MS
A patient is being treated in the ER for a possible sprained ankle after a fall. The Xray ruled out a fracture. Before sending the patient home, the nurse plans to teach the client to avoid which of the following in the next 24 hours? 1.Resting the foot 2.Applying a heat pad 3.Applying an elastic compression bandage 4.Elevating the ankle on a pillow while sitting or lying down
2
A plaster splint is applied with an elastic bandage to the leg of a patient hospitalized with a fractured tibia in preparation for open reduction and internal fixation of the fracture. The patient complains of increasing pain in the affected leg and foot that is not relieved by loosening of the elastic bandage. The most appropriate action by the nurse is to 1.Elevate the leg on two pillows. 2.Perform neurovascular assessment of the foot. 3.Notify the health care provider. 4.Apply ice over the fracture site.
2
A nurse caring for a patient diagnosed with osteoarthritis. The nurse performs an assessment, knowing that which of the following is a clinical manifestation associated with the disorder? 1.Morning stiffness 2.A decreased sedimentation rate 3.Joint pain that diminishes after rest 4.Elevated antinuclear antibody levels
3
A nurse is conducting health screening for osteoporosis. Which of the following patients is at greatest risk of developing osteoporosis? 1.A 25-year-old woman who jogs 2.A 36-year-old man with asthma 3.A 70-year-old man who consumes excess alcohol 4.A sedentary 65-year-old woman who smokes
4
A patient with a hip fracture asks the nurse why the Buck's traction is being applied before surgery. The nurse explains that Buck's traction primarily: 1.Allows bony healing to begin before surgery 2.Provides rigid immobilization of the fracture site 3.Lengthens the fractured leg to prevent severing blood vessels 4.Provides comfort by reducing muscle spasms and provides fracture immobilization.
4
A patient is scheduled for an arthrocentesis. The nurse explains that this diagnostic test involves a. incision or puncture of the joint capsule b. measurement of heat from muscle contractions c. administration of a radioisotope before the procedure d. placement of skin electrodes to record muscle activity
A
A patient with a fracture of the pelvis should be monitored for a. changes in urinary output b. petechiae on the abdomen c. a palpable lump in the buttock d. sudden decrease in blood pressure
A
During the postoperative period, the nurse instructs the patient with an above the knee amputation that the residual limb should not be routinely elevated because this position promotes a. hip flexion contractures b. skin irritation and breakdown c. clot formation at the incision site d. increased risk of wound dehiscence
A
Teach the patient with ankylosing spondylitis the importance of a. regular exercise and maintaining proper posture b. continuing with physical activity during flare ups c. avoiding extremes in environmental temperatures d. applying cool compresses for relief of local symptoms
A
The increased risk for falls in the older adult is most likely due to a. changes in balance b. decreased in bone mass c. loss of ligament elasticity d. erosion of articular cartilage
A
The nurse explains to a patient with a distal tibial fracture who is returning for a three week checkup that healing is indicated by a. formation of callus b. complete bony union c. hematoma at fracture site d. presence of granulation tissue
A
The nurse is caring for a 76-year-old man who has undergone left knee arthroplasty with prosthetic replacement of the knee joint to relieve the pain of severe osteoarthritis. Postoperatively the nurse expects which of the following will be included in the care of the affected leg? A) a. Progressive leg exercises to obtain 90-degree flexion B) b. Early ambulation with full weight bearing on the left leg C) c. Bed rest for 3 days with the left leg immobilized in extension D) d. Immobilization of the left knee in 30-degree flexion for 2 weeks to prevent dislocation
A
While obtaining subjective assessment data related to the musculoskeletal system, it is particularly important to ask a patient about other medical problems such as a. hemophilia b. hypertension c. thyroid problems d. pulmonary disease
A
A patient with osteomyelitis is treated with surgical debridement with implantation of antibiotic beads. In responding to the patient who asks why the beads are used, the nurse answers (select all that apply) a. the beads are used to directly deliver antibiotics to the site of infection b. there are no effective oral or IV antibiotics to treat most cases of bone infection c. the beads are adjunct to debridement and oral and IV antibiotics for deep infections d. The ischemia and bone death that occurs with osteomyelitis are impenetrable to IV antibiotics
A,C
In assessing the joints of a patient with rheumatoid arthritis, the nurse understands that the joints are damaged by (select all that apply) a. bony ankylosis following inflammation of the joints b. the deterioration of cartilage by proteolytic enzymes c. the development of heberdens nodes in the joint capsule d. increased cartilage and bony growth at the joint margins e. invasion of pannus into the joint causing a loss of cartilage
A,E
A home care nurse is visiting a diabetic client with a new cast on the arm. On assessment, the nurse finds the client's fingers to be pale, cool, and slightly swollen. What is the nurse's best first action? 1.Elevate the arm above the level of the heart. 2.Withhold the next dose of insulin. 3.Apply heat to the affected hand. 4.Bivalve the cast.
Answer is #1 • Arm casts can impinge circulation when in the dependent position. The nurse should elevate the arm above the level of the heart, ensuring that the hand is above the elbow, and reassess the extremity in 15 minutes. If the
A client with a ORIF of the right femur 4 days ago. The client complains of intense pain, swelling, tenderness, and warmth at the side, chills, malaise, and has a temperature of 102.2F. The data indicates which of the following? 1.Fat embolism 2.Compartment syndrome 3.Osteomyelitis 4.Malunion of bone
Answer is #3 • These are all signs and symptoms of an infection...
The nurse notes that the skin around the client's skeletal traction pin site is swollen, red, and crusty, with dried drainage. What is the nurse's priority action? 1.Decrease the traction weight. 2.Apply a new dressing. 3.Document the finding as the only action. 4.Notify the physician.
Answer is #4 • These clinical manifestations indicate inflammation and possible infection. Infected pin sites can lead to osteomyelitis and should be treated immediately.
A 54-year-old patient with acute osteomyelitis asks the nurse how this problem will be treated. Which of the following responses by the nurse is most appropriate? A) a. "Oral antibiotics are often required for several months." B) b. "Intravenous antibiotics are usually required for several weeks." C) c. "Surgery is almost always necessary to remove the dead tissue that is likely to be present." D) d. "Drainage of the foot and instillation of antibiotics into the affected area is the usual therapy."
B
A patient has been diagnosed with osteosarcoma of the femur. He shows an understanding of his treatment options when he states a. I accept that I have to lose my leg with surgery b. the chemotherapy before surgery will shrink the tumor c. this tumor is related to the colon cancer I had 3 years ago d. I'm glad they can take out the cancer with such a small scar
B
During a public health screening day, which of the following assessment findings would alert the nurse to the presence of osteoporosis in a 61-year-old female? A) a. The presence of bowed legs B) b. A measurable loss of height C) c. Poor appetite and aversion to dairy products D) d. The development of unstable, wide-gait ambulation
B
The nurse interprets that which of the following prescribed medications is being used to treat osteomyelitis for a 54-year-old patient admitted to the nursing unit? A) a. Thiamine (vitamin B1) B) b. Gentamicin (Garamycin) C) c. Chlordiazepoxide (Librium) D) d. Oxycodone with acetaminophen (Percocet)
B
The nurse is admitting a patient who is scheduled for knee arthroscopy related to osteoarthritis (OA). Which of the following findings would the nurse expect to be present on examination of the patient's knees? A) a. Ulnar drift B) b. Pain with joint movement C) c. Reddened, swollen affected joints D) d. Stiffness that increases with movement
B
The nurse is caring for a patient who has osteoarthritis (OA) of the knees. The nurse teaches the patient that the most beneficial measure to protect the joints is to do which of the following? A) a. Use a wheelchair to avoid walking as much as possible. B) b. Eat a well-balanced diet to maintain a healthy body weight. C) c. Use a walker for ambulation to relieve the pressure on her hips. D) d. Sit in chairs that do not cause her hips to be lower than her knees.
B
The nurse is working with a 73-year-old patient with osteoarthritis (OA). In assessing the patient's understanding of this disorder, the nurse concludes teaching has been effective when the patient describes the condition as which of the following? A) a. Joint destruction caused by an autoimmune process B) b. Degeneration of articular cartilage in synovial joints C) c. Overproduction of synovial fluid resulting in joint destruction D) d. Breakdown of tissue in non-weight-bearing joints by enzymes
B
When administering medications to the patient with gout, the nurse would recognize which of the following as a treatment for chronic disease? a. colchicine b. febuxostat c. sulfasalazine d. cyclosporine
B
When grading muscle strength, the nurse records a score of 1, which indicates a. no detection of muscular contraction b. a barely detectable flicker of contraction c. active movement against gravity with some resistance d. active movement against full resistance without fatigue
B
When reinforcing health teaching about the management of osteoarthritis (OA), the nurse determines that the patient needs additional instruction after making which of the following statements? A) a. "I should take the Celebrex as prescribed to help control the pain." B) b. "I should try to stay standing all day to keep my joints from becoming stiff." C) c. "I can use a cane if I find it helpful in relieving the pressure on my back and hip." D) d. "A warm shower in the morning will help relieve the stiffness I have when I get up."
B
While completing an admission history for a 73-year-old man with osteoarthritis admitted for knee arthroplasty, the nurse asks about the patient's perception of the reason for admission. The nurse expects the patient to relate which of the following responses to this question? A) a. Recent knee trauma B) b. Debilitating joint pain C) c. Repeated knee infections D) d. Onset of "frozen" knee joint
B
The nurse is caring for a 49-year-old patient admitted to the nursing unit with osteomyelitis. Which of the following symptoms will the nurse most likely find on physical examination of the patient? A) a. Nausea and vomiting B) b. Localized pain and redness C) c. Paresthesia in the affected extremity D) d. Generalized bone pain throughout the leg
B Osteomyelitis is an infection of bone and bone marrow that can occur with trauma, surgery, or extension of nearby infection. Because it is an infection, the patient will exhibit typical signs of inflammation and infection, including localized pain and redness.
When caring for a patient with systemic sclerosis, the nurse knows it is important to instruct the patient related to (select all that apply) a. avoiding consumption of high purine foods b. strategies for good dental hygiene and mouth care c. protecting the extremities from hot and cold temperatures d. maintaining joint function and preserving muscle strength e. performing mouth excursion (yawning) exercises on a daily basis
B,C,D,E
A patient with rheumatoid arthritis is scheduled for a total hip arthroplasty. The nurse explains that the purpose of this procedure is to (select all that apply) a. fuse the joint b. replace the joint c. prevent further damage d. improve or maintain ROM e. decrease the amount of destruction in the joint
B,D
An indication of a neurovascular problem noted during assessment of the patient with a fracture is a. exaggeration of strength with movement b. increased redness and heat below the injury c.decreased sensation distal to the fracture site d. purulent drainage at the site of an open fracture
C
Assessment data in the patient with osteoarthritis commonly include a. gradual weight loss b. elevated WBC count c. joint pain that worsens with use d. straw colored synovial fluid
C
The nurse is assessing the recent health history of a 63-year-old patient with osteoarthritis (OA). The nurse determines that the patient is trying to manage the condition appropriately when the patient describes which of the following activity patterns? A) a. Bed rest with bathroom privileges B) b. Daily high-impact aerobic exercise C) c. A regular exercise program of walking D) d. Frequent rest periods with minimal exercise
C
The nurse is caring for a patient with osteoarthritis who is about to undergo total left knee arthroplasty. The nurse assesses the patient carefully to be sure that there is no evidence of which of the following in the preoperative period? A) a. Pain B) b. Left knee stiffness C) c. Left knee infection D) d. Left knee instability
C
The nurse formulates a nursing diagnosis of impaired physical mobility related to decreased muscle strength for a 78-year-old patient following left total knee replacement. Which of the following would be an appropriate nursing intervention for this patient? A) a. Promote vitamin D and calcium intake in the diet. B) b. Provide passive range of motion to all of the joints q4hr. C) c. Encourage isometric quadriceps-setting exercises at least qid. D) d. Keep the left leg in extension and abduction to prevent contractures.
C Great emphasis is placed on postoperative exercise of the affected leg, with isometric quadriceps setting beginning on the first day after surgery.
A female patient's complex symptomatology over the past year has culminated in a diagnosis of systemic lupus erythematosus (SLE). Which of the patient's following statements demonstrates the need for further teaching about the disease? A) a. "I'll try my best to stay out of the sun this summer." B) b. "I know that I probably have a high chance of getting arthritis." C) c. "I'm hoping that surgery will be an option for me in the future." D) d. "I understand that I'm going to be vulnerable to getting infections."
C SLE carries an increased risk of infection, sun damage, and arthritis. Surgery is not a key treatment modality for SLE.
The nurse determines that dietary teaching for a 75-year-old patient with osteoporosis has been most successful when the patient selects which of the following highest-calcium meals? A) a. Chicken stir-fry with 1 cup each onions and snap peas, and 1 cup of steamed rice B) b. Ham and Swiss cheese sandwich on whole wheat bread, steamed broccoli, and an apple C) c. A sardine (3 oz) sandwich on whole wheat bread, 1 cup of fruit yogurt, and 1 cup of skim milk D) d. A two-egg omelet with 2 oz of American cheese, one slice of whole wheat toast, and a half grapefruit
C The highest calcium content is present in this lunch containing milk and milk products, and small fish with bones (sardines).
26. A patient with restless legs syndrome (RLS) tells the nurse, "My leg pain and twitching keep me awake so much of the night, I am tired most of the day. Is there anything I can do?" Based on this information, which nursing diagnosis is most appropriate? a. Ineffective role performance related to fatigue b. Chronic pain related to RLS c. Anxiety related to lack of knowledge about RLS treatment d. Sleep deprivation related to leg pain and involuntary movement
Correct Answer: D Rationale: The patient's statement indicates that daytime fatigue caused by lack of sleep is the major concern. The patient does not indicate concern with role performance. Although pain is a concern with RLS, the patient's concern is with the impact of pain on sleep. The patient is asking for information about treatment but does not appear anxious. Cognitive Level: Application Text Reference: p. 1557 Nursing Process: Diagnosis NCLEX: Physiological Integrity
A normal assessment finding of the musculoskeletal system is a. muscle and bone strength of 4 b. ulnar deviation and subluxation c. angulation of bone toward midline d. no tenderness with spine palpation
D
A patient with a comminuted fracture of the femur is to have an open reduction with internal fixation (ORIF) of the fracture. The nurse explains that ORIF is indicated when a. the patient is unable to tolerate prolonged immobilization b. the patient cannot tolerate the surgery of a closed reduction c. a temporary cast would be too unstable to provide normal motility d. adequate alignment cannot be obtained by other nonsurgical methods
D
A patient with a stable, closed fracture of the humerus caused by trauma to the arm has a temporary splint with bulky padding applied with an elastic bandage. The nurse suspects compartment syndrome and notifies the physician when the patient experiences a. increasing edema of the limb b. muscle spasms of the lower arm c. rebounding pulse at the fracture site d. pain when passively extending the fingers
D
A patient with bursitis of the should asks what the bursa does. The nurse's response is based on the knowledge that bursae. a. connect bone to muscle b. provide strength to muscle c. lubricate joints with synovial fluid d. relieve friction between moving parts
D
In teaching a patient scheduled for a total ankle replacement it is important that the nurse tell the patient that after surgery he should avoid a. lifting heavy objects b. sleeping on the back c. abduction exercises of the affected ankle d. bearing weight on the affected leg for 6 weeks
D
In teaching a patient with SLE about the disorder, the nurse knows that the pathophysiology of SLE includes a. circulating immune complexes formed from IgG autoantibodies reacting with IgG b. an autoimmune T cell reaction that results in destruction of the deep dermal skin layer c. immunologic dysfunction leading to chronic inflammation in the cartilage and muscles d. the production of a variety of autoantibodies directed against component of the cell nucleus
D
In teaching a patient with chronic fatigue syndrome (CFS) about this disorder, the nurse understands that a. palpating tender points is an indicator of CFS severity b. many symptoms are similar to fibromyalgia syndrome c. definitive treatment includes low dose hydrocortisone d. CFS is characterized by progressive memory impairment
D
The nurse is caring for a 75-year-old woman who underwent left total knee arthroplasty and has a new physician order to be "up in chair today before noon." Which of the following actions would the nurse take to protect the knee joint while carrying out the order? A) a. Administer a dose of prescribed analgesic before completing the order. B) b. Ask the physical therapist for a walker to limit weight bearing while getting out of bed. C) c. Keep the continuous passive motion machine in place while lifting the patient from bed to chair. D) d. Put on a knee immobilizer before moving the patient out of bed and keep the surgical leg elevated while sitting.
D
The nurse is completing discharge teaching with an 80-year-old male patient who underwent right total hip arthroplasty. The nurse identifies a need for further instruction if the patient states the need to do which of the following? A) a. Avoid crossing his legs. B) b. Use a toilet elevator on toilet seat. C) c. Notify future caregivers about the prosthesis. D) Maintain hip in adduction and internal rotation.
D
The nurse is reinforcing health teaching about osteoporosis with a 72-year-old patient admitted to the hospital. In reviewing this disorder, the nurse explains which of the following to the patient? A) a. With a family history of osteoporosis, there is no way to prevent or slow bone resorption. B) b. Continuous, low-dose corticosteroid treatment is effective in stopping the course of osteoporosis. C) c. Estrogen replacement therapy must be maintained to prevent rapid progression of the osteoporosis. D) d. Even with a family history of osteoporosis, the calcium loss from bones can be slowed by increased calcium intake and exercise.
D
The nurse suspects an ankle sprain when a patient at the urgent care center relates a. being hit by another soccer player during a game b. having ankle pain after sprinting around the track c. dropping a 10 pound weight on his lower leg at the health center d. twisting his ankle while running bases during a baseball game
D
Which of the following patient statements most clearly suggests a need to assess the patient for ankylosing spondylitis (AS)? A) a. "My right elbow has become red and swollen over the last few days." B) b. "I wake up stiff every morning and my knees just don't want to bend." C) c. "My husband tells me that my posture has become so stooped this winter." D) d. "My lower back pain seems to be getting worse all the time and nothing seems to help."
D AS primarily affects the axial skeleton. Based on this, symptoms of inflammatory spine pain are often the first clues to a diagnosis of AS. Knee or elbow involvement is not consistent with the typical course of AS. Back pain is likely to precede the development of kyphosis.
A 67-year-old patient hospitalized with osteomyelitis has an order for bed rest with bathroom privileges with the affected foot elevated on two pillows. The nurse would place highest priority on which of the following interventions? A) a. Ambulate the patient to the bathroom every 2 hours. B) b. Ask the patient about preferred activities to relieve boredom. C) c. Allow the patient to dangle legs at the bedside every 2 to 4 hours. D) d. Perform frequent position changes and range-of-motion exercises.
D The patient is at risk for atelectasis of the lungs and for contractures because of prescribed bed rest. For this reason, the nurse should change the patient's position frequently to promote lung expansion and perform range-of-motion exercises to prevent contractures.
The nurse is reinforcing general health teaching with a 64-year-old patient with osteoarthritis (OA) of the hip. Which of the following points would the nurse include in this review of the disorder (select all that apply)? A) a. OA cannot be successfully treated with any current therapy options. B) b. OA is an inflammatory disease of the joints that may present symptoms at any age. C) c. Joint degeneration with pain and disability occurs in the majority of people by the age of 60. D) d. OA is more common with aging, but usually it remains confined to a few joints and does not cause crippling. E) e. OA can be prevented from progressing when well controlled with a regimen of exercise, diet, and medication.
D,E
