CH44 musculoskeletal

the nurse is providing care for a patient who has just had a hip replacement. which comment from the patient indicates the need for further education (1354) 1. i need to be on bedrest for the first 72 hr 2. i need to obtain a seat riser for my toilet at home 3. i should never sit with my legs crossed 4. ill have limitations in hip position for 2-3 months

1

the patient is admitted for acute osteomyelitis of the left lower extremity. which instruction should the nurse give to the unlicensed assistive personnel (UAP) (1350) 1. use drainage and secretion precautions when caring for the patient 2. assist the patient to ambulate in the hall every 2-3 hours 3. anticipate that movement is more difficult in the morning 4. refresh the patients ice pack every 2 hours or as needed

1

the patient was in a car accident and reports pain over the pelvic region with difficulty raising legs in a supine position, the nurse notes ecchymosis over the pelvic region. which laboratory test is the primary concern in teh immediate phase of care (1365) 1. hemoglobin and hematocrit 2. blood type and Rh 3. urinalysis 4. stool for occult blood

1

the home health nurse is reviewing the medication reconciliation list for a patient who has osteoarthritis. the list includes tramadol, acetaminophen, lisinopril, cortisone, and ibuprofen. which drug-drug combination is cause for greatest concern (1345) 1. lisinopril and tramadol 2. lisinopril and acetaminophen 3. lisinopril and cortisone 4. lisinopril and ibuprofen

1, 2, 3,4

the nurse is planning car for several patients on the orthopedic unit. which patient will need frequent neruovascular checks during the shift. select all that apply (1357) 1. patient had been a long leg cast for fracture sustained in an automobile accident 2. older patient had elective hip replacement surgery secondary to arthritis 3. construction worker sustained a crush injury to the lower leg 4. patient had Volkmanns's contracture of the right upper hand 5. young athlete sustained a dislocated shoulder during a football game

1, 2, 3,4

the nurse sees that the patient has a new prescription for alendronate. in addition to medication teaching, which self care measure is the nurse most likely to review with the patient (1348) 1. fluid intake of at least 2000ml 2. postural and breathing exercises 3. weight bearing exercise, such as walking 4 application of heat and cold packs for pain

1, 2, 3,4

what information would the nurse teach about sleep hygiene for a patient who has fibromyalgia (1351) 1. take a long, hot bath just before bedtime 2. keep the sleeping environment dark, quiet, and comfortable 3. keep a diary of sleep patterns 4. exercise regularly every day 5. have a protein snack just before going to bed

1, 2, 3,4

which foods should the nurse recommend as good sources of calcium for a 59 yo woman who is concerned about her risk for osteoporosis. select all that apply (1348) 1. milk 2. spinach 3. potatoes 4. sardines 5. organ meats

1, 2, 3,4

which patient needs to be monitored for shock (1365) 1. patient reports pain in the muscle, bones, joints; headaches, altered though processes and stiffness 2. patient reports chest pain, especially on inspiration; nurse observes irritability, restlessness and stupor 3. patient experiences deep, unrelenting, progressive, and poorly localized pain unrelieved by analgesics 4. patient appears anxious, weak, and lethargic; nurse observes hypotension, tachycardia, and diaphoresis

1, 2, 3,4

the nurse is caring for a patient who had uni-compartmental knee surgery. which interventions will the nurse use in the postoperative period. select all that apply (1352) 1. encourage deep breathing and coughing every 2 hr 2. begin with clear liquid diet and advance to regular as tolerated 3. inspect the skin at the edge of the cast for erythema 4. assess the patients ability to use an assistive device such as a walker 5. monitor IV fluids and effectiveness of antibiotics 6. administer intraarticular injections of corticosteroids

1,2,4,5

a patient is prescribed colchicine to treat gout. the nurse would assess for which potential medication side effects (1346) 1. diarrhea, nausea, and vomiting 2. seizures and dysrhythmia 3. fluid retention and sodium retention 4. hypercalcemia and orthostatic hypotension

1.

a computer data entry clerk reports paresthesia in the thumb, index finger, and middle finger and pain that increase during the night, the clerk has an appointment with a health care provider next week. in the meantime what self care measure would the nurse advise(1381) 1. use warm packs and sleep with hands on a pillow 2. frequently change position ans stretch hands while working 3. use mild analgesic such as ibuprofen or aspirin 4. wrap the wrist snugly with an elastic bandage

2

a fiberglass cast has been applied to the frozen arm of a 6 yo child to treat and stabilize a greenstick fracture. which teaching point is the most important to emphasize with the child (1366) 1. instructing the child to keep the cast dry 2. teaching the child to report pain to the patients 3. showing the child how to test capillary refill 4. reminding the child to wiggle fingers

2

a nurse is checking on an older neighbor who just feel down. the man cheerfully tells the nurse "i just tripped on the carpet and took a spill. no harm done" based on mechanism of injury, which assessment is the nurse most likely to perform if the neighbor will allow it (1362) 1. head to toe to detect occult injury 2. palpation and range of motion for wrist injury 3. mental status examination for head injury 4. environmental assessment for other hazards

2

the nurse hears in report that the patient has a medical diagnosis of ankylosing spondylitis. what will the nurse include in the focused assessment for this patient (1342) 1. perform the 7 p's of orthopedic assessment 2. assess for back pain and vision changes 3. frequently check for change in mental status 4. check for urinary retention and overflow incontinence

2

the nurse hears in report that the patient has volkmann's contracture of the dominant upper extremity. which intervention would the nurse plan to use (1367) 1. frequently assess using the 7 p's of orthopedic assessment 2. assess the patients abilities to perform activities of daily living 3. teach the patient to report pain, loss of sensation, or swelling 4. instruct the UAP on proper position and alignment

2

the nurse is interviewing a young woman who injured her ankle while playing soccer. considering the diagnostic testing most likely to be ordered, which question is most important to ask (1331) 1. do you have allergies to seafood or iodine 2. is there any chance you could be pregnant 3. are you currently taking any medications 4. do you have a history of radiation exposure

2

the patient had a hip arthroplasty and returned form the postanethesia care unit several hours ago. the patient is now restless and anxious. what is the nurses first action (1367) 1. decrease anxiety by reassuring the patient that everything is going as expected 2. initiate vital signs every 15 minutes, compare to baseline, and monitor trends 3. look at the urinary output and compare the total to baseline 4. call the patients family and invite them to spend time at the bedside

2

the nurse is assessing a patient who has a myelogram 3 hr ago, which patient comment causes the greatest concern (1332) 1. my head hurts. could i get an aspirin or tylenol tablet 2. i am thirsty would it be okay if i drank soda or some juice 3. my foot feels numb and i cant move my toes very well 4. i am not used to lying n bed all day long; id like to walk around

3

the patient says to the nurse "i have excruciating pain in my big toe at night" which assessment questions is the nurse most likely to ask (1346) 1. have you noticed a change in your bowel movements 2. how much exercise would you normally get in a week 3. do you eat organ meats, yeast, herring, or mackerel 4. do you notice jaw tension, excessive fatigue, or anxiety

3

the patient who had a laminectomy reports abdominal discomfort with gaseous, bloated feeling and mild nausea. what should the nurse do first (1383) 1. offer clear liquids 2. encourage ambulation 3. listen bowel sounds 4. administer an antiemetic

3

the nurse is supervising a nursing student in caring for a patient who had internal fixation for a hip fracture. the nurse would intervene if the student performed which action (1358) 1. assessed the amount of drainage in the jackson-pratt drain 2. encouraged coughing and the use of the incentive spirometer 3. removed the anti-embolism stocking assess the skin

4

the patient reports long bone pain that increases with weight bearing. the health care provider tels the nurse that the patient has an elevated serum alkaline phosphatase. the nurse prepare to give emotional support because the provider must tell the patient that additional diagnostic testing is needed to rule out which condition (1383) 1. phantom limb pain 2. compartment syndrome 3. fibromyalgia 4. osteogenic sarcoma

4

the patient with a cast on the lower extremity reports pain at 7/10. what should the nurse do first (1357) 1. reposition the leg so that elevation is maintained 2. administer pain medication as prescribed 3. report potential compartment syndrome to RN 4. perform the 7 p's of orthopedic assessment

4