Musculoskeletal AB Practice

A nurse is reinforcing teaching with a client who is postoperative following the insertion of a femoral head prosthesis. Which of the following clients statement should indicate to the nurse the need for further instructions?

" I will bend from my hip to tie my shoes" The client should not bend over from the hip. This can cause the hip to flex greater than 90°, which increases the risk of dislocation of the prosthesis

A nurse is reinforcing teaching for a client who has to have a myelogram. Which of the following statements indicates the client understands the teaching?

" I will not eat or drink anything for eight hours before the procedure" The client should remain NPO for 4 to 8 hours before the procedure to prevent any movement that could occur from the client being nauseated or vomiting during the procedure

A nurse is reinforcing teaching with a client who is taking ibuprofen to treat chronic hip pain. Which of the following instruction should the nurse include in the teaching

"Have regular eye exams done while taking this medication" The nurse should instruct the client to have regular vision and hearing examinations due to the potential adverse effects of ibuprofen

A nurse is reinforcing teaching for a female client who has multiple sclerosis in a new prescription for dantrolene. Which of the following client statements indicates an understanding of the teaching?

"I need to notify my provider if I don't get some relief from my muscle spasms within three months" Dantrolene is highly hepatotoxic. If the client does not get relief for muscle spasms within 45 days, the provider should discontinue the medication

A nurse is reinforcing discharge teaching to a client following arthroscopic surgery. To prevent postoperative complications which of the following actions should be reinforced during the teaching?

Administer an opioid analgesic to the client 30 min prior to initiating CPM exercises. The nurse should administer analgesics prior to initiating any exercise program for the client who has had joint arthroplasty. It is important that administered in time for the medication to work before the start of the exercise program to ensure discomfort is minimized.

A nurse is collecting data from a client who has rheumatoid arthritis. Which of the following is an expected finding for this client?

Boutonniere deformity. rheumatoid arthritis is a chronic, inflammatory autoimmune disorder which primarily affects the synovia (lining of the joints). boutonniere deformity is a manifestation of rheumatoid arthritis in which a finger is flexed or bent in word towards the palm of the lowest joint and then extend it out word away from the palm of the furthest most distal joint. This deformity arises due to the loss of collagen (connective tissue) in the joints.

A nurse is reinforcing teaching to a client who has a fractured ulna and is to start taking cyclobenzaprine. The nurse should instruct the client to expect which of the following therapeutic effects?

Decreased muscle spasms. cyclobenzaprine is a centrally acting muscle relaxant that relieves painful muscle spasms due to acute musculoskeletal injury.

A nurse is collecting data from a client who has an exacerbation of gout. Which of the following findings should the nurse expect

Edema, Erythema, Tophi, Tight skin

A nurse is caring for a client who has been placed in halo traction to immobilize his cervical spine. Which of the following actions should the nurse take?

Elevate the head of the bed. to keep the client from migrating toward the head of the bed while using cervical halter traction, the nurse should elevate the head of the bed.

A nurse in a clinic is collecting data from a client who reports wrist pain caused by carpal tunnel syndrome. The nurse should expect which of the following findings?

Positive Phalen's sign The client who has a positive Fallons test, has carpal tunnel syndrome. The test is performed by having the client hold the rest in a 90° flexion for 60 seconds.

A nurse is talking with a client who reports acute lower back pain after moving heavy boxes. which of the following information should the nurse reinforce?

Use ice packs intermittently for 48 hr. the nurse should instruct the client to use ice for the first 2 days following injury to reduce back spasms.

A nurse at a providers office is reviewing information about management about Osteoarthritis with a client. Which of the following intervention should the nurse recommend? (select all that apply)

Weight management, Aerobic exercise, massage therapy, isometric exercise

A nurse is caring for a client who is postoperative following a below the knee amputation and will soon undergo a fitting for a leg prosthesis. Which of the following is an appropriate nursing intervention for the client at this time?

Wrap the stump with an elastic bandage in a figure eight configuration. The nurse should use the figure 8 style of wrapping to help her vent blood flow restriction and to shave and shrink the limb to prepare it for the prosthesis

A nurse is reinforcing teaching with a client who has gout. Which of the following dietary restriction should the nurse include in the teaching?

alcohol alcohol can trigger painful gout attacks and should be avoided.

A nurse is collecting data from a client who has a herniated intravertebral cervical disc. Which of the following findings should the nurse expect?

tingling in the arms, shoulder pain, and neck stiffness

A nurse is reinforcing discharge teaching with a client who is postoperative following hip arthroplasty and is to continue use of enoxaparin at home. Which of the following statements by the client indicates an understanding of the teaching?

"I will need to give myself an injection in my abdomen twice a day" enoxaparin is an anticoagulant used to prevent deep vein thrombosis after orthopedic and other types of surgery. It is administered only by the subcutaneous route and it's duration of action is 12 hours. It is considered safe to allow the client to self administer.

A nurse is reinforcing teaching about Russells traction with a newly licensed nurse. Which of the following statements and the nurse me?

"Russell's traction uses a sling under the knee to treat a fracture of the femur" Russels traction is a type of skin traction which incorporates a sling under the knee that is connected by a rope to an overhead bar pulley

A nurse is teaching an assistive personnel about attaching a footboard to the bed of a client who is immobile. Which of the following information should the nurse include in the teaching?

"The footboard will help to prevent plantar flexion" The nurse should teach that the purpose of a footboard is to prevent plantar flexion contracture or foot drop

A nurse is reinforcing teaching about colchicine with a client who has gout. Which of the following statements by the clients indicates understanding of the teaching?

"This medication should eliminate the swelling in 2 to 3 days" Gout is an anti inflammatory disorder. high dose colchicine produces pain relief within several hours and can reverse inflammation and bring significant pain relief in 48 hr to 72 hr

A nurse is discharging a client who came to the outpatient clinic with an ankle sprain. Which of the following statements are the nurse identify as an indication that the client understands the discharge instructions?

"i'll apply ice to my ankle for 20 minutes every hour" The client should apply ice for 20 minutes every hour for the first 24 to 48 hours

A nurse provides teaching to a client who is being fitted for a prosthetic leg. Which of the following statements indicate to the nurse I need for further instruction?

"i'll learn to balance well on one leg so I don't have to use crutches"

A nurse is reinforcing teaching with a client who is about to start taking allopurinol to treat gout. Which of the following statements by the client indicates an understanding of the teaching?

-" I need to drink at least 3 quarts of water a day "(should instruct client to drink 3000ml of water a day to produce 2000 ml of urine a day )

A nurse is caring for a client Who is two days post operative following an above the knee amputation. which of the following is an appropriate nursing intervention for the client at this time?

have the client lie prone several times each day

A nurse is collecting data from a client who reports shoulder pain. Which of the following findings should cause the nurse to suspect that the client has a rotator cuff injury?

Inability to abduct the arm at the shoulder. A client who has a rotator cuff injury has limited ability to abduct the arm at the shoulder

A nurse is caring for a client who has a balanced skeletal traction with a Thomas splint for the treatment of a fracture of the femur. Which of the following actions should the nurse take to prevent skin breakdown?

Pad the top of the splint with protective dressings. The nurse should pad the top of the splint with protective dressings or soft cotton padding to prevent skin breakdown at the splint edge

A client who has a compound fracture of the right tibia has a long leg fiberglass cast. To reinforce teaching for the client about how to observe and manage his fracture at home, the nurse should include which of the following instructions?

Report any worsening or unrelieved pain. pain can be a sign of complications such as compartment syndrome or skin breakdown. The client should report it to the provider.

A nurse is reinforcing teaching with a client who has gout. which of the following medication classes should the nurse instruct client to avoid?

Salicylates. Salicylate, such as aspirin, can trigger gout attacks and should be avoided. additionally, clients who have gout and are prescribed probenecid or sulfinpyrazone, uricosuric drugs, should not take aspirin.

A nurse is caring for a client who is postoperative following foot surgery and is not to bear weight on the operative foot. The nurse enters the room to discover the client hopped on 1 foot to the bathroom, using an IV pole for support. Which of the following actions should the nurse take?

Tell the client to remain in the bathroom after toileting and obtain a wheelchair.

A nurse is collecting data from a client who is 24 hours postoperative from a hip open reduction with internal fixation of the tibia. Which of the following findings should the nurse report the provider?

The clients affect extremity is cool to touch cool skin is an indication of decreased arterial perfusion

A client returns to the surgical unit from the PACU in skeletal traction. The nurse should take action to correct which of the following problems with the traction set up?

The weights rest against the foot of the bed. weights that rest against the foot of the bed or on the floor do not apply the traction essential for reducing the fracture and immobilizing the bone.

A nurse is collecting data from a female client who has osteoarthritis and reports she is thinking about taking aspirin for pain control. Which of the following data in the clients history should the nurse realize might be a contradiction to taking aspirin and should be reported to the provider?

history of vitamin K deficiency. aspirin inhibit platelet aggregation and should not be taken by clients who have bleeding disorders, such as a history of vitamin K deficiency. Vitamin K must be present in order to synthesize several clotting factors in a deficiency of the vitamin causes bleeding tendencies.

A nurse is reinforcing teaching for a client who is about to start therapy with alendronate to treat osteoporosis. For which of the following findings should the nurse instructed client to monitor and report as an adverse effect at this medication?

jaw pain, dysphasia and blurred vision

A client who is postoperative returns to the unit and skeletal traction. When collecting data from the client, the nurse should expect which of the following findings?

redness at the pin sites, warmth at the pin sites

A nurse is discussing cast application with a newly licensed nurse. which of the following statements by the newly licensed nurse indicates an understanding of the information?

"A synthetic cast is lighter weight" The nurse should recognize that is synthetic cast is less restrictive, is lighter in weight, and requires Less drying time than a plaster cast.

A nurse is caring for a client who has a skeletal traction for a treatment of a femur fracture. which of the following actions should the nurse take?

administer pain medication to the client before performing pin care. The nurse should administer pain medication to the client 30 minutes prior to performing pin care to reduce the clients discomfort.

A nurse is reinforcing teaching with a client who is about to start therapy with methotrexate to treat rheumatoid arthritis. Which of the following instruction should the nurse include? Select all that apply

do not drink alcoholic beverages, report unexplained bruising to the provider and avoid people who have infections

A nurse is reinforcing teaching with a female client who has rheumatoid arthritis and a prescription for methotrexate. Which of the following information should the nurse include in the teaching?

drink 10 to 12 glasses of water per day. methotrexate can cause renal toxicity. Adequate hydration promotes it's excretion and helps prevent this adverse effect.

while collecting data from a client who has a cast on his right leg, a nurse locate an area on the cast that feels warm to the touch. Which of the following findings should the nurse identify as a complication to the clients condition?

infection. an area of warmth on a cast is an indication of an infection therefore, the nurse should report this finding to the provider

A nurse is reinforcing teaching with a client who has a new diagnosis of gout. The client asked the nurse how she got the disorder. Which of the following information should the nurse include in the teaching?

intra-articular urate crystal deposits causes inflammation. gout, or gouty arthritis, develops when urate crystals deposit in joints and tissues, leading to inflammation and pain.

A nurse is reinforcing teaching with a group of young athletes about injury prevention during sports activities. Which of the following joints should the nurse explain his most susceptible to a sports related injury

knee

A nurse is reinforcing teaching with a client who has a new prescription for methotrexate for the treatment of rheumatoid arthritis. The nurse should instruct the client to notify the provider of which of the following manifestations?

malaise The nurse should instruct the client to report manifestations of infection, such as fever and malaise, to the provider. Disease modifying antirheumatic drugs such as methotrexate can suppress the clients natural immune response, increasing the risk for infection

A nurse is caring for a client who is taking celecoxib daily. The nurse should identify that history of which of the following disorders indicates a need for this type of medication

osteoarthritis. celecoxib is a nonsteroidal anti-inflammatory cyclooxygenate-2 (COX-2) inhibitor used to relieve the pain and inflammation caused by rheumatoid arthritis and osteoarthritis

A nurse is collecting data from a client who has a short arm cast for a fractured wrist. Which of the following findings indicate impaired venous return in the affected arm?

pain unrelieved by opiod analgesic pain that is not relieved by opiod analgesics is a manifestation of compartment syndrome. The nurse should elevate the extremity and notify the provider immediately

A nurse is collecting data from a client following the application of a leg cast for the treatment of a fracture. Which of the following findings should the nurse expect to find first if the cast is too tight?

pallor of the toes. The client who has a cast that is too tight may have pallor of the toes caused from inflammation and edema that puts pressure on the vascular system, tissues and nerves, which decreases blood flow and can lead to compartment syndrome. When this occurs, pallor of the toes is the initial finding.

A nurse is collecting data on a client who has a femur fracture. Which of the following findings is a manifestation of that embolism syndrome?

petechiae over the clients chest. A client has fat embolism syndrome can develop petechiae over the chest, arms, neck, and abdomen. Other manifestations include change in mental status, dyspnea, tachypnea and tachycardia. This develops due to an adequate arterial oxygen from that globules blocking small arteries that provide oxygen to various organs

A nurse is assisting a client who is postop following a total hip arthroplasty into a supine position. Which of the following actions as appropriate to prevent hip dislocation?

place a wedge pillow between the legs. The nurse should place a wedge pillow or a different abduction device between the legs to prevent abduction, which can lead to possible dislocation

an older adult client and an orthopedic unit has an intracapsular fracture of the right hip following a fall. The client is in buck's traction and will have hip prosthesis surgery in the morning. The nurse should reinforce with a client that this type of traction promotes which of the following outcomes?

relief from muscle spasms. Buck's traction immobilizes a fractured bone to relieve muscle spasms at the fracture site and therefore relieve pain. Any movement of fracture fragments induces severe muscle spasms and triggers pain

A nurse is collecting data from an older adult client who is preoperative for a total hip arthroplasty. For which of the following findings should the nurse notify the provider?

the client has an abscessed tooth. The nurse should assess for and report any sign of infection in the preoperative client as this increases the risk of surgery and postoperative surgical site infection

A nurse is contributing to the plan of care for a client to achieve the outcome of functional healing of a fracture. Which of the following nursing interventions is the highest priority to assist in meeting this outcome?

Maintain immobilization and alignment.

A nurse is talking with a client who has a new diagnosis of acute bursitis in her right shoulder. Which of the following self-care strategies should the nurse recommend?

Intermittent ice and heat. bursitis is an inflammation of the fluid filled portion of a joint and is common in the shoulder.

A nurse is reinforcing teaching the client about taking high doses of oral glucocorticoids for an extended period of time to treat rheumatoid arthritis. Which of the following information should the nurse include in the teaching?

Monitor for compression fractures of the back and neck.

A nurse is collecting data from a client who has multiple fractures in his left leg and reports severe pain and tingling in the extremity. The nurse should suspect which of the following complications?

acute compartment syndrome. in compartment syndrome, increase pressure within the fascia leads to reduce circulation of the area. The nurse should check for other manifestations of compartment syndrome and report them to the provider immediately.

A nurse is assisting with a plan of care for an older adult client who is four hour postoperative following an open reduction and internal fixation of a fractured femur. Which of the following intervention should the nurse include in the plan of care?

check capillary refill in the affected extremity every four hours.

A nurse is caring for a client who has a new cast in place for a fractured tibia. The nurse should recognize that which of the following interventions as a priority?

check the capillary refill distal to the clients cast. The priority action the nurse should take when using the airway, breathing, and circulation (ABC) approach to client care is to check capillary refill. Reduced capillary refill can indicate a change in neurovascular status due to the injury or pressure from the cast. The nursing monitor color, movement, temperature, sensation, and capillary refill of the toes on the affected extremity.

A client who has undergone a right below the knee amputation now has a prosthetic limb. when reinforcing teaching with the client about prosthesis and residual limb care, The nurse should include which of the following instructions?

dry the prosthesis socket completely before applying it to the limb. Moisture between the socket and the residual limb can put the client at risk for fungal or bacterial infection and skin breakdown.

A nurse is assisting with the care of a client who has a femur fracture and is in skeletal traction. Which of the following actions should the nurse take?

ensure the clients weights are hanging freely from the bed. The nurse should ensure that the clients weights are hanging freely from the bed to maintain the client in proper body alignment and should never be removed without a provider prescription.

A nurse is contributing to the plan of care for an older adult client who is postoperative following a right hip arthroplasty. Which of the following intervention should the nurse include in the plan?

maintain abduction of the right hip

A nurse is collecting data from an older adult client who had it femoral head fracture 24 hours ago and is in Buck's traction. Which of the following findings is an indication of fat embolism syndrome?

petechiae on the chest. a red rash on the clients abdomen, chest, neck or upper arms is a manifestation of fat embolism.

A nurse is reinforcing teaching about ergonomically principles with a group of assistive personnel. Which of the following strategies should the nurse include in the teaching?

tighten the abdominal muscles when lifting objects, flex knees and hips periodically when standing for a period of time

A nurse is collecting data from a client who reports having stiffness in her joints. Which of the following findings should indicate to the nurse that the client may have rheumatoid arthritis?

ulnar deviation The client who is rheumatoid arthritis develops inflammation and deformity of the metacarpal phalangeal joints. The fingers deviate toward the ulnar bone while the rest devious towards the radial side