Exam 6 Mobility -Immobility Prep U
During a routine physical examination on an older female client, a nurse notes that the client is 5 feet, 3/8 inches (1.6 m) tall. The client states, "How is that possible? I was always 5 feet and 1/2? (1.7 m) tall." Which statement is the best response by the nurse? "After age 40, height may show a gradual decrease as a result of spinal compression" "There may be some slight discrepancy between the measuring tools used." "The posture begins to stoop after middle age." "After menopause, the body's bone density declines, resulting in a gradual loss of height."
"After menopause, the body's bone density declines, resulting in a gradual loss of height." Explanation: The nurse should tell the client that after menopause, the loss of estrogen leads to a loss in bone density, resulting in a loss of height. This client's history doesn't indicate spinal compression. Telling the client that measuring tools used to obtain the client's height may have a discrepancy or that the posture begins to stoop after middle age doesn't address the client's question.
A client is treated in the emergency department for acute muscle strain in the left leg caused by trying a new exercise. During discharge preparation, the nurse should provide which instruction? "Apply heat packs for the first 24 hours, then apply ice packs for the next 48 hours." "Apply ice packs for the first 12 to 18 hours." "Apply heat packs for the first 24 to 48 hours." "Apply ice packs for the first 24 to 48 hours, then apply heat packs."
"Apply ice packs for the first 24 to 48 hours, then apply heat packs." Explanation: The nurse should instruct the client to apply ice packs to the injured area for the first 24 to 48 hours to reduce swelling and then apply heat to increase comfort, promote reabsorption of blood and fluid, and speed healing. Applying ice for only 12 to 18 hours may not keep swelling from recurring. Applying heat for the first 24 to 48 hours would worsen, not ease, swelling. Applying ice 48 hours after the injury would be less effective because swelling already has occurred by that time.
A nurse is teaching a client who was recently diagnosed with carpal tunnel syndrome. Which statement should the nurse include? "This condition is associated with various sports." "Using arm splints will prevent hyperflexion of the wrist." "Ergonomic changes can be incorporated into your workday to reduce stress on your wrist." "Surgery is the only sure way to manage this condition."
"Ergonomic changes can be incorporated into your workday to reduce stress on your wrist." Explanation: Ergonomic changes, such as adjusting keyboard height, can help clients with carpal tunnel syndrome avoid hyperextension of the wrist. This condition is associated with repetitive tasks such as clerical work, not sports. The condition may be managed with medications, yoga, acupuncture, and wrist (not arm) splints.
A client undergoes an arthroscopy at the outpatient clinic. After the procedure, the nurse provides discharge teaching. Which response by the client indicates the need for further teaching? "My physician may prescribe pain pills after the procedure." "I should use my heating pad this evening to reduce some of the pain in my knee." "Elevating my leg will reduce swelling after the procedure." "I may notice some bruising or swelling in my knee."
"I should use my heating pad this evening to reduce some of the pain in my knee." Explanation: The client requires additional teaching if he states that he'll use a heating pad to reduce pain the evening of the procedure. The client shouldn't use heat at the procedure site during the first 24 hours because doing so may increase localized swelling. Ice is indicated during this time. Elevating the extremity helps reduce swelling. The client may experience some discomfort after the procedure for which the physician may order medication. Bruising and swelling are common after an arthroscopy.
A client with a sports injury undergoes a diagnostic arthroscopy of the left knee. What comment by the client following the procedure will the nurse address first? "My foot is swollen." "My knee aches." "My toes are numb." "My feet are cold."
"My toes are numb." Explanation: Numbness would indicate neurological compromise of the extremity and requires immediate intervention to prevent permanent damage. An aching knee is expected after the procedure. Cold or swollen feet are not priority assessments.
The nurse is preparing the client for computed tomography. Which information should be given by the nurse? "A small bit of tissue will be removed and sent to the lab." "Fluid will be removed from you affected joint." "A radioisotope will be given through an IV." "You must remain very still during the procedure."
"You must remain very still during the procedure." Explanation: In computed tomography, a series of detailed x-rays are taken. The client must lie very still during the procedure. A contrast agent, not a radioisotope, may or may not be injected. Arthrocentesis involves the removal of fluid from a joint. A small bit of tissue is removed with a biopsy.
The client displays manifestations of compartment syndrome. What treatment will the nurse expect the client to be scheduled for? A fasciotomy A total hip replacement An open reduction A total knee replacement
A fasciotomy Explanation: A treatment option for compartment syndrome is fasciotomy.
The client displays manifestations of compartment syndrome. What treatment will the nurse expect the client to be scheduled for? A total hip replacement A total knee replacement An open reduction A fasciotomy
A fasciotomy Explanation: A treatment option for compartment syndrome is fasciotomy.
A client is experiencing muscle weakness in the upper extremities. The client raises an arm above the head but then loses the ability to maintain the position. Muscular dystrophy is suspected. Which diagnostic test would evaluate muscle weakness or deterioration? An arthroscopy An electromyography A magnetic resonance imaging (MRI) A serum calcium test
An electromyography Explanation: An electromyography tests the electrical potential of muscles and nerves leading to the muscles. It is done to evaluate muscle weakness or deterioration. A serum calcium test evaluates the calcium in the blood. An arthroscopy assesses changes in the joint. An MRI identifies abnormalities in the targeted area.
The nurse is taking an initial history of a new client with a musculoskeletal problem. Which factor is most important for the nurse to keep in mind for this assessment? Duration and location of discomfort or pain Client's lifestyle Client's age Any chronic disorder or recent injury
Any chronic disorder or recent injury Explanation: The focus of the initial history depends on the nature of the musculoskeletal problem, whether the client has a chronic disorder or a recent injury. If the disorder is long-standing, the nurse obtains a thorough medical, drug, and allergy history. If the client is injured, the nurse finds out when and how the trauma occurred. The client's age, lifestyle, or duration and location of discomfort or pain, although important, have little influence on the focus of the initial history and assessment of the client.
A client's cast is removed. The client is worried because the skin appears mottled and is covered with a yellowish crust. What advice should the nurse give the client to address the skin problem? Consult a skin specialist. Avoid exposure to direct sunlight. Scrub the area vigorously to remove the crust. Apply lotions and take warm baths or soaks.
Apply lotions and take warm baths or soaks. Explanation: The client should be advised to apply lotions and take warm baths or soaks. This will help in softening the skin and removing debris. The client usually sheds this residue in a few days so the client need not consult a skin specialist. It is not advisable to scrub the area vigorously. The client need not avoid exposure to direct sunlight because the area is not photosensitive.
During a general musculoskeletal assessment, what would help the nurse determine the client's muscle strength? Palpating each of the client's muscles and joints. Examining extremities for symmetry, size, and contour. Asking the client to lift specified amounts of weights. Applying force to the client's extremity as the client pushes against that force.
Applying force to the client's extremity as the client pushes against that force. Explanation: To correctly test the client's muscle strength, the nurse should apply force to the client's extremity while the client pushes against that force. Palpating the muscles and joints helps identify swelling, degree of firmness, local warm areas, and any involuntary movements. Examining the client for symmetry, size, and contour of extremities will not help determine the client's muscle strength. It is not advisable to ask the client to lift weights with an affected limb during a musculoskeletal assessment.
What food can the nurse suggest to the client at risk for osteoporosis? Carrots Chicken Broccoli Bananas
Broccoli Explanation: Calcium is important for the prevention of osteoporosis. Broccoli is high in calcium.
Which medication directly inhibits osteoclasts, thereby reducing bone loss and increasing bone mass density (BMD)?
Calcitonin Explanation: Calcitonin directly inhibits osteoclasts, thereby reducing bone loss and increased BMD. Raloxifene reduces the risk of osteoporosis by preserving BMD without estrogenic effects on the uterus. Teriparatide has been recently approved by the FDA for the treatment of osteoporosis. Vitamin D increases the absorption of calcium.
Which of the following inhibits bone resorption and promotes bone formation? Estrogen Calcitonin Parathyroid hormone Corticosteroids
Calcitonin Explanation: Calcitonin, which inhibits bone resorption and promotes bone formation, is decreased in osteoporosis. Estrogen, which inhibits bone breakdown, decreases with aging. On the other hand, parathyroid hormone (PTH) increases with aging, increasing bone turnover and resorption. The consequence of these changes is net loss of bone mass over time. Corticosteroids place patients as risk for developing osteoporosis.
A home care nurse assesses for disease complications in a client with bone cancer . Which laboratory value may indicate the presence of a disease complication? Calcium level of 2.9mmol/L Potassium level of 6.3 mEq/L Sodium level of 110 mEq/L Magnesium level of 0.36 mmol/L
Calcium level of 2.9mmol/L Explanation: In clients with bone cancer, tumor destruction of bone commonly causes excessive calcium release. When the calcium-excreting capacity of the kidneys and GI tract is exceeded, the serum calcium level rises above normal, leading to hypercalcemia (a serum calcium level greater than 10.2 mg/dl). Hyperkalemia (a potassium level greater than 5 mEq/L) isn't caused by bone cancer and is seldom associated with chemotherapy. Hyponatremia (a sodium level less than 135 mEq/L) and hypomagnesemia (a magnesium level less than 0.53mmol/L) are potential adverse effects of chemotherapy; these electrolyte disturbances don't result directly from bone cancer.
Which nursing assessment finding would be indicative of compartment syndrome in the client with a cast applied to the left forearm 3 hours earlier? Absence of numbness and tingling Fingers pink and warm and move freely Radial pulses palpable and +2 bilaterally Capillary refill of left fingers greater than 3 seconds
Capillary refill of left fingers greater than 3 seconds Explanation: Compartment syndrome is characterized by neurovascular compromise. Capillary refill should be less than 3 seconds.
Which is an indicator of neurovascular compromise? Diminished pain Capillary refill of more than 3 seconds Pain upon active stretch Warm skin temperature
Capillary refill of more than 3 seconds Explanation: Capillary refill of more than 3 seconds is an indicator of neurovascular compromise. Other indicators include cool skin temperature, pale or cyanotic color, weakness, paralysis, paresthesia, unrelenting pain, pain upon passive stretch, and absence of feeling. Cool skin temperature is an indicator of neurovascular compromise. Unrelenting pain is an indicator of neurovascular compromise. Pain upon passive stretch is an indicator of neurovascular compromise.
Which common problem of the upper extremity results from entrapment of the median nerve at the wrist? Ganglion Impingement syndrome Carpal tunnel syndrome Dupuytren contracture
Carpal tunnel syndrome Explanation: Carpal tunnel syndrome is commonly due to repetitive hand activities. A ganglion is a collection of gelatinous material near the tendon sheaths and joints that appears as a round, firm, cystic swelling, usually on the dorsum of the wrist. Dupuytren contracture is a slowly progressive contracture of the palmar fascia. Impingement syndrome is associated with the shoulder and may progress to a rotator cuff tear.
A client sustains a fractured right humerus in an automobile accident. The arm is edematous, the client states not being able to move or feel the fingers, and the nurse does not feel a pulse. What condition should the nurse be concerned about that requires emergency measures? Subluxation Muscle spasms Dislocation Compartment syndrome
Compartment syndrome Explanation: Separation of adjacent bones from their articulating joint interferes with normal use and produces a distorted appearance. The injury may disrupt local blood supply to structures such as the joint cartilage, causing degeneration, chronic pain, and restricted movement. Compartment syndrome is a condition in which a structure such as a tendon or nerve is constricted in a confined space. The fractured humerus may also be dislocated but is not the result of the impaired circulatory status. Muscle spasms may occur around the fracture site but are not the cause of circulatory impairment. Subluxation is a partial dislocation.
Which of the following is a term used to describe a soft tissue injury produced by a blunt force? Contusion Sprain Hematoma Strain
Contusion Explanation: A contusion is a soft tissue injury produced by blunt force, such as a blow, kick, or fall, that results in bleeding into soft tissues (ecchymosis, or bruising). A hematoma develops when the bleeding is sufficient to form an appreciable solid swelling. A strain, or a "pulled muscle," is an injury to a musculotendinous unit caused by overuse, overstretching, or excessive stress. A sprain is an injury to the ligaments and supporting muscle fibers that surround a joint often caused by a trauma, wrenching or twisting motion.
A client comes to the emergency department complaining of pain in the right leg. When obtaining the history, the nurse learns that the client has a history of obesity and hypertension. Based on this information the nurse anticipates the client having which musculoskeletal disorder? Degenerative joint disease Paget's disease Scoliosis Muscular dystrophy
Degenerative joint disease Explanation: Obesity predisposes the client to degenerative joint disease. Obesity isn't a predisposing factor for muscular dystrophy, scoliosis, or Paget's disease.
Which term refers to the shaft of the long bone?
Diaphysis Explanation: The diaphysis is primarily cortical bone. An epiphysis is an end of a long bone. Lordosis refers to an increase in lumbar curvature of spine. Scoliosis refers to lateral curving of the spine.
Which term refers to a flexion deformity caused by a slowly progressive contracture of the palmar fascia? Hammertoe Callus Hallux valgus Dupuytren's contracture
Dupuytren's contracture Explanation: Dupuytren's disease results in a slowly progressive contracture of the palmar fascia, called Dupuytren's contracture. A callus is a discretely thickened area of skin that has been exposed to persistent pressure or friction. A hammertoe is a flexion deformity of the interphangeal joint, which may involve several toes. Hallux valgus is a deformity in which the great toe deviates laterally.
Which diagnostic test would the nurse expect to be ordered for a client with lower extremity muscle weakness? Electromyograph (EMG) Bone scan Biopsy Arthrocentesis
Electromyograph (EMG) Explanation: The EMG provides information about the electrical potential of the muscles and the nerves leading to them. The test is performed to evaluate muscle weakness, pain, and disability. An arthrocentesis, bone scan, and biopsy does not measure muscle weakness.
Which group is at the greatest risk for osteoporosis? Asian American women African American women European American women Men
European American women Explanation: Small-framed, nonobese European American women are at greatest risk for osteoporosis. Asian American women of slight build are at risk for low peak bone mineral density. African American women, who have a greater bone mass than European American women and Asian American Women, are less susceptible to osteoporosis. Men have a greater peak bone mass and do not experience sudden estrogen reduction.
A patient has had a stroke and is unable to move the right upper and lower extremity. During assessment the nurse picks up the arm and it is limp and without tone. How would the nurse document this finding? Tetanic Rigidity Flaccidity Atonic
Flaccidity Explanation: A muscle that is limp and without tone is described as flaccid; a muscle with greater-than-normal tone is described as spastic. Conditions characterized by lower motor neuron destruction (e.g., muscular dystrophy), denervated muscle becomes atonic (soft and flabby) and atrophies.
Which term refers to a break in the continuity of a bone? Fracture Dislocation Malunion Subluxation
Fracture Explanation: A fracture is a break in the continuity of the bone. A malunion occurs when a fractured bone heals in a misaligned position. Dislocation is a separation of joint surfaces. A subluxation is a partial separation or dislocation of joint surfaces.
The nurse notes that the client's left great toe deviates laterally. This finding would be recognized as Hallux valgus Pes cavus Hammertoe Flatfoot
Hallux valgus Explanation: Hallux valgus is commonly referred to as a bunion. Hammertoes are usually pulled upward. Pes cavus refers to a foot with an abnormally high arch and a fixed equinus deformity of the forefoot. The client with flatfoot demonstrates a diminished longitudinal arch of the foot.
The client with osteoarthritis is seen in the clinic. Which assessment finding indicates the client is having difficulty implementing self-care? Has a weight gain of 5 pounds Reports ability to perform ADLs Reports decreased joint pain Shows increased joint flexibility
Has a weight gain of 5 pounds Explanation: Obesity is a risk factor for osteoarthritis. Excess weight is a stressor on the weight-bearing joints. Weight reduction is often a part of the therapeutic regimen.
Which assessment finding would cause the nurse to suspect compartment syndrome in the client following a bone biopsy? Bounding dorsalis pedis pulses Increased diameter of the calf Capillary refill < 3 seconds Toes move freely without pain
Increased diameter of the calf Explanation: Increasing diameter of the calf can be indicative of bleeding into the muscle. The other findings are within normal limits.
Which of the following is the most common site of joint effusion? Knee Hip Shoulder Elbow
Knee Explanation: The most common site for joint effusion is the knee. If inflammation or fluid is suspected in a joint, consultation with a provider is indicated. The elbow, hip, and shoulder are not the most common site of joint effusion.
A client visits an orthopedic specialist because of pain beginning in the low back and radiating behind the right thigh and down below the right knee. The doctor suspects a diagnosis of sciatica. The nurse knows that the origin of the pain is between which intervertebral disks? L2, L3, and L5 L4, L5, and S1 C3, C4, and L1 L1, L2, and L4
L4, L5, and S1 Explanation: The lower lumbar disks, L4-L5 and L5-S1, are subject to the greatest mechanical stress and the greatest degenerative changes. Disk protrusion (herniated nucleus pulposus) or facet joint changes can cause pressure on nerve roots as they leave the spinal canal, which results in pain that radiates along the nerve.
The nurse assesses a client after total right hip arthroplasty and observes a shortening of the extremity. The client reports severe pain in the right side of the groin. What is the priority action of the nurse? Bend the knee and rotate the knee internally. Apply Buck's traction. Externally rotate the extremity. Notify the health care provider.
Notify the health care provider. Explanation: If any clinical manifestations of dislocation of the prosthesis occur, including acute groin pain in the affected hip or shortening of the affected extremity, the nurse (or the client, if at home) must immediately notify the surgeon, because the hip must be reduced and stabilized promptly so that the leg does not sustain circulatory and nerve damage. After closed reduction, the hip may be stabilized with Buck's traction or a brace to prevent recurrent dislocation. As the muscles and joint capsule heal, the chance of dislocation diminishes. Stresses to the new hip joint should be avoided for the first 8 to 12 weeks, when the risk of dislocation is greatest.
The nurse is caring for a client with an external fixator that requires pin care twice a day. The nurse observes that there is a new purulent drainage around one of the pins. What intervention should the nurse anticipate doing? Scrubbing the drainage from around the pin site Apply ointment to the pin site. Applying iodine-based solution Obtaining a culture
Obtaining a culture Explanation: A culture should be obtained if purulent drainage is present. Drainage should be gently removed, not scrubbed. Iodine-based products interfere with tissue healing and are not recommended for cleaning pin sites. Ointment should not be applied to the pin site unless specifically ordered.
A client's fracture was reduced by surgically exposing the bone and realigning it. What type of treatment does the nurse identity this as? Skeletal traction Buck's traction Open reduction Internal fixation
Open reduction Explanation: In an open reduction, the bone is surgically exposed and realigned. Buck's traction is a type of skin traction that provides pulling on the structures. Skeletal traction is applied directly to the bone using a wire, pin, or cranial tongs. Internal fixation involves the use of metal screws, plates, rods, nails or pins to stabilize a reduced fracture.
Which of the following is the most common and most fatal primary malignant bone tumor? Osteochondroma Osteogenic sarcoma (osteosarcoma) Rhabdomyoma Enchondroma
Osteogenic sarcoma (osteosarcoma) Explanation: Osteogenic sarcoma (osteosarcoma) is the most common and most often fatal primary malignant bone tumor. Benign primary neoplasms of the musculoskeletal system include osteochondroma, enchondroma, and rhabdomyoma.
Which of the following presents with an onset of heel pain with the first steps of the morning? Plantar fasciitis Morton's neuroma Hallux valgus Ganglion
Plantar fasciitis Explanation: Plantar fasciitis, an inflammation of the foot-supporting fascia, present as an acute onset of heal pain experienced with the first steps in the morning. Hallux valgus (commonly called a bunion) is a deformity in which the great toe deviates laterally. Morton's neuroma is a swelling of the third (lateral) branch of the median plantar nerve. A ganglion, a collection of gelatinous material near the tendon sheaths and joints, appears as a round, firm compressible cystic swelling, usually on the dorsum of the wrist.
A 10-year-old boy who was brought to the emergency room after a skiing accident is diagnosed with a fracture of the distal end of the femur. Why is this type of fracture significant? Periosteal blood vessels will be damaged, thus compromising blood flow to the compact bone. Osteoblast formation will stop during the time needed for fracture healing. Potential growth problems may result from damage to the epiphyseal plate. Red blood cell production will be temporarily reduced because of the damage to the medullar cavity.
Potential growth problems may result from damage to the epiphyseal plate. Explanation: The distal and proximal ends of a long bone are called epiphyses, which are composed of cancellous bone. The epiphyseal plate, which separates the epiphyses from the diaphysis, is the center for longitudinal growth in children. Its damage can be a critical indictor of potential growth problems if fractured. All other choices are wrong.
A nurse is caring for a client who underwent a total hip replacement. What should the nurse and other caregivers do to prevent dislocation of the new prosthesis? Keep the hip flexed by placing pillows under the client's knee. Prevent internal rotation of the affected leg. Use measures other than turning to prevent pressure ulcers. Keep the affected leg in a position of adduction.
Prevent internal rotation of the affected leg. Explanation: The nurse and other caregivers should prevent internal rotation of the affected leg. However, external rotation and abduction of the hip will help prevent dislocation of a new hip joint. Postoperative total hip replacement clients may be turned onto the unaffected side. The hip may be flexed slightly, but it shouldn't exceed 90 degrees. Maintenance of flexion isn't necessary.
After a fracture, during which stage or phase of bone healing is devitalized tissue removed and new bone reorganized into its former structural arrangement? Remodeling Revascularization Inflammation Reparative
Remodeling Explanation: Remodeling is the final stage of fracture repair. During inflammation, macrophages invade and debride the fracture area. Revascularization occurs within about 5 days after a fracture. Callus forms during the reparative stage but is disrupted by excessive motion at the fracture site.
A client diagnosed with osteoporosis is being discharged home. Which priority education should the nurse should provide? Remove all small rugs from the home Classify medications Increase calcium and vitamin D in the diet Participate in weight-bearing exercises
Remove all small rugs from the home Explanation: A client with osteoporosis is at risk for fractures related to falls. The home environment needs to be evaluated for safety issues, such as rugs and other objects that could cause a fall. All other education is important in educating the client, but the risk for injury from a fall and potential for a fracture makes safety in the home environment a priority.
A client has a fracture that is being treated with open rigid compression plate fixation devices. What teaching will the nurse reinforce to the client about how the progress of bone healing will be monitored? The plate will be removed to determine if the bone is growing back. Serial x-rays will be taken. The bone will heal on its own without intervention. An arthroscopy will be performed.
Serial x-rays will be taken. Explanation: Serial x-rays are used to monitor the progress of bone healing. The plate need not be disturbed. An arthroscopy is used to visualize joints. While the bone will heal without interference, monitoring of bone healing is needed to ensure further adjustments are not necessary.
A client arrives in the emergency department with a suspected bone fracture of the right arm. How does the nurse expect the client to describe the pain? Similar to "muscle cramps" Sore and aching A dull, deep, boring ache Sharp and piercing
Sharp and piercing Explanation: The nurse must carefully evaluate pain associated with the musculoskeletal condition, asking the client to indicate the exact site and to describe the character and intensity of the pain using a pain rating scale. Most pain can be relieved by elevating the involved part, applying ice or cold packs, and administering analgesic agents as prescribed. Pain associated with the underlying condition (e.g., fracture, which is sharp and piercing) is frequently controlled by immobilization. Pain due to edema that is associated with trauma, surgery, or bleeding into the tissues can frequently be controlled by elevation and, if prescribed, intermittent application of ice or cold packs. Ice bags (one third to one half full) or cold application devices are placed on each side of the cast, if prescribed, making sure not to indent or wet the cast. Unrelieved or disproportionate pain may indicate complications. Pain associated with compartment syndrome is relentless and is not controlled by modalities such as elevation, application of ice or cold, and usual dosages of analgesic agents. Severe burning pain over bony prominences, especially the heels, anterior ankles, and elbows, warns of an impending pressure ulcer. This may also occur from too-tight elastic wraps used to hold splints in place.
A client comes to the emergency department and it is found that the client's radial head is partially dislocated. What is this partially dislocated radial head documented as? Compartment syndrome Sprain Subluxation Volkmann's contracture
Subluxation Explanation: A partial dislocation is referred to as a subluxation. A Volkmann's contracture is a claw like deformity that results from compartment syndrome or obstructed arterial blood flow to the forearm and hand. Compartment syndrome is a condition in which a structure such as a tendon or nerve is constricted in a confined space and affects nerve innervation, leading to subsequent palsy. A sprain is injury to the ligaments surrounding the joint.
A patient is having low back pain. What position can the nurse suggest to relieve this discomfort? Supine, with the bed flat and a firm mattress in place High-Fowler's to allow for maximum hip flexion Supine, with the knees slightly flexed and the head of the bed elevated 30 degrees Prone, with a pillow under the shoulders
Supine, with the knees slightly flexed and the head of the bed elevated 30 degrees Explanation: A medium to firm, not sagging mattress (a bed board may be used) is recommended; there is no evidence to support the use of a firm mattress (National Guideline Clearinghouse, 2010). Lumbar flexion is increased by elevating the head and thorax 30 degrees by using pillows or a foam wedge and slightly flexing the knees supported on a pillow. Alternatively, the patient can assume a lateral position with knees and hips flexed (curled position) with a pillow between the knees and legs and a pillow supporting the head (Fig. 42-1). A prone position should be avoided because it accentuates lordosis.
A client with chronic osteomyelitis has undergone 6 weeks of antibiotic therapy. The wound appearance has not improved. What action would the nurse anticipate to promote healing? Surgical debridement Wound irrigation Wound packing Vitamin supplements
Surgical debridement Explanation: In chronic osteomyelitis, surgical debridement is used when the wound fails to respond to antibiotic therapy. Wound packing, vitamin supplements, and wound irrigation are not the standard of care when treating chronic osteomyelitis.
Morton neuroma is exhibited by which clinical manifestation? Swelling of the third (lateral) branch of the median plantar nerve Diminishment of the longitudinal arch of the foot High arm and a fixed equinus deformity Inflammation of the foot-supporting fascia
Swelling of the third (lateral) branch of the median plantar nerve Explanation: Morton neuroma is swelling of the third branch of the median plantar nerve. Pes cavus refers to a foot with an abnormally high arch and a fixed equinus deformity of the forefoot. Flatfoot is a common disorder in which the longitudinal arch of the foot is diminished. Plantar fasciitis is an inflammation of the foot-supporting fascia.
Morton neuroma is exhibited by which clinical manifestation? Longitudinal arch of the foot is diminished Swelling of the third (lateral) branch of the median plantar nerve Inflammation of the foot-supporting fascia High arm and a fixed equinus deformity
Swelling of the third (lateral) branch of the median plantar nerve Explanation: Morton neuroma is swelling of the third branch of the median plantar nerve. Pes cavus refers to a foot with an abnormally high arch and a fixed equinus deformity of the forefoot. Flatfoot is a common disorder in which the longitudinal arch of the foot is diminished. Plantar fasciitis is an inflammation of the foot-supporting fascia.
The nurse working in the orthopedic surgeon's office is asked to schedule a shoulder arthrography. The nurse determines that the surgeon suspects which finding? Fracture of the clavicle Tear in the joint capsule Injury to the radial nerve Decreased bone density
Tear in the joint capsule Explanation: Arthrography is useful in identifying acute or chronic tears of the joint capsule or supporting ligaments of the knee, shoulder, ankle, hip, or waist. X-rays are used to diagnose bone fractures. Bone densitometry is used to estimate bone mineral density. An electromyogram (EMG) provides information about the electrical potential of the muscles and nerves leading to them.
Which statement is accurate regarding care of a plaster cast? The cast can be dented while it is damp. The cast will dry in about 12 hours. The cast must be covered with a blanket to keep it moist during the first 24 hours. A dry plaster cast is dull and gray.
The cast can be dented while it is damp. Explanation: The cast can be dented while it is damp. A dry plaster case is white and shiny. The cast will dry in 24 to 72 hours. A freshly applied cast should be exposed to circulating air to dry and should not be covered with clothing or bed linens or placed on plastic-coated mats or bedding.
The emergency room nurse is reporting the location of a fracture to the client's primary care physician. When stating the location of the fracture on the long shaft of the femur, the nurse would be most correct to state which terminology locating the fractured site? The fracture is ventrally located. The fracture is on the diaphysis. The fracture is on the epiphyses. The fracture is on the tuberosity.
The fracture is on the diaphysis. Explanation: A fracture that is on the diaphysis is understood to be chiefly found in the long shafts of the arms and legs. The epiphyses are rounded, irregular ends of the bones. Saying a fracture is ventrally located does not assist in providing adequate details of the location of the fracture. A tuberosity is a projection from the bone or a protuberance.
A client has severe osteoarthritis in the left hip and is having surgery to replace both articular surfaces of the hip. What type of surgical procedure will the nurse prepare the client for? Arthrodesis Osteotomy Hemiarthroplasty Total arthroplasty
Total arthroplasty Explanation: A total arthroplasty is a replacement of both articular surfaces within one joint. An arthrodesis is a fusion of a joint for stabilization and pain relief and is usually done on a wrist or knee. A hemiarthroplasty is the replacement of one of the articular surfaces in a joint, such as the femoral head but not the acetabulum. An osteotomy is the cutting and removal of a wedge of bone to change the bone's alignment, thereby improving function and relieving pain.
The nurse is teaching a client about a vitamin that supports calcium's absorption. What vitamin is the nurse teaching the client about? Vitamin B12 Vitamin D Vitamin C Vitamin A
Vitamin D Explanation: To support the absorption of calcium from the gastrointestinal tract and increase the amount of calcium in the blood, there needs to be sufficient active vitamin D. Vitamin A is for eye health. Vitamin B12 is for anemia prevention. Vitamin C is used for skin and immune health.
Which medication taken by the client in the previous 24 hours would be of greatest concern to the nurse caring for a client undergoing a bone biopsy? furosemide NPH insulin digoxin aspirin
aspirin Explanation: Aspirin has anti-clotting properties, and bone is a very vascular tissue. The client taking aspirin in close proximity to a bone biopsy is at increased risk for excessive bleeding.
A client has experienced increasing pain and progressing inflammation of the hands and feet. The rheumatologist has prescribed NSAID use to treat the condition. What client education is most important for the nurse to address with the use of these medications? dietary restrictions loading-dose schedule activity restrictions common adverse effects
common adverse effects Explanation: The most common adverse effects of NSAIDs are related to the GI tract: nausea, vomiting, diarrhea, and constipation. GI bleeding, which in some cases is severe, has been reported with the use of these drugs. Use of NSAIDs does not pose significant dietary or activity restrictions nor is there a loading-dose schedule.
A client is brought to the emergency department after being struck with a baseball bat on the upper arm while diving for a pitched ball. Diagnostic tests reveal that the humerus is not broken but that the client has suffered another type of injury. What type of injury would the physician likely diagnose? sprain strain subluxation contusion
contusion Explanation: A contusion is a soft tissue injury resulting from a blow or blunt trauma. Sprains are injuries to the ligaments surrounding a joint. A strain is an injury to a muscle when it is stretched or pulled beyond its capacity. A subluxation is a partial dislocation.
Which is not one of the general nursing measures employed when caring for the client with a fracture? administering analgesics cranial nerve assessment assisting with ADLs providing comfort measures
cranial nerve assessment Explanation: Cranial nerve assessment would only be carried out for head-related injuries or diseases. General nursing measures include administering analgesics, providing comfort measures, assisting with ADLs, preventing constipation, promoting physical mobility, preventing infection, maintaining skin integrity, and preparing client for self-care.
The nurse is admitting an older adult to a skilled nursing facility. What assessment parameters will the nurse expect to find with the musculoskeletal assessment? Select all that apply. decreased endurance increased muscle strength joint stiffness decreased range of motion increase in height
decreased endurance joint stiffness decreased range of motion Explanation: Significant assessment findings of the musculoskeletal system in the older adult would include joint stiffness and decreased height, range of motion, muscle strength, and endurance. Older adults may have decreased height from osteoporosis and decreased muscle strength from atrophy.
Each bone is composed of cells, protein matrix, and mineral deposits. Which type of bone cell works to repair a bone fracture? osteoblasts osteoclasts osteocytes
osteocytes Explanation: During times of rapid bone growth or bone injury, osteocytes function as osteoblasts to form new bone.
The nurse is conducting a medication reconciliation with a client admitted with a fracture. What medication predisposes a client for a risk for fractures? furosemide metoprolol prednisone digoxin
prednisone Explanation: Prednisone, a corticosteroid, causes increased bone resorption and decreased bone formation, resulting in increased risk for fractures. Furosemide, digoxin, and metoprolol do not interfere with bone resorption or predispose clients to fractures.
The nurse is assigned to a client admitted with advanced Parkinson's disease. What type of gait correlates with Parkinson's disease? shuffling scissors spastic hemiparesis steppage
shuffling Explanation: A variety of neurologic conditions are associated with abnormal gaits, such as spastic hemiparesis gait (stroke), steppage gait (lower motor neuron disease), and shuffling gait (Parkinson's disease). Scissors gait is seen in cerebral palsy.
A client has had surgical repair of a hip injury after joint manipulation was unsuccessful. After surgery, the nurse implements measures to prevent complications. Which complications is the nurse seeking to prevent? Select all that apply. wound infection diarrhea pneumonia skin breakdown
skin breakdown wound infection pneumonia Explanation: After surgery, the nurse implements measures to prevent skin breakdown, wound infection, pneumonia, constipation, urinary retention, muscle atrophy, and contractures.
