E6-comp
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?
"How would you describe the pain that you are feeling?" 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.
After teaching a client who is recovering from a vertebroplasty, the nurse assesses the client's understanding. Which statement by the client indicates a need for additional teaching?
"I can drive myself home after the procedure." 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 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." 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
A client who had an elective above-the-knee amputation (AKA) reports pain in the foot that was amputated. What is the nurse's best response to the client's pain?
"On a scale of 0 to 10, how would you rate your pain?" The client is experiencing phantom limb pain, which should be treated the same as any other type of pain. The best response is for the nurse to have the patient rate the pain and proceed to treat it appropriately.
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?
"Please come to the clinic today to have your arm checked by the provider." 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.
A nurse teaches a client about prosthesis care after amputation. Which statements should the nurse include in this client's teaching? (Select all that apply.)
"The device has been custom made specifically for you." "Make sure that you wear the correct liners with your prosthetic." "I have scheduled a follow-up appointment for you." A client with a new prosthetic should be taught that the prosthetic device is custom made for the client, taking into account the client's 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.
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?
"This is a big change for you. What support system do you have to help you cope?" 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
During a community education program the nurse is asked about the risk of a woman breaking a bone due to osteoporosis after age 50. The nurse knows which of the following is the risk?
1 in 2 women Rationale: One in two women over the age of 50 will break a bone because of osteoporosis. A woman's risk of breaking a hip due to osteoporosis is equal to her risk of breast, ovarian, and uterine cancer combined. Women have lighter, thinner bones than men. Many women also lose bone quickly after menopause. Up to one in four men over the age of 50 will break a bone because of osteoporosis. A man older than age 50 is more likely to break a bone due to osteoporosis than he is to get prostate cancer.
A hospitalized client is being treated for Ewing's sarcoma. What action by the nurse is most important?
Handling and disposing of chemotherapeutic agents per policy All actions are appropriate for this client. However, for safety, the nurse should place priority on proper handling and disposal of chemotherapeutic agents.
The client has sustained a traumatic amputation of the left arm after a machine accident. In what order should the following nursing actions be taken? 1. Apply direct pressure to the amputated site. 2. Elevate the extremity above the client's heart. 3. Assess the client for breathing problems. 4. Examine the amputation site.
3, 4, 1, 2 Assess the client for breathing problems Examine the amputation site Apply direct pressure to the amputated site Elevate the extremity above the client's heart First, the airway must be assessed for breathing problems. Second, the nurse should examine the amputation site. Third, the nurse should apply direct pressure to the amputated site. Finally, the extremity should be elevated above the client's heart to decrease bleeding.
A nurse is assessing a community group for dietary factors that contribute to osteoporosis. In addition to inquiring about calcium, the nurse also assesses for which other dietary components? (Select all that apply.)
Alcohol Caffeine Carbonated beverages Vitamin D Dietary components that affect the development of osteoporosis include alcohol, caffeine, high phosphorus intake, carbonated beverages, and vitamin D. Tobacco is also a contributing lifestyle factor.
The nurse refers a client with an amputation and the client's family to which community resource?
Amputee Coalition of America (ACA) The ACA is an available resource for clients with amputations and supports them and their families
The nurse prepares to perform a neurovascular assessment on a client with closed multiple fractures of the right humerus. Which technique does the nurse use?
Assess sensation of the right upper extremity. Assessing sensation of the right upper extremity is part of a focused neurovascular assessment for the client with multiple fractures of the right humerus.
A client's left arm is placed in a plaster cast. Which assessment does the nurse perform before the client is discharged?
Assess that the cast is dry. The cast must be dry and free of cracking and crumbling before the client is discharged
A client is in the internal medicine clinic reporting bone pain. The client's alkaline phosphatase level is 180 units/L. What action by the nurse is most appropriate?
Assess the client for leg bowing. This client has manifestations of Paget's disease. The nurse should assess for other manifestations such as bowing of the legs.
A client has scoliosis with a 65-degree curve to the spine. What action by the nurse takes priority?
Assess the client's cardiac and respiratory systems. This degree of curvature of the spine affects cardiac and respiratory function. The nurse's priority is to assess those systems.
A client with bone cancer is hospitalized for a limb salvage procedure. How can the nurse best address the client's psychosocial needs?
Assess the client's coping skills and support systems. The first step in the nursing process is assessment. The nurse should assess coping skills and possible support systems that will be helpful in this client's treatment.
The nurse studying osteoporosis learns that which drugs can cause this disorder? (Select all that apply.)
Barbiturates Corticosteroids Loop diuretics
The nurse admits an older adult client who sustained a left hip fracture and is in considerable pain. The nurse anticipates that the client will be placed in which type of traction?
Buck's traction Buck's traction may be applied before surgery to help decrease pain associated with muscle spasm. Balanced skin traction is indicated for fracture of the femur or pelvis. Overhead traction is indicated for fracture of the humerus with or without involvement of the shoulder and clavicle. Plaster traction is indicated for wrist fracture.
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.)
Edema - Increased capillary permeability Unequal pulses - Increased production of lactic acid Cyanosis - Anaerobic metabolism 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.
A client is suspected to have muscular dystrophy. About what diagnostic testing does the nurse educate the client? (Select all that apply.)
Electromyography Muscle biopsy Serum aldolase Serum creatinine kinase
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?
Ensure that the weights remain freely hanging at all times. 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.
Which statement by the client regarding lifestyle changes to prevent osteoporosis indicates a need for further teaching by the nurse?
I will cut down to only three martinis at night Clients should eliminate or substantially decrease their alcohol intake to decrease their risk of developing osteoporosis. The client should be taught that three martinis is still considered too much intake of alcohol.
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?
Immobilize the left arm. 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 client's arm and tell the client not to move the arm.
A nurse assesses a client with a rotator cuff injury. Which finding should the nurse expect to assess?
Inability to initiate or maintain abduction of the affected arm at the shoulder 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.
A client is in skeletal traction. Which nursing intervention ensures proper care of this client?
Inspect the skin at least every 8 hours. The client's skin should be inspected every 8 hours for signs of irritation, inflammation, or actual skin breakdown.
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?
Intravenous calcitonin 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.
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.)
It leads to minimal blood loss. It allows for early ambulation. It promotes healing. 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.
A client is recovering from an above-the-knee amputation resulting from peripheral vascular disease. Which statement indicates that the client is coping well after the procedure?
It will take me some time to get used to this. Acknowledging that it will take time to get used to the amputation indicates that the client is expressing acceptance and effective coping.
An older adult client has had an open reduction and internal fixation of a fractured right hip. Which intervention does the nurse implement for this client?
Keep the client's heels off the bed at all times. Because the client is an older adult and is more at risk for skin breakdown because of impaired circulation and sensation, the client's heels must be kept off the bed at all times to avoid constant pressure on this sensitive area. Re-positioning the older adult client must be done every 2 hours, not every 3 to 4 hours, to prevent skin breakdown and to inspect the skin for any signs of breakdown
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?
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.
The nurse is assessing a client with Ewing's sarcoma. Which finding does the nurse expect to observe?
Leukocytosis Ewing's sarcoma is a malignant tumor, and the client may experience systemic manifestations, including leukocytosis, anemia, and low-grade fever.
A client has undergone an elective below-the-knee amputation of the right leg as a result of severe peripheral vascular disease. In postoperative care teaching, the nurse instructs the client to notify the health care provider if which change occurs?
Observation of a large amount of serosanguineous or bloody drainage A large amount of serosanguineous or bloody drainage may indicate hemorrhage or, if an incision is present, that the incision has opened. This requires immediate attention.
A nurse cares for a client in skeletal traction. The nurse notes that the skin around the client's pin sites is swollen, red, and crusty with dried drainage. Which action should the nurse take next?
Obtain a prescription to culture the drainage. 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
A client is admitted with a large draining wound on the leg. What action does the nurse take first?
Obtain cultures of the leg wound. The nurse first obtains wound cultures prior to administering broad-spectrum antibiotics. The nurse would need to start the IV prior to giving the antibiotics as they will most likely be parenteral. Pain should be treated but that is not the priority.
A middle-aged patient has a tight cast on the left lower leg. Which assessment finding would prompt the nurse to assess further for compartment syndrome?
Pain more intense than expected based on initial injury Rationale: The classic sign of acute compartment syndrome is pain, and the pain is more intense than what would be expected from the injury itself. Other symptoms include tingling or burning sensations (paresthesias) in the skin. Decreased pulses and numbness or paralysis are late signs of compartment syndrome.
An older client with diabetes is admitted with a heavily draining leg wound. The client's white blood cell count is 38,000/mm3 but the client is afebrile. What action does the nurse take first?
Place the client on contact isolation. In the presence of a heavily draining wound, the nurse should place the client on contact isolation
A client has a bone density score of -2.8. What action by the nurse is best?
Planning to teach about bisphosphonates A T-score from a bone density scan at or lower than -2.5 indicates osteoporosis. The nurse should plan to teach about medications used to treat this disease. One class of such medications is bisphosphonates.
After teaching a client with a fractured humerus, the nurse assesses the client's understanding. Which dietary choice demonstrates that the client correctly understands the nutrition needed to assist in healing the fracture?
Roast beef with low-fat milk and a vitamin C supplement 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
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 client's risk for infection?
Schedule for pin care to be provided every shift. 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 client's skin; these do not need to be washed
The nurse suspects that a client may have plantar fasciitis if the client has which assessment finding?
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.
A nurse is providing education to a community women's group about lifestyle changes helpful in preventing osteoporosis. What topics does the nurse cover? (Select all that apply.)
Strengthening exercises are important. Take recommended calcium and vitamin D. Walk 30 minutes at least 3 times a week.
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
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.
A client has sustained a fracture of the left tibia. The extremity is immobilized using an external fixation device. Which postoperative instruction does the nurse include in this client's teaching plan?
Use pain medication as prescribed to control pain The client should be taught the correct use of prescribed pain medication to control pain adequately. Pin sites must be cleaned at least every 8 hours and as needed to reduce the risk for infection, not when any drainage is noticed. The client will have to adjust the type of clothing worn while the fixation device is in place.
A client has an ingrown toenail. About what self-management measure does the nurse teach the client?
Warm moist soaks Treatment of an ingrown toenail includes a podiatrist clipping away the ingrown part of the nail, warm moist soaks, and antibiotic ointment if needed.
The nurse is taking the history of an adult female client. Which factor places the client at risk for osteoporosis?
Working at a desk and playing the piano for a hobby Sedentary lifestyle and prolonged immobility produce rapid bone loss.
A client had a bunionectomy with osteotomy. The client asks why healing may take up to 3 months. What explanation by the nurse is best?
Your feet have less blood flow, so healing is slower The feet are the most distal to the heart and receive less blood flow than other organs and tissues, prolonging the healing time after surgery.
Which risk factor is shared by clients who have osteoporosis or osteomalacia?
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.
A client has a new synthetic leg cast for a tibial fracture. What health care teaching does the nurse include for the client's self-management at home? Select all that apply.
"Keep your leg elevated, preferably above your heart, as much as possible." "Report severe numbness or inability to move your toes to your health care provider." "Take your pain medication as needed according to the prescription directions."
The nurse is instructing a local community group about ways to reduce the risk for musculoskeletal injury. What information does the nurse include in the teaching plan?
"Wear helmets when riding a motorcycle." Those who ride motorcycles or bicycles should wear helmets to prevent head injury.
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?
"You need a new cast now that the swelling is decreased." 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 client's skin, the cast needs to be replaced.
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 client's plan of care? (Select all that apply.)
- Elevate heels off the bed with a pillow. - Ambulate the client on the first postoperative day. - Push the client's patient-controlled analgesia button. - Re-position the client every 2 hours. Postoperative care for a client who has ORIF of the hip includes elevating the client's 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 who is at risk for carpal tunnel syndrome. Which health promotion activities should the nurse include in this client's teaching? (Select all that apply.)
- Frequently assess the ergonomics of the equipment being used - Take breaks to stretch fingers and wrists during working hours - Adjust chair height to allow for good posture
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 74-year-old man who smokes and has a fractured pelvis 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.
Which statement indicates to the nursing instructor that the nursing student understands the normal healing process of bone after a fracture?
A hematoma forms at the site of the fracture. In stage 1, within 24 to 72 hours after a fracture, a hematoma forms at the site of the fracture because bone is extremely vascular. This then prompts the formation of fibrocartilage, providing the foundation for bone healing. Stage 2 of bone healing occurs within 3 days to 2 weeks after the fracture, when granulation tissue begins to invade the hematoma. Stage 3 of bone healing occurs as a result of vascular and cellular proliferation. In stage 4 of a healing fracture, callus is gradually reabsorbed and transformed into bone.
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?
Administer oxygen to keep saturations greater than 92%. The client's symptoms are consistent with the development of pulmonary embolism caused by leg immobility in the long cast. The nurse should check the client's pulse oximetry reading and provide oxygen to keep saturations greater than 92%
The nurse knows that a patient with crush injuries to the lower extremities is at high risk for what complication?
Acute Kidney injury Crush injuries cause several potential complications. The release of myoglobin from the muscle places the patient at high risk for developing rhabdomyolysis and acute kidney injury, which requires immediate intervention. Other complications include hyperkalemia leading to cardiac dysrhythmias, hypovolemia, and peripheral nerve injury. Potassium is also released with crush injuries and may cause cardiac dysrhythmias. If extensive blood volume is lost, the patient is at risk for developing hypovolemia. Presence of peripheral nerve injury should be assessed with all musculoskeletal trauma. Spinal nerve injury is not likely with a lower extremity injury
A rock climber has sustained an open fracture of the right tibia after a 20-foot fall. The nurse plans to assess the client for which potential complications? (Select all that apply.)
Acute compartment syndrome (ACS) Fat embolism syndrome (FES) Osteomyelitis
A client with chronic osteomyelitis is being discharged from the hospital. What information is important for the nurse to teach this client and family? (Select all that apply.)
Adherence to the antibiotic regimen Eating high-protein and high-carbohydrate foods Proper use of the intravenous equipment
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.)
Administer additional opioids as prescribed. Elevate the extremity on pillows. Apply ice to the fracture site. 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.
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 client's 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?
Administer oxygen via nasal cannula. 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
What information does the nurse teach a women's group about osteoporosis?
For 5 years after menopause you lose 2% of bone mass yearly Men have a slower loss of bone after the age of 75. Many treatments are now available for women to slow osteoporosis after menopause.
A client with Paget's disease is hospitalized for an unrelated issue. The client reports pain and it is not yet time for more medication. What comfort measures can the nurse delegate to the unlicensed assistive personnel (UAP)? (Select all that apply.)
Applying a heating pad Providing a massage
A client with osteoporosis is going home, where the client lives alone. What action by the nurse is best?
Arrange a home safety evaluation This client has several risk factors that place him or her at a high risk for falling. The nurse should consult social work or home health care to conduct a home safety evaluation.
A client has been advised to perform weight-bearing exercises to help minimize osteoporosis. The client admits to not doing the prescribed exercises. What action by the nurse is best?
Ask the client about a fear of falling Fear of falling can limit participation in activity. The nurse should first assess if the client has this fear and then offer suggestions for dealing with it.
A client is admitted with a bone tumor. The nurse finds the client weak and lethargic with decreased deep tendon reflexes. What actions by the nurse are best? (Select all that apply.)
Assess the daily serum calcium level. Consult the provider about a loop diuretic. Instruct the client to call for help out of bed.
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?
Assess the pedal pulses. 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.
The nurse is concerned that a client who had an ankle open reduction and internal fixation is at risk for complex regional pain syndrome. What assessment findings at the affected area are common when a client has this complication? Select all that apply.
Burning pain Increase in sweating Edema A triad of clinical manifestations is present in complex regional pain syndrome (CRPS), including abnormalities of the autonomic nervous system (changes in color, temperature, and sensitivity of skin over the affected area; excessive sweating; edema), motor symptoms (paresis, muscle spasms, loss of function), and sensory perception symptoms (intense burning pain that becomes intractable [unrelenting]).
A client with a compound fracture of the left femur is admitted to the emergency department after a motorcycle crash. Which action is most essential for the nurse to take first?
Check the dorsalis pedis pulses. The first action should be to assess the circulatory status of the leg because the client is at risk for acute compartment syndrome, which can begin as early as 6 to 8 hours after an injury. Severe tissue damage can also occur if neurovascular status is compromised.
Which nursing action does the nurse on the orthopedic unit plan to delegate to unlicensed assistive personnel (UAP)?
Check the vital signs for a client who was admitted after a total knee replacement 3 hours ago. Vital sign assessment is a skill that is within the role of the UAP.
A nurse sees clients in an osteoporosis clinic. Which client should the nurse see first?
Client taking raloxifene (Evista) who reports unilateral calf swelling The client on raloxifene needs to be seen first because of the manifestations of deep vein thrombosis, which is an adverse effect of raloxifene
The nurse sees several clients with osteoporosis. For which client would bisphosphonates not be a good option?
Client with a spinal cord injury who cannot tolerate sitting up Clients on bisphosphonates must be able to sit upright for 30 to 60 minutes after taking them. The client who cannot tolerate sitting up is not a good candidate for this class of drug.
A client with a fracture asks the nurse about the difference between a compound fracture and a simple fracture. Which statement by the nurse is correct?
Compound fracture involves a break in the bone, with damage to the skin A compound fracture involves a break in the bone with damage to the skin. A simple fracture does not extend through the skin. A compound fracture is accompanied by damage to blood vessels.
A nurse is assessing an older client and discovers back pain with tenderness along T2 and T3. What action by the nurse is best?
Consult with the provider about an x-ray Back pain with tenderness is indicative of a spinal compression fracture, which is the most common type of osteoporotic fracture. The nurse should consult the provider about an x-ray.
The nurse is assessing a client for chronic osteomyelitis. Which features distinguish this from the acute form of the disease? (Select all that apply.)
Draining sinus tracts Presence of foot ulcers
A client is starting on risedronate (Actonel) for treatment of Paget's disease. What precaution does the nurse include in the client's health teaching about this drug?
Drink a full glass of water after taking the drug Risedronate (Actonel), a drug taken orally, should be taken with a full glass of water.
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 client's plan of care?
Encourage range-of-motion exercises. 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
A client in a nursing home refuses to take medications. She is at high risk for osteomalacia. What action by the nurse is best?
Ensure the client gets 15 minutes of sun exposure daily. Sunlight is a good source of vitamin D, and the nursing staff can ensure some sun exposure each day
A client is scheduled for a bone biopsy. What action by the nurse takes priority?
Ensuring that informed consent is on the chart The priority is to ensure that informed consent is on the chart. The preoperative medications should not be administered until the nurse is confident the procedure will occur and the client has already signed the consent, if the medications include anxiolytics or sedatives or opioids.
The nurse is caring for an older adult client diagnosed with osteomalacia. The nurse anticipates that the health care provider will request which medication?
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.
A client has a metastatic bone tumor. What action by the nurse takes priority?
Handle the affected extremity with caution. Bones invaded by tumors are very fragile and fracture easily. For client safety, the nurse handles the affected extremity with great care.
A nurse assesses a client with a pelvic fracture. Which assessment finding should the nurse identify as a complication of this injury?
Hematuria 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.
The nurse is assessing a client with osteomalacia. Which findings does the nurse expect to observe? (Select all that apply.)
Hypophosphatemia Looser's lines of 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
A client has sustained a rotator cuff tear while playing baseball. The nurse anticipates that the client will receive which immediate conservative treatment?
Immobilizer for the affected arm The conservative treatment for this client is to place the injured arm in an immobilizer. Surgical intervention is not considered conservative treatment. Exercises are prohibited immediately after a rotator cuff injury. The client with a rotator cuff injury is treated primarily with nonsteroidal anti-inflammatory drugs to manage pain.
Which nursing intervention helps to reduce the incidence of osteomyelitis for a client receiving hemodialysis?
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.
The nurse is taking a patient for testing to determine the extent of injury sustained to the patient's knee when a fall occurred at work. The nurse explains that which diagnostic test best demonstrates musculoskeletal and soft tissue damage?
Magnetic resonance imaging (MRI) Rationale: MRI is useful in determining the amount of soft tissue damage that may have occurred with the fracture. Standard x-rays and CT are helpful in determining simple and complex bone fractures. EMG assists with diagnosis problems associated with muscles.
A client has been prescribed denosumab (Prolia). What instruction about this drug is most appropriate?
Make appointments to come get your shot Denosumab is given by subcutaneous injection twice a year.
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?
Meperidine (Demerol) 50 mg IV every 4 hours Meperidine (Demerol) should not be used for older adults because it has toxic metabolites that can cause seizures. The nurse should question this prescription.
A client returns to the same-day surgical unit after having an ankle open reduction internal fixation (ORIF). What is the nurse's priority action when caring for this client?
Monitor the client's vital signs frequently. The postoperative care for a patient undergoing ORIF or external fixation is similar to that provided for any patient undergoing surgery. Because bone is a vascular, dynamic body tissue, the patient is at risk for complications specific to fractures and musculoskeletal surgery. As the priority, monitor vital signs frequently to assess for signs of bleeding, shock, or infection.
The nurse plans to refer a client diagnosed with osteoporosis to which community resource?
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.
A nurse cares for a client with a fractured fibula. Which assessment should alert the nurse to take immediate action?
Numbness in the extremity 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.
The nurse anticipates providing collaborative care for a client with a traumatic amputation of the right hand with which health care team members? (Select all that apply.)
Occupational therapist Physical therapist Psychologist
A nurse obtains the health history of a client with a fractured femur. Which factor identified in the client's history should the nurse recognize as an aspect that may impede healing of the fracture?
Paget's disease Paget's disease and bone cancer can cause pathologic fractures such as a fractured femur that do not achieve total healing.
Which symptom specifically in older patients presenting with acute osteomyelitis would require immediate nursing intervention?
Pain Rationale: Common presenting symptoms of osteomyelitis are pain, fever, edema, elevated leukocyte count, fatigue, and general malaise. However, older adults may not have an extreme temperature elevation because of lower core body temperature and compromised immune system that occur with normal aging
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?
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
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?
Paresis of right lower extremity Paresis indicates a neurovascular compromise that must be reported immediately to the surgeon
The nurse knows that a patient with Paget's disease is at greatest risk for developing which complication?
Pathologic bone fractures Rationale: Pathologic fractures may be the presenting clinical manifestation of the disorder. The femur and the tibia are most often affected, and fracture of these bones can result from minimal trauma. Patients with Paget's disease frequently are fatigued and, although less common, may develop kidney stones, gout, and heart failure.
A nurse cares for an older adult client with multiple fractures. Which action should the nurse take to manage this client's pain?
Patient-controlled analgesia (PCA) pump with morphine 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.
An older adult client has multiple tibia and fibula fractures of the left lower extremity after a motor vehicle crash. Which pain medication does the nurse anticipate will be requested for this client?
Patient-controlled analgesia (PCA) with morphine Morphine is an opioid narcotic analgesic; given through PCA, it is the most appropriate mode of pain management for this type of acute pain associated with multiple injuries.
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?
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.
A nurse is caring for four clients. After the hand-off report, which client does the nurse see first
Post-microvascular bone transfer client whose distal leg is cool and pale This client is the priority because the assessment findings indicate a critical lack of perfusion.
Which is a priority problem for the older adult client diagnosed with bone cancer?
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.
A home health nurse assesses a client with diabetes who has a new cast on the arm. The nurse notes the client's fingers are pale, cool, and slightly swollen. Which action should the nurse take first?
Raise the arm above the level of the heart. 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.
An emergency department nurse triages a client with diabetes mellitus who has fractured her arm. Which action should the nurse take first?
Remove the medical alert bracelet from the fractured arm. A client's 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 client is brought to the emergency department via ambulance after a motor vehicle crash. What condition does the nurse assess for first?
Respiratory distress The client should first be assessed for respiratory distress, and any oxygen interventions instituted accordingly. Bleeding is the second assessment priority, head injury is the third assessment priority, and pain is the fourth assessment priority in this case.
Which information about a client who was admitted with pelvic and bilateral femoral fractures after being crushed by a tractor is most important for the nurse to report to the health care provider?
Serum potassium level is 7 mEq/L The elevated potassium level may indicate that the client has rhabdomyolysis and acute tubular necrosis caused by the crush injury. Further assessment and treatment are needed immediately to prevent further kidney damage or cardiac dysrhythmias.
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?
Skeletal traction will assist in realigning your fractured bone. 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.
What is the primary role of the nurse when caring for an adult client with muscular dystrophy (MD)?
Supportive care Management of the client with MD is supportive and involves the entire health care team.
The nurse is instructing a client who has been prescribed calcium citrate (Citracal). Which instruction does the nurse include?
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.
Which intervention does the nurse suggest to a client with a leg amputation to help cope with loss of the limb?
Talking with an amputee close to the client's age who has had the same type of amputation Meeting with someone of a comparable age who has gone through a similar experience will help the client cope better with his or her own situation.
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?
Traction weights are resting on the floor 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.
Which finding does the nurse expect to observe in a client with suspected common chronic osteomyelitis?
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.
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.)
Urinary output Blood pressure Skin color With a pelvic fracture, internal organ damage may result in bleeding and hypovolemic shock. The nurse monitors the client's 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.
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)?
Use a cloth-covered pillow to elevate the client's leg 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.
A client has a grade III compound fracture of the right tibia. To prevent infection, which intervention does the nurse implement?
Use strict aseptic technique when cleaning the site Using aseptic technique is the best way to prevent infection. Chlorhexidine (Hibiclens), 2 mg/mL solution, is the better cleansing solution for pin site care, not Neosporin ointment. A wound of this type should be kept covered, not left open to the air. The wound site of a compound fracture must not be exposed to a shower; this practice violates maintaining aseptic technique.
The nurse admits a client diagnosed with Paget's disease. The nurse anticipates that the client will have which condition?
enlarged thick skull An enlarged thick skull is a feature of Paget's disease.
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?
walk 30 min 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
