Dynamic Quiz- Musculoskeletal
A nurse is caring for a client who is 72 hr postoperative following an above-the knee amputation. Which of the following actions should the nurse take? A. Elevate the residual limb on a soft pillow B. Assist the client into a prone position every 4 hr C. Re-apply a bandage to the residual limb every 12 hr D. Apply dressings to the site in a proximal-to-distal direction
Correct Answer: B. Assist the client into a prone position every 4 hr The nurse should assist the client into a prone position for 20 to 30 minutes every 3 flexion contractures.
A nurse is preparing a client for discharge who is postoperative following a conventional lumbar disk excision. Which of the following statements indicates that the client understands the nurse's instructions? A. "I should have no problem climbing stairs when I get home." B. "I'll wait about 3 weeks before I return to my usual activities." C. "I'll use my heating pad if I feel any muscle spasms in my back." D. "I can go back to driving in about 2 weeks or so."
Correct Answer: C. "I'll use my heating pad if I feel any muscle spasms in my back." The client should apply heat to the back to relax the paraspinal muscles and reduce spasms.
A nurse is assessing a client who has a fractured left femur and is in skeletal traction. Which of the following findings should the nurse report to the provider? A. Ecchymosis of the thigh B. Serous drainage at the pin site C. Chest petechiae D. Muscle spasms in the left leg
Correct Answer: C. Chest petechiae The nurse should identify chest petechiae as an indication of fat embolism syndrome. Clients who have fractures of the long bones such as the femur are at increased risk of fat emboli. Fat emboli typically occur 12 to 48 hours after the injury when fat droplets from the marrow enter into the systemic circulation and are deposited in the lungs. The nurse should immediately notify the provider because the client could progress to acute respiratory failure.
A nurse is caring for a client who has a depressed skull fracture of the bone that makes up the larger part of the upper and side wall of the cranium. This fracture is located on which of the following bones? A. Sphenoid B. Occipital C. Parietal D. Frontal Check
Correct Answer: C. Parietal The parietal bones form the larger part of the upper and side wall of the cranium.
A nurse is preparing a community education program about reducing the risk of osteoporosis. Which of the following pieces of information should the nurse include? A. Avoid sun exposure. B. Take a calcium supplement once each day if at risk for osteoporosis. C. Walking is the preferred mode of exercise to maintain strong bones. D. Caffeine intake minimizes the risk of developing osteoporosis.
Correct Answer: C. Walking is the preferred mode of exercise to maintain strong bones. The nurse should emphasize that regular walks are the preferred weight-bearing exercise to build and maintain strong bones.
A nurse is caring for a client who is scheduled to undergo surgery to repair an open hip fracture. In which of the following positions should the nurse plan to place the client postoperatively? A. With the leg on the affected side adducted B. With the hip externally rotated on the affected side C. With the leg on the affected side abducted D. With the hip flexed to 90° on the affected side
Correct Answer: C. With the leg on the affected side abducted The nurse should plan to place the client with the leg abducted on the affected side postoperatively. Adduction or external rotation of the leg will cause the hip to dislocate.
A nurse is teaching a client who has a new prescription for alendronate for the treatment of osteoporosis. Which of the following statements by the client indicates an understanding of the teaching? A. "I will take the medication in the evening." B. "I will drink a full glass of milk with the medication." C. "I will take the medication at mealtime." D. "I will sit upright after taking the medication."
Correct Answer: D. "I will sit upright after taking the medication." A client taking alendronate should sit upright for 30 minutes after administration to prevent esophageal irritation and ulceration. Therefore, the nurse should identify this statement as indicating an understanding of the teaching.
A nurse is discussing the difference between rheumatoid arthritis (RA) and osteoarthritis with a newly licensed nurse. Which of the following pieces of information should the nurse include about osteoarthritis? A. "Osteoarthritis is caused by autoimmune processes." B. "Osteoarthritis leads to a decreased erythrocyte sedimentation rate." C. "Osteoarthritis affects other organ systems." D. "Osteoarthritis can impair a joint on a single side of the body.
Correct Answer: D. "Osteoarthritis can impair a joint on a single side of the body." The nurse should identify unilateral joint involvement as a finding of osteoarthritis. A client who has RA experiences symmetrical joint impairment.
A nurse is discussing the plan of care with a client who has osteomyelitis of an open wound on his heel. Which of the following information should nurse include? A. "You will need to apply a cold pack to the site 3 times a day." B. "Your provider might ask you to walk frequently to increase circulation to the area." C. "You will need to limit your consumption of high-protein foods." D. "Your provider might prescribe a central catheter line for long-term antibiotic therapy."
Correct Answer: D. "Your provider might prescribe a central catheter line for long-term antibiotic therapy." Osteomyelitis is an acute or chronic bone infection. The client will require weeks to months of IV antibiotic therapy for treatment. Therefore, the nurse should discuss the need for long-term IV access for antibiotic therapy.
A nurse is preparing an in-service presentation about the basics of bone injuries. Which of the following types of fractures is especially common in children? A. Impacted B. Depressed C. Compound D. Greenstick
Correct Answer: D. Greenstick With a greenstick fracture, there is an incomplete break in the bone. One side of the bone usually splinters, while the other side is bent but intact. This type of fracture is common in children because their bones are more flexible than those of an adult.
A nurse is preparing a client who is scheduled to have an arthroscopy the following day. Which of the following statements indicates that the client understands the pre-procedure teaching? A. "I have to keep my leg straight throughout the whole procedure." B. "The doctor will be able to see if I have signs of rheumatoid arthritis." C. "I should expect to stay overnight until I can walk around." D. "I'll have a scar that will be about an inch long."
Correct Answer: B. "The doctor will be able to see if I have signs of rheumatoid arthritis." An arthroscopy helps with diagnosing musculoskeletal disorders such as rheumatoid arthritis, osteoarthritis, and internal joint injuries.
A home health nurse is performing an assessment on a client who is 1 week postoperative following a total knee replacement. Which of the following statements by the client indicates an understanding of the teaching? A. "I will discontinue the blood thinner my doctor prescribed once I am at home." B. "I will keep a pillow under my knee when I am in bed." C. "I plan to use a walker to help me get around." D. "I will discontinue using the CPM machine when I get home."
Correct Answer: C. "I plan to use a walker to help me get around." The nurse should identify that the client will receive a prescription for a walker, cane, or crutches to promote ambulation following a total knee replacement.
A nurse is reviewing the medical record of a client who has a prescription for probenecid to treat gout. The nurse should identify that which of the following medications can interact with probenecid? A. Colchicine B. Naproxen C. Aspirin D. Prednisone
Correct Answer: C. Aspirin Aspirin can decrease the effectiveness of probenecid. The nurse should caution the client to avoid interaction between probenecid and salicylate medications.
A nurse is performing medication reconciliation for a newly admitted client who has rheumatoid arthritis (RA). Which of the following medications should the nurse identify as the treatment for this condition? A. Misoprostol B. Dantrolene C. Celecoxib D. Colchicine
Correct Answer: C. Celecoxib Celecoxib is a type of NSAID known as cyclooxygenase-2 (COX-2) inhibitors that are used to relieve some of the manifestations caused by RA in adults. The nurse should identify that the medication is also prescribed for osteoarthritis, spondylitis, and painful menstruation.
A nurse is planning care for a client following a total hip arthroplasty. Which of the following interventions should the nurse include in the plan? A. Position the client with her legs adducted B. Internally rotate the client's affected hip C. Place a pillow between the client's legs D. Instruct the client to avoid flexing her hip more than 95º
Correct Answer: C. Place a pillow between the client's legs The nurse should plan to place a pillow or a wedge between the client's legs to reduce the risk of hip dislocation.
A nurse is providing nutrition education to a client who has osteomalacia. The nurse should identify that this condition is caused by a deficiency in which of the following nutrients? A. Fluoride B. Vitamin A C. Vitamin D D. Phosphorus
Correct Answer: C. Vitamin D Osteomalacia, a softening of the bones due to defective bone mineralization, results from a deficiency of vitamin D.
A nurse in the emergency department is preparing to discharge a client following a Grade II (moderate) ankle sprain. Which of the following instructions should the nurse plan to give to the client? A. Perform passive range-of-motion exercises of the ankle hourly B. Keep the affected extremity in a dependent position C. Wrap a loose dressing around the affected ankle D. Apply cold compresses to the extremity intermittently
Correct Answer: D. Apply cold compresses to the extremity intermittently Cold minimizes swelling and erythema to the affected area. Therefore, the nurse should instruct the client to apply cold compresses for no more than 20 minutes at a time.
A nurse is teaching a client who has osteoporosis. Which of the following instructions should the nurse include in the teaching? A. Reduce dietary protein intake B. Apply ice to painful areas C. Increase calcium intake to 900 mg per day D. Perform weight-bearing exercises
Correct Answer: D. Perform weight-bearing exercises The nurse should instruct the client to perform weight-bearing exercises to promote bone formation and increase strength and mobility.
A nurse is caring for a client following a hip arthroplasty. The nurse places an abduction pillow on the client for which of the following purposes? A. To raise the bed linens off the client's feet to prevent plantar flexion B. To keep the client's heels off the bed to prevent pressure ulcers C. To position the client off the operative site while in bed D. To prevent dislocation of the hip during position changes or movement
Correct Answer: D. To prevent dislocation of the hip during position changes or movement Following surgery, the nurse should use an abduction pillow to prevent dislocation of the new hip joint. The nurse should place the wedge-shaped pillow between the client's legs to prevent adduction beyond the midline of the body during position changes or client movement, which can lead to subluxation or total dislocation of the hip joint.
A nurse is caring for a client with a hip fracture who has Buck's extension traction in the client about this type of traction? (Select all that apply.) A. "You'll have considerably less pain with the traction in place." B. "You'll have the traction in place for a week or so." C. "The traction will help decrease muscle spasms." D. "The weights act as a pulling force to keep your leg and hip still." E. "We have to make sure the weights are just barely touching the floor."
Correct Answers: A. "You'll have considerably less pain with the traction in place." C. "The traction will help decrease muscle spasms." D. "The weights act as a pulling force to keep your leg and hip still." Pain is usually more severe without the traction. Buck's extension traction uses weight to help decrease muscle spasms (5 to 10 lb) of force helps stabilize the hip and leg preoperatively.
A nurse is determining a client's risk of developing osteoporosis. The nurse should identify which of the following as risk factors for bone loss? (Select all that apply.) A. Small body frame B. Hypertension C. African-American ethnicity D. Low vitamin D intake E. Smoking
Correct Answers: A. Small body frame D. Low vitamin D intake E. Smoking/ Females have a higher risk of developing osteoporosis than males. Other risk factors include family history, low body mass index, and a small body frame. Consuming inadequate levels of calcium and vitamin D, smoking, and ingesting high amounts of alcohol or caffeine also increase the risk of developing osteoporosis.
A nurse is teaching a client who is on bed rest about preventing complications. Which of the following client statements indicates an understanding of the teaching? A. "I should perform range-of-motion exercises once per day." B. "I should cough and deep-breathe every hour." C. "I should change my position every 4 hours." D. "I should perform foot and ankle pumps every 3 hours."
Correct Answer: B. "I should cough and deep-breathe every hour." The nurse should instruct the client to cough and deep-breathe every hour to promote lung expansion, maintain adequate gas exchange, and mobilize secretions.
A nurse is preparing a client who is postoperative following total hip arthroplasty for discharge. Which of the following statements indicates that the client understands the instructions? A. "I'll use alcohol pads to clean my incision each day." B. "When I'm doing my exercises, I'll include bent-leg raises." C. "I'll use a reacher to help me pick up anything I drop on the floor." D. "When I can walk without my walker, I can stop attending physical therapy."
Correct Answer: C. "I'll use a reacher to help me pick up anything I drop on the floor." To prevent dislocation, the client must avoid flexing to 90° at the waist. Using a device that allows the client pick up objects from the floor without bending will help avoid this type of flexion.
A nurse is assessing a female client who reports severe joint pain. The nurse should identify that which of the following factors places the client at risk for gout? A. Perimenopause B. Migraine headaches C. Diuretic use D. Irritable bowel syndrome
Correct Answer: C. Diuretic use The client's use of diuretics is a risk factor for gout. Gout is a systemic disorder that affects the joints as a result of high uric acid levels in the blood.
A nurse is caring for a client who is postoperative following a lumbar disk excision. Which of the following interventions should the nurse include in the client's plan of care? A. Keep the client's legs flat with the knees extended B. Encourage the client to sit up in a chair for as long as possible C. Logroll the client in bed for care procedures D. Expect urinary retention for the first postoperative day
Correct Answer: C. Logroll the client in bed for care procedures The client should receive instructions about logrolling preoperatively. The nurse may need to engage other staff members in assisting with logrolling to maintain proper alignment of the client's spine at all times postoperatively.
A nurse is caring for a client immediately following application of a plaster cast. The nurse should monitor for and report which of the following findings as an indication of compartment syndrome? A. Sensation of heat on the surface of the cast B. Paresthesias of the extremity C. Pruritus of the extremity D. Musty odor noted from cast materials
Correct Answer: B. Paresthesias of the extremity The nurse should identify paresthesias as a finding of compartment syndrome. Compartment syndrome involves the compression of nerves and blood vessels in an enclosed space, leading to impaired blood flow and nerve damage. Other findings include numbness, tingling, weakness, and pain that does not respond to medication.
A nurse is caring for a client who has a pelvic fracture. The client reports sudden shortness of breath, stabbing chest pain, and feelings of doom. This client is experiencing which of the following complications? A. Pneumonia B. Pulmonary embolus C. Tension pneumothorax D. Tuberculosis Check
Correct Answer: B. Pulmonary embolus Immobility following musculoskeletal trauma places the client at an increased risk of pulmonary embolus. The client might also exhibit tachycardia and chest petechiae and have a decreased SaO2. The nurse should notify the rapid response team immediately.
A nurse is caring for a client who is 3 days postoperative following a below-the-knee amputation. Which of the following actions should the nurse take? A. Place the client on a soft mattress B. Rewrap the residual limb with a bandage 3 times per day C. Assist the client into a prone position for 20 min every 8 hr daily D. Turn the client every 4 hr while in bed.
Correct Answer: B. Rewrap the residual limb with a bandage 3 times per day The nurse should rewrap the client's residual limb with a pressure bandage 3 times daily. This keeps the bandage taught, which ensures the residual limb will shrink. Rewrapping the bandage also allows the nurse to check the skin for redness or skin breakdown.
A nurse is caring for a client who is postoperative following shoulder surgery. The client has a prescription to keep the affected arm adducted. Which of the following instructions should the nurse share with the client? A. "Keep your arm bent at the elbow." B. "Use a pillow to prop your shoulder up close to your ear." C. "Hold your arm against the side of your body." D. "Position your arm with the shoulder at a 90° angle."
Correct Answer: C. "Hold your arm against the side of your body." Adduction means to position toward the midline of the body. Therefore, the nurse should provide these instructions to explain the provider's prescription.
A nurse is caring for a client who is postoperative following a total knee arthroplasty and has been prescribed a continuous passive motion (CPM) machine and PCA. The client tells the nurse, "I am in so much pain." Which of the following actions should the nurse take first? A. Remind the client to push the button for the PCA device B. Discuss activities the client may use to distract from the pain C. Ask the client to describe the characteristics of the pain D. Pause the CPM machine briefly to apply a cold pack to the client's knee
Correct Answer: C. Ask the client to describe the characteristics of the pain The nurse can use the nursing process to plan client care and prioritize nursing actions. Each step of the nursing process builds on the previous step, beginning with an assessment or data collection. Before the nurse can formulate a plan of action, implement a nursing intervention, or notify a provider of a change in the client's status, the nurse must first collect adequate data from the client. Assessing or collecting additional data will provide the nurse with the knowledge to make an appropriate decision. Therefore, the first action the nurse should take is to acquire further data by asking the client to describe the characteristics of the pain.
A nurse is assessing a client's skeletal system. The nurse should be in which of the following positions to screen the client for scoliosis? A. Standing beside the client, who is lying on the examination table B. Facing the client, who is sitting in a chair C. Standing behind the client, who is bent over at the waist D. Standing at the client's side, while the client leans back
Correct Answer: C. Standing behind the client, who is bent over at the waist The nurse should stand behind the client, who is bent over at the waist, to inspect the symmetry of the scapula and curvature of the spine from the posterior view. These are essential components of a scoliosis screening.
A nurse is caring for a client who has a fractured right hip. Which of the following types of traction should the nurse expect the client to have prior to hip arthroplasty surgery? A. Balanced skeletal traction B. Pelvic belt C. Pelvic sling D. Buck's traction
Correct Answer: D. Buck's traction Buck's traction is used prior to hip arthroplasty to maintain alignment and prevent muscle spasms prior to surgery.
A nurse in the emergency department is caring for a client who reports pain in her left leg following a motor-vehicle crash. The client's left leg has bruising, swelling, and displacement of the bones. Which of the following actions should the nurse take first? A. Obtain an X-ray of the injured leg B. Apply ice packs to the affected area C. Check neurovascular status distal to the injury D. Elevate the affected leg on 2 pillows
Correct Answer C. Check neurovascular status distal to the injury The nurse should apply the safety and risk-reduction priority-setting framework, which assigns priority to the factor or situation posing the greatest safety risk to the client. When there are several risks to client safety, the one posing the greatest threat is the highest priority. The nurse should use Maslow's hierarchy of needs, the ABC priority-setting framework, and/or nursing knowledge to identify which risk poses the greatest threat to the client. The greatest risk to this client is impaired circulation to the limb from trauma and the resulting edema; therefore, the first action is to check the circulation, sensation, and movement distal to the level of the injury. If the nurse notes a weak or absent pulse distal to the injury, the limb's circulation is compromised, and immediate action is critical.
A nurse is assessing a client who is 48 hr postoperative following open reduction and internal fixation of a fractured tibia. Which of the following findings should the nurse report to the provider? A. Toes that are cold to the touch B. Serous drainage from the pin sites C. Blanching of the toenail beds with pressure D. Pink tissue around the fixator insertion sites
Correct Answer: A. Toes that are cold to the touch The nurse should monitor for and report manifestations of compartment syndrome following internal fixation. Therefore, the nurse should contact the provider immediately if the client's toes are cold to the touch.
A nurse is caring for a client who had a fiberglass cast placed on her left arm several hours ago and now reports itching under the cast. Which of the following actions should the nurse plan to take? A. Use a hair dryer on a cool setting to blow air into the cast B. Ask the provider to bivalve the cast C. Provide the client with a sterile cotton swab to rub the affected skin D. Wrap the extremity with a dry heating pad
Correct Answer: A. Use a hair dryer on a cool setting to blow air into the cast The nurse should provide relief for this client's itching by blowing air into the cast using a hair dryer on a cool setting or an empty 60 mL plunger syringe.
A nurse is providing discharge teaching for a client who had a left total hip arthroplasty. Which of the following client statements indicates the teaching was effective? A. "I should expect swelling of the affected leg for several weeks." B. "I should not cross my legs at the ankles or knees." C. "I will inspect my hip incision every other day for redness." D. "I can bend over at the hip to pick up objects."
Correct Answer: B. "I should not cross my legs at the ankles or knees." The nurse should instruct the client to avoid crossing the legs at the knees or ankles because this can result in the dislocation of the femoral head
A nurse is providing preoperative teaching for a client who is scheduled for total knee arthroplasty. Which of the following statements by the client indicates an understanding of the teaching? A. "I will wear a continuous movement machine on my knee for 24 hr a day." B. "I should avoid taking NSAID medications for pain after surgery." C. "I should wear elastic stockings on both of my legs." D. "I will begin exercising my legs the day after surgery."
Correct Answer: C. "I should wear elastic stockings on both of my legs." The purpose of elastic stockings is to prevent venous thromboembolism, which is a common complication following orthopedic surgery. Therefore, the nurse should identify this statement as an understanding of the teaching.
A nurse is assessing a client who has osteoarthritis. The client's medical record indicates the presence of Heberden's nodes. Which of the following findings should the nurse expect? A. Inflamed, fluid-filled sacs over the joints B. Clubbing of the fingernails C. Flexion contracture of the fingers D. Hard lumps over the joints of the fingers
Correct Answer: D. Hard lumps over the joints of the fingers Heberden's nodes are hard, bony lumps or nodules in the joints of the fingers.
A nurse is preparing a client for a bone scan. Which of the following statements indicates that the client understands the pre-procedure teaching? (Select all that apply.) A. "I will have to drink a radioactive solution before the test begins." B. "A special camera will scan the bones in my entire body." C. "There will be better absorption of the radiation by healthy bone." D. "I'll have to drink a lot of water to help get the radiation out of my body." E. "I understand the radiation is harmless, and I don't have to worry about it."
Correct Answers: B. "A special camera will scan the bones in my entire body." D. "I'll have to drink a lot of water to help get the radiation out of my body." E. "I understand the radiation is harmless, and I don't have to worry about it." A bone scan is a radionuclide procedure that allows viewing of the entire skeleton. It is less common than other diagnostic tests but is still useful for identifying hairline fractures and some malignancies. The client should drink plenty of fluids to promote urinary excretion of the radioactive material. Also, the nurse should reassure the client that the radioactive material is not dangerous because it deteriorates quickly in the body and exits via urine and stool.
A nurse is preparing a client for an electromyogram (EMG). Which of the following statements indicates that the client understands the pre-procedure teaching? A. "This test will help my doctor know if my nerves are working correctly." B. "The doctor will be able to fix the problem with my arm during this procedure." C. "I cannot eat or drink for at least 10 hr before I have this procedure." D. "I will get enough sedation to put me to sleep for this procedure."
Correct Answer: A. "This test will help my doctor know if my nerves are working correctly." An EMG shows electrical activity within the muscles during contraction. It is useful for discriminating between muscular dysfunction and nerve dysfunction.
A nurse is caring for a client who had a below-the-knee amputation for gangrene of the right foot. The client reports sensations of burning and crushing pain in the toes of the absent right foot. Which of the following statements should the nurse make? A. "This type of pain usually decreases over time as the limb becomes less sensitive." B. "Try to look at the surgical wound as a reminder the limb is gone." C. "Use a cold compress intermittently to decrease these pain sensations." D. "Grief over the lost limb can sometimes cause denial that the limb is really gone."
Correct Answer: A. "This type of pain usually decreases over time as the limb becomes less sensitive." The nurse should recognize that the client is reporting phantom limb pain, a frequent complication following an amputation. The nurse should instruct the client that the sensation should decrease over time. The nurse should recognize the pain, provide treatment, and handle the limb gently to decrease the risk of triggering pain.
A nurse in an acute care clinic is talking with a client who reports that the osteoarthritis pain in her knees is increasing each day. The client wants to discuss non-pharmacological approaches to help relieve her pain. Which of the following interventions should the nurse suggest? A. Applying warm compresses to sore joints B. Decreasing the daily intake of dietary protein C. Keeping joints in extension during rest periods D. Limiting sleep to 6 to 7 hr per night
Correct Answer: A. Applying warm compresses to sore joints Warm packs or warm soaks (e.g. in a bath or hot tub) are often effective for relieving arthritic pain. The nurse should teach the client to avoid temperatures that are hot enough to cause burns. She should plan for a temperature just a little warmer than body temperature for optimal comfort.
A nurse is assessing a client who is 24 hr postoperative following an above-the elbow amputation. Which of the following findings should the nurse identify as the priority? A. Client report of muscle spasms B. Inability to get dressed without assistance C. Client report of feelings of anger D. Refusal to look at the affected limb
Correct Answer: A. Client report of muscle spasms The nurse should consider Maslow's hierarchy of needs, which includes 5 levels of priority. The levels are as follows: physiological needs, safety and security needs, love and belonging needs, personal achievement and self-esteem needs, and achieving the ability to problem solve and cope with life situations. When applying Maslow's hierarchy of needs in a priority-setting framework, the nurse should review physiological needs first. The nurse should then address the client's needs by following the remaining 4 hierarchical levels. It is important, however, for the nurse to consider all contributing client factors, as higher levels of the pyramid can compete with those at the lower levels, depending on the specific client situation. Therefore, the nurse should identify the report of muscle spasms (a physiological need) as the priority client finding.
A nurse is providing discharge instructions for a client who is postoperative following inner maxillary fixation with wiring. Which of the following pieces of information should the nurse include? A. Cut the wiring if emesis occurs B. Consume 3 meals daily as part of a low-protein diet C. Swab the mouth with hydrogen peroxide if wiring produces oral irritation D. Resume a soft diet in 3 to 5 days
Correct Answer: A. Cut the wiring if emesis occurs Inner maxillary fixation involves wiring of the teeth to support the fractured jaw by holding the jawbones together. The wires are left in place until the fracture is healed. To preserve the client's airway, the nurse should instruct the client to have wire cutters available to cut the wiring immediately if emesis occurs. The client should return to the provider as soon as possible for re-wiring.
A nurse is caring for a client who has osteoporosis and a new prescription for calcium supplements. Which of the following foods should the nurse recommend to promote calcium absorption? A. Fortified milk B. Ripe bananas C. Steamed broccoli D. Green leafy vegetables
Correct Answer: A. Fortified milk Fortified milk provides 2.45 mcg of vitamin D, which promotes calcium absorption from the gastrointestinal tract. Adults up to age 70 need 600 international units of vitamin D per day and 800 international units thereafter. Therefore, fortified milk is a good source of vitamin D.
A nurse is providing teaching for a client following a below-the-knee amputation. Which of the following pieces of information should the nurse include in the teaching? A. Instruct the client to lie prone while in bed B. Ensure the client sleeps on a soft mattress C. Pull up the residual limb while in bed D. Keep the residual limb exposed to air to heal
Correct Answer: A. Instruct the client to lie prone while in bed The nurse should instruct the client to lie in a prone position for 20 to 30 minutes every 3 to 4 hours. This prevents the client from developing contractures while in bed.
A nurse is preparing to care for a client who is in balanced skeletal traction to stabilize a femur fracture. Which of the following actions should the nurse include in the client's plan of care? A. Offering the client a diet high in fluid and fiber B. Encouraging active range of motion of the affected leg C. Removing the weights prior to repositioning the client D. Inspecting pin sites every 24 hr for drainage
Correct Answer: A. Offering the client a diet high in fluid and fiber A client who is immobile is at risk of constipation. The nurse should encourage a diet high in fluid and fiber to promote gastrointestinal function.
A nurse is caring for a client who has a fractured hip and was placed in Buck's traction 4 hr ago. Which of the following actions should the nurse take? A. Inspect the client's skin underneath the boot every 12 hr B. Encourage the client to perform dorsiflexion of the affected extremity every 2 hr C. Remove the weights from the traction while repositioning the client in bed D. Loosen the ropes if the client reports muscle spasms in the affected extremity
Correct Answer: B. Encourage the client to perform dorsiflexion of the affected extremity every 2 hr The nurse should encourage the client to perform dorsiflexion of the affected extremity every 2 hours to assess if the client is experiencing nerve damage. Weakness of dorsiflexion can indicate peroneal nerve damage. If this occurs, the nurse should notify the provider immediately.
A nurse in the emergency department is assessing a client who was in a motor vehicle crash 2 days ago and sustained fractures of his tibia, ulna, and several ribs. The client is now disoriented to time and place and has a SaO2 of 87%. The nurse notes generalized petechiae on the client's skin. Which of the following complications should the nurse suspect? A. Hypovolemic shock B. Fat embolism syndrome C. Thrombophlebitis D. Avascular bone necrosis
Correct Answer: B. Fat embolism syndrome The nurse should identify the triad of neurological changes, petechial rash, and hypoxemia as findings of fat embolism syndrome. Risk factors include multiple fractures and a fracture of a long bone. Male clients are also at greater risk. The manifestations occur when fat globules occlude small blood vessels.
A nurse is reviewing the medical record of a female client. Which of the following findings should the nurse identify as a risk factor for osteoporosis? A. Decreased intake of phosphate containing foods B. Spending several hours in the sun daily C. Increased estrogen levels D. History of anorexia nervosa
Correct Answer: D. History of anorexia nervosa The nurse should identify anorexia nervosa as a risk factor for osteoporosis. Inadequate protein intake can lead to decreased bone density, increasing the risk of fractures.
A nurse is providing discharge teaching to a client who has osteoarthritis. Which of the following instructions should the nurse include? A. "Rest frequently after periods of activity." B. "Perform your exercises only on days that you feel good." C. "Perform your exercises after applying cold packs to your joints." D. "Place a large pillow under your knees when lying down
Correct Answer: A. "Rest frequently after periods of activity." The joint pain in osteoarthritis is caused by deterioration of the synovial membranes and often worsens after activity. Rest usually helps relieve the pain, so performing activities at a comfortable pace with periods of rest is appropriate.
A nurse is teaching a client who had an amputation of the left lower leg 3 days ago. Which of the following statements indicates that the client understands how to care for the incision and his left upper leg? A. "I should use powder inside my limb sock to keep it cool." B. "I will lie on my stomach for 30 min a few times a day." C. "I should expect some drainage with a strong odor because I had gangrene." D. "I will keep elevating my leg on 2 pillows to keep the swelling down."
Correct Answer: B. "I will lie on my stomach for 30 min a few times a day." The client should lie prone 3 or 4 times per day for 20 to 30 minutes. This position will help reduce the risk of developing hip flexion contractures.
A nurse is caring for a client who is in skeletal traction following a femur fracture. On entering, the nurse finds that the client has slid toward the foot of the bed, and the traction weight is resting on the floor. Which of the following actions should the nurse take? A. Remove the weight temporarily to reposition the client to the correct alignment in bed B. Have the client use a trapeze to pull himself up while ensuring the weight hangs freely C. Lift the rope off the pulley while the client rocks back and forth to reposition himself D. Lift the weight manually while another staff member moves the client up in bed
Correct Answer: B. Have the client use a trapeze to pull himself up while ensuring the weight hangs freely The nurse should ensure that traction weight is hanging freely. The client can use an overhead trapeze bar to move up in bed, or the nurse can assist the client while making sure to maintain proper alignment of the extremity.
A nurse is caring for a client who is 3 days postoperative following a right total hip arthroplasty. While transferring to a chair, the client cries out in pain. The nurse should assess the client for which of the following manifestations of dislocation of the hip prosthesis? A. Bulging in the area over the surgical incision B. Shortening of the right leg C. Sensation of warmth over the surgical incision D. Pallor following elevation of the right leg
Correct Answer: B. Shortening of the right leg The nurse should monitor the client for shortening of the affected leg as an indication of dislocation of the prosthesis. Other findings include increased hip pain, an inability to move the extremity, and rotation of the hip internally or externally.
A nurse is providing teaching about disease management to a client who has rheumatoid arthritis. Which of the following responses by the client indicates an understanding of the teaching? A. "I will take a hot bath every morning to decrease my stiffness." B. "When my arthritis acts up, I will rest all day and avoid exercising." C. "I will have handrails installed in my bathroom and hall." D. "I will avoid taking naps so I sleep better at night."
Correct Answer: C. "I will have handrails installed in my bathroom and hall." The nurse should instruct the client to have handrails installed in the bathroom and hall to promote safety as the disease progresses.
A nurse is caring for a client who has chronic phantom limb pain following an above-knee amputation. Which of the following medication prescriptions should the nurse verify with the provider? A. Meperidine B. Amitriptyline C. Gabapentin D. Propranolol
Correct Answer: A. Meperidine Opioids are more effective for residual limb pain rather than phantom limb pain. Additionally, meperidine is not recommended for chronic pain because long-term use can cause accumulation of a toxic metabolite.
A nurse is assessing a client who has several risk factors for osteoporosis. Which of the following findings indicates that the client requires further evaluation for this disorder? A. Leg cramps with exercise B. Stress incontinence C. Abdominal distention D. Lower back pain
Correct Answer: D. Lower back pain Lower back pain is common among clients who have osteoporosis, especially when they lift, stoop, or bend. Back pain and tenderness that cause movement restriction might indicate vertebral compression fractures, which are the most common type of fracture resulting from osteoporosis.
A nurse is preparing an in-service presentation about the basics of bone injuries. Which of the following types of fractures results when a client's bone breaks into multiple pieces? A. Avulsion B. Comminuted C. Compression D. Spiral Check
Correct Answer: B. Comminuted A comminuted fracture is one in which the bone breaks into multiple pieces or fragments
A nurse is teaching a group of clients at a senior center about the risk factors for osteoporosis. Which of the following statements should the nurse include in the teaching? A. "Extended periods of immobility increase your risk of osteoporosis." B. "Prolonged periods of sun exposure increase your risk of osteoporosis." C. "Eating a diet high in protein can reduce your risk of osteoporosis." D. "Corticosteroid therapy will reduce your risk of osteoporosis."
Correct Answer: A. "Extended periods of immobility increase your risk of osteoporosis." Osteoporosis is a disorder of weakened bones due to a loss of bone mass and a change in bone structure. Immobility can result in osteoporosis; therefore, weight-bearing exercise, such as walking, can help prevent osteoporosis.
A nurse is caring for a client who is wearing a halo fixator. Which of the following interventions should the nurse implement? (Select all that apply.) A. Monitor the client's vital signs every 4 hr B. Monitor the client's pin sites for loosening C. Hold the halo device when turning the client D. Check the client's skin to ensure the jacket is not applying pressure E. Adjust the screws holding the client's halo device in place to ensure a proper fit
Correct Answers: A. Monitor the client's vital signs every 4 hr B. Monitor the client's pin sites for loosening D. Check the client's skin to ensure the jacket is not applying pressure The nurse should monitor the client's vital signs and neurological status every 1 to 4 hours, depending on the client's overall status. Also, the nurse should monitor the client's pin sites for loosening. Loosening of the pins of the halo device can place the client's cervical or thoracic traction at risk, and the provider should be notified immediately if this occurs. Finally, the nurse should check the client's skin for redness and ensure the vest is not rubbing against the client's skin, which can create a pressure ulcer. The nurse should check the client's skin to ensure that it is dry and clean to prevent skin breakdown.
A nurse is providing post-procedural teaching to a client who had a diagnostic knee arthroscopy. Which of the following statements indicates that the client understands the nurse's instructions? A. "I'll take aspirin to relieve my pain." B. "I'll keep my leg elevated for the first day." C. "I'll put a heating pad on my knee for the first day." D. "I'll resume my usual activities as soon as I leave.
Correct Answer: B. "I'll keep my leg elevated for the first day." Following a diagnostic arthroscopy, the client should keep the leg elevated for 12 to 24 hours to help reduce pain and swelling.
A nurse is preparing a client for magnetic resonance imaging (MRI) of the spine. Which of the following pieces of information should the nurse give the client prior to the procedure? A. "You can have a mild sedative before the procedure." B. "You'll have to lie still on your back for 15 to 20 min." C. "You can't have this test if you've had cataract surgery." D. "Your exposure to radiation will be minimal."
Correct Answer: A. "You can have a mild sedative before the procedure." Some clients need mild sedation, especially when using an older closed MRI machine. Clients can feel claustrophobic and anxious as they slowly pass through what seems like a tunnel.
A nurse is talking with an older adult client who has an elevated risk for osteoporosis about strategies for preventing bone loss. Which of the following instructions should the nurse provide? A. Begin a program of brisk walking B. Take 800 mg of calcium per day C. Drink plenty of sparkling water D. Drink 8 oz of red wine each day
Correct Answer: A. Begin a program of brisk walking Weight-bearing exercises help maintain bone mass and prevent osteoporosis. Walking is generally a safe activity for older clients.
A nurse is teaching a client with arthritis who is experiencing joint pain that impairs mobility. Which of the following instructions should the nurse include? A. "Engage your joints in resistance exercises." B. "Avoid using assistive devices when walking." C. "Perform passive exercises." D. "Apply heat to your joints prior to exercising
Correct Answer: D. "Apply heat to your joints prior to exercising." The nurse should instruct the client to apply heat to the joints prior to exercising to increase mobility and reduce pain.
A nurse is teaching a client who has a cast on his left arm to treat a forearm fracture. Which of the following statements indicates that the client understands the teaching? A. "I'll call the doctor's office if my fingers get colder on the arm with the cast." B. "If I have any itching under the cast, I'll try to reach the area with a cotton swab." C. "If my fingers swell, I should put a heating pad on them and rest." D. "If I have any tingling under my cast, I'll know I need to move my fingers more.
Correct Answer: A. "I'll call the doctor's office if my fingers get colder on the arm with the cast." The nurse should emphasize the importance of doing neurovascular checks and notifying the provider of any unexpected findings, such as temperature variances.
