of the daily dose is best taken at bedtime. MOM is not indicated and actually may lead to decreased absorption of calcium citrate.

While assessing an older adult client admitted 2 days ago with a fractured hip, the nurse notes that the client is confused, tachypneic, and restless. Which is the nurses first action? a. Administer oxygen via nasal cannula. b. Apply restraints and ask for a sitter. c. Slow the IV flow rate. d. Discontinue the pain medication.

A ~ The client is at high risk for a fat embolism and has some of the clinical manifestations of altered mental status and dyspnea. Although this is a life-threatening emergency, the nurse should take the time to administer oxygen first and then notify the health care provider. Oxygen administration can reduce the risk for cerebral damage from hypoxia. The nurse would not restrain a client who is confused without further assessment and orders. Pain medication most likely would not cause the client to be restless. The IV rate is not related.

A nurse assesses an older adult client who was admitted 2 days ago with a fractured hip. The nurse notes that the client is confused and restless. The clients vital signs are heart rate 98 beats/min, respiratory rate 32 breaths/min, blood pressure 132/78 mm Hg, and SpO2 88%. Which action should the nurse take first? a. Administer oxygen via nasal cannula. b. Re-position to a high-Fowlers position. c. Increase the intravenous flow rate. d. Assess response to pain medications.

A ~ The client is at high risk for a fat embolism and has some of the clinical manifestations of altered mental status and dyspnea. Although this is a life-threatening emergency, the nurse should take the time to administer oxygen first and then notify the health care provider. Oxygen administration can reduce the risk for cerebral damage from hypoxia. The nurse would not restrain a client who is confused without further assessment and orders. Sitting the client in a high-Fowlers position will not decrease hypoxia related to a fat embolism. The IV rate is not related. Pain medication most likely would not cause the client to be restless.

The nurse is performing an assessment on a client admitted with a fractured left humerus. When the client moves the extremity, the nurse notes the presence of a grating sound. Which is the nurses best intervention? a. Immobilize the arm. b. Perform range of motion. c. Monitor for other signs of infection. d. Administer steroids.

A ~ The grating sound heard when the affected part is moved is known as crepitation. This sound is created by bone fragments. Because bone fragments may be present, the nurse should immobilize the clients arm and tell him or her not to move the arm. The nurse should not move the extremity for range of motion. The grating sound does not indicate infection. Steroids would not be indicated.

A client who has sustained a crush injury to the right lower leg reports numbness and tingling of the affected extremity. The skin of the right leg appears pale. Which is the nurses first intervention? a. Assess pedal pulses. b. Apply oxygen by nasal cannula. c. Increase the IV flow rate. d. Document the finding.

A ~ The symptoms represent early warning of acute compartment syndrome. In acute compartment syndrome, sensory deficits such as paresthesias precede changes in vascular or motor signs. If the nurse finds a decrease in pedal pulses, the health care provider should be notified as soon as possible.

An emergency department nurse cares for a client who sustained a crush injury to the right lower leg. The client reports numbness and tingling in the affected leg. Which action should the nurse take first? a. Assess the pedal pulses. b. Apply oxygen by nasal cannula. c. Increase the IV flow rate. d. Loosen the traction.

A ~ These symptoms represent early warning signs of acute compartment syndrome. In acute compartment syndrome, sensory deficits such as paresthesias precede changes in vascular or motor signs. If the nurse finds a decrease in pedal pulses, the health care provider should be notified as soon as possible. Vital signs need to be obtained to determine if oxygen and intravenous fluids are necessary. Traction, if implemented, should never be loosened without a providers prescription.

The nurse is caring for a client 3 days after a below-knee amputation. Which is a priority intervention? a. Muscle-strengthening exercises b. Use of a very soft bed mattress c. Placing a pillow between the clients knees d. Placing the client in high Fowlers position

A ~ To prepare for a prosthesis, the nurse instructs the client in muscle-strengthening exercises, provides the client with a firm mattress, and places the client in a prone position every 3 to 4 hours for 20 to 30 minutes to prevent flexion contractures. A pillow should not be placed between the clients knees.

A client with a new fracture reports pain in the site of the fracture. An opioid pain medication was administered 20 minutes ago. Which is the nurses best intervention? (Select all that apply.) a. Administration of additional opioids b. Elevation of the extremity c. Application of ice d. Application of heat e. Keeping the extremity in a dependent position

A, B, C ~ The client with a new fracture likely has edema; elevating the extremity and applying ice probably will help in decreasing pain. Heat will increase edema and may increase pain. Dependent positioning will also increase edema. Administration of an additional opioid within the dosage guidelines may be ordered.

A nurse is teaching a community group about bone health. Which of the following does the nurse recommend? (Select all that apply.) A ~ Engage in regular weight-bearing exercise. B ~ Get plenty of calcium and vitamin D in the diet C ~ If diagnosed with osteoporosis, take medications as prescribed D ~ Stop, or do not start, smoking. E ~ Swim or cycle to get aerobic activity without stressing joints.

A, B, C, D ~ All four options are good for bone health. Swimming/cycling provides muscle-strengthening exercises that may help prevent falls, but does not improve actual bone health

A client who will not regain mobility has a case manager. What important topics does the nurse need to address in the client's long-term plan of care? (Select all that apply.) A ~ Informal caregivers B ~ Sexuality C ~ Recreation D ~ Vocational adjustments

A, B, C, D ~ The client who will not regain mobility must make many choices regarding a lifestyle that has been changed dramatically. All topics are important, but sexuality is often overlooked. Sexuality, recreation, and vocation are important components of quality of life. Informal caregivers can fill the gap between formal, provided services and client need.

A nurse plans care for a client who is recovering from open reduction and internal fixation (ORIF) surgery for a right hip fracture. Which interventions should the nurse include in this clients plan of care? (Select all that apply.) a. Elevate heels off the bed with a pillow. b. Ambulate the client on the first postoperative day. c. Push the clients patient-controlled analgesia button. d. Re-position the client every 2 hours. e. Use pillows to encourage subluxation of the hip.

A, B, D ~ Postoperative care for a client who has ORIF of the hip includes elevating the clients heels off the bed and re-positioning every 2 hours to prevent pressure and skin breakdown. It also includes ambulating the client on the first postoperative day, and using pillows or an abduction pillow to prevent subluxation of the hip. The nurse should teach the client to use the patient-controlled analgesia pump, but the nurse should never push the button for the client.

A nurse teaches a client with a fractured tibia about external fixation. Which advantages of external fixation for the immobilization of fractures should the nurse share with the client? (Select all that apply.) a. It leads to minimal blood loss. b. It allows for early ambulation. c. It decreases the risk of infection. d. It increases blood supply to tissues. e. It promotes healing.

A, B, E ~ External fixation is a system in which pins or wires are inserted through the skin and bone and then connected to a ridged external frame. With external fixation, blood loss is less than with internal fixation, but the risk for infection is much higher. The device allows early ambulation and exercise, maintains alignment, stabilizes the fracture site, and promotes healing. The device does not increase blood supply to the tissues. The nurse should assess for distal circulation, movement, and sensation, which can be disturbed by fracture injuries and treatments.

A nurse teaches a client who is at risk for carpal tunnel syndrome. Which health promotion activities should the nurse include in this clients teaching? (Select all that apply.) a. Frequently assess the ergonomics of the equipment being used. b. Take breaks to stretch fingers and wrists during working hours. c. Do not participate in activities that require repetitive actions. d. Take ibuprofen (Motrin) to decrease pain and swelling in wrists. e. Adjust chair height to allow for good posture.

A, B, E ~ Health promotion activities to prevent carpal tunnel syndrome include assessing the ergonomics of the equipment being used, taking breaks to stretch fingers and wrists during working hours, and adjusting chair height to allow for good posture. The client should be allowed to participate in activities that require repetitive actions as long as precautions are taken to promote health. Pain medications are not part of health promotion activities.

A client has a fractured tibia and is asking the nurse about external fixation. What are some advantages for the use of external fixation for the immobilization of fractures? (Select all that apply.) a. Leads to minimal blood loss b. Allows for early ambulation c. Decreases the risk of infection d. Increases blood supply to tissues e. Provides visualization of bone ends f. Promotes healing

A, B, F ~ Blood loss is less. The device allows early ambulation and exercise, maintains alignment, stabilizes the fracture site, and promotes healing. The device does place the client at risk for infection and does not increase the blood supply to tissues, nor does it provide visualization of the ends of the bone.

A nurse assesses a client with a cast for potential compartment syndrome. Which clinical manifestations are correctly paired with the physiologic changes of compartment syndrome? (Select all that apply.) a. Edema ~ Increased capillary permeability b. Pallor ~ Increased blood blow to the area c. Unequal pulses ~ Increased production of lactic acid d. Cyanosis ~ Anaerobic metabolism e. Tingling ~ A release of histamine

A, C, D ~ Clinical manifestations of compartment syndrome are caused by several physiologic changes. Edema is caused by increased capillary permeability, release of histamine, decreased tissue perfusion, and vasodilation. Unequal pulses are caused by an increased production of lactic acid. Cyanosis is caused by anaerobic metabolism. Pallor is caused by decreased oxygen to tissues, and tingling is caused by increased tissue pressure.

What statements about amputation are correct? A. Lower extremity amputations are more common than upper extremity amputations. B. Traumatic amputations are caused by peripheral vascular diseases. C. In a Syme amputation, most of the foot is removed but the ankle remains. D. Lower extremity amputations are less common in black and Hispanic populations. E. Lisfranc and Chopart amputations are types of midfoot amputations.

A, C, E ~ Lower extremity amputations are performed more frequently than upper extremity amputations. In the Syme amputation, most of the foot is removed but the ankle remains. Syme amputation are types of midfoot amputations. Traumatic amputations usually result from accidents and are often upper extremity amputations. Lower extremity amputations are more common in Lisfranc and Chopart amputations due to the high incidence of diabetes and arteriosclerosis.

A nurse teaches a client about prosthesis care after amputation. Which statements should the nurse include in this clients teaching? (Select all that apply.) a. The device has been custom made specifically for you. b. Your prosthetic is good for work but not for exercising. c. A prosthetist will clean your inserts for you each month. d. Make sure that you wear the correct liners with your prosthetic. e. I have scheduled a follow-up appointment for you.

A, D, E ~ A client with a new prosthetic should be taught that the prosthetic device is custom made for the client, taking into account the clients level of amputation, lifestyle (including exercise preferences), and occupation. In collaboration with a prosthetist, the client should be taught proper techniques for cleansing the sockets and inserts, wearing the correct liners, and assessing shoe wear. Follow-up care and appointments are important for ongoing assessment.

The nurse is rounding on assigned orthopedic clients. The client with which type of fracture requires immediate interventions to prevent infection? a. Fractured clavicle b. Open fracture of the tibia c. Simple fracture of the wrist d. Compression fracture of a vertebra

B ~ Bone infection or osteomyelitis is most common in clients with an open fracture because skin integrity is lost and organisms gain access easily. The nurse will remind all those who come into contact with the client to use good handwashing and will observe the wound daily for signs of infection. The other clients do not have extra risk factors for infection.

A nurse plans care for a client who is recovering from a below-the-knee amputation of the left leg. Which intervention should the nurse include in this clients plan of care? a. Place pillows between the clients knees. b. Encourage range-of-motion exercises. c. Administer prophylactic antibiotics. d. Implement strict bedrest in a supine position.

B ~ Clients with a below-the-knee amputation should complete range-of-motion exercises to prevent flexion contractions and prepare for a prosthesis. A pillow may be used under the limb as support. Clients recovering from this type of amputation are at low risk for infection and should not be prescribed prophylactic antibiotics. The client should be encouraged to re-position, move, and exercise frequently, and therefore should not be restricted to bedrest.

The nurse is caring for a client with a fractured fibula. Which assessment prompts immediate action by the nurse? a. Reported pain of 4 on a scale of 0 to 10 b. Numbness and tingling in the extremity c. Swollen extremity where the injury occurred d. Reports of being cold in bed

B ~ The client with numbness and tingling of the extremity may be displaying the first signs of acute compartment syndrome. This is an acute problem that requires immediate intervention because of possible decreased circulation. Moderate pain and swelling is an expected assessment after a fracture. These findings can be treated with comfort measures. Being cold can be treated with additional blankets or by increasing the temperature of the room.

A nurse cares for a client with a fractured fibula. Which assessment should alert the nurse to take immediate action? a. Pain of 4 on a scale of 0 to 10 b. Numbness in the extremity c. Swollen extremity at the injury site d. Feeling cold while lying in bed

B ~ The client with numbness and/or tingling of the extremity may be displaying the first signs of acute compartment syndrome. This is an acute problem that requires immediate intervention because of possible decreased circulation. Moderate pain and swelling is an expected assessment after a fracture. These findings can be treated with comfort measures. Being cold can be treated with additional blankets or by increasing the temperature of the room.

A nurse cares for a client who had a long-leg cast applied last week. The client states, "I cannot seem to catch my breath and I feel a bit light-headed." Which action should the nurse take next? a. Auscultate the clients lung fields anteriorly and posteriorly. b. Administer oxygen to keep saturations greater than 92%. c. Check the clients blood glucose level. d. Ask the client to take deep breaths.

B ~ The clients symptoms are consistent with the development of pulmonary embolism caused by leg immobility in the long cast. The nurse should check the clients pulse oximetry reading and provide oxygen to keep saturations greater than 92%. Auscultating lung fields, checking blood glucose level, or deep breathing will not assist this client.

A client has a fracture and is being treated with skeletal traction. Which assessment causes the nurse to take immediate action? a. The clients blood pressure is 130/86 mm Hg. b. The traction weights are resting on the floor. c. Slight oozing of clear fluid is noted at the pin site. d. Capillary refill of the extremity is less than 3 seconds.

B ~ The immediate action of the nurse should be to reapply the weights to give traction to the fracture. The health care provider must be notified that the weights were lying on the floor, and the client should be realigned in bed. Slight oozing of clear fluid is normal as is the capillary refill time. The clients blood pressure is slightly elevated; this could be related to pain and muscle spasms resulting from lack of pressure to reduce the fracture.

A nurse assesses a client with a fracture who is being treated with skeletal traction. Which assessment should alert the nurse to urgently contact the health provider? a. Blood pressure increases to 130/86 mm Hg b. Traction weights are resting on the floor c. Oozing of clear fluid is noted at the pin site d. Capillary refill is less than 3 seconds

B ~ The immediate action of the nurse should be to reapply the weights to give traction to the fracture. The health care provider must be notified that the weights were lying on the floor, and the client should be realigned in bed. The clients blood pressure is slightly elevated; this could be related to pain and muscle spasms resulting from lack of pressure to reduce the fracture. Oozing of clear fluid is normal, as is the capillary refill time.

A nurse cares for an older adult client with multiple fractures. Which action should the nurse take to manage this clients pain? a. Meperidine (Demerol) injections every 4 hours around the clock b. Patient-controlled analgesia (PCA) pump with morphine c. Ibuprofen (Motrin) 600 mg orally every 4 hours PRN for pain d. Morphine 4 mg intravenous push every 2 hours PRN for pain

B ~ The older adult client should never be treated with meperidine because toxic metabolites can cause seizures. The client should be managed with a PCA pump to control pain best. Motrin most likely would not provide complete pain relief with multiple fractures. IV morphine PRN would not control pain as well as a pump that the client can control.

When implementing and delegating the application of heat or cold therapies to an unlicensed assistive personnel (UAP), the NURSE SHOULD (Select all that apply) A ~ allow the UAP to document the treatment and the client's response. B ~ clarify the order to ensure the task can be delegated. C ~ inspect the client's skin before the treatment D ~ Instruct the UAP to wrap the heat or cold in a protective cover. E ~ reassess the client's skin after the treatment is done.

B, C, D, E ~ The nurse is responsible for assessments before and after the treatment and for documenting the client's response to a treatment. The nurse should also ensure that the task is appropriate for delegation.

An emergency nurse assesses a client who is admitted with a pelvic fracture. Which assessments should the nurse monitor to prevent a complication of this injury? (Select all that apply.) a. Temperature b. Urinary output c. Blood pressure d. Pupil reaction e. Skin color

B, C, E ~ With a pelvic fracture, internal organ damage may result in bleeding and hypovolemic shock. The nurse monitors the clients heart rate, blood pressure, urine output, skin color, and level of consciousness frequently to determine whether shock is manifesting. It is important to monitor the urine for blood to assess whether the urinary system has been damaged with the pelvic fracture. Changes in temperature and pupil reactions are not directly associated with hypovolemic shock. Temperature changes are usually associated with hypo- or hyperthermia or infectious processes. Pupillary changes occur with brain injuries, bleeds, or neurovascular accidents.

A client who had a plaster cast applied to the right arm 3 weeks ago presents to the clinic with an erythrocyte sedimentation rate (ESR) that has increased from 15 to 25 mm/hr. Which is the nurses best action? a. Repeat this laboratory assessment in 4 hours. b. Have the cast reapplied. c. Evaluate temperature and vital signs. d. Obtain blood for a platelet count.

C ~ A rise in the ESR during fracture healing suggests a bone infection or a fat embolism. The nurse should collect all other assessment data that can assist in confirming this diagnosis and then should notify the health care provider. Repeating the laboratory assessment, reapplying the cast, and assessing a platelet count would not be indicated.

A nurse assesses a client with a rotator cuff injury. Which finding should the nurse expect to assess? a. Inability to maintain adduction of the affected arm for more than 30 seconds b. Shoulder pain that is relieved with overhead stretches and at night c. Inability to initiate or maintain abduction of the affected arm at the shoulder d. Referred pain to the shoulder and arm opposite the affected shoulder

C ~ Clients with a rotator cuff tear are unable to initiate or maintain abduction of the affected arm at the shoulder. This is known as the drop arm test. The client should not have difficulty with adduction of the arm, nor experience referred pain to the opposite shoulder. Pain is usually more intense at night and with overhead activities.

A nurse cares for an older adult client who is recovering from a leg amputation surgery. The client states, "I don't want to live with only one leg. I should have died during the surgery." How should the nurse respond? a. Your vital signs are good, and you are doing just fine right now. b. Your children are waiting outside. Do you want them to grow up without a father? c. This is a big change for you. What support system do you have to help you cope? d. You will be able to do some of the same things as before you became disabled.

C ~ The client feels like less of a person following the amputation. The nurse should help the client to identify coping mechanisms that have worked in the past and current support systems to assist the client with coping. The nurse should not ignore the clients feelings by focusing on vital signs. The nurse should not try to make the client feel guilty by alluding to family members. The nurse should not refer to the client as being disabled as this labels the client and may fuel the clients poor body image.

A nurse cares for a client recovering from an above-the-knee amputation of the right leg. The client reports pain in the right foot. Which prescribed medication should the nurse administer first? a. Intravenous morphine b. Oral acetaminophen c. Intravenous calcitonin d. Oral ibuprofen

C ~ The client is experiencing phantom limb pain, which usually manifests as intense burning, crushing, or cramping. IV infusions of calcitonin during the week after amputation can reduce phantom limb pain. Opioid analgesics such as morphine are not as effective for phantom limb pain as they are for residual limb pain. Oral acetaminophen and ibuprofen are not used in treating phantom limb pain.

A client who has had an above-knee amputation of the right leg reports pain in the right foot. Which priority medication does the nurse administer? a. IV morphine b. 650 mg of acetaminophen c. IV calcitonin d. 600 mg of ibuprofen

C ~ The client is experiencing phantom limb pain. IV infusions of calcitonin during the week after amputation can reduce phantom limb pain. The other medications will not assist in decreasing the clients pain.

A client who had a long-leg cast applied last week reports to the clinic nurse, I cant seem to catch my breath and I feel a bit lightheaded. Which is the priority action of the nurse? a. Listen to the clients lungs and check the clients blood glucose level. b. Give the client 2 L of oxygen via nasal cannula and check vital signs. c. Check the clients pulse oximetry and arrange emergency transfer to the hospital. d. Reassure the client that it takes much more effort to move with a long-leg cast.

C ~ The clients symptoms are consistent with the development of pulmonary embolism (PE) caused by leg immobility in the long cast. The nurse should check the clients pulse oximetry reading and arrange for transfer to the hospital for further testing and treatment. The client should not be reassured that the symptoms are caused by exertion. The nurse can check vital signs, administer oxygen, and check the clients blood glucose level while waiting for transport to the emergency department.

A mother who is a carrier of muscular dystrophy (MD) has a daughter. The client asks the nurse what the daughter's genetic risk is for having MD. What is the nurse's best response? A ~ "Because you are a carrier of the MD gene, your daughter will develop MD." B ~ "She will not have MD nor will she be a carrier." C ~ "There is a 50% chance that your daughter may carry the gene." D ~ "Your daughter is X-linked dominant for the MD gene."

C ~ There is a 50% chance that your daughter may carry the gene." ~ MD is an X-linked recessive disorder, so the daughter of a mother who is a carrier has a 50% chance of carrying the gene. The daughter would only be a carrier of the disease; she would not have MD. Telling the client that the daughter will not have MD or will not be a carrier is only half true.

A nurse coordinates care for a client with a wet plaster cast. Which statement should the nurse include when delegating care for this client to an unlicensed assistive personnel (UAP)? a. Assess distal pulses for potential compartment syndrome. b. Turn the client every 3 to 4 hours to promote cast drying. c. Use a cloth-covered pillow to elevate the clients leg. d. Handle the cast with your fingertips to prevent indentations.

C ~ When delegating care to a UAP for a client with a wet plaster cast, the UAP should be directed to ensure that the extremity is elevated on a cloth pillow instead of a plastic pillow to promote drying. The client should be assessed for impaired arterial circulation, a complication of compartment syndrome; however, the nurse should not delegate assessments to a UAP. The client should be turned every 1 to 2 hours to allow air to circulate and dry all parts of the cast. Providers should handle the cast with the palms of the hands to prevent indentations.

The nurse is caring for a client with a pelvic fracture. Which is the nurses priority action to prevent complications? a. Monitor temperature daily. b. Insert a urethral catheter. c. Monitor blood pressure frequently. d. Turn the client every 2 hours.

C ~ With a pelvic fracture, internal organ damage may result in bleeding and hypovolemic shock. The nurse monitors the clients vital signs, skin color, and level of consciousness frequently to determine whether shock is occurring. The client may need a urethral catheter inserted at some point in time if voiding is a problem. It is important to monitor the urine for blood to assess whether the urinary system has been damaged with the pelvic fracture. The client should not be turned on his or her side unless the fracture is stabilized.

When a 68-year-old client with a new full-leg cast exhibits bilateral pedal edema, the nurse would assess for ~ compartment syndrome. ~ cardiovascular disease. ~ local leg trauma. ~ thrombophlebitis.

Cardiovascular disease ~ Swelling after traumatic injury and reduction should peak within 24-48 hours, but mild swelling afterwards is expected. Moderate or severe swelling and discoloration are abnormal. With ab-normal unilateral pedal edema, the nurse should consider whether it is caused by further trauma, by compartment syndrome, or by thrombophlebitis. With bilateral pedal edema, the nurse should consider a cardiovascular origin

A client with a new cast for his fractured ulna tells the nurse that he cannot feel his fingers. The nurse should initially ~ check for capillary refill in the client's fingers. ~ notify the physician immediately. ~ reassure the client that this is normal ~ remove the padding around the fingers to increase space.

Check for capillary refill in the client's fingers ~ When casts prevent full neurovascular assessment, the nurse should observe for edema, capillary refill, and joint movement

A nurse delegates care of a client in traction to an unlicensed assistive personnel (UAP). Which statement should the nurse include when delegating hygiene care for this client? a. Remove the traction when re-positioning the client. b. Inspect the clients skin when performing a bed bath. c. Provide pin care by using alcohol wipes to clean the sites. d. Ensure that the weights remain freely hanging at all times.

D ~ Traction weights should be freely hanging at all times. They should not be lifted manually or allowed to rest on the floor. The client should remain in traction during hygiene activities. The nurse should assess the clients skin and provide pin and wound care for a client who is in traction; this should not be delegated to the UAP.

The nurse is caring for several clients with fractures. Which client does the nurse consider at highest risk for developing deep vein thrombosis? a. Middle-aged woman with a fractured ankle taking aspirin for rheumatoid arthritis b. Young adult male athlete with a fractured clavicle c. Female with type 2 diabetes with fractured ribs d. Older man who smokes and has a fractured pelvis

D ~ Deep vein thrombosis (DVT) as a complication with bone fractures occurs more often when fractures are sustained in the lower extremities and the client has additional risk factors for thrombus formation. Other risk factors include obesity, smoking, oral contraceptives, previous thrombus events, advanced age, venous stasis, and heart disease. The other clients do not have risk factors for DVT.

The nurse is caring for a client with an external fixator in place on the leg. What does the nurse assess for first? a. Alteration in skin integrity b. Impaired motor action c. Acute pain d. Signs of infection

D ~ As long as the external fixator is in place, a direct connection is present between the external environment and the bone. The risk for infection is high. An expected alteration in skin integrity and a decrease in movement are noted. Acute pain would not be expected, but the client should be medicated for pain if necessary.

A trauma nurse cares for several clients with fractures. Which client should the nurse identify as at highest risk for developing deep vein thrombosis? a. An 18-year-old male athlete with a fractured clavicle b. A 36-year old female with type 2 diabetes and fractured ribs c. A 55-year-old woman prescribed aspirin for rheumatoid arthritis d. A 74-year-old man who smokes and has a fractured pelvis

D ~ Deep vein thrombosis (DVT) as a complication with bone fractures occurs more often when fractures are sustained in the lower extremities and the client has additional risk factors for thrombus formation. Other risk factors include obesity, smoking, oral contraceptives, previous thrombus events, advanced age, venous stasis, and heart disease. The other clients do not have risk factors for DVT.

A nurse cares for a client who had a wrist cast applied 3 days ago. The client states, The cast is loose enough to slide off. How should the nurse respond? a. Keep your arm above the level of your heart. b. As your muscles atrophy, the cast is expected to loosen. c. I will wrap a bandage around the cast to prevent it from slipping. d. You need a new cast now that the swelling is decreased.

D ~ Often the surrounding soft tissues may be swollen considerably when the cast is initially applied. After the swelling has resolved, if the cast is loose enough to permit two or more fingers between the cast and the clients skin, the cast needs to be replaced. Elevating the arm will not solve the problem, and the clients muscles should not atrophy while in a cast for 6 weeks or less. An elastic bandage will not prevent slippage of the cast.

A nurse obtains the health history of a client with a fractured femur. Which factor identified in the clients history should the nurse recognize as an aspect that may impede healing of the fracture? a. Sedentary lifestyle b. A 30 pack-year smoking history c. Prescribed oral contraceptives d. Paget's disease

D ~ Paget's disease and bone cancer can cause pathologic fractures such as a fractured femur that do not achieve total healing. The other factors do not impede healing but may cause other health risks.

The nurse is caring for a client with a fractured femur. Which factor in the clients history may impede healing of the fracture? a. A sedentary lifestyle b. A history of smoking c. Oral contraceptive use d. Paget's disease

D ~ Paget's disease and bone cancer can cause pathologic fractures such as a fractured femur that do not achieve total healing. The other factors do not impede healing but may cause other health risks.

A phone triage nurse speaks with a client who has an arm cast. The client states, "My arm feels really tight and puffy." How should the nurse respond? a. Elevate your arm on two pillows and get ice to apply to the cast. b. Continue to take ibuprofen (Motrin) until the swelling subsides. c. This is normal. A new cast will often feel a little tight for the first few days. d. Please come to the clinic today to have your arm checked by the provider.

D ~ Puffy fingers and a feeling of tightness from the cast may indicate the development of compartment syndrome. The client should come to the clinic that day to be evaluated by the provider because delay of treatment can cause permanent damage to the extremity. Ice and ibuprofen are acceptable actions, but checking the cast is the priority because it ensures client safety. The nurse should not reassure the client that this is normal.

After teaching a client with a fractured humerus, the nurse assesses the clients understanding. Which dietary choice demonstrates that the client correctly understands the nutrition needed to assist in healing the fracture? a. Baked fish with orange juice and a vitamin D supplement b. Bacon, lettuce, and tomato sandwich with a vitamin B supplement c. Vegetable lasagna with a green salad and a vitamin A supplement d. Roast beef with low-fat milk and a vitamin C supplement

D ~ The client with a healing fracture needs supplements of vitamins B and C and a high-protein, high-calorie diet. Milk for calcium supplementation and vitamin C supplementation are appropriate. Meat would increase protein in the diet that is necessary for bone healing. Fish, a sandwich, and vegetable lasagna would provide less protein.

A nurse is caring for a client who is recovering from an above-the-knee amputation. The client reports pain in the limb that was removed. How should the nurse respond? a. The pain you are feeling does not actually exist. b. This type of pain is common and will eventually go away. c. Would you like to learn how to use imagery to minimize your pain? d. How would you describe the pain that you are feeling?

D ~ The nurse should ask the client to rate the pain on a scale of 0 to 10 and describe how the pain feels. Although phantom limb pain is common, the nurse should not minimize the pain that the client is experiencing by stating that it does not exist or will eventually go away. Antiepileptic drugs and antispasmodics are used to treat neurologic pain and muscle spasms after amputation. Although imagery may assist the client, the nurse must assess the clients pain before determining the best action.

A nurse assesses a client with a pelvic fracture. Which assessment finding should the nurse identify as a complication of this injury? a. Hypertension b. Constipation c. Infection d. Hematuria

D ~ The pelvis is very vascular and close to major organs. Injury to the pelvis can cause integral damage that may manifest as blood in the urine (hematuria) or stool. The nurse should also assess for signs of hemorrhage and hypovolemic shock, which include hypotension and tachycardia. Constipation and infection are not complications of a pelvic fracture.

A nurse cares for a client in skeletal traction. The nurse notes that the skin around the clients pin sites is swollen, red, and crusty with dried drainage. Which action should the nurse take next? a. Request a prescription to decrease the traction weight. b. Apply an antibiotic ointment and a clean dressing. c. Cleanse the area, scrubbing off the crusty areas. d. Obtain a prescription to culture the drainage.

D ~ These clinical manifestations indicate inflammation and possible infection. Infected pin sites can lead to osteomyelitis and should be treated immediately. The nurse should obtain a culture and assess vital signs. The provider should be notified. By decreasing the traction weight, applying a new dressing, or cleansing the area, the infection cannot be significantly treated.

A nurse plans care for a client who is prescribed skeletal traction. Which intervention should the nurse include in this plan of care to decrease the clients risk for infection? a. Wash the traction lines and sockets once a day. b. Release traction tension for 30 minutes twice a day. c. Do not place the traction weights on the floor. d. Schedule for pin care to be provided every shift.

D ~ To decrease the risk for infection in a client with skeletal traction of external fixation, the nurse should provide routine pin care and assess manifestations of infection at the pin sites every shift. The traction lines and sockets are external and do not come in contact with the clients skin; these do not need to be washed. Although traction weights should not be removed or released for any period of time without a prescription, or placed on the floor, this does not decrease the risk for infection.

The nurse explains that the rationale for LMW (low-molecular-weight) heparin therapy after open reduction of a fractured femur is to ~ decrease hematoma at the fracture site. ~ decreases the threat of thrombus. ~ increase blood supply at the fracture site. ~ increase platelet formation.

Decreases the threat of thrombus. ~ Prevention of DVT is a primary goal for the client after ORIF. Pharmacologic agents such as LMW heparin or warfarin are used to prevent DVT

A patient who has undergone total hip arthroplasty is advised to do exercises. Which action made by the patient indicates a quadriceps-setting exercise? A. Pushing the heels into the bed B. Bending the knees to 100 degrees C. Crossing the legs beyond the midline of the body D. Straightening the legs and pushing the back of the knees into the bed

D. ~ Quadriceps-setting exercises are achieved by straightening the legs and pushing the back of the knees into the bed. Pushing the heels into the bed is a gluteal exercise that helps to prevent venous thromboembolism. Bending the knees to 100 degrees is not recommended because the action may cause a dislocation. Crossing the legs beyond the midline of the body after total hip arthroplasty can lead to complications such as a hip dislocation.

A client with a left lower leg fracture in a cast for 3 days complains to the nurse that the pain medication does not relieve the pain any more. The priority action by the nurse would be to ~ administer more analgesics. ~ do a neurovascular assessment. ~ elevate the cast on pillows. ~ notify the physician.

Do a neurovascular assessment. ~ Unrelieved pain is a manifestation of compartment syndrome, which is a serious complication of fractures. Other manifestations include pain out of proportion to the injury and escalating pain. If unrecognized or untreated, the client can lose nerve and muscle function. Amputation may be necessary. The nurse should perform a complete neurovascular assessment and notify the physician

The nurse notices a stain on a newly dried plaster cast over a client's fracture site. The most appropriate method to assess this finding is to ~ assess for a "hot spot" over the stain. ~ bivalve the cast and inspect the site. ~ draw around the circumference with a pen and record. ~ dry the stained area of the cast with a hair dryer.

Draw around the circumference with a pen and record. ~ A stain indicates wound drainage and should be carefully measured and documented. Drawing on the cast around the stain gives a baseline against which to compare extension of the stain.

The nursing intervention that would be most appropriate for a client who has entered the emergency department with a severe strain to the knee is ~ apply a heat pack to reduce swelling. ~ elevate the leg and apply ice. ~ manipulate the knee in the full range of motion. ~ teach the client exercises to speed healing.

Elevate the leg and apply ice. ~ Acute sprains require RICE: rest, ice, compression, and elevation for the first 24-48 hours to reduce swelling. Heat may be used after that if desired. During healing, which takes 4-6 weeks, movement of the injured part should be minimized

The nurse admits a client diagnosed with Paget's disease. The nurse anticipates that the client will have which condition? Progressive muscle weakness Low body weight, thin build Enlarged, thick skull Bone infection

Enlarged, thick skull ~ An enlarged thick skull is a feature of Paget's disease. Progressive muscle weakness is a feature of muscular dystrophy. Low body weight with a thin build is a feature of osteoporosis. Bone infection is a feature of osteomyelitis.

The nurse is caring for an older adult client diagnosed with osteomalacia. The nurse anticipates that the health care provider will request which medication? ~ Ascorbic acid (vitamin C) ~ Ergocalciferol (Calciferol) ~ Phenytoin (Dilantin) ~ Prednisone (Deltasone)

Ergocalciferol (Calciferol) ~ Osteomalacia is loss of bone related to vitamin D deficiency. The major treatment for osteomalacia is vitamin D in an active form such as ergocalciferol. Ascorbic acid (vitamin C) is not indicated for treatment of osteomalacia, which is related to vitamin D deficiency. Phenytoin interferes with the metabolism of vitamin D. Prednisone is a glucocorticoid for treatment of inflammatory disorders and is not indicated in the treatment of osteomalacia.

The initial process of bone healing occurring at the fracture site in the first 72 hours is ~ formation of a hematoma. ~ formation of a provisional callus. ~ proliferation of osteoblasts. ~ reabsorption of the clot.

F ormation of a hematoma ~ Immediate formation of a hematoma at a fracture site occurs in 1 to 3 days.

The nurse explains to a client with delayed union of a fractured femur that treatment for this complication is based on ~ finding and correcting the cause. ~ physical therapy using deep-heat modalities. ~ realigning the fracture with traction. ~ stabilizing the fracture with a metal plate

Finding and correcting the cause. ~ If the cause of the delayed union can be identified and corrected, the fracture usually heals.

A client is admitted to the emergency department with a complete fracture of the left radius. The nurse understands that with this type of fracture, the bone is ~ displaced with fragments out of normal position. ~ fractured only through one cortex of bone. ~ fractured through the entire bone. ~ fragmented with multiple pieces of bone.

Fractured through the entire bone. ~ In a complete fracture, the fracture line extends across the entire bone. the other options: displaced fracture; is an incomplete fracture (only through cortex of bone); and multiple fragments is a burst fracture

In the application of a cast, the most appropriate nursing intervention is to ~ allow excess casting material to dry on the skin before removal. ~ carefully cut the stockinette to the exact length of the cast. ~ gently support the extremity from underneath. ~ flush plaster-laden water down the toilet rather than the sink.

Gently support the extremity from underneath ~ The nurse assisting during a cast application should support the extremity from underneath using only the palms of the hands to avoid applying pressure to any one area. The nurse should ensure he/she does not press fingertips into the cast or allow it to rest on a hard surface because this can lead to indentations in the cast that can ultimately cause pressure and injury to the client. The stockinette is cut several inches longer than the anticipated cast. As soon as the cast is applied, excess plaster needs to be removed from the client's skin. The water used to wet the plaster should be dumped down a sink with a plaster trap. If no such sink is available, the water should be allowed to sit until the plaster settles at the bottom of the bucket; then the water can be drained off the top and the plaster scooped out into a trash bag

The nurse is assessing a client with osteomalacia. Which findings does the nurse expect to observe? Select all that apply. Hyperparathyroidism Hyperuricemia Hypophosphatemia Looser's lines or zones Unsteady gait

Hypophosphatemia Looser's lines or zones Unsteady gait Osteomalacia is loss of bone related to vitamin D deficiency, which can lead to bone softening and inadequate deposits of calcium and phosphorus in the bone matrix; this may cause hypophosphatemia. Looser's lines or zones (radiolucent bands) represent stress fractures and are a classic diagnostic finding of osteomalacia. Muscle weakness in the lower extremities may cause waddling and an unsteady gait. Hyperparathyroidism and hyperuricemia may be observed in Paget's disease.

Which nursing intervention helps to reduce the incidence of osteomyelitis for a client receiving hemodialysis? Instructing the client to brush teeth after every meal Maintaining clean dressing change technique for long-term IV catheters Using clean technique Using Standard Precautions

Instructing the client to brush teeth after every meal ~ Proper dental hygiene helps prevent periodontal infection, which can be a causative factor in osteomyelitis of the facial bone. Long-term IV catheters can be a primary source of infection, so dressing changes are done using sterile technique. All clients undergoing hemodialysis require careful sterile technique before needle cannulation. Standard Precautions should be used for all clients.

Important self-care measures the nurse should teach to the client who is expected to be immobile in a wheelchair for a lengthy period of time include ~ learning how to inspect all skin surfaces for friction or pressure. ~ massaging bony prominences four times a day. ~ sitting upright in a chair or wheelchair on the sacrum. ~ using a gel wheelchair cushion to prevent pressure ulcers.

Learning how to inspect all skin surfaces for friction or pressure. ~ Clients, especially those with paraplegia and decreased sensation, need to learn to inspect all body surfaces for pressure or friction injuries, using a long-handled mirror if necessary. Clients should not massage bony prominences because this leaves them soft and vulnerable to pressure or shear. Clients should sit upright on their buttocks. Gel cushions should be avoided because they are expensive and heavy, they tend to break down, and they make moving the wheelchair more difficult

The nurse is assessing a client with Ewing's sarcoma. Which finding does the nurse expect to observe? ~ Bradycardia ~ High fever ~ Leukocytosis ~ Migraine headaches

Leukocytosis ~ Ewing's sarcoma is a malignant tumor, and the client may experience systemic manifestations, including leukocytosis, anemia, and low-grade fever. Bradycardia and migraine headache are not symptoms of Ewing's sarcoma. A low-grade fever is a systemic manifestation of Ewing's sarcoma.

The nurse plans to refer a client diagnosed with osteoporosis to which community resource? ~ American Bone Society ~ CanSurmount ~ I Can Cope ~ National Osteoporosis Foundation

National Osteoporosis Foundation ~ Clients with musculoskeletal problems should be referred to appropriate community resources, such as the National Osteoporosis Foundation, for help and support for their diagnosis. There is no organization known as the American Bone Society. CanSurmount is a cancer support group geared toward client and family education. I Can Cope is also a support group for clients with cancer.

The nurse is caring for a client with prostate cancer who has bone metastasis. The nurse anticipates that the health care provider will prescribe which medication? Calcitonin (Calcimar) Medroxyprogesterone (Prempro) Pamidronate (Aredia) Tamsulosin hydrochloride (Flomax)

Pamidronate (Aredia) ~ Pamidronate is a bisphosphonate that is available intravenously and is approved for bone metastasis from the breast, lung, and prostate. Pamidronate protects bones and prevents fractures. Calcitonin is used for the treatment of postmenopausal osteoporosis, Paget's disease, and hypercalcemia associated with cancer. Medroxyprogesterone is indicated for treating menopausal symptoms and preventing osteoporosis. Tamsulosin hydrochloride is an alpha-adrenergic blocking agent used for the treatment of benign prostatic hyperplasia.

A client has had a sequestrectomy of the right fibula for osteomyelitis 1 day ago. Which assessment finding requires the nurse to immediately contact the surgeon? Swelling of the right lower extremity 1+ to 2+ bilateral palpable pedal pulses Pain of right lower extremity on movement Paresis of right lower extremity

Paresis of right lower extremity ~ Paresis indicates a neurovascular compromise that must be reported immediately to the surgeon. The client undergoing a sequestrectomy experiences increased swelling after the procedure; the affected extremity should be elevated to increase venous return and thus control swelling. Palpable pulses of 1+ to 2+ bilaterally are a sign of adequate blood flow. Pain on movement of the right lower extremity is an expected finding.

In caring for a client in skeletal traction with a nursing diagnosis of Risk for Injury related to traction, the nurse should take special care to ~ carefully inspect pin sites every other day to assess for pin site infection. ~ encourage the client to assume a position of comfort to reduce the risk of pressure ulcers. ~ knot ropes between the client and pulley to prevent weights from touching the floor. ~ position weight ropes to ensure that the weights hang freely from pulleys.

Position weight ropes to ensure that the weights hang freely from pulleys. ~ The weights must hang freely to ensure traction. Knotting the ropes between the client and the pulley causes distraction. The client must be kept in anatomic alignment to prevent poor union. Pin sites should be checked more often than every other day

A client with long-standing dementia is sent to the emergency department from the nursing home in which the client resides. The report from the nursing staff states that the client is complaining of vague pain in the buttocks but seems to be ambulating without problems. The family requested the transfer. The emergency department nurse would suspect ~ an overprotective family. ~ arthritis pain the client cannot articulate. ~ possible hip fracture. ~ worsening dementia.

Possible hip fracture ~ Some clients with hip fractures have normal ambulation and complain only of vague pain in their buttocks, knees, thighs, groin, or back, especially if they also have dementia. Since hip fractures are one of the leading causes of morbidity and mortality in the elderly, the nurse must maintain a high index of suspicion for fractures, especially in a client who has dementia

Which is a priority problem for the older adult client diagnosed with bone cancer? Potential for injury related to weakness and drug therapy Altered self-esteem related to fear of death and dying Reduced mobility related to weakness and fatigue Pain of a chronic nature related to tumor invasion of other organs

Potential for injury related to weakness and drug therapy ~ Older adult clients are more likely to fall and injure themselves because of weakness and the medications that they are prescribed, especially analgesics. Client problems of altered self-esteem, reduced mobility, and chronic pain are relevant, but are not the priority. The client's safety comes first.

The nurse explains to the client that in addition to approximating the bone fragments, traction also ~ increases blood supply to the fracture site. ~ increases speed of bone healing. ~ reduces muscle spasm. ~ reduces neuromuscular dysfunction.

Reduces muscle spasm ~ The purpose of traction is to realign the fracture and decrease muscle spasm. It does not increase blood supply, speed healing, or reduce neuromuscular dysfunction.

The principal concept that a nurse would include in a teaching plan regarding partial weight-bearing is that the client should ~ bear as much weight as can be tolerated 30% to 50% of the time. ~ prevent the affected limb from touching the floor; bear weight on the unaffected limb. ~ rest the affected foot on the floor and place weight on it 30% to 50% of the time. ~ use a walker or crutches and bear 30% to 50% of weight on the affected limb

Rest the affected foot on the floor and place weight on it 30% to 50% of the time. ~ Partial weight-bearing allows the client to bear 30% to 50% of weight on the affected limb

The nurse suspects that a client may have plantar fasciitis if the client has which assessment finding? ~ Lateral deviation of the great toe; first metatarsal head becomes enlarged ~ Dorsiflexion of any metatarsophalangeal (MTP) joint, with plantar flexion of the adjacent proximal interphalangeal (PIP) joint ~ Severe pain in the arch of the foot, especially when getting out of bed ~ A small tumor in a digital nerve of the foot

Severe pain in the arch of the foot, especially when getting out of bed ~ Severe pain in the arch of the foot, especially when getting out of bed, is a description of plantar fasciitis. Lateral deviation of the great toe with an enlarged first metatarsal head describes a bunion of the foot. Dorsiflexion of any MTP joint with plantar flexion of the adjacent PIP joint is a description of a hallux valgus and hammertoe of the foot. A small tumor in a digital nerve of the foot describes Morton's neuroma of the foot.

The complaint of proximal thigh pain in an older client who has fallen leads the nurse to suspect a hip fracture and that the location of the fracture is ~ intracapsular. ~ intratrochanteric. ~ subtrochanteric. ~ the femoral neck.

Subtrochanteric ~ Subtrochanteric fractures typically produce pain over the proximal thigh. Groin pain is associated with a femoral neck fracture and pain over the trochanter with an intratrochanteric fracture

What is the primary role of the nurse when caring for an adult client with muscular dystrophy (MD)? ~ Pain management ~ Supportive care ~ Teaching the importance of keeping appointments ~ Advocating for the client and the family

Supportive care ~ Management of the client with MD is supportive and involves the entire health care team. Coordinating pain management is not the nurse's primary role for the adult client with MD. The nurse's role does not focus on whether the client keeps appointments; this would be more important for clients who, for example, are receiving intermittent chemotherapy. The nurse is always an advocate for all clients and families, but this is not the nurse's primary role when caring for the client with MD.

Which finding does the nurse expect to observe in a client with suspected common chronic osteomyelitis? Erythema of the affected area Fever; temperature usually above 101° F (38° C) Ulceration of the skin Constant, localized, and pulsating bone pain

Ulceration of the skin ~ Ulceration of the skin is a feature of chronic osteomyelitis. Erythema of the affected area; fever; and constant, localized, pulsating bone pain are features of acute osteomyelitis.

Which is the best way to decrease the risk for osteoporosis in a client who has just been determined to be at high risk for the disease? ~ Increase nutritional intake of calcium. ~ Engage in high-impact exercise, such as running. ~ Increase nutritional intake of phosphorus. ~ Walk for 30 minutes three times a week.

Walk for 30 minutes three times a week. ~ Walking for 30 minutes three to five times a week is the single most effective exercise for osteoporosis prevention. Walking is a safe way to promote weight bearing and muscle strength. A variety of nutrients are needed to maintain bone health, so the promotion of a single nutrient will not prevent or treat osteoporosis. High-impact exercise and overtraining, such as running, may cause vertebral compression fractures and should be avoided. Calcium loss occurs at a more rapid rate when intake of phosphorus is high; people who drink large amounts of carbonated beverages each day (over 40 ounces) are at high risk for calcium loss and subsequent osteoporosis, regardless of age or gender.

The nurse is taking the history of an adult female client. Which factor places the client at risk for osteoporosis? Consuming 12 ounces of carbonated beverages daily Working at a desk and playing the piano for a hobby Having a hysterectomy and taking estrogen replacement therapy Consuming one alcoholic drink per week

Working at a desk and playing the piano for a hobby ~ Sedentary lifestyle and prolonged immobility produce rapid bone loss. The client would have to consume large amounts of carbonated beverages daily (over 40 ounces) for this to be a risk factor for osteoporosis. Maintaining estrogen levels reduces the risk for osteoporosis. Alcohol has a direct toxic effect on bone tissue, resulting in decreased bone formation and increased bone resorption. For those who have excessive alcohol intake, alcohol calories decrease hunger and the need to take in adequate quantities of nutrients. This client's alcoholic intake is not high, so it is not a risk factor.