Musculoskeletal

A client is being discharged home after application of a plaster leg cast. The nurse determines that the client understands proper care of the cast if the client makes which statement? 1. "i need to avoid getting the cast wet" 2. "I will use my fingertips to lift and move the leg" 3. "I need to cover the casted leg with warm blankets" 4. "I can use a padded coat hanger end to scratch under the cast"

"I need to avoid getting the cast wet"

A client diagnosed with gout has been started on medication therapy with allopurinol (Zyloprim). The nurse reinforces teaching with this client regarding which point about this medication?

"It is important to drink 3 L of fluid per day."

A client with acute muscle spasms has been taking baclofen. The client calls the clinic nurse because of continuous feelings of weakness and fatigue and asks the nurse about discontinuing the medication. The nurse should make which appropriate response to the client?

"Weakness and fatigue commonly occur and will diminish with continued medication use."

A nurse is caring for the client who is going to have an arthrogram using a contrast medium. Which of the following data collected by the nurse would be of highest priority? 1. Allergy to iodine or shellfish 2. Whether the client needs to void before the procedure 3. Ability of the client to remain still during the procedure 4. Whether the client has any remaining questions about the procedure

1. Allergy to iodine or shellfish

A nurse has reviewed activity restrictions with a client who is being discharged following hip surgery and insertion of a femoral head prosthesis. The nurse determines that the client understands the material presented if the client states that it is acceptable to: 1. Use a raised toilet seat. 2. Bend carefully to put on socks and shoes. 3. Sit in chairs without arms for better mobility. 4. Exercise the leg past the point of 90-degree flexion.

1. Use a raised toilet seat. Rationale: The client who has had an insertion of a femoral head prosthesis should use a raised toilet seat. The client should also maintain the leg in a neutral, straight position when lying, sitting, or walking. The leg should not be adducted, internally rotated, or flexed more than 90 degrees. The client should sit in chairs that have arms so there will be assistance when the client is ready to rise from the sitting position. The client should avoid putting on own socks and shoes for 8 weeks after surgery because it would force the leg into acute flexion. (POSSIBLE MISTAKE ON EXAM)

1. Clear mentation. 2. Minimal dyspnea. 3. Oxygen saturation of 85%. 4. Arterial oxygen level of 78 mm Hg.

1. Clear mentation

841. The nurse is caring for a client being treated for fat embolus after multiple fractures. Which data would the nurse evaluate as the most favorable indication of resolution of the fat embolus? 1. Clear mentation 2. Minimal dyspnea 3. Oxygen saturation of 85% 4. Arterial oxygen level of 78 mm Hg

1. Clear mentation

1. Temperature of 101.6 Forally 2. Complaints of discomfort during repositioning 3. old bloody drainage outlined on the surgical dressing 4. Discomfort during coughing and deep-breathing exercises

1. Temperature of 101.6 F orally

A nurse is preparing a client scheduled for a bone marrow aspiration, and the client asks the nurse whether the procedure will be painful. The nurse should make which response to the client? 1. "No, it is not painful." 2. "A local anesthetic will be given." 3. "You will receive general anesthesia." 4. "You will be heavily medicated before the procedure."

2. "A local anesthetic will be given."

A client has just undergone spinal fusion after suffering a herniated lumbar disk. The nurse should avoid which of the following to maintain client safety after this procedure? 1. Head of bed flat 2. Overhead trapeze 3. Pillows under the length of the legs 4. Logrolling technique for repositioning

2. Overhead trapeze Rationale: Following spinal fusion, the head of the bed is generally kept in a flat position. The client is logrolled from side to side as prescribed. Pillows may be placed under the entire length of the legs by surgeon preference to relieve tension on the lower back. The use of an overhead trapeze is contraindicated because its use could promote twisting of the spine after surgery.

A nurse is providing postprocedure instructions to a client returning home after arthroscopy of the shoulder. The nurse would encourage the client to: 1. Not eat or drink anything until the following morning. 2. Report to the health care provider the development of fever or redness and heat at the site. 3. Keep the shoulder completely immobilized for the rest of the day. 4. Resume regular full activity the following day.

2. Report to the health care provider the development of fever or redness and heat at the site.

A nurse is caring for a client who had an above-the-knee amputation 2 days ago. The residual limb was wrapped with an elastic compression bandage that has fallen off. The nurse immediately: 1. Calls the health care provider 2. Rewraps the residual limb with an elastic compression bandage 3. Applies ice to the site 4. Applies a dry sterile dressing and elevates it on one pillow

2. Rewraps the residual limb with an elastic compression bandage

A nurse is evaluating the pin sites of a client in skeletal traction. The nurse would be least concerned with which finding? 1. Inflammation 2. Serous drainage 3. Pain at a pin site 4. Purulent drainage

2. Serous drainage

A client who has had spinal fusion and insertion of hardware is extremely concerned about the perceived lengthy rehabilitation period. The client expresses concerns about finances and the ability to return to work. The nurse understands that the client's needs could best be addressed by referral to the: 1. Surgeon 2. Social worker 3. Physical therapist 4. Clinical nurse specialist

2. Social worker

1. Calcium level of 9.0 mg/dl. 2. Uric acid level of 8.6 mg/dL 3. Potassium level of 4.1 mEq/L 4. Phosphorus level of 3.1 mg/dL

2. Uric acid level of 8.6 mg/dL

847. The nurse is caring for a client with a diagnosis of gout. Which laboratory value would the nurse expect to note in the client? 1. Calcium level of 9.0 mg/dl. 2. Uric acid level of 8.6 mg/dL 3. Potassium level of 4.1 mEq/L 4. Phosphorus level of 3.1 mg/dL

2. Uric acid level of 8.6 mg/dL

Which statement by the client who has received home care instruction following an arthroscopy of the knee indicates a need for further education? 1. "I should elevate my knee while sitting." 2. "I should avoid excessive use of the joint for several days." 3. "I can apply heat to my knee if it becomes uncomfortable." 4. "I should return to the health care provider in about 7 days for followup."

3. "I can apply heat to my knee if it becomes uncomfortable."

A client who has had a total knee replacement tells the nurse that there is pain with extension of the knee. The nurse should: 1. Put the client's knee through full passive range of motion. 2. Immobilize the knee temporarily. 3. Administer an analgesic. 4. Notify the health care provider immediately.

3. Administer an analgesic.

A nurse is providing care of the client following a bone biopsy. Which action by the nurse is unnecessary in the care of this client? 1. Elevating the limb for 24 hours 2. Monitoring vital signs every 4 hours 3. Administering intramuscular opioid analgesics 4. Monitoring the site for swelling, bleeding, hematoma

3. Administering intramuscular opioid analgesics

1. Infection under the cast. 2. The anxiety of the client. 3. Impaired tissue perfusion. 4. The recent occurrence of the fracture.

3. Impaired tissue perfusion

836. A client has sustained a closed fracture and has just had a cast applied to the affected arm. The client is complaining of intense pain. The nurse elevates the limb, applies an ice bag, and administers an analgesic, with little relief. Which problem may be causing this pain? 1. Infection under the cast 2. The anxiety of the client 3. Impaired tissue perfusion 4. The recent occurrence of the fracture

3. Impaired tissue perfusion

A nurse is evaluating goal achievement for a client in traction with impaired physical mobility. The nurse determines that the client has not successfully met all of the goals formulated if which of the following outcomes was noted? 1. Equal calf measurements bilaterally 2. Active range of motion (ROM) of uninvolved joints 3. Intact skin surfaces 4. Bowel movement every 5 days

4. Bowel movement every 5 days

A nurse has provided instructions to the client returning home after arthroscopy of the knee. The nurse determines that the client understands the instructions if the client states that he or she will: 1. Resume regular exercise the following day. 2. Stay off of the leg entirely for the rest of the day. 3. Refrain from eating food for the remainder of the day. 4. Report fever or site inflammation to the health care provider.

4. Report fever or site inflammation to the health care provider.

830. The nurse is conducting health screening for osteoporosis. Which client is at greatest risk of developing this disorder? 1. A 25-year-old woman who jogs 2. A 36-year-old man who has asthma 3. A 70-year-old man who consumes excess alcohol 4. A sedentary 65-year-old woman who smokes cigarettes

4. A sedentary 65-year-old woman who smokes cigarettes

1. A 25-year-old woman who jogs. 2. A 36-year-old man who has asthma. 3. A 70-year-old man who consumes excess alcohol. 4. A sedentary 65-year-old woman who smokes cigarettes

4. A sedentary 65-year-old woman who smokes cigarettes.

848. A client with a hip fracture asks the nurse why Buck's (extension) traction is being applied before surgery. The nurse provides a response based on which purpose of Buck's (extension) traction? 1. Allows bony healing to begin before surgery 2. Provides rigid immobilization of the fracture site 3. Lengthens the fractured leg to prevent severing of blood vessels 4. Provides comfort by reducing muscle spasms and provides fracture immobilization

4. Provides comfort by reducing muscle spasms and provides fracture immobilization

1. Apply ice to the site. 2. Call the health care provider (HCP) 3. Apply a dry sterile dressing and elevate it on one pillow. 4. Rewrap the residual limb with an elastic compression bandage.

4. Rewrap the residual limb with an elastic compression bandage.

1. Hemorrhage 2. Edema of the residual limb 3. Slight redness of the incision 4. Separation of the wound edges

4. Separation of the wound edges

The nurse is planning to reinforce instructions to the client about how to stand on crutches. In the instructions, the nurse should plan to tell the client to place the crutches in which position? 1. 3 inches to the front and side of the clients toes 2. 8 inches to the front and side of the clients toes 3. 15 inches to the front and side of the clients toes 4. 20 inches to the front and side of the clients toes

8 inches to the front and side of the clients toes

A nursing assistant is assigned to care for a client who has a CPM machine in place after a total knee arthroplasty. Which statement by the NA indicates a need for further teaching and supervision? A. "I will turn off the machine if the client has any pain." B. "I will turn off the machine when the client wants to eat." C. "I will store the machine on a chair when not used." D. "I will check to make sure the clients leg is correctly placed."

A

Which drug is not appropriate to treat the disease with which it is matched? A. RA-zyloprim B. Osteoarthritis- Celebrex C. Acute gout- colsalide D. Lupus- deltasone

A

A nurse discovers that a client who is in traction for a long bone fracture has a slight fever, is short of breath, and is restless. What does the client most likely have?

A fat embolism, characterized by hypoxemia, respiratory distress, irritability, restlessness, fever and petechiae

Treating Rib Fractures

A single rib fracture is pain management and deep breathing to prevent atelectasis. Multiple rib fractures is higher priority to treat due to possibility of flail chest and respiratory complications

When working with patients, the nurse knows that patients have the most difficulties with diarthrodial joints. Which joints are included in this group of joints (select all that apply)? a. Hinge joint of the knee b. Ligaments joining the vertebrae c. Fibrous connective tissue of the skull d. Ball and socket joint of the shoulder or hip e. Cartilaginous connective tissue of the pubis joint

A, D The diarthrodial joints include the hinge joint of the knee and elbow, the ball and socket joint of the shoulder and hip, the pivot joint of the radioulnar joint, and the condyloid, saddle, and gliding joints of the wrist and hand. The ligaments and cartilaginous connective tissue joining the vertebrae and pubis joint and the fibrous connective tissue of the skull are synarthrotic joints

The nurse admits a 55-year-old female with multiple sclerosis to a long-term care facility. Which finding is of most immediate concern to the nurse? A. Ataxic gait B. Radicular pain C. Severe fatigue D. Urinary retention

A. Ataxis gait An ataxic gait is a staggering, uncoordinated gait. Fall risk is the highest in individuals with gait instability or visual or cognitive impairments. The other signs and symptoms (e.g., fatigue, urinary retention, radicular pain) may also occur in the patient with multiple sclerosis and need to be managed, but are not the priority.

A 50-year-old patient is reporting a sore shoulder after raking the yard. The nurse should suspect which problem? A. Bursitis B. Fasciitis C. Sprained ligament D. Achilles tendonitis

A. Bursitis Bursitis is common in adults over age 40 and with repetitive motion, such as raking. Plantar fasciitis frequently occurs as a stabbing pain at the heel caused by straining the ligament that supports the arch. Achilles tendonitis is an inflammation of the tendon that attaches the calf muscle to the heel bone, not the shoulder, and causes pain with walking or running. A sprained ligament occurs when a ligament is stretched or torn from a direct injury or sudden twisting of the joint, not repetitive motion.

Musculoskeletal assessment is an important component of care for patients on what type of long-term therapy? A. Corticosteroids B. β-Adrenergic blockers C. Antiplatelet aggregators D. Calcium-channel blockers

A. Corticosteroids Corticosteroids are associated with avascular necrosis and decreased bone and muscle mass. β-blockers, calcium-channel blockers, and antiplatelet aggregators are not commonly associated with damage to the musculoskeletal system.

When working with patients, the nurse knows that patients have the most difficulties with diarthrodial joints. Which joints are included in this group of joints? (Select all that apply.) A. Hinge joint of the knee B. Ligaments joining the vertebrae C. Fibrous connective tissue of the skull D. Ball and socket joint of the shoulder or hip E. Cartilaginous connective tissue of the pubis joint

A. Hinge joint of the knee D. Ball and socket joint of the shoulder or hip The diarthrodial joints include the hinge joint of the knee and elbow, the ball and socket joint of the shoulder and hip, the pivot joint of the radioulnar joint, and the condyloid, saddle, and gliding joints of the wrist and hand. The ligaments and cartilaginous connective tissue joining the vertebrae and pubis joint and the fibrous connective tissue of the skull are synarthrotic joints.

The nurse is performing a musculoskeletal assessment of an 81-year-old female patient whose mobility has been progressively decreasing in recent months. How should the nurse best assess the patient's range of motion (ROM) in the affected leg? A. Observe the patient's unassisted ROM in the affected leg. B. Perform passive ROM, asking the patient to report any pain. C. Ask the patient to lift progressive weights with the affected leg. D. Move both of the patient's legs from a supine position to full flexion.

A. Observe the patient's unassisted ROM in the affected leg. Passive ROM should be performed with extreme caution and may be best avoided when assessing older patients. Observing the patient's active ROM is more accurate and safe than asking the patient to lift weights with her legs.

Anakinra (Kineret) is prescribed for a patient who has rheumatoid arthritis (RA). When teaching the patient about this drug, the nurse will include information about a. self-administration of subcutaneous injections. b. taking the medication with at least 8 oz of fluid. c. avoiding concurrently taking aspirin or nonsteroidal antiinflammatory drugs (NSAIDs). d. symptoms of gastrointestinal (GI) irritation or bleeding.

ANS: A Anakinra is administered by subcutaneous injection. GI bleeding is not a side effect of this medication. Because the medication is injected, instructions to take it with 8 oz of fluid would not be appropriate. The patient is likely to be concurrently taking aspirin or NSAIDs, and these should not be discontinued.

Which assessment finding about a patient who has been using naproxen (Naprosyn) for 3 weeks to treat osteoarthritis is most important for the nurse to report to the health care provider? a. The patient has dark colored stools. b. The patient's pain has not improved. c. The patient is using capsaicin cream (Zostrix). d. The patient has gained 3 pounds over 3 weeks.

ANS: A Dark colored stools may indicate that the patient is experiencing gastrointestinal bleeding caused by the naproxen. The information about the patient's ongoing pain and weight gain also will be reported and may indicate a need for a different treatment and/or counseling about avoiding weight gain, but these are not as large a concern as the possibility of gastrointestinal bleeding. Use of capsaicin cream with oral medications is appropriate.

Which statement by a 24-year-old woman with systemic lupus erythematosus (SLE) indicates that the patient has understood the nurse's teaching about management of the condition? a. "I will use a sunscreen whenever I am outside." b. "I will try to keep exercising even if I am tired." c. "I should take birth control pills to keep from getting pregnant." d. "I should not take aspirin or nonsteroidal anti-inflammatory drugs."

ANS: A Severe skin reactions can occur in patients with SLE who are exposed to the sum. Patients should avoid fatigue by balancing exercise with rest periods as needed. Oral contraceptives can exacerbate lupus. Aspirin and nonsteroidal anti-inflammatory drugs are used to treat the musculoskeletal manifestations of SLE.

When helping a patient with rheumatoid arthritis (RA) plan a daily routine, the nurse informs the patient that it is most helpful to start the day with a. a warm bath followed by a short rest. b. a short routine of isometric exercises. c. active range-of-motion (ROM) exercises. d. stretching exercises to relieve joint stiffness.

ANS: A Taking a warm shower or bath is recommended to relieve joint stiffness, which is worse in the morning. Isometric exercises would place stress on joints and would not be recommended. Stretching and ROM should be done later in the day, when joint stiffness is decreased.

During assessment of the patient with fibromyalgia syndrome (FMS), the nurse would expect the patient to report (select all that apply)? a. sleep disturbances. b. multiple tender points. c. cardiac palpitations and dizziness. d. multijoint pain with inflammation and swelling. e. widespread bilateral, burning musculoskeletal pain.

ANS: A, B, C, E These symptoms are commonly described by patients with FMS. Cardiac involvement and joint inflammation are not typical of FMS.

Which information will the nurse include when teaching range-of-motion exercises to a patient with an exacerbation of rheumatoid arthritis? a. Affected joints should not be exercised when pain is present. b. Application of cold packs before exercise may decrease joint pain. c. Exercises should be performed passively by someone other than the patient. d. Walking may substitute for range-of-motion (ROM) exercises on some days.

ANS: B Cold application is helpful in reducing pain during periods of exacerbation of RA. Because the joint pain is chronic, patients are instructed to exercise even when joints are painful. ROM exercises are intended to strengthen joints as well as improve flexibility, so passive ROM alone is not sufficient. Recreational exercise is encouraged but is not a replacement for ROM exercises.

A patient with dermatomyositis is receiving long-term prednisone (Deltasone) therapy. Which assessment finding by the nurse is most important to report to the health care provider? a. The blood glucose is 112 mg/dL. b. The patient has painful hematuria. c. The patient has an increased appetite. d. Acne is noted on the back and face.

ANS: B Corticosteroid use is associated with increased risk for infection, so the nurse should report the urinary tract symptoms immediately to the health care provider. The increase in blood glucose, increased appetite, and acne also are adverse effects of corticosteroid use, but do not need diagnosis and treatment as rapidly as the probable urinary tract infection.

Which information will the nurse include when teaching a patient with newly diagnosed ankylosing spondylitis (AS) about the management of the condition? a. Exercise by taking long walks. b. Do daily deep breathing exercises. c. Sleep on the side with hips flexed. d. Take frequent naps during the day.

ANS: B Deep breathing exercises are used to decrease the risk for pulmonary complications that may occur with the reduced chest expansion that can occur with ankylosing spondylitis (AS). Patients should sleep on the back and avoid flexed positions. Prolonged standing and walking should be avoided. There is no need for frequent naps.

Which finding will the nurse expect when assessing a 60-year-old patient who has osteoarthritis (OA) of the left knee? a. Heberden's nodules b. Pain upon joint movement c. Redness and swelling of the knee joint d. Stiffness that increases with movement

ANS: B Initial symptoms of OA include pain with joint movement. Heberden's nodules occur on the fingers. Redness of the joint is more strongly associated with rheumatoid arthritis (RA), and stiffness in OA is worse right after the patient rests and decreases with joint movement.

A patient has systemic sclerosis manifested by CREST (calcinosis, Raynaud's phenomenon, esophageal dysfunction, sclerodactyly, telangiectasia) syndrome. Which action will the nurse include in the plan of care? a. Avoid use of capsaicin cream on hands. b. Keep patient's room warm and draft free. c. Obtain capillary blood glucose before meals. d. Assist to bathroom every 2 hours while awake.

ANS: B Keeping the room warm will decrease the incidence of Raynaud's phenomenon, one aspect of the CREST syndrome. Capsaicin cream may be used to improve circulation and decrease pain. There is no need to obtain blood glucose levels or to assist the patient to the bathroom every 2 hours.

The health care provider has prescribed the following collaborative interventions for a 49-year-old who is taking azathioprine (Imuran) for systemic lupus erythematosus. Which order will the nurse question? a. Draw anti-DNA blood titer. b. Administer varicella vaccine. c. Use naproxen (Aleve) 200 mg BID. d. Take famotidine (Pepcid) 20 mg daily.

ANS: B Live virus vaccines, such as varicella, are contraindicated in a patient taking immunosuppressive drugs. The other orders are appropriate for the patient.

A patient with gout tells the nurse that he takes losartan (Cozaar) for control of the condition. The nurse will plan to monitor a. blood glucose. b. blood pressure. c. erythrocyte count. d. lymphocyte count.

ANS: B Losartan, an angiotensin II receptor antagonist, will lower blood pressure. It does not affect blood glucose, red blood cell count (RBC), or lymphocytes.

A 22-year-old patient hospitalized with a fever and red, hot, and painful knees is suspected of having septic arthritis. Information obtained during the nursing history that indicates a risk factor for septic arthritis is that the patient a. has a parent who has reactive arthritis. b. is sexually active and has multiple partners. c. recently returned from a trip to South America. d. had several sports-related knee injuries as a teenager.

ANS: B Neisseria gonorrhoeae is the most common cause for septic arthritis in sexually active young adults. The other information does not point to any risk for septic arthritis.

After the nurse has finished teaching a patient with osteoarthritis (OA) of the left hip and knee about how to manage the OA, which patient statement indicates a need for more education? a. "I can take glucosamine to help decrease my knee pain." b. "I will take 1 g of acetaminophen (Tylenol) every 4 hours." c. "I will take a shower in the morning to help relieve stiffness." d. "I can use a cane to decrease the pressure and pain in my hip."

ANS: B No more than 4 g of acetaminophen should be taken daily to avoid liver damage. The other patient statements are correct and indicate good understanding of OA management.

When teaching a patient who has rheumatoid arthritis (RA) about how to manage activities of daily living, the nurse instructs the patient to a. stand rather than sit when performing household chores. b. avoid activities that require continuous use of the same muscles. c. strengthen small hand muscles by wringing sponges or washcloths. d. protect the knee joints by sleeping with a small pillow under the knees.

ANS: B Patients are advised to avoid repetitious movements. Sitting during household chores is recommended to decrease stress on joints. Wringing water out of sponges would increase the joint stress. Patients are encouraged to position joints in the extended position, and sleeping with a pillow behind the knees would decrease the ability of the knee to extend and also decrease knee range of motion (ROM).

The nurse obtains this information when assessing a patient who is taking hydroxychloroquine (Plaquenil) to treat rheumatoid arthritis. Which symptom is most important to report to the health care provider? a. Abdominal cramping b. Complaint of blurry vision c. Phalangeal joint tenderness d. Blood pressure 170/84 mm Hg

ANS: B Plaquenil can cause retinopathy; the medication should be stopped. The other findings are not related to the medication, although they also will be reported.

When the nurse is reviewing laboratory results for a patient with systemic lupus erythematosus (SLE), which result is most important to communicate to the health care provider? a. Decreased C-reactive protein (CRP) b. Elevated blood urea nitrogen (BUN) c. Positive antinuclear antibodies (ANA) d. Positive lupus erythematosus cell prep

ANS: B The elevated BUN and creatinine levels indicate possible lupus nephritis and a need for a change in therapy to avoid further renal damage. The positive lupus erythematosus (LE) cell prep and ANA would be expected in a patient with SLE. A drop in CRP shows an improvement in the inflammatory process.

A 35-year-old patient with three school-age children who has recently been diagnosed with rheumatoid arthritis (RA) tells the nurse that the inability to be involved in many family activities is causing stress at home. Which response by the nurse is most appropriate? a. "You may need to see a family therapist for some help." b. "Tell me more about the situations that are causing stress." c. "Perhaps it would be helpful for you and your family to get involved in a support group." d. "Your family may need some help to understand the impact of your rheumatoid arthritis."

ANS: B The initial action by the nurse should be further assessment. The other three responses might be appropriate based on the information the nurse obtains with further assessment.

A patient hospitalized with polymyositis has joint pain, an erythematosus facial rash with eyelid edema, and a weak, hoarse voice. The priority nursing diagnosis for the patient is a. acute pain related to inflammation. b. risk for aspiration related to dysphagia. c. risk for impaired skin integrity related to scratching. d. disturbed visual perception related to eyelid swelling.

ANS: B The patient's vocal weakness and hoarseness indicate weakness of the pharyngeal muscles and a high risk for aspiration. The other nursing diagnoses also are appropriate but are not as high a priority as the maintenance of the patient's airway.

When caring for a patient with a new diagnosis of rheumatoid arthritis, which action will the nurse include in the plan of care? a. Instruct the patient to purchase a soft mattress. b. Teach patient to use lukewarm water when bathing. c. Suggest that the patient take a nap in the afternoon. d. Suggest exercise with light weights several times daily.

ANS: C Adequate rest helps decrease the fatigue and pain that are associated with rheumatoid arthritis. Patients are taught to avoid stressing joints, to use warm baths to relieve stiffness, and to use a firm mattress.

Prednisone (Deltasone) is prescribed for a patient with an acute exacerbation of rheumatoid arthritis. Which laboratory result will the nurse monitor to determine whether the medication has been effective? a. Blood glucose test b. Liver function tests c. C-reactive protein level d. Serum electrolyte levels

ANS: C C-reactive protein is a marker for inflammation, and a decrease would indicate that the corticosteroid therapy was effective. Blood glucose and serum electrolyte levels also will be monitored to check for side effects of prednisone. Liver function is not routinely monitored for patients receiving steroids.

When caring for a patient who has osteoarthritis, the nurse will anticipate the need to teach the patient about which of these medications? a. Adalimumab (Humira) b. Prednisone (Deltasone) c. Capsaicin cream (Zostrix) d. Sulfasalazine (Azulfidine)

ANS: C Capsaicin cream blocks the transmission of pain impulses and is helpful for some patients in treating OA. The other medications would be used for patients with RA.

A patient with rheumatoid arthritis refuses to take the prescribed methotrexate (Rheumatrex), telling the nurse "That drug has too many side effects. My arthritis isn't that bad yet." The most appropriate response by the nurse is a. "You have the right to refuse to take the methotrexate." b. "Methotrexate is less expensive than some of the newer drugs." c. "It is important to start methotrexate early to decrease the extent of joint damage." d. "Methotrexate is effective and has fewer side effects than some of the other drugs."

ANS: C Disease-modifying antirheumatic drugs (DMARDs) are prescribed early to prevent the joint degeneration that occurs as soon as the first year with RA. The other statements are accurate, but the most important point for the patient to understand is that it is important to start DMARDs as quickly as possible.

Which of these patients seen by the nurse in the outpatient clinic is most likely to require teaching about ways to reduce risk for osteoarthritis (OA)? a. A 56-year-old man who is a member of a construction crew b. A 24-year-old man who participates in a summer softball team c. A 49-year-old woman who works on an automotive assembly line d. A 36-year-old woman who is newly diagnosed with diabetes mellitus

ANS: C OA is more likely to occur in women as a result of estrogen reduction at menopause and in individuals whose work involves repetitive movements and lifting. Moderate exercise, such as softball, reduces risk for OA. Diabetes is not a risk factor for OA. Working on a construction crew would involve nonrepetitive work and thus would not be as risky

A 26-year-old patient with urethritis and knee pain is diagnosed with reactive arthritis. The nurse will plan to teach the patient about the need for several months of therapy with a. anakinra (Kineret). b. etanercept (Enbrel). c. doxycycline (Vibramycin). d. methotrexate (Rheumatrex).

ANS: C Reactive arthritis associated with urethritis is usually caused by infection with Chlamydia trachomatis and requires 3 months of treatment with doxycycline. The other medications are used for chronic inflammatory problems such as rheumatoid arthritis.

A patient who has rheumatoid arthritis is seen in the outpatient clinic and the nurse notes that rheumatoid nodules are present on the patient's elbows. Which action will the nurse take? a. Draw blood for rheumatoid factor analysis. b. Teach the patient about injection of the nodule. c. Assess the nodules for skin breakdown or infection. d. Discuss the need for surgical removal of the nodule.

ANS: C Rheumatoid nodules can break down or become infected. They are not associated with changes in rheumatoid factor and injection is not needed. Rheumatoid nodules are usually not removed surgically because of a high probability of recurrence

To determine whether a patient with joint swelling and pain has systemic lupus erythematosus, which test will be most useful for the nurse to review? a. Rheumatoid factor (RF) b. Antinuclear antibody (ANA) c. Anti-Smith antibody (Anti-Sm) d. Lupus erythematosus (LE) cell prep

ANS: C The anti-Sm is antibody found almost exclusively in SLE. The other blood tests also are used in screening but are not as specific to SLE.

While working at a summer camp, the nurse notices a circular lesion with a red border and clear center on the arm of a patient who is in the camp clinic complaining of chills and muscle aches. Which action should the nurse take next? a. Palpate the abdomen. b. Auscultate the heart sounds. c. Ask the patient about recent outdoor activities. d. Question the patient about immunization history.

ANS: C The patient's clinical manifestations suggest possible Lyme disease. A history of recent outdoor activities such as hikes will help confirm the diagnosis. The patient's symptoms do not suggest cardiac or abdominal problems or lack of immunization.

A home health patient with rheumatoid arthritis (RA) complains to the nurse about having chronically dry eyes. Which action by the nurse is most appropriate? a. Reassure the patient that dry eyes are a common problem with RA. b. Teach the patient more about adverse affects of the RA medications. c. Suggest that the patient start using over-the-counter (OTC) artificial tears. d. Ask the health care provider about lowering the methotrexate (Rheumatrex) dose.

ANS: C The patient's dry eyes are consistent with Sjögren's syndrome, a common extraarticular manifestation of RA. Symptomatic therapy such as OTC eye drops is recommended. Dry eyes are not a side effect of methotrexate. Although dry eyes are common in RA, it is more helpful to offer a suggestion to relieve these symptoms than to offer reassurance. The dry eyes are not caused by RA treatment, but by the disease itself.

A patient with an acute attack of gout in the left great toe has a new prescription for probenecid (Benemid). Which information about the patient's home routine indicates a need for teaching regarding gout management? a. The patient sleeps about 8 to 10 hours every night. b. The patient usually eats beef once or twice a week. c. The patient generally drinks about 3 quarts of juice and water daily. d. The patient takes one aspirin a day prophylactically to prevent angina.

ANS: D Aspirin interferes with the effectiveness of probenecid and should not be taken when the patient is taking probenecid. The patient's sleep pattern will not affect gout management. Drinking 3 quarts of water and eating beef only once or twice a week are appropriate for the patient with gout.

A long-term care patient who takes multiple medications develops acute gouty arthritis. The nurse will consult with the health care provider before giving the prescribed dose of a. sertraline (Zoloft). b. famotidine (Pepcid). c. oxycodone (Roxicodone). d. hydrochlorothiazide (HydroDIURIL).

ANS: D Diuretic use increases uric acid levels and can precipitate gout attacks. The other medications are safe to administer.

The home health nurse is doing a follow-up visit to a patient with recently diagnosed rheumatoid arthritis (RA). Which assessment made by the nurse indicates that more patient teaching is needed? a. The patient requires a 2-hour midday nap. b. The patient has been taking 16 aspirins daily. c. The patient sits on a stool when preparing meals. d. The patient sleeps with two pillows under the head.

ANS: D The joints should be maintained in an extended position to avoid contractures, so patients should use a small, flat pillow for sleeping. The other information is appropriate for a patient with RA and indicates that teaching has been effective.

A patient with systemic lupus erythematosus (SLE) who has a facial rash and alopecia tells the nurse, "I hate the way I look! I never go anywhere except here to the health clinic." An appropriate nursing diagnosis for the patient is a. activity intolerance related to fatigue and inactivity. b. impaired social interaction related to lack of social skills. c. impaired skin integrity related to itching and skin sloughing. d. social isolation related to embarrassment about the effects of SLE.

ANS: D The patient's statement about not going anywhere because of hating the way he or she looks supports the diagnosis of social isolation because of embarrassment about the effects of the SLE. Activity intolerance is a possible problem for patients with SLE, but the information about this patient does not support this as a diagnosis. The rash with SLE is nonpruritic. There is no evidence of lack of social skills for this patient.

What is the priority nursing intervention used with clients taking NSAIDs?

Administer or teach clients to take drugs with food or milk.

1. Based on the nurse's understanding of the physiology of bone and cartilage, the injury that the nurse would expect to heal most rapidly is a a. fracture of the midhumerus. b. torn knee cruciate ligament. c. fractured nose. d. severely sprained ankle.

Answer: A Rationale: Bone is dynamic tissue that is continually growing. Nasal fracture, sprains, and ligament tears injure cartilage, tendons, and ligaments, which are slower to heal. Cognitive Level: Application Text Reference: p. 1615 Nursing Process: Assessment NCLEX: Physiological Integrity

1. A patient with an open fracture of the left tibia and soft tissue damage underwent a surgical reduction and fixation of the tibia with debridement of nonviable tissue and drain placement. When assessing the patient during the postoperative period, the nurse will be most concerned about a. fever with chills and night sweats. b. light yellow drainage from the wound. c. pain on movement of the affected limb. d. muscle spasms around the affected bone.

Answer: A Rationale: Fever, chills, and night sweats are suggestive of osteomyelitis. The other clinical manifestations are typical after a fracture repair. Cognitive Level: Application Text Reference: p. 1669 Nursing Process: Assessment NCLEX: Physiological Integrity

4. A patient has chronic osteomyelitis of the left femur, which is being managed at home with self-administration of IV antibiotics. On a home visit, the nurse identifies the nursing diagnosis of ineffective therapeutic regimen management when the nurse finds that the patient a. is unable to plantar-flex the foot on the affected side. b. uses crutches to avoid weight bearing on the affected leg. c. takes and records the oral temperature twice a day. d. is irritable and frustrated with the length of treatment required.

Answer: A Rationale: Footdrop is an indication that the foot is not being supported in a neutral position by a splint. Using crutches and monitoring the oral temperature are appropriate self-care activities. Frustration with the length of treatment is not an indicator of ineffective management of the osteomyelitis. Cognitive Level: Application Text Reference: p. 1672 Nursing Process: Diagnosis NCLEX: Health Promotion and Maintenance

18. When planning care for a patient who will be treated with 2 days of bed rest for low back pain, which intervention will the nurse include? a. Telling the patient about the importance of a high fiber and fluid intake b. Instructing the patient to avoid positioning the knee in the flexed position c. Educating the patient that continuous heat application will reduce pain d. Teaching the patient that the prone position will help relieve back pain

Answer: A Rationale: Prevention of constipation caused by immobility is a goal for the patient with low back pain. The knee should be flexed to prevent pressure on the muscles and support structures of the spine. Heat and cold should be alternated. The prone position places more strain on the back and should be avoided. Cognitive Level: Application Text Reference: p. 1676 Nursing Process: Planning NCLEX: Physiological Integrity

14. The nurse determines that teaching regarding diet for a patient with osteoporosis has been successful when the patient selects which of these meals as having the highest amount of calcium? a. Sardine sandwich on whole wheat bread, one cup of fruit yogurt, and one cup of skim milk b. Two-egg omelet with American cheese, one slice of whole-wheat toast, and a half grapefruit c. Ham and Swiss cheese sandwich on whole-wheat bread, steamed broccoli, and an apple d. Chicken stir-fry with bok choy, onions, and snap peas and one cup of steamed brown rice

Answer: A Rationale: Sardines, yogurt, and milk are all high in calcium. The other choices have some foods that are high in calcium but also include foods that are low in calcium, such as eggs, apples, and grapefruit. Cognitive Level: Application Text Reference: p. 1689 Nursing Process: Evaluation NCLEX: Physiological Integrity

8. A patient whose work involves loading and unloading boxes has a history of chronic back pain. Which statement after the nurse has taught the patient about correct body mechanics indicates that the teaching has been effective? a. "I plan to start doing sit-ups and leg lifts to strengthen the muscles of my back." b. "I will try to sleep with my hips and knees extended to prevent back strain." c. "I can tell my boss that I need to change to a job where I can work at a desk." d. "I will keep my back straight when I need to lift anything higher than my waist."

Answer: A Rationale: Sit-ups and leg lifts will help to strengthen the muscles that support the back. Flexion of the hips and knees places less strain on the back. Modifications in the way the patient lifts boxes are needed, but sitting for prolonged periods can aggravate back pain. The patient should not lift above the level of the elbows. Cognitive Level: Application Text Reference: p. 1677 Nursing Process: Evaluation NCLEX: Health Promotion and Maintenance

11. After teaching a patient with a bunion about how to prevent further problems, the nurse will determine that more teaching is needed if the patient says, a. "I will wear soft slippers whenever possible." b. "I will throw away my high heel shoes." c. "I will use the bunion pad to relieve the pain." d. "I will take ibuprofen (Motrin) when I need it."

Answer: A Rationale: The shank of the shoe should be rigid enough to support the foot. The other patient statements indicate that the teaching has been effective. Cognitive Level: Application Text Reference: pp. 1684-1685 Nursing Process: Evaluation NCLEX: Physiological Integrity

3. When the health care provider tells a patient that the pain in the patient's knee is caused by bursitis, the patient asks the nurse to explain just what bursitis is. The nurse's best response would be to tell the patient bursitis is an inflammation of a. the fibrocartilage that acts as a shock absorber in the knee joint. b. a small, fluid-filled sac found at many joints. c. any connective tissue that is found supporting the joints of the body. d. the synovial membrane that lines the area between two bones of a joint.

Answer: B Rationale: Bursae are fluid-filled sacs that cushion joints and bony prominences. Fibrocartilage is a solid tissue that cushions some joints. Bursae are a specific type of connective tissue. The synovial membrane lines many joints but is not a bursa. Cognitive Level: Comprehension Text Reference: p. 1618 Nursing Process: Implementation NCLEX: Physiological Integrity

2. A patient is hospitalized for initiation of regional antibiotic perfusion for acute osteomyelitis of the right femur. Which intervention will be included in the plan of care? a. Frequent weight-bearing exercise b. Immobilization of the right leg c. Avoid administration of NSAIDs d. Support right leg in a flexed position

Answer: B Rationale: Immobilization of the affected leg helps to decrease pain and reduce the risk for pathologic fractures. Weight-bearing exercise increases the risk for pathologic fractures. NSAIDs are frequently prescribed to treat pain. Flexion of the affected limb is avoided to prevent contractures. Cognitive Level: Application Text Reference: pp. 1670-1671 Nursing Process: Planning NCLEX: Physiological Integrity

5. Which statement by a patient who is scheduled for an above-the-knee amputation for treatment of an osteogenic sarcoma of the right tibia indicates that patient teaching is needed? a. "I wish that I did not have to have chemotherapy after this surgery." b. "I do not mind the surgery because it will finally cure the cancer." c. "I know that I will need lots of physical therapy after surgery." d. "I will use the patient-controlled analgesia to help control my pain level after surgery."

Answer: B Rationale: Osteogenic sarcoma is an aggressive cancer with early metastasis and is not considered cured by surgery alone. Postoperative chemotherapy will also be required. The other patient statements indicate that patient teaching has been effective. Cognitive Level: Application Text Reference: p. 1674 Nursing Process: Evaluation NCLEX: Physiological Integrity

12. A patient with kyphosis is scheduled for dual-energy x-ray absorptiometry (DEXA) testing. The nurse will plan to a. start an intravenous line. b. screen the patient for shellfish allergies. c. teach the patient that DEXA is noninvasive. d. give an oral sedative.

Answer: C Rationale: DEXA testing is painless and noninvasive. No IV access is necessary. Contrast medium is not used. Because the procedure is painless, no antianxiety medications are required. Cognitive Level: Application Text Reference: p. 1625 Nursing Process: Implementation NCLEX: Physiological Integrity

19. Which of these nursing actions included in the care of a patient after laminectomy can the nurse delegate to an experienced nursing assistant? a. Evaluation of the effectiveness of the PCA b. Monitoring plantar and dorsiflexion of the feet c. Logrolling the patient from side to side every 2 hours d. Determining the patient's readiness to ambulate

Answer: C Rationale: Repositioning a patient is included in the education and scope of practice of nursing assistants, and an experienced nursing assistant would be familiar with logrolling. Evaluation of the effectiveness of pain medications, assessment of neurologic function, and evaluation of a patient's readiness to ambulate after surgery require higher-level nursing education and scope of practice. Cognitive Level: Application Text Reference: pp. 1683-1684 Nursing Process: Planning NCLEX: Safe and Effective Care Environment

7. The nurse identifies a nursing diagnosis of pain related to muscle spasms for a patient with acute low back pain associated with acute lumbosacral strain. An appropriate nursing intervention for this problem is to teach the patient to a. twist gently from side to side to maintain range-of-motion in the spine. b. place a small pillow under the upper back to flex the lumbar spine gently. c. keep the head elevated slightly and flex the knees when resting in bed. d. avoid the use of cold because it will exacerbate the muscle spasms.

Answer: C Rationale: Resting with the head elevated and knees flexed will reduce the strain on the back and decrease muscle spasms. Twisting from side to side will increase tension on the lumbar area. A pillow placed under the upper back will cause strain on the lumbar spine. Alternate application of cold and heat should be used to decrease pain. Cognitive Level: Application Text Reference: pp. 1676-1677 Nursing Process: Planning NCLEX: Physiological Integrity

3. A patient is being discharged after 2 weeks of IV antibiotic therapy for acute osteomyelitis in the left leg. Which information will be included in the discharge teaching? a. The reason for taking oral antibiotics for 7 to 10 days after discharge b. The need for daily aerobic exercise to help maintain muscle strength c. How to monitor and care for the long-term IV catheter site d. How to apply warm packs safely to the leg to reduce pain

Answer: C Rationale: The patient will be on IV antibiotics for several months, and the patient will need to recognize signs of infection at the IV site and how to care for the catheter during daily activities such as bathing. IV antibiotics rather than oral antibiotics are used for acute osteomyelitis. Patients are instructed to avoid exercise and heat application because these will increase swelling and the risk for spreading infection. Cognitive Level: Application Text Reference: p. 1670 Nursing Process: Implementation NCLEX: Physiological Integrity

9. When assessing the musculoskeletal system, the nurse's initial action will usually be to a. have the patient move the extremities against resistance. b. feel for the presence of crepitus during joint movement. c. observe the patient's body build and muscle configuration. d. check active and passive range of motion for the extremities.

Answer: C Rationale: The usual technique in the physical assessment is to begin with inspection. Abnormalities in muscle mass or configuration will allow the nurse to perform a more focused assessment of abnormal areas. The other assessments are also included in the assessment but are usually done after inspection. Cognitive Level: Comprehension Text Reference: p. 1621 Nursing Process: Assessment NCLEX: Health Promotion and Maintenance

11. A patient suffers an injury to the shoulder while playing football. To identify abnormalities of cartilage and soft tissue surrounding the joint, the nurse would expect the patient to be evaluated with a. radioisotope bone scanning. b. arthroscopy. c. standard x-rays. d. magnetic resonance imaging (MRI).

Answer: D Rationale: MRI is most useful in assessing for soft tissue injuries. Bone scanning and standard radiographs are used to assess for injures or lesions of bone. Arthroscopy is used for visualizing the joints. Cognitive Level: Comprehension Text Reference: p. 1625 Nursing Process: Assessment NCLEX: Physiological Integrity

6. A 20-year-old patient with a 6-year history of muscular dystrophy is hospitalized with a respiratory tract infection. Which nursing action will be included in the plan of care? a. Logroll the patient every 1 to 2 hours. b. Teach the patient about the muscle biopsy procedure. c. Provide the patient with a pureed diet. d. Assist the patient with active range-of-motion (ROM) exercises.

Answer: D Rationale: The goal for the patient with muscular dystrophy is to keep the patient active for as long as possible. The patient would not be confined to bed rest and would not require logrolling. Muscle biopsies are necessary to confirm the diagnosis but would not be ordered for a patient who already had a diagnosis. There is no indication that the patient requires a pureed diet. Cognitive Level: Application Text Reference: p. 1675 Nursing Process: Planning NCLEX: Physiological Integrity

Which statement by the client regarding lifestyle changes to prevent osteoporosis indicates a need for further teaching by the nurse? A. "I need to eat more green, leafy veggies and dairy." B. "I will cut down the amount of wine I drink each night." C. "I plan to begin smoking cessation classes at the hospital." D. "I am going to want to work out 3 days/week at the gym."

B

A nurse is performing a musculoskeletal assessment on an older adult. What physiologic changes of aging will the nurse expect? (select all) A. scoliosis B. Muscle Atrophy C. Slowed Movement D. Rheumatoid Arthritis E. Antalgic gait

B,C

A client has a new synthetic arm cast for a radial fracture. What health care teaching does the nurse include for the clients home care? (Select all) A. "Apply heat on the cast for the first 24 hours to increase blood flow for healing." B. "keep your arm elevated, preferably above your heart, as much as possible." C. "Report severe numbness or inability to move your fingers to your physician." D. "Don't cover the cast with anything because it will stay wet for 24 hours."

B,C,D

Which assessment findings will the nurse expect for the client with late stage rheumatoid arthritis (select all) A. Heberdens nodes B. High erythrocyte sedimentation values C. Positive antinuclear antibody titer D. Subcutaneous nodules E. Anemia F. Red, swollen joints

B,C,D,E,F

An older woman had a left total hip arthroplasty yesterday afternoon mom which precautions will the nurse teach before helping the client transfer from the bed to the chair? (Select all) A. "Stand on your left leg and pivot to the chair. " B. "Do not hyper flex your hips when sitting." C. "Cross your legs to be more comfortable." D. "Avoid twisting your body when moving." E. "Use your cane to help move into the chair. "

B,D,E

The home care nurse visits an 84-year-old woman with pneumonia after her discharge from the hospital. Which assessment finding would the nurse expect because of age-related changes in the musculoskeletal system? A. Positive straight-leg-raising test B. Muscle strength is scale grade 3/5 C. Lateral S-shaped curvature of the spine D. Fingers drift to the ulnar side of the forearm

B. Muscle strength is scale grade 3/5 Decreased muscle strength is an age-related change of the musculoskeletal system caused by decreased number and size of the muscle cells. The other assessment findings indicate musculoskeletal abnormalities. A positive straight-leg-raising test indicates nerve root irritation from intervertebral disk prolapse and herniation. An ulnar deviation or drift indicates rheumatoid arthritis due to tendon contracture. Scoliosis is a lateral curvature of the spine.

In reviewing bone remodeling, what should the nurse know about the involvement of bone cells? A. Osteoclasts add canaliculi. B. Osteoblasts deposit new bone. C. Osteocytes are mature bone cells. D. Osteons create a dense bone structure.

B. Osteoblasts deposit new bone. Bone remodeling is achieved when osteoclasts remove old bone and osteoblasts deposit new bone. Osteocytes are mature bone cells, and osteons or Haversian systems create a dense bone structure, but these are not involved with bone remodeling.

Describe nursing care for the client who is experiencing phantom pain after amputation.

Be aware that phantom pain is real and will eventually disappear. Administer pain medication; phantom pain responds to medication.

The nurse is concerned that a client who had an open reduction, internal fixation of his tibia and fibula 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) A. Dull, aching pain B. Decrease in sweating C. Muscle spasms D. Skin discoloration E. paresis F. Edema

C,D,E,F

A 54-year-old patient admitted with cellulitis and probable osteomyelitis received an injection of radioisotope at 9:00 AM before a bone scan. The nurse should plan to send the patient for the bone scan at what time? A. 9:30 PM B. 10:00 AM C. 11:00 AM D. 1:00 PM

C. 11:00 AM A technician usually administers a calculated dose of a radioisotope 2 hours before a bone scan. If the patient was injected at 9:00 AM, the procedure should be done at 11:00 AM. 10:00 AM would be too early; 1:00 PM and 9:30 PM would be too late.

A 63-year-old woman has been taking prednisone (Deltasone) daily for several years after a kidney transplant to prevent organ rejection. What is most important for the nurse to assess? A. Staggering gait B. Ruptured tendon C. Back or neck pain D. Tardive dyskinesia

C. Back or neck pain Osteoporosis with resultant fractures is a frequent and serious complication of systemic corticosteroid therapy. The ribs and vertebrae are affected the most, and patients should be observed for signs of compression fractures (back and neck pain). Phenytoin (Dilantin) is an antiseizure medication. An adverse effect of phenytoin is an ataxic (or staggering) gait. A rare adverse effect of ciprofloxacin (Cipro) and other fluoroquinolones is tendon rupture, usually of the Achilles tendon. The highest risk is in people age 60 and older and in people taking corticosteroids. Antipsychotics and antidepressants may cause tardive dyskinesia, which is characterized by involuntary movements of the tongue and face.

Calcium Administration

Calcium and Vitamin D are essential for bone strength. Calcium absorption is IMPAIRED if taken in excess so it needs to be divided in less than 500 mg per dose.

The nurse is caring for the client who has had skeletal traction applied to the left leg. The client is complaining of severe left leg pain. Which action should the nurse take first? 1. Provide pin care 2. Call the health care provider (HCP) 3. Check the clients alignment in bed 4. Medicate the client with an analgesic

Check the clients alignment in bed

A client has been taking indomethacin (Indocin) for gout and experiencing side/adverse effects. Which assessment should the nurse expect the health care provider to prescribe?

Checking for occult blood

A 20-year-old baseball pitcher has an arthroscopic repair of a rotator cuff injury performed in same-day surgery. When the nurse plans postoperative teaching for the patient, which information will be included? a. "You have an appointment with a physical therapist for tomorrow." b. "Leave the shoulder immobilizer on for the first few days to minimize pain." c. "The doctor will use the drop-arm test to determine the success of the procedure." d. "You should try to find a different position to play on the baseball team."

Correct Answer: A Rationale: Physical therapy after a rotator cuff repair begins on the first postoperative day to prevent "frozen shoulder." A shoulder immobilizer is used immediately after the surgery, but leaving the arm immobilized for several days would lead to loss of ROM. The drop-arm test is used to test for rotator cuff injury, but not after surgery. The patient may be able to return to pitching after rehabilitation.

9. A patient with a fractured radius asks when the cast can be removed. The nurse will instruct the patient that the cast can be removed only after the bone a. is strong enough to stand mild stress. b. union is complete on the x-ray. c. fragments are fully fused. d. healing has started.

Correct Answer: A Rationale: The cast may be removed when callus ossification has occurred. It is not necessary to wait until radiologic union or complete bone fusion occurs. Bone healing starts immediately after the injury, but the cast will need to be worn at least 3 weeks.

7. A 22-year-old patient started an exercise regimen 2 months ago that includes running 3 to 4 miles a day. The patient tells the nurse, "I enjoy my daily runs, but now I have shin splints." Which response by the nurse is appropriate? a. "You may be increasing your running time too quickly and need to cut back a little bit." b. "You need to have x-rays of your lower legs to be sure you do not have stress fractures." c. "You should expect some leg pain while running." d. "You should try speed-walking rather than running."

Correct Answer: A Rationale: The patient's information about running 3 to 4 miles daily after starting an exercise program only 2 months previously suggests that the shin splints are caused by overuse. Radiographs are not indicated for the type of injury described by the patient. Shin splints are not a normal or expected response to running. Because the patient expresses enjoyment of running, it would not be appropriate for the nurse to suggest a different sport. Cognitive Level: Application Text Reference: p. 1630 Nursing Process: Implementation NCLEX: Physiological Integrity

13. Following the application of a hip spica cast for a patient with a fracture of the proximal third of the left femur, an appropriate nursing intervention is to a. use the cast support bar to reposition the patient every 2 to 3 hours. b. ask the patient about any abdominal discomfort or nausea. c. discuss the reasons for remaining on bed rest for several weeks. d. promote drying of the cast by placing the patient in a prone position every 4 hours.

Correct Answer: B Rationale: Assessment of bowel tones, abdominal pain, and nausea and vomiting will detect the development of cast syndrome. To avoid breakage, the support bar should not be used for repositioning. After the cast dries, the patient can begin ambulating with the assistance of physical therapy personnel. The patient should not be placed in the prone position until the cast has dried to avoid breaking the cast. Cognitive Level: Application Text Reference: p. 1640 Nursing Process: Implementation NCLEX: Physiological Integrity

A patient arrives in the emergency department with ankle swelling and severe pain after twisting the ankle playing soccer. All of the following orders are written by the health care provider. Which one will the nurse act on first? a. Administer naproxen (Naprosyn) 500 mg PO. b. Wrap the ankle and apply an ice pack. c. Give acetaminophen with codeine (Tylenol #3). d. Take the patient to the radiology department for x-rays.

Correct Answer: B Rationale: Immediate care after a sprain or strain injury includes the application of cold and compression to the injury to minimize swelling. The other actions should be taken after the ankle is wrapped with a compression bandage and ice is applied. Cognitive Level: Application Text Reference: p. 1631 Nursing Process: Implementation NCLEX: Physiological Integrity

Following x-rays of an injured wrist, the patient is informed that it is badly sprained. In teaching the patient to care for the injury, the nurse tells the patient to a. apply a heating pad to reduce muscle spasms. b. wear an elastic compression bandage continuously. c. use pillows to keep the arm elevated above the heart. d. gently exercise the joint to prevent muscle shortening.

Correct Answer: C Rationale: Elevation of the arm will reduce the amount of swelling and pain. For the first 24 to 48 hours, cold packs are used to reduce swelling. Compression bandages are not left on continuously. The wrist should be rested and kept immobile to prevent further swelling or injury.

A patient is admitted to the emergency department with possible fractures of the bones of the left lower extremity. The initial action by the nurse should be to a. splint the lower leg. b. elevate the left leg. c. check the popliteal, dorsalis pedis, and posterior tibial pulses. d. obtain information about the patient's tetanus immunization status.

Correct Answer: C Rationale: The initial nursing action should be assessment of the neurovascular status of the injured leg. After assessment, the nurse may need to splint and elevate the leg, based on the assessment data. Information about tetanus immunizations should be done if there is an open wound. Cognitive Level: Application Text Reference: p. 1642 Nursing Process: Assessment NCLEX: Physiological Integrity

3. A checkout clerk in a grocery store has muscle and tendon tears that have become inflamed, causing pain and weakness in the left hand and elbow. The nurse identifies these symptoms as related to a. muscle spasms. b. meniscus injury. c. repetitive strain injury. d. carpal tunnel syndrome.

Correct Answer: C Rationale: The patient's occupation and the inflammation, pain, and weakness in the elbow and hand suggest a repetitive strain injury. Muscle spasms would be characterized by a palpable, firm muscle mass during the spasm. Meniscus injury would affect the knee. Carpal tunnel syndrome is characterized by weakness and numbness of the hand.

12. Following a motor-vehicle accident, a patient arrives in the emergency department with massive right lower-leg swelling. Which action will the nurse take first? a. Elevate the leg on pillows. b. Apply a compression bandage. c. Place ice packs on the lower leg. d. Check leg pulses and sensation.

Correct Answer: D Rationale: The initial action by the nurse will be to assess the circulation to the leg and to observe for any evidence of injury such as fractures or dislocations. After the initial assessment, the other actions may be appropriate based on what is observed during the assessment.

A client is starting on alendronate (Fosamax) for prevention of osteoporosis. What precaution will the nurse include in the clients health teaching about this drug? A. "Take food or milk to prevent stomach upset." B. "Monitor the drug injection site for redness or itching." C. "Take the drug at night before you go to bed." D. "Do not lie down for at least 30 minutes after the drug."

D

An 82-year-old patient is frustrated by her flabby belly and rigid hips. What should the nurse tell the patient about these frustrations? A. "You should go on a diet and exercise more to feel better about yourself." B. "Something must be wrong with you because you should not have these problems." C. "You have arthritis and need to go on nonsteroidal antiinflammatory drugs (NSAIDs)." D. "Decreased muscle mass and strength and increased hip rigidity are normal changes of aging."

D. "Decreased muscle mass and strength and increased hip rigidity are normal changes of aging." The musculoskeletal system's normal changes of aging include decreased muscle mass and strength; increased rigidity in the hips, neck, shoulders, back, and knees; decreased fine motor dexterity; and slowed reaction times. Going on a diet and exercising will help but not stop these changes. Telling the patient "Something must be wrong with you..." will not be helpful to the patient's frustrations.

A 54-year-old patient is about to have a bone scan. In teaching the patient about this procedure, the nurse should include what information? A. Two additional follow-up scans will be required. B. There will be only mild pain associated with the procedure. C. The procedure takes approximately 15 to 30 minutes to complete. D. The patient will be asked to drink increased fluids after the procedure.

D. The patient will be asked to drink increased fluids after the procedure. Patients are asked to drink increased fluids after a bone scan to aid in excretion of the radioisotope, if not contraindicated by another condition. No follow-up scans and no pain are associated with bone scans that take 1 hour of lying supine.

The nurse is caring for a client with Paget's disease of the bone. The nurse understands that the client is receiving calcitonin (Cibacalcin) to produce which effect?

Decrease bone reabsorption.

Baclofen (Lioresal) is prescribed for the client with multiple sclerosis. The nurse evaluates that the medication is having the intended effect if which finding is noted in the client?

Decreased muscle spasms

A client has a new medication prescription for allopurinol (Zyloprim). A practical nursing student co-assigned with the licensed practical nurse (LPN) states, "I know this is for gout, but how does it work?" In formulating a response, the LPN includes that allopurinol works in which manner?

Decreases uric acid production

A client with a history of spinal cord injury is beginning medication therapy with baclofen (Lioresal). The nurse who is providing medication information should caution the client about which side effect of this medication?

Drowsiness

Common Manifestations of hip fractures

Ecchymosis and tenderness over the thigh and hip due to bleeding. Groin and hip pain with weight bearing Muscle spasm in the injured area - occurs as the muscles surrounding the fracture contract to try to protect and stabilize the injured area Shortening of extremity EXTERNALLY ROTATED

Describe postoperative residual limb (stump) care (after amputation) for the first 48 hours.

Elevate residua limb for first 24 hours. Do not elevate residual limb after 48 hours. Keep residual limb in extended position, and turn client to prone position three times a day to prevent flexion contractions.

The nurse is assigned to care for a client with multiple traumas who is admitted to the hospital. The client has a leg fracture, and a plaster cast has been applied. In positioning the casted leg, the nurse should perform which intervention? 1. Keep the leg in a level position 2. Elevate the leg for 3 hours, and put it flat for 1 hour 3. Keep the leg level for 3 hours, and elevate for 1 hour 4. Elevate the leg on pillows continuously for 24 to 48 hours

Elevate the leg on pillows continuously for 24 to 48 hours

Crutch Paralysis

Excessive and prolonged pressure on the axilla can cause damage to the RADIAL NERVE at the axilla. This manifests as muscle weakness of the arm, wrist, and hand. Main culprit is crutches that are too long and patients supporting body weight in axillae.

What are the common side effects of salicylates?

GI irritation, tinnitus, thrombocytopenia, mild liver enzyme elevation

List three of the most common joints that are replaced.

Hip, knee, finger

The nurse witnesses a client sustain a fall and suspects that the clients leg may be fractured. Which action is the priority? 1. Take a set of vital signs 2. Call the radiology department 3. Immobilize the leg before moving the client 4. Reassure the client that everything will be fine

Immobilize the leg before moving the client

The biggest concern in wound healing

Infection

Tumor Necrosis Factor Inhibitors (3)

Infliximab Adalimumab Etanercept Suppress the inflammatory response in autoimmune diseases such as Rheumatoid Arthritis, Crohn's and psoriasis. Due to immunosuppression clients are at risk for infection. A patient with a current, recent, or chronic infection SHOULD NOT take.

The nurse is preparing a list of cast care instructions for a client who just had a plaster cast applied to his right forearm. Which instructions should the nurse include on the list? Select all that apply. 1. Keep the cast and extremity elevated 2. The cast needs to be kept clean and dry 3. Allow the wet cast 24 to 72 hours to dry 4. Expect tingling and numbness in the extremity 5. Use a hair dryer set on a warm to hot setting to dry the cast 6. Use a soft padded object that will fit under the cast to scratch the skin under the cast

Keep the cast and extremity elevated, the cast needs to be kept clean and dry, and allow the wet cast 24 to 48 hours to dry

Allopurinol

Medication given for prevention of gout. It can take several months to become effective. Gout is the buildup of uric acid deposited in the joints that causes pain and inflammation. Should take with a glass of water and increase daily fluid intake to prevent kidney stones. Can also take with food or following a meal ANY RASH SHOULD BE REPORTED IMMEDIATELY AND CLIENT STOPS MEDICATION. Can lead to steven johnsons syndrome (Super anaphlyaxis)

The nurse is evaluating the clients use of a cane for left-sided weakness. The nurse should intervene and correct the client if the nurse observed that the client performed which action? 1. Holds the cane to the right side 2. Moves the cane when the right leg is moved 3. Leans on the cane when the right leg swings through 4. Keeps the cane 6 inches out to the side of the right foot

Moves the cane when the right leg is moved

Identify the categories of drugs commonly used to treat arthritis.

NSAIDs, of which salicylates are the cornerstone of treatment, and corticosteroids (used when arthritic symptoms are severe).

Methotrexate

Nonbiologic Disease-modifying antirheumatic drug used for RHEUMATOID ARTHRITIS. Adverse effects include bone marrow suppression, hepatotoxicity, and GI irritation Bone marrow suppression can lead to anemia, leukopenia, and thrombocytopenia. Anemia leads to fatigue, dyspnea on EXERTION, and pallor. Leukopenia increases risk for infection Thrombocytopenia presents as petechiae, purpura, or bleeding. Stomatitis (Inflammation of the mouth, oral ulcers) is a common side effect

What are the immediate nursing actions if fat embolization is suspected in a client with a fracture or other orthopedic condition?

Notify physician state, draw blood gases, administer O2 according to blood gas results, assist with endotracheal intubation and treatment of respiratory failure

Joint dislocation

Orthopedic EMERGENCY due to the possibility of severe complications. Acute pain, joint deformity, decreased R.O.M and extremity numbness (paresthesia) When the joint is dislocated, the articular tissues, blood vessels and nerves are often stretched and torn. Ischemia from disruption in blood supply may threaten the limb.

Carpal tunnel

Pain and paresthesia over the first 3.5 fingers.

List three nursing interventions for the prevention of thromboembolism in immobilized clients with musculoskeletal problems.

Passive ROM exercises; elastic stockings; elevation of foot of bed 25 degrees to increase venous return

What measures should the nurse encourage female clients to take to prevent osteoporosis?

Possible estrogen replacement after menopause, high calcium and vitamin D intake beginning in early adulthood, calcium supplements after menopause, and weight-bearing exercise

A client with a hip fracture asks the nurse why Buck's extension traction is being applied before surgery. The nurses response is based on the understanding that Buck's extension traction has which primary function? 1. Allows bony healing to begin before surgery 2. Provides rigid immobilization of the fracture site 3. Lengthens the fractured leg to prevent severing of blood vessels 4. Provides comfort by reducing muscle spasms and provides fracture immobilization

Provides comfort by reducing muscle spasms and provides fracture immobilization

Differentiate between rheumatoid arthritis and OA in terms of joint involvement.

Rheumatoid arthritis occurs bilaterally. OA occurs asymmetrically.

A licensed practical nurse (LPN) is told that baclofen (Lioresal) is prescribed for an assigned client. The LPN questions the registered nurse about the health care provider's prescription if which condition is noted on the client problem list?

Seizure disorder

The nurse is evaluating the pin sites of a client in skeletal traction. The nurse would be least concerned with which finding? 1. Inflammation 2. Serous drainage 3. Pain at a pin site 4. Purulent drainage

Serous drainage

The nurse is evaluating the pin sites of a client in skeletal traction. The nurse would be least concerned with which finding?

Skeletal traction involves placing a pin, wire, or screw in the fractured bone

The nurse has conducted teaching with a client in an arm cast about the signs and symptoms of compartment syndrome.

The nurse determines that the client understands the information if the client states that he or she should report which early symptom of compartment syndrome?

A client has sustained a closed fracture and has just had a cast applied to the affected arm. The client is complaining of intense pain.

The nurse elevates the limb, applies an ice bag, and administers an analgesic, with little relief. Which problem may be causing this pain?

A client being measured for crutches asks the nurse why the crutches cannot rest up underneath the arm for extra support.

The nurse responds knowing that which would most likely result from this improper crutch measurement?

The nurse is caring for a client with a diagnosis of gout. Which laboratory value should the nurse expect to note in the client?

Uric acid level of 8 mg/dL

Boston Brace, Wilmington Brace, Milwaukee brace

Used to diminish the progression of deformed spinal curves in scoliosis. Braces DO NOT CURE but prevent further worsening. Patients should wear cotton t-shirt under the brace to decrease skin irritation and absorb sweat. The use of lotion or powder can cause skin irritation due to heat buildup under the brace. The exact course of treatment varies but braces are worn for 18-23 hours and taken off during bathing and exercise. NEVER SHOWER WITH BRACE.

List three problems associated with immobility.

Venous thrombosis, urinary calculi, skin integrity problems

A client with osteoarthritis is receiving diclofenac sodium (Voltaren). The licensed practical nurse (LPN) reviewing the client's medication prescription sheet should verify the prescription with the registered nurse (RN) if which other medication is listed?

Warfarin (Coumadin)

Rheumatoid Arthritis Morning Routine

Warm shower or bath immediately after getting out of bed Perform range of motion exercises Eat a balanced breakfast Take NSAID medication

The nurse is caring for a client who had an above knee amputation 2 days ago. The residual limb was wrapped with an elastic compression bandage, which has come off.

Which immediate action should the nurse take?

The nurse is admitting a client with multiple trauma to the nursing unit. The client has a leg fracture and had a plaster cast applied.

Which position would be best for the casted leg?

The increased risk for falls in the older adult is most likely due to a.changes in balance. b.decrease in bone mass. c.loss of ligament elasticity. d.erosion of articular cartilage.

a.changes in balance Aging can cause changes in a person's sense of balance, making the person unsteady, and proprioception may be altered. The risk for falls also increases in older adults partly because of a loss of strength.

A patient with tendonitis asks what the tendon does. The nurse's response is based on the knowledge that tendons a.connect bone to muscle. b.provide strength to muscle. c.lubricate joints with synovial fluid. d.relieve friction between moving parts.

a.connect bone to muscle Tendons are composed of dense, fibrous connective tissue that contains bundles of closely packed collagen fibers arranged in the same plane for additional strength. They connect the muscle sheath to adjacent bone.

While performing passive range of motion for a patient, the nurse puts the ankle joint through the movements of (select all that apply) a.flexion and extension. b.inversion and eversion. c.pronation and supination d.flexion, extension, abduction, and adduction. e.pronation, supination, rotation, and circumduction.

a.flexion and extension. b.inversion and eversion. Common movements that occur at the ankle include inversion, eversion, flexion, and extension.

A normal assessment finding of the musculoskeletal system is a.no deformity or crepitation. b.muscle and bone strength of 4. c.ulnar deviation and subluxation. d.angulation of bone toward midline.

a.no deformity or crepitation Normal physical assessment findings of the musculoskeletal system include normal spinal curvatures; no muscle atrophy or asymmetry; no joint swelling, deformity, or crepitation; no tenderness on palpation of muscles and joints; full range of motion of all joints without pain or laxity; and muscle strength score of 5.

A patient is scheduled for an electromyogram (EMG). The nurse explains that this diagnostic test involves a.incision or puncture of the joint capsule. b.insertion of small needles into certain muscles. c.administration of a radioisotope before the procedure. d.placement of skin electrodes to record muscle activity.

b.insertion of small needles into certain muscles Electromyography (EMG) is an evaluation of electrical potential associated with skeletal muscle contraction. Small-gauge needles are inserted into certain muscles and attached to leads that record electrical activity of muscle. Results provide information related to lower motor neuron dysfunction and primary muscle disease

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.hypertension. b.thyroid problems. c.diabetes mellitus. d.chronic bronchitis.

c.diabetes mellitus The nurse should question the patient about past medical problems because certain illnesses are known to affect the musculoskeletal system directly or indirectly. These diseases include tuberculosis, poliomyelitis, diabetes mellitus, parathyroid problems, hemophilia, rickets, soft tissue infection, and neuromuscular disabilities.

The bone cells that function in the resorption of bone tissue are called a.osteoids b.osteocytes c.osteoclasts d.osteoblasts

c.osteoclasts Osteoclasts participate in bone remodeling by assisting in the breakdown of bone tissue.

When grading muscle strength, the nurse records a score of 3, which indicates a.no detection of muscular contraction. b.a barely detectable flicker of contraction. c.active movement against full resistance without fatigue. d.active movement against gravity but not against resistance.

d. active movement against gravity but not against resistance Muscle strength score of 3 indicates active movement only against gravity and not against resistance

To prevent muscle atrophy, the nurse teaches the patient with a leg immobilized in traction to perform (select all that apply) a.flexion contractions. b.tetanic contractions. c.isotonic contractions. d.isometric contractions. e.extension contractions.

d.isometric contractions Isometric contractions increase the tension within a muscle but do not produce movement. Repeated isometric contractions make muscles grow larger and stronger. Muscular atrophy (i.e., decrease in size) occurs with the absence of contraction that results from immobility.

Ankylosing Spondilitis

inflammatory disease of the spine that has no cause or cure. Stiffness and fusion of the axial joints that lead to restricted spinal mobility. Low back pain and morning stiffness that improve with activity are classic findings. Client with AS should: Promote extension of the spine with proper posture, daily stretching, and swimming/racquet sports Stop smoking and practice breathing to increase chest expansion Manage pain with MOIST HEAT and NSAIDs Take immunosuppressant and anti-infalmmatory meds Sleep on a firm mattress to prevent spinal flexion and deformity

1. Bed rest 2. Bending or lifting 3. Application of heat 4. Ibuprofen (Motrin IB)

2. Bending or lifting

After teaching a patient diagnosed with progressive systemic sclerosis about health maintenance activities, the nurse determines that additional instruction is needed when the patient says, a. "I should lie down for an hour after meals." b. "Paraffin baths can be used to help my hands." c. "Lotions will help if I rub them in for a long time." d. "I should perform range-of-motion exercises daily."

ANS: A Because of the esophageal scarring, patients should sit up for 2 hours after eating. The other patient statements are correct and indicate that the teaching has been effective.

A female patient with a long-standing history of rheumatoid arthritis has sought care because of increasing stiffness in her right knee that has culminated in complete fixation of the joint. The nurse would document the presence of which problem? a. Atrophy b. Ankylosis c. Crepitation d. Contracture

B Ankylosis is stiffness or fixation of a joint, whereas contracture is reduced movement as a consequence of fibrosis of soft tissue (muscles, ligaments, or tendons). Atrophy is a flabby appearance of muscle leading to decreased function and tone. Crepitation is a grating or crackling sound that accompanies movement.

A 42-year-old man who is scheduled for an arthrocentesis arrives at the outpatient surgery unit and states, "I do not want this procedure done today." Which response by the nurse is most appropriate? A. "When would you like to reschedule the procedure?" B. "Tell me what your concerns are about this procedure." C. "The procedure is safe, so why should you be worried?" D. "The procedure is not painful because an anesthetic is used."

B. "Tell me what your concerns are about this procedure." The nurse should use therapeutic communication to determine the patient's concern about the procedure. The nurse should not provide false reassurance. It is not appropriate for the nurse to assume the patient is concerned about pain or to assume the patient is asking to reschedule the procedure.

A 57-year-old postmenopausal woman is scheduled for dual-energy x-ray absorptiometry (DXA). Which statement, if made by the patient to the nurse, indicates understanding of the procedure? A. "The bone density in my heel will be measured." B. "This procedure will not cause any pain or discomfort." C. "I will not be exposed to any radiation during the procedure." D. "I will need to remove my hearing aids before the procedure."

B. "This procedure will not cause any pain or discomfort." Dual-energy x-ray absorptiometry (DXA) is painless and measures the bone mass of spine, femur, forearm, and total body with minimal radiation exposure. A quantitative ultrasound (QUS) evaluates density, elasticity, and strength of bone using ultrasound of the calcaneus (heel). Magnetic resonance imaging would require removal of objects such as hearing aids that have metal parts.

A 54-year-old patient is about to have a bone scan. In teaching the patient about this procedure, the nurse should include what information? a. Two additional follow-up scans will be required. b. There will be only mild pain associated with the procedure. c. The procedure takes approximately 15 to 30 minutes to complete. d. The patient will be asked to drink increased fluids after the procedure.

D Patients are asked to drink increased fluids after a bone scan to aid in excretion of the radioisotope, if not contraindicated by another condition. No follow-up scans and no pain are associated with bone scans that take 1 hour of lying supine.

An 82-year-old patient is frustrated by her flabby belly and rigid hips. What should the nurse tell the patient about these frustrations? a. "You should go on a diet and exercise more to feel better about yourself." b. "Something must be wrong with you because you should not have these problems." c. "You have arthritis and need to go on nonsteroidal antiinflammatory drugs (NSAIDs)." d. "Decreased muscle mass and strength and increased hip rigidity are normal changes of aging."

D The musculoskeletal system's normal changes of aging include decreased muscle mass and strength; increased rigidity in the hips, neck, shoulders, back, and knees; decreased fine motor dexterity; and slowed reaction times. Going on a diet and exercising will help but not stop these changes. Telling the patient "Something must be wrong with you..." will not be helpful to the patient's frustrations.

A nurse is preparing a list of cast care instructions for a client who just had a plaster cast applied to his right forearm. Which instructions should the nurse include on the list? Select all that apply. 1. Keep the cast and extremity elevated. 2. The cast needs to be kept clean and dry. 3. Allow the wet cast 24 to 72 hours to dry. 4. Expect tingling and numbness in the extremity. 5. Use a hair dryer set on a warm to hot setting to dry the cast. 6. Use a soft padded object that will fit under the cast to scratch the skin under the cast.

1. Keep the cast and extremity elevated. 2. The cast needs to be kept clean and dry. 3. Allow the wet cast 24 to 72 hours to dry.

A nurse in the emergency department is caring for a client with a fractured arm. The nurse understands that which item is not necessary before reduction of the fracture in the casting room? 1. Anesthesia consent 2. Consent for the procedure 3. Administration of an analgesic 4. Explanation of the procedure to the client

1. Anesthesia consent

A client is being discharged home after application of a plaster leg cast. The nurse determines that the client understands proper care of the cast if the client states to: 1. Avoid getting the cast wet. 2. Cover the casted leg with warm blankets. 3. Use the fingertips to lift and move the leg. 4. Use a padded coat hanger end to scratch under the cast.

1. Avoid getting the cast wet.

A nurse is caring for a client who had a total knee replacement. Postoperatively, the nurse monitors for which highest priority item? 1. Calf pain 2. Heel breakdown 3. Bladder distention 4. Extremity shortening

1. Calf pain

A nurse is caring for a client following total hip replacement who has a Hemovac wound suction drain in place. At the end of the 8-hour shift, the nurse empties 45 mL of drainage from the wound-suction device. Based on this amount of drainage, which action is appropriate? 1. Document the findings. 2. Place the leg in a flat position. 3. Check the client's blood pressure. 4. Immediately notify the health care provider.

1. Document the findings.

A nurse is caring for a client with fresh application of a plaster leg cast. The nurse plans to prevent the development of compartment syndrome by: 1. Elevating the limb and applying ice to the affected leg 2. Elevating the limb and covering the limb with bath blankets 3. Keeping the leg horizontal and applying ice to the affected leg 4. Placing the leg in a slightly dependent position and applying ice

1. Elevating the limb and applying ice to the affected leg

A client with right-sided weakness needs to learn how to use a cane. The nurse plans to teach the client to position the cane by holding it with the: 1. Left hand, and 6 inches lateral to the left foot 2. Right hand, and 6 inches lateral to the right foot 3. Left hand, and placing the cane in front of the left foot 4. Right hand, and placing the cane in front of the right foot

1. Left hand, and 6 inches lateral to the left foot

A nurse is caring for a client who was admitted to the hospital with a fractured right femur sustained from a fall 5 hours ago. The client's plan of care includes interventions related to monitoring for signs of fat embolism. The nurse provides appropriate care by: 1. Monitoring for signs of dyspnea 2. Monitoring the client's temperature regularly 3. Maintaining external rotation of the right leg 4. Educating the client to report paresthesia of the right lower leg

1. Monitoring for signs of dyspnea

A client with a herniated intervertebral lumbar disk complains of a knifelike, stabbing pain in the lower back, as well as pain radiating into the right buttock. The nurse interprets that the sharp, stabbing pain is probably a result of: 1. Muscle spasm in the area of the herniated disk 2. Pressure on the spinal cord 3. Pressure on the spinal nerve root 4. Excess cerebrospinal fluid production in the area

1. Muscle spasm in the area of the herniated disk

Which of the following interventions would be contraindicated in the postprocedure care of the client following a bone biopsy of the left arm? 1. Place the left arm in a dependent position for 24 hours. 2. Monitor vital signs every 4 hours. 3. Monitor site for swelling, bleeding, hematoma. 4. Administer oral analgesics as needed.

1. Place the left arm in a dependent position for 24 hours.

A nurse is providing instructions to a client with osteoporosis regarding appropriate food items to include in the diet. The nurse tells the client that which food item would provide the least amount of calcium? 1. Pork 2. Seafood 3. Sardines 4. Plain yogurt

1. Pork

A client who has experienced a brain attack (stroke) has partial hemiplegia of the left leg. The straight-leg cane formerly used by the client is not sufficient any longer. The nurse determines that the client could benefit from the somewhat greater support and stability provided by a: 1. Quad cane 2. Wheelchair 3. Wooden crutch 4. Lofstrand crutch

1. Quad cane

A client has sustained multiple fractures in the left leg and is in skeletal traction. The nurse has obtained an overhead trapeze for the client's use to aid in bed mobility. The nurse would pay particular attention to monitoring for which of the following high-risk areas for pressure and breakdown? 1. Right heel 2. Left heel 3. Scapulae 4. Back of the head

1. Right heel

An older client with advanced Alzheimer's disease is placed in balanced suspension traction, and the health care provider expects to internally fixate the client's femur in 1 week. Based on this information, the nurse determines that the first priority relates to addressing which of the following nursing diagnoses? 1. Risk for constipation 2. Risk for activity intolerance 3. Impaired tissue integrity 4. Disturbed thought processes

1. Risk for constipation

A client with type 1 diabetes mellitus has had a left above-the-knee amputation. The nurse carefully inspects the residual limb for which of the following complications because of the history of diabetes? 1. Separation of wound edges 2. Pain 3. Edema of the stump 4. Hemorrhage

1. Separation of wound edges

A nurse stops at the scene of an automobile accident to assist a victim. The victim complains of severe leg pain, is unable to get out of the automobile, and is frightened. The appropriate nursing action is to: Submit 1. Stay with the victim. 2. Assist the victim out of the automobile. 3. Leave the victim to call an ambulance. 4. Tell the victim to keep moving the leg to maintain circulation.

1. Stay with the victim.

1. "I need to avoid getting the cast wet." 2. I need to cover the casted leg with warm blankets. 3. "I need to use my fingertips to lift and move my leg. 4. "I need to use something like a padded coat hanger end to scratch under the cast if it itches."

1. "I need to avoid getting the cast wet."

838. A client is being discharged to home after application of a plaster leg cast. Which statement indicates that the client understands proper care of the cast? 1. "I need to avoid getting the cast wet." 2. I need to cover the casted leg with warm blankets 3. "I need to use my fingertips to lift and move my leg. 4. "I need to use something like a padded coat hanger end to scratch under the cast if it itches."

1. "I need to avoid getting the cast wet."

840. The nurse has given a client instructions about crutch safety. Which client statement indicates that the client understands the instructions? Select all that apply. 1. "I should not use someone else's crutches 2. "I need to remove any scatter rugs at home." 3. "I can use crutch tips even when they are wet. 4. "I need to have spare crutches and tips available. 5. "When I'm using the crutches my arms need to be completely straight."

1. "I should not use someone else's crutches 2. "I need to remove any scatter rugs at home." 4. "I need to have spare crutches and tips available.

1. "I should not use someone else's crutches. 2. "I need to remove any scatter rugs at home." 3. "I can use crutch tips even when they are wet. 4. "I need to have spare crutches and tips available. 5. "When I'm using the crutches my arms need to be completely straight."

1. "I should not use someone else's crutches. 2. "I need to remove any scatter rugs at home." 4. "I need to have spare crutches and tips available.

1. Keep the cast clean and dry. 2. Allow the cast 24 to 72 hours to dry. 3. Keep the cast and extremity elevated.

1. Keep the cast clean and dry. 2. Allow the cast 24 to 72 hours to dry. 3. Keep the cast and extremity elevated.

833. Which cast care instructions should the nurse provide to a client who just had a plaster cast applied to the right forearm? Select all that apply. 1. Keep the cast clean and dry. 2. Allow the cast 24 to 72 hours to dry. 3. Keep the cast and extremity elevated. 4. Expect tingling and numbness in the extremity. 5. Use a hair dryer set on a warm to hot setting to dry the cast. 6. Use a soft padded object that will fit under the cast to scratch the skin under the cast.

1. Keep the cast clean and dry. 2. Allow the cast 24 to 72 hours to dry. 3. Keep the cast and extremity elevated.

846. The nurse is caring for a client who has had spinal fusion, with insertion of hardware. The nurse would be most concerned with which assessment finding? 1. Temperature of 101.6 Forally 2. Complaints of discomfort during repositioning 3. old bloody drainage outlined on the surgical dressing 4. Discomfort during coughing and deep-breathing exercises

1. Temperature of 101.6 F orally

A client has just had a cast removed and the underlying skin is yellow-brown and crusted. The nurse determines that further skin care instructions are required when the client states: 1. "I will soak the skin and then wash it gently." 2. "I need to scrub the skin vigorously with soap and water." 3. "I need to apply an emollient lotion to enhance softening." 4. "I need to use a sunscreen on the skin if it's exposed for a period of time."

2. "I need to scrub the skin vigorously with soap and water."

A client with possible rib fracture has never had a chest x-ray. The nurse would plan to tell the client which of the following items about the procedure? 1. "The x-ray stimulates a small amount of pain." 2. "It is necessary to remove jewelry and any other metal objects." 3. "The client will be asked to breathe in and out during the x-ray." 4. "The x-ray technologist will stand next to the client during the x-ray."

2. "It is necessary to remove jewelry and any other metal objects."

A nurse is planning to teach the client with a left arm cast about measures to keep the left shoulder from becoming stiff. Which suggestion should the nurse include in the teaching plan? 1. "Use a sling on the left arm." 2. "Lift the left arm up over the head." 3. "Lift the right arm up over the head." 4. "Make a fist with the hand of the casted arm."

2. "Lift the left arm up over the head." Rationale: Immobility and the weight of a casted arm may cause the shoulder above an arm fracture to become stiff. The shoulder of a casted arm should be lifted over the head periodically as a preventive measure. The use of slings further immobilizes the shoulder and may be contraindicated. Making fists with the left hand provides isometric exercise to maintain muscle strength. Range of motion of the affected fingers is also a useful general measure. Lifting the right arm is of no particular value.

A nurse is planning to provide instructions to the client about how to stand on crutches. In the instructions, the nurse plans to tell the client to place the crutches: 1. 3 inches to the front and side of the client's toes 2. 8 inches to the front and side of the client's toes 3. 20 inches to the front and side of the client's toes 4. 15 inches to the front and side of the client's toes

2. 8 inches to the front and side of the client's toes Rationale: The classic tripod position is taught to the client before giving instructions on gait. The crutches are placed anywhere from 6 to 10 inches in front and to the side of the client, depending on the client's body size. This provides a wide enough base of support to the client and improves balance.

A client is admitted to the nursing unit after a left below-knee amputation following a crush injury to the foot and lower leg. The client tells the nurse, "I think I'm going crazy. I can feel my left foot itching." The nurse interprets the client's statement to be: 1. A normal response and indicates the presence of phantom limb pain 2. A normal response and indicates the presence of phantom limb sensation 3. An abnormal response and indicates that the client is in denial about the limb loss 4. An abnormal response and indicates that the client needs more psychological support

2. A normal response and indicates the presence of phantom limb sensation

A client is complaining of pain underneath a cast in the area of a bony prominence. The nurse interprets that this client may need to have: 1. The cast bivalved 2. A window cut in the cast 3. The cast replaced with an air splint 4. Extra padding put over this area of the cast

2. A window cut in the cast

A client has had surgery to repair a fractured left hip. The nurse plans to use which of the following important items when repositioning the client from side to side in the bed? 1. Bed pillow 2. Abductor splint 3. Adductor splint 4. Overhead trapeze

2. Abductor splint

A nurse is caring for a client who has had spinal fusion with insertion of hardware. The nurse should be especially concerned with which of the following findings? 1. Complaints of discomfort during repositioning 2. An oral temperature of 101° F orally 3. Old bloody drainage outlined on the surgical dressing 4. Discomfort during coughing and deep breathing exercises

2. An oral temperature of 101° F orally

A client in skeletal leg traction with an overbed frame is not allowed to turn from side to side. Which action by the nurse would be most useful in trying to provide good skin care to the client? 1. Having another nurse tilt the client to the side 2. Asking the client to pull up on a trapeze to lift the hips off the bed 3. Pushing down on the mattress of the bed while administering care 4. Asking the client to lift up by digging into the mattress with the unaffected leg

2. Asking the client to pull up on a trapeze to lift the hips off the bed

A nurse is caring for a client diagnosed with Paget's disease. The nurse understands that this condition usually affects which bones? 1. Anterior rib cage and sternum 2. Axial skeleton including vertebrae 3. Bones of hands and feet 4. Shoulder and humerus

2. Axial skeleton including vertebrae

During admission data collection, a nurse asks the client to run the heel of one foot down the lower anterior surface of the other leg. The nurse notices rhythmic tremors of the leg being tested and concludes that the client has interference in the area of: 1. Muscle strength and flexibility 2. Balance and coordination 3. Bowel and bladder control 4. Sensation and reflexes

2. Balance and coordination

A client is complaining of low back pain, with radiation down the left posterior thigh. The nurse continues to collect data from the client to see if the pain is worsened or aggravated by: 1. Bedrest 2. Bending or lifting 3. Ibuprofen (Motrin) 4. Application of heat

2. Bending or lifting

A nurse is caring for a client who has developed compartment syndrome from a severely fractured arm. The client asks the nurse how this can happen. The nurse's response is based on the understanding that: 1. A bone fragment has injured the nerve supply in the area. 2. Bleeding and swelling cause increased pressure in an area that cannot expand. 3. An injured artery causes impaired arterial perfusion through the compartment. 4. The fascia expands with injury, causing pressure on underlying nerves and muscles.

2. Bleeding and swelling cause increased pressure in an area that cannot expand.

A client with a 4-day-old lumbar vertebral fracture is experiencing muscle spasms. The nurse avoids using which of the following in an effort to relieve the spasm? 1. Heat 2. Cold 3. Analgesics 4. Prescribed intermittent traction

2. Cold

A nurse is caring for a client following the application of a plaster cast because of a fractured left radius. The nurse monitors the neurovascular status of the client's casted extremity because: 1. The skin under the cast is at high risk for infection. 2. Compartment syndrome may lead to irreversible nerve and muscle tissue injury. 3. Alterations in the neurovascular status of the fingers may be early signs of fat embolism. 4. The client is at high risk of neurovascular compromise until the cast is completely dry.

2. Compartment syndrome may lead to irreversible nerve and muscle tissue injury.

A nurse is caring for a client who has had an open reduction with internal fixation (ORIF) with a posterior approach. The client has been prescribed hip precautions. The nurse plans to implement which of the following in the care of the client? Select all that apply. 1. Ensure the client doesn't bend the hips beyond 120 degrees. 2. Ensure the client doesn't sit or stand for long periods of time. 3. Ensure the client engages in rigorous exercise to maintain strength. 4. Ensure the client doesn't cross the legs past the midline of the body. 5. Ensure the client uses assistive/adaptive devices with activities of daily living.

2. Ensure the client doesn't sit or stand for long periods of time. 4. Ensure the client doesn't cross the legs past the midline of the body. 5. Ensure the client uses assistive/adaptive devices with activities of daily living.

A nurse is monitoring a confused older client admitted to the hospital with a hip fracture. Which of the following data obtained by the nurse could place the client at increased risk for disturbed thought processes? 1. Relatives at the bedside 2. Eyeglasses left at home 3. Familiar hospital setting 4. Hearing aid available and in working order

2. Eyeglasses left at home

A nurse has a prescription to place a client with a herniated lumbar intervertebral disk on bedrest to minimize the pain. The nurse plans to put the bed: 1. In high-Fowler's position with the foot of the bed flat 2. In semi-Fowler's position with the knee gatch slightly raised 3. In semi-Fowler's position with the foot of the bed flat 4. Flat with the knee gatch raised

2. In semi-Fowler's position with the knee gatch slightly raised Rationale: Clients with low back pain are often more comfortable when placed in semi-Fowler's position with the knee gatch slightly raised or with pillows under the knees. The bed is placed in semi-Fowler's position with the knee gatch raised sufficiently to flex the knees. This relaxes the muscles of the lower back and relieves pressure on the spinal nerve root. Keeping the foot of the bed flat will enhance extension of the spine. Option 4 stretches the lower back.

A nurse is caring for an older client with a diagnosis of osteoarthritis. Which of the following would be least helpful for the client? Submit 1. Gentle regular exercise 2. Increasingly vigorous and high-impact exercise 3. A warm bath or shower early in the day 4. An individualized program of pain medication administration

2. Increasingly vigorous and high-impact exercise

A client being measured for crutches asks the nurse why the crutches cannot rest up underneath the arm for extra support. The nurse's response is based on the understanding that this could result in: 1. A fall and further injury 2. Injury to the brachial plexus nerves 3. Skin breakdown in the area of the axilla 4. Impaired range of motion while the client ambulates

2. Injury to the brachial plexus nerves

A client has had skeletal traction applied to the right leg and has an overhead trapeze available for use. The nurse should monitor which of the following as a high-risk area for pressure and breakdown? 1. Scapulae 2. Left heel 3. Right heel 4. Back of the head

2. Left heel

A nurse is caring for a client with a long bone fracture who is at risk for fat embolism. The nurse specifically monitors for the earliest signs of this complication by checking the client's: Select all that apply. 1. Renal system 2. Mental status 3. Mobility status 4. Respiratory function 5. Cardiovascular system

2. Mental status 4. Respiratory function

A client has undergone fasciotomy to treat compartment syndrome of the leg. The nurse should anticipate that which type of wound care will be prescribed for the fasciotomy site? 1. Dry, sterile dressings 2. Moist, sterile saline dressings 3. Hydrocolloid dressings 4. Half-strength povidone-iodine (Betadine) dressings

2. Moist, sterile saline dressings

A nurse is evaluating the client's use of a cane for left-sided weakness. The nurse would intervene and correct the client if the nurse observed that the client: 1. Holds the cane on the right side 2. Moves the cane when the right leg is moved 3. Leans on the cane when the right leg swings through 4. Keeps the cane 6 inches out to the side of the right foot

2. Moves the cane when the right leg is moved Rationale: The cane is held on the stronger side to minimize stress on the affected extremity and provide a wide base of support. The cane is held 6 inches lateral to the fifth great toe. The cane is moved forward with the affected leg. The client leans on the cane for added support while the stronger side swings through.

A client with a left arm fracture exhibits loss of sensation in the left fingers, pallor, slow refill, and diminished left radial pulse. The nurse should take which of the following actions? Submit 1. Administer an analgesic. 2. Notify the registered nurse. 3. Check the circulation again in 30 minutes. 4. Provide range-of-motion exercises to the fingers of the left hand.

2. Notify the registered nurse.

Which data would indicate a potential complication associated with age-related changes in the musculoskeletal system? 1. Decrease in height 2. Overall sclerotic lesions 3. Diminished lean body mass 4. Changes in structural bone tissue

2. Overall sclerotic lesions Rationale: Sclerotic lesions occur as bone resorption increases and results in replacement of original bone with fibrous material. This condition occurs in Paget's disease, an age-related disorder. Options 1, 3, and 4 identify normal age-related changes in the musculoskeletal system.

A client has undergone total hip replacement of the right hip, which was damaged by osteoarthritis. Which of the following should be included in the postoperative plan of care? 1. Assist the client to keep her legs as close together as possible. 2. Partial weight bearing on the operative leg is usually permitted 72 hours postoperatively. 3. Remind the client to use a handrail if she is lowering her hips into a 120-degree flexion. 4. Ensure the client receives her daily tablet of enoxaparin (Lovenox).

2. Partial weight bearing on the operative leg is usually permitted 72 hours postoperatively.

A client is complaining of skin irritation from the edges of a cast applied the previous day. The nurse should plan for which of the following actions? 1. Massaging the skin at the rim of the cast 2. Petaling the cast edges with adhesive tape 3. Using a rough file to smooth the cast edges 4. Applying lotion to the skin at the rim of the cast

2. Petaling the cast edges with adhesive tape

A nurse is repositioning the client who has returned to the nursing unit following internal fixation of a fractured right hip. The nurse plans to use a: 1. Trochanter roll to prevent abduction while turning 2. Pillow to keep the right leg abducted during turning 3. Pillow to keep the right leg adducted during turning 4. Trochanter roll to prevent external rotation while turning

2. Pillow to keep the right leg abducted during turning

A nurse is caring for a client who sustained multiple fractures in a motor vehicle accident 12 hours ago. The client develops severe dyspnea, tachycardia, and mental confusion, and the nurse suspects fat embolism. The initial action of the nurse is to: 1. Place the client in a supine position. 2. Place the client in a Fowler's position. 3. Perform a neurological assessment. 4. Reassess the vital signs.

2. Place the client in a Fowler's position. Rationale: Clients with fractures are at risk for fat embolism. If the nurse suspects fat embolism, the nurse should place the client in a sitting (Fowler's) position to relieve dyspnea. Supplemental oxygen is indicated to reduce the signs of hypoxia. The health care provider needs to be notified. A neurological assessment needs to be performed, but this would not be the initial nursing action. Vital signs will need to be taken, but this action may delay initial and required interventions.

A nurse has given the client instructions regarding crutch safety. The nurse determines that the client needs reinforcement of the instructions if the client states: 1. That use of someone else's crutches is a bad idea 2. That crutch tips will not slip, even when wet 3. That he or she needs to have spare crutches and tips available 4. That crutch tips should be inspected periodically for wear

2. That crutch tips will not slip, even when wet

A nurse is planning to reinforce instructions to the client about proper use of a thoracolumbosacral orthosis (TLSO) after spinal fusion with instrumentation. The nurse plans to include which of the following teaching points in discussion with the client? 1. The brace should be applied directly next to the skin. 2. The device is applied before getting out of bed in the morning. 3. The Velcro closures should be fairly loose to avoid constriction. 4. Areas of skin redness at the edges of the brace indicate a good, snug fit.

2. The device is applied before getting out of bed in the morning.

A client has a newly fractured fibula that is plaster casted in the emergency department. Because the client will need to use crutches, the nurse plans to teach the client which crutch-walking gait before discharge? 1. Four-point alternate gait 2. Three-point gait 3. Two-point gait 4. Swing-through gait

2. Three-point gait

A nurse is caring for a client with a diagnosis of gout. Which laboratory value would the nurse expect to note in the client? 1. Calcium level of 9 mg/dL 2. Uric acid level of 8 mg/dL 3. A uric acid level of 5 mg/dL 4. Phosphorus level of 3 mg/dL

2. Uric acid level of 8 mg/dL

A nurse is collecting data from a client who is being seen in the health care clinic. The client is complaining of unrelieved back pain that has persisted over the past 3 months. The nurse determines that which of the following harmful effects can occur as a result of uncontrolled muscle pain? 1. Anorexia 2. Weakness 3. Weight loss 4. Hypertension

2. Weakness

845. A client is complaining of low back pain that radiates down the left posterior thigh. The nurse should ask the client if the pain is worsened or aggravated by which factor? 1. Bed rest 2. Bending or lifting 3. Application of heat 4. Ibuprofen (Motrin IB)

2. Bending or lifting

1. A fall and further injury. 2. Injury to the brachial plexus nerves. 3. Skin breakdown in the area of the axilla. 4. Impaired range of motion while the client ambulates.

2. Injury to the brachial plexus nerves

839. A client being measured for crutches asks the nurse why the crutches cannot rest up underneath the arm for extra support. The nurse responds knowing that which would most likely result from this improper crutch measurement? 1. A fall and further injury 2. Injury to the brachial plexus nerves 3. Skin breakdown in the area of the axilla 4. Impaired range of motion while the client ambulates

2. Injury to the brachial plexus nerves

1. Cold, bluish-colored fingers. 2. Numbness and tingling in the fingers. 3. Pain that increases when the arm is dependent.. 4. Pain that is out of proportion to the severity of the fracture.

2. Numbness and tingling in the fingers

842. The nurse has conducted teaching with a client in an arm cast about the signs and symptoms of compartment syndrome. The nurse determines that the client understands the information if the client states that he or she should report which early symptom of compartment syndrome? 1. Cold, bluish-colored fingers 2. Numbness and tingling in the fingers 3. Pain that increases when the arm is dependent 4. Pain that is out of proportion to the severity of the fracture

2. Numbness and tingling in the fingers

1. Inflammation. 2. Serous drainage. 3. Pain at a pin site. 4. Purulent drainage

2. Serous drainage

834. The nurse is evaluating the pin sites of a client in skeletal traction. The nurse would be least concerned with which finding? 1. Inflammation 2. Serous drainage 3. Pain at a pin site 4. Purulent drainage

2. Serous drainage

A client with a left arm fracture complains of severe, diffuse pain that is unrelieved with pain medication. On further data collection, the nurse notes that the client experiences more pain during passive motion of the left arm as compared with active motion. Based on these findings, the nurse should take which action? 1. Check to see whether it is time for more pain medication. 2. Encourage the client to continue with active range-of-motion exercises to the left arm. 3. Notify the registered nurse. 4. Reassess the client in 30 minutes.

3. Notify the registered nurse.

A postoperative client received a spinal anesthetic during the repair of a right hip fracture. The client has not experienced pain because the anesthetic has not yet worn off. The nurse will monitor the client closely for pain and provide the client with which instruction? 1. "I will be bringing your pain medication at ten o'clock PM." 2. "You will not feel pain because of the spinal anesthesia." 3. "You will need to let me know when you start to get feeling back in your legs." 4. "You will not be able to take pain medication until you have been up to the bathroom."

3. "You will need to let me know when you start to get feeling back in your legs."

A nurse is preparing to collect data from a client who has sustained a pelvic fracture following a motor vehicle accident. The nurse reviews the health care provider's (HCP) prescriptions and notes that the HCP has prescribed a pelvic (skin) sling. The nurse prepares to place the client in which device? Refer to figure. 1. 1 2. 2 3. 3 4. 4

3. 3

A client has been taught to use a walker to aid in mobility following internal fixation of a hip fracture. The nurse determines that the client is using the walker incorrectly if the client: 1. Holds the walker using the handgrips 2. Leans forward slightly when advancing the walker 3. Advances the walker with reciprocal motion 4. Supports body weight on the hands while advancing the weaker leg

3. Advances the walker with reciprocal motion Rationale: The client should use the walker by placing the hands on the handgrips for stability. The client lifts the walker to advance it and leans forward slightly while moving it. The client walks into the walker, supporting the body weight on the hands while moving the weaker leg. A disadvantage of the walker is that it does not allow for reciprocal walking motion. If the client were to try to use reciprocal motion with a walker, the walker would advance forward one side at a time as the client walks, thus the client would not be supporting the weaker leg with the walker during ambulation.

A client with skeletal traction applied to the right leg complains to the nurse about severe right leg pain in spite of being medicated with a prescribed analgesic. Which action should the nurse take? 1. Remove some of the traction weights. 2. Provide pin care. 3. Notify the registered nurse. 4. Find out when the next dose of the prescribed analgesic can be given.

3. Notify the registered nurse.

A client is treated in the health care provider's office after a fall, which sprained an ankle. Radiography has ruled out fracture. Before sending the client home, the nurse would plan to teach the client about which item that is to be avoided in the next 24 hours? 1. Resting the foot 2. Application of an Ace wrap 3. Application of a heating pad 4. Elevating the ankle on a pillow while sitting or lying down

3. Application of a heating pad

A client who has had a right total knee replacement asks the nurse how long the right leg must be kept in the continuous passive motion (CPM) machine. The nurse's response is based on the understanding that the device should be used: 1. Every other hour for 60 minutes 2. For 30 minutes out of every hour 3. As much as the client can tolerate 4. For 3 hours at a time, followed by 1 hour of rest

3. As much as the client can tolerate

A nurse is caring for the client who has had skeletal traction applied to the left leg. The client is complaining of severe left leg pain. Which action should the nurse take first? 1. Provide pin care. 2. Call the health care provider (HCP). 3. Check the client's alignment in bed. 4. Medicate the client with an analgesic.

3. Check the client's alignment in bed.

A client with a fractured femur is placed in skeletal traction. The nurse should do which to monitor for nerve injury? 1. Check the blood pressure. 2. Check the pin sites for drainage. 3. Check the neurovascular status of the affected extremity. 4. Monitor the client's ability to perform active range of motion to the affected extremity.

3. Check the neurovascular status of the affected extremity.

A nurse is caring for a client being treated for fat embolus after multiple fractures. Which of the following data indicates to the nurse favorable resolution of the fat embolus? 1. Arterial oxygen level of 78 mm Hg 2. Minimal dyspnea 3. Clear chest x-ray 4. Oxygen saturation 85%

3. Clear chest x-ray

A client has several fractures of the lower leg and has been placed in an external fixation device. The client is upset about the appearance of the leg, which is very edematous. The nurse determines that the client is experiencing which problem? 1. Feelings of isolation 2. Inability to tolerate activity 3. Concerns about appearance 4. Inability to physically move about

3. Concerns about appearance

A nurse is giving the client with a left leg cast crutch-walking instructions using the three-point gait. The client is allowed touch-down of the affected leg. The nurse tells the client to advance the: 1. Crutches and then both legs simultaneously 2. Crutches and the right leg, then advance the left leg 3. Crutches and the left leg, then advance the right leg 4. Left leg and right crutch, then right leg and left crutch

3. Crutches and the left leg, then advance the right leg Rationale: A three-point gait requires good balance and arm strength. The crutches are advanced with the affected leg, and then the unaffected leg is moved forward. Option 4 describes a two-point gait. Option 1 describes a swing-to gait. Option 2 describes the three-point gait used for a right leg problem.

A nurse is talking to a client who underwent a below-the-knee amputation 2 days earlier. The client says to the nurse, "I hate looking at this; I feel that I'm not even myself anymore." The nurse understands that the client is experiencing which problem? 1. Self-care deficit 2. Ineffective coping 3. Disturbed body image 4. Ineffective health maintenance

3. Disturbed body image

A client seeks treatment in the emergency department for a lower leg injury. There is visible deformity to the lower aspect of the leg, and the injured leg appears shorter than the other. The area is painful, swollen, and beginning to become ecchymotic. The nurse interprets that this client has experienced a: 1. Strain 2. Sprain 3. Fracture 4. Contusion

3. Fracture

A nursing instructor asks a nursing student about the risk factors associated with osteoporosis. The instructor tells the student that she needs to read and learn about this disorder if the student states that which of the following is an associated risk factor? 1. Postmenopausal age 2. Family history of osteoporosis 3. High-calcium diet consumption 4. Long-term use of corticosteroids

3. High-calcium diet consumption

A nurse witnesses a client sustain a fall and suspects that the client's leg may be fractured. Which action is the priority? 1. Take a set of vital signs. 2. Call the radiology department. 3. Immobilize the leg before moving the client. 4. Reassure the client that everything will be fine.

3. Immobilize the leg before moving the client.

A client has sustained a closed fracture and has just had a cast applied to the affected arm. The client is complaining of intense pain. The nurse has elevated the limb, applied an ice bag, and administered an analgesic, which was ineffective in relieving the pain. The nurse interprets that this pain may be caused by: 1. Infection under the cast 2. The anxiety of the client 3. Impaired tissue perfusion 4. The newness of the fracture

3. Impaired tissue perfusion

A nurse is caring for a comatose client at risk for fat embolism because of a fractured femur and pelvis sustained in a fall. Which of the following findings does the nurse identify as early signs of possible fat embolism? 1. Increased heart rate and increased oxygen saturation 2. Decreased heart rate and decreased respiratory rate 3. Increased heart rate and adventitious breath sounds 4. Decreased heart rate and increased restlessness

3. Increased heart rate and adventitious breath sounds

A client has Buck's extension traction applied to the right leg. The nurse should plan which intervention to prevent complications of the device? 1. Giving pin care once a shift 2. Massaging the skin of the right leg with lotion every 8 hours 3. Inspecting the skin on the right leg at least once every 8 hours 4. Releasing the weights on the right leg for range-of-motion exercises daily

3. Inspecting the skin on the right leg at least once every 8 hours

A nurse is caring for the client who has skeletal traction applied to the left leg. The client complains of severe left leg pain. The nurse checks the client's alignment in bed and notes that proper alignment is maintained. Which action should the nurse take next? 1. Medicate the client. 2. Provide pin care. 3. Notify the registered nurse. 4. Remove 2 pounds of weight from the traction.

3. Notify the registered nurse.

A nurse is checking the casted extremity of a client. The nurse would check for which of the following signs and symptoms indicative of infection? 1. Dependent edema 2. Diminished distal pulse 3. Presence of a "hot spot" on the cast 4. Coolness and pallor of the extremity

3. Presence of a "hot spot" on the cast

An client is brought to the emergency department via ambulance after sustaining a fall. An x-ray indicates that the client sustained a femoral neck fracture. The nurse should anticipate which of the following on inspection of the client's leg? 1. Lengthening, adduction, and external rotation 2. Shortening, abduction, and internal rotation 3. Shortening, adduction, and external rotation 4. Lengthening, abduction, and internal rotation

3. Shortening, adduction, and external rotation

A client has been placed in Buck's extension traction. The nurse can provide for countertraction by: 1. Using a footboard 2. Providing an overhead trapeze 3. Slightly elevating the foot of the bed 4. Slightly elevating the head of the bed

3. Slightly elevating the foot of the bed

The nurse prepares to care for a client with inflamed joints and plans to use which item to maintain proper positioning for rest of the inflamed joints? 1. Large pillows 2. Footboards 3. Small pillows 4. Soft mattress

3. Small pillows

A nurse provides cast application instructions to a client who is going to have a plaster cast applied. The nurse determines that the client needs further instruction if the client states that: 1. The cast will give off heat as it dries. 2. The cast edges may be trimmed with a cast knife. 3. The client may bear weight on the cast in 30 minutes. 4. A stockinette will be placed over the leg area to be casted.

3. The client may bear weight on the cast in 30 minutes.

A nurse is preparing to teach a client how to safely use crutches. Before initiating the teaching the nurse collects data on the client. The priority data would include which of the following? 1. The client's fear related to the use of the crutches 2. The client's understanding of the need for increased mobility 3. The client's vital signs, muscle strength, and previous activity level of the client 4. The client's feelings about the restricted mobility

3. The client's vital signs, muscle strength, and previous activity level of the client

A nurse is teaching a client who is to have a gallium scan about the procedure. The nurse should include which of the following items as part of the instructions? 1. The client must stand erect during the filming. 2. The procedure takes about 15 minutes to perform. 3. The gallium will be injected intravenously 2 to 3 hours before the procedure. 4. The client should remain on bedrest for the remainder of the day after the scan.

3. The gallium will be injected intravenously 2 to 3 hours before the procedure.

835. The nurse is assessing the casted extremity of a client. Which sign is indicative of infection? 1. Dependent edema 2. Diminished distal pulse 3. Presence of a "hot spot" on the cast 4. Coolness and pallor of the extremity

3. Presence of a "hot spot" on the cast

1. Dependent edema. 2. Diminished distal pulse. 3. Presence of a "hot spot" on the cast. 4. Coolness and pallor of the extremity

3. Presence of a "hot spot" on the cast. An area of the cast that becomes progressively painful sometimes referred to as a "hot spot."

A nurse is providing discharge instructions to a client following surgical treatment for carpal tunnel syndrome. Which statement by the client would indicate a need for further instruction? 1. "I should elevate my arm to reduce the swelling." 2. "I should use a sling to limit movement and keep my arm elevated." 3. "I should return to the health care provider in about ten days to have the sutures removed." 4. "I should perform pronation and supination exercises of my wrist starting twenty-four hours after surgery."

4. "I should perform pronation and supination exercises of my wrist starting twenty-four hours after surgery."

A nurse is assisting in preparing a client for discharge to home. Daily cold therapy has been prescribed for the client, and the nurse provides instructions about this treatment. Which statement by the client indicates adequate understanding of cold therapy treatment? 1. "I need to apply the cold pack for at least 60 minutes." 2. "I should check my pulse before using the ice on my joints." 3. "I can lie on the ice by placing it between the bed and my body." 4. "I should wrap the frozen ice pack in a warm towel to help adjust to the cold."

4. "I should wrap the frozen ice pack in a warm towel to help adjust to the cold."

A nurse has reinforced instructions with the client with a nonplaster (fiberglass) leg cast about cast care at home. The nurse determines that the client needs further instruction if the client makes which statement? 1. "I should avoid walking on wet, slippery floors." 2. "I'm not supposed to scratch the skin underneath the cast." 3. "It's all right to wipe dirt off the top of the cast with a damp cloth." 4. "If the cast gets wet, I can dry it with a hair dryer turned to the warmest setting."

4. "If the cast gets wet, I can dry it with a hair dryer turned to the warmest setting."

A client who is scheduled for surgery and who is to be placed in skeletal traction says to the nurse, "I'm not sure if I want to have this skeletal traction or if the skin traction would be best to stabilize my fracture." Based on the client's statement, the nurse should make which response to the client? 1. "Your fracture is very unstable. You will die if you don't have this surgery performed." 2. "There is no reason to be concerned. I have seen lots of these procedures." 3. "Skeletal traction is much more effective than skin traction in your situation." 4. "You have concerns about skeletal versus skin traction for your type of fracture?"

4. "You have concerns about skeletal versus skin traction for your type of fracture?"

A nurse has a prescription to get the client out of bed to a chair on the first postoperative day after total knee replacement. The nurse plans to do which of the following to protect the knee joint? 1. Obtain a walker to minimize weight bearing by the client on the affected leg. 2. Apply an Ace wrap around the dressing and put ice on the knee while sitting. 3. Lift the client to the bedside chair, leaving the continuous passive motion (CPM) machine in place. 4. Apply a knee immobilizer before getting the client up, and elevate the client's surgical leg while sitting.

4. Apply a knee immobilizer before getting the client up, and elevate the client's surgical leg while sitting. Rationale: The nurse assists the client to get out of bed on the first postoperative day after putting a knee immobilizer on the affected joint for stability. The surgeon prescribes the weight-bearing limits on the affected leg. The leg is elevated while the client is sitting in the chair to minimize edema.

A nurse is caring for a client diagnosed with Paget's disease. The nurse plans care, knowing that this condition usually affects which bones? 1. Shoulder and humerus 2. Bones of the hands and feet 3. Anterior rib cage and sternum 4. Axial skeleton including the vertebrae

4. Axial skeleton including the vertebrae Rationale: Paget's disease usually affects the axial skeleton, especially the vertebrae and skull. Besides the vertebrae and skull, the pelvis, femur, and tibia are other common sites of the disease. Skull involvement and deformed facial bones frequently occur.

A nurse is caring for a client with a fractured tibia and fibula. Eight hours after a long leg cast was applied, the client began to report an increase in pain level even after administration of the prescribed dose of opioid analgesic. The initial nursing action is to: 1. Contact the health care provider. 2. Elevate the casted leg. 3. Administer another dose of pain medication. 4. Check the neurovascular status of the toes on the casted leg.

4. Check the neurovascular status of the toes on the casted leg.

This morning a client sustained a right proximal fibula and tibia fracture that was casted in a long leg plaster cast. During evening rounds, the nurse notes that the right lower extremity capillary refill is greater than 3 seconds and the toes are edematous and dusky. The client states that the pain medication is not working anymore and that the right foot feels like it is asleep. The nurse analyzes the data and determines that the client's symptoms are indicative of: 1. Fat embolism 2. Volkmann's thrombosis 3. Venous thrombosis 4. Compartment syndrome

4. Compartment syndrome

A client has had a bone scan procedure. The nurse determines that the client understands the elements of follow-up care if the client states that he or she will: 1. Report any feelings of nausea or flushing. 2. Eat only small meals for the remainder of the day. 3. Ambulate at least three times before the end of the day. 4. Drink plenty of water for a day or two following the procedure.

4. Drink plenty of water for a day or two following the procedure. Rationale: There are no special restrictions following a bone scan. The client is encouraged to drink large amounts of water for 24 to 48 hours to flush the radioisotope from the system. The minimal amount of radioactivity of the isotope poses no hazards to the client or staff.

A nurse is caring for a client with osteoarthritis. The nurse collects data, knowing that which of the following is a clinical manifestation associated with the disorder? Submit 1. Morning stiffness 2. Positive rheumatoid factor 3. An elevated sedimentation rate 4. Dull aching pain in the affected joints

4. Dull aching pain in the affected joints

A nurse is assigned to care for a client with multiple traumas who is admitted to the hospital. The client has a leg fracture, and a plaster cast has been applied. In positioning the casted leg, the nurse should: 1. Keep the leg in a level position. 2. Elevate the leg for 3 hours, and put it flat for 1 hour. 3. Keep the leg level for 3 hours, and elevate it for 1 hour. 4. Elevate the leg on pillows continuously for 24 to 48 hours.

4. Elevate the leg on pillows continuously for 24 to 48 hours.

A nurse has provided instructions to a client with a herniated lumbar disk about proper body mechanics and other items pertinent to low back care. The nurse determines that the client needs further instructions if the client verbalizes that he or she will: 1. Increase fiber and fluids in the diet. 2. Bend at the knees to pick up objects. 3. Strengthen the back muscles by swimming or walking. 4. Get out of bed by sitting straight up and swinging the legs over the side of the bed.

4. Get out of bed by sitting straight up and swinging the legs over the side of the bed.

A nurse is providing care to a client with this type of cast. (Refer to figure.) The nurse documents that the client has a: 1. Short leg cast 2. Long leg cast 3. Body jacket cast 4. Hip spica cast

4. Hip spica cast

A nurse is collecting physical data of the musculoskeletal system on an assigned client. The nurse should document the presence of which of the following as a normal finding? 1. Presence of fasciculations 2. Atrophy on the client's dominant side 3. Atrophy on the client's nondominant side 4. Hypertrophy on the client's dominant side

4. Hypertrophy on the client's dominant side Rationale: Hypertrophy, or increased muscle size on the client's dominant side of up to 1 cm, is considered normal. Atrophy on either side is considered an abnormal finding. Fasciculations are fine muscle twitches that are not normally present.

A nurse is caring for a client following a total hip replacement. The client has been diagnosed with iron deficiency anemia. The nurse instructs the client to increase intake of which of the following foods? 1. Milk and yogurt 2. Potatoes and carrots 3. Apples and mangos 4. Lean beef and chicken liver

4. Lean beef and chicken liver

A nurse is discussing primary prevention measures to clients regarding osteoporosis. The nurse plans to tell the clients that which of the following is a primary prevention measure? 1. Applying nonskid strips on areas that get wet 2. Selecting shoes that have firm nonskid soles 3. Installing telephones in several rooms of the house 4. Maintaining body weight at or above minimum recommended levels

4. Maintaining body weight at or above minimum recommended levels

A nurse has provided instructions to a client in an arm cast about the signs and symptoms of compartment syndrome. The nurse determines that the client understands the information if the client states to report which early symptom of compartment syndrome? 1. Pain that is relieved only by an opioid analgesic 2. Pain that increases when the arm is dependent 3. Cold, bluish fingers 4. Numbness and tingling in the fingers

4. Numbness and tingling in the fingers

A nurse is caring for a client with osteoarthritis. The nurse monitors the client, knowing that which of the following is a clinical manifestation associated with the disorder? 1. An elevated platelet count 2. Symmetrical joint discomfort 3. Elevated antinuclear antibody levels 4. Pain that increases with activity and is relieved by rest

4. Pain that increases with activity and is relieved by rest

A nurse has provided instructions regarding specific leg exercises for the client immobilized in right skeletal lower leg traction. The nurse determines that the client needs further instruction if the nurse observes the client: 1. Pulling up on the trapeze 2. Flexing and extending the feet 3. Doing quadriceps-setting and gluteal-setting exercises 4. Performing active range of motion (ROM) to the right ankle and knee

4. Performing active range of motion (ROM) to the right ankle and knee

A nurse is caring for a client who has a cast applied to the left lower leg. On data collection of the client, the nurse notes the presence of skin irritation from the edges of a cast. Which nursing intervention is appropriate? 1. Massage the skin at the edges of the cast. 2. Contact the health care provider. 3. Place a small face cloth in the cast around the edges of the cast. 4. Petal the cast edges with adhesive tape.

4. Petal the cast edges with adhesive tape.

A nurse is preparing a plan of care for a client in skeletal leg traction with an overbed frame. Which nursing intervention should be included in the plan of care to best assist the client with positioning in bed? 1. Encourage the client to pull up by pushing with the unaffected leg on the bed mattress. 2. Use the assistance of four nurses to reposition the client. 3. Place a draw sheet under the client for pulling the client up in bed. 4. Place a trapeze on the bed to provide a means for the client to lift the hips off the bed.

4. Place a trapeze on the bed to provide a means for the client to lift the hips off the bed.

A client with a hip fracture asks the nurse why Buck's extension traction is being applied before surgery. The nurse's response is based on the understanding that Buck's extension 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 of blood vessels 4. Provides comfort by reducing muscle spasms and provides fracture immobilization

4. Provides comfort by reducing muscle spasms and provides fracture immobilization Rationale: Buck's extension traction is a type of skin traction often applied after hip fracture, before the fracture is reduced in surgery. It reduces muscle spasms and helps immobilize the fracture. It does not lengthen the leg for the purpose of preventing blood vessel severance. It also does not allow for bony healing to begin.

A client with diabetes mellitus has had a right below-knee amputation. The nurse would be especially vigilant in monitoring for which of the following because of the client's history of diabetes mellitus? 1. Hemorrhage 2. Edema of residual limb 3. Slight redness of incision 4. Separation of wound edges

4. Separation of wound edges

A client is fearful about having an arm cast removed. Which of the following actions by the nurse would be the most helpful? 1. Telling the client that the saw makes a frightening noise 2. Reassuring the client that no one has had an arm lacerated yet 3. Stating that the hot cutting blades cause burns only very rarely 4. Showing the client the cast cutter and explaining how it works

4. Showing the client the cast cutter and explaining how it works

A nurse is one of several people who witness a vehicle hit a pedestrian at a fairly low speed on a small street. The individual is dazed and tries to get up, and the leg appears fractured. The nurse would plan to: 1. Try to manually reduce the fracture. 2. Assist the person to get up and walk to the sidewalk. 3. Leave the person for a few moments to call an ambulance. 4. Stay with the person and encourage the person to remain still.

4. Stay with the person and encourage the person to remain still.

A client has slight weakness in the right leg. Based on this information, the nurse determines that the client would benefit most from the use of a: 1. Walker 2. Wooden crutch 3. Lofstrand crutch 4. Straight-leg cane

4. Straight-leg cane

A health care provider has given a prescription for dietary iron supplements to the client with osteoporosis who has an iron deficiency anemia. The nurse suggests that the client do which of the following to enhance compliance with therapy? 1. Decrease fluid intake. 2. Decrease dietary fiber. 3. Chew the tablet thoroughly. 4. Take the medication following a meal.

4. Take the medication following a meal.

A client who is learning to use a cane is afraid it will slip with ambulation, causing a fall. The nurse provides the client with the greatest reassurance by telling the client that: 1. Canes prevent falls, not cause them. 2. The physical therapist will determine if the cane is inadequate. 3. The cane would help to break a fall, even if the client does slip. 4. The cane has a flared tip with concentric rings to provide stability.

4. The cane has a flared tip with concentric rings to provide stability.

A nurse plans dietary measures for a client with osteomalacia, knowing that the client is deficient in which of the following? 1. Vitamin A 2. Vitamin B 3. Vitamin C 4. Vitamin D

4. Vitamin D

A client has a fiberglass (nonplaster) cast applied to the lower leg. The client asks the nurse when he will be able to walk on the cast. The nurse replies that the client will be able to bear weight on the cast: 1. In 24 hours 2. In 48 hours 3. In approximately 8 hours 4. Within 20 to 30 minutes of application

4. Within 20 to 30 minutes of application

A nurse is caring for a client who had a below-the-knee amputation of the right leg and has a cast on the residual limb. The client calls the nurse and reports that the cast fell off. The nurse immediately: 1. Replaces the cast with a new one 2. Contacts the surgeon 3. Documents the findings 4. Wraps the residual limb with an elastic compression bandage

4. Wraps the residual limb with an elastic compression bandage

1. "I can resume regular exercise tomorrow." 2. "I can't eat food for the remainder of the day." 3. "I need to stay off the leg entirely for the rest of the day." 4. "I need to report a fever or site inflammation to my health care provider."

4. "I need to report a fever or site inflammation to my health care provider."

831. The nurse has given instructions to a client returning home after knee arthroscopy. Which statement by the client indicates that the instructions are understood? 1. "I can resume regular exercise tomorrow." 2. "I can't eat food for the remainder of the day." 3. "I need to stay off the leg entirely for the rest of the day." 4. "I need to report a fever or site inflammation to my health care provider."

4. "I need to report a fever or site inflammation to my health care provider."

1. Flat for 12 hours, then elevated for 12 hours. 2. Elevated for 3 hours and then flat for 1 hour. 3. Flat for 3 hours and then elevated for 1 hour. 4. Elevated on pillows continuously for 24 to 48 hours.

4. Elevated on pillows continuously for 24 to 48 hours.

837. The nurse is admitting a client with multiple trauma to the nursing unit. The client has a leg fracture and had a plaster cast applied. Which position would be best for the casted leg? 1. Flat for 12 hours, then elevated for 12 hours. 2. Elevated for 3 hours and then flat for 1 hour. 3. Flat for 3 hours and then elevated for 1 hour. 4. Elevated on pillows continuously for 24 to 48 hours.

4. Elevated on pillows continuously for 24 to 48 hours.

1. Allows bony healing to begin before surgery 2. Provides rigid immobilization of the fracture site 3. Lengthens the fractured leg to prevent severing of blood vessels 4. Provides comfort by reducing muscle spasms and provides fracture immobilization

4. Provides comfort by reducing muscle spasms and provides fracture immobilization

1. Allows bony healing to begin before surgery. 2. Provides rigid immobilization of the fracture site. 3. Lengthens the fractured leg to prevent severing of blood vessels. 4. Provides comfort by reducing muscle spasms and provides fracture immobilization.

4. Provides comfort by reducing muscle spasms and provides fracture immobilization

844. The nurse is caring for a client who had an above knee amputation 2 days ago. The residual limb was wrapped with an elastic compression bandage, which has come off. Which immediate action should the nurse take? 1. Apply ice to the site. 2. Call the health care provider (HCP) 3. Apply a dry sterile dressing and elevate it on one pillow. 4. Rewrap the residual limb with an elastic compression bandage.

4. Rewrap the residual limb with an elastic compression bandage.

843. A client with diabetes mellitus has had a right below-knee amputation. Given the client's history of diabetes mellitus, which should the nurse fically observe in the postoperative period? 1. Hemorrhage 2. Edema of the residual limb 3. Slight redness of the incision 4. Separation of the wound edges

4. Separation of the wound edges

1. Try to reduce the fracture manually. 2. Assist the victim to get up and walk to the sidewalk. 3. Leave the victim for a few moments to call an ambulance. 4. Stay with the victim and encourage the person to remain still.

4. Stay with the victim and encourage the person to remain still.

832. The nurse is one of several persons who witnessed a vehicle hit a pedestrian at fairly low speed on a small street. The victim is dazed and tries to get up. The leg appears fractured. Which intervention should the nurse take? 1. Try to reduce the fracture manually. 2. Assist the victim to get up and walk to the sidewalk. 3. Leave the victim for a few moments to call an ambulance. 4. Stay with the victim and encourage the person to remain still.

4. Stay with the victim and encourage the person to remain still.

The nurse admits a 55-year-old female with multiple sclerosis to a long-term care facility. Which finding is of most immediate concern to the nurse? a. Ataxic gait b. Radicular pain c. Severe fatigue d. Urinary retention

A An ataxic gait is a staggering, uncoordinated gait. Fall risk is the highest in individuals with gait instability or visual or cognitive impairments. The other signs and symptoms (e.g., fatigue, urinary retention, radicular pain) may also occur in the patient with multiple sclerosis and need to be managed, but are not the priority.

A 50-year-old patient is reporting a sore shoulder after raking the yard. The nurse should suspect which problem? a. Bursitis b. Fasciitis c. Sprained ligament d. Achilles tendonitis

A Bursitis is common in adults over age 40 and with repetitive motion, such as raking. Plantar fasciitis frequently occurs as a stabbing pain at the heel caused by straining the ligament that supports the arch. Achilles tendonitis is an inflammation of the tendon that attaches the calf muscle to the heel bone, not the shoulder, and causes pain with walking or running. A sprained ligament occurs when a ligament is stretched or torn from a direct injury or sudden twisting of the joint, not repetitive motion.

Musculoskeletal assessment is an important component of care for patients on what type of long-term therapy? a. Corticosteroids b. β-Adrenergic blockers c. Antiplatelet aggregators d. Calcium-channel blockers

A Corticosteroids are associated with avascular necrosis and decreased bone and muscle mass. β-blockers, calcium-channel blockers, and antiplatelet aggregators are not commonly associated with damage to the musculoskeletal system.

The nurse is performing a musculoskeletal assessment of an 81-year-old female patient whose mobility has been progressively decreasing in recent months. How should the nurse best assess the patient's range of motion (ROM) in the affected leg? a. Observe the patient's unassisted ROM in the affected leg. b. Perform passive ROM, asking the patient to report any pain. c. Ask the patient to lift progressive weights with the affected leg. d. Move both of the patient's legs from a supine position to full flexion.

A Passive ROM should be performed with extreme caution and may be best avoided when assessing older patients. Observing the patient's active ROM is more accurate and safe than asking the patient to lift weights with her legs.

A patient with an acute attack of gout is treated with colchicine. The nurse determines that the drug is effective upon finding a. relief of joint pain. b. increased urine output. c. elevated serum uric acid. d. decreased white blood cells (WBC).

ANS: A Colchicine produces pain relief in 24 to 48 hours by decreasing inflammation. The recommended increase in fluid intake of 2 to 3 L/day would increase urine output but would not indicate the effectiveness of colchicine. Elevated uric acid levels would result in increased symptoms. The WBC count might decrease with decreased inflammation, but this would not be as useful in determining the effectiveness of colchicine as a decrease in pain.

A patient with an exacerbation of rheumatoid arthritis (RA) is taking prednisone (Deltasone) 40 mg daily. Which of these assessment data obtained by the nurse indicate that the patient is experiencing a side effect of the medication? a. The patient's blood glucose is 165 mg/dL. b. The patient has no improvement in symptoms. c. The patient has experienced a recent 5-pound weight loss. d. The patient's erythrocyte sedimentation rate (ESR) has increased.

ANS: A Corticosteroids have the potential to cause diabetes mellitus. The finding of an elevated blood glucose reflects this side effect of prednisone. Corticosteroids increase appetite and lead to weight gain. An elevated ESR and no improvement in symptoms would indicate that the prednisone was not effective but would not be side effects of the medication

A patient who had arthroscopic surgery of the left knee 5 days ago is admitted with a red, swollen, and hot knee. Which assessment finding by the nurse should be reported to the health care provider immediately? a. The blood pressure is 88/46 mm Hg. b. The white blood cell count is 14,200/µL. c. The patient is taking ibuprofen (Motrin). d. The patient says the knee is very painful.

ANS: A The low blood pressure suggests that the patient may be developing septicemia as a complication of septic arthritis. Immediate blood cultures and initiation of antibiotic therapy are indicated. The other information is typical of septic arthritis and also should be reported to the health care provider, but it does not indicate any immediately life-threatening problems.

After obtaining the health history from a 28-year-old woman who is taking methotrexate (Rheumatrex) to treat rheumatoid arthritis, which information about the patient is most important for the nurse to report to the health care provider? a. The patient had a history of infectious mononucleosis as a teenager. b. The patient is trying to have a baby before her disease becomes more severe. c. The patient has a family history of age-related macular degeneration of the retina. d. The patient has been using large doses of vitamins and health foods to treat the RA.

ANS: B Methotrexate is teratogenic, and the patient should be taking contraceptives during methotrexate therapy. The other information will not impact the choice of methotrexate as therapy.

When the nurse is reviewing laboratory data for a patient who is taking methotrexate (Rheumatrex) to treat rheumatoid arthritis, which information is most important to communicate to the health care provider? a. The blood glucose is 75 mg/dL. b. The rheumatoid factor is positive. c. The white blood cell (WBC) count is 1500/L. d. The erythrocyte sedimentation rate is elevated.

ANS: C Bone marrow suppression is a possible side effect of methotrexate, and the patient's low WBC count places the patient at high risk for infection. The elevated erythrocyte sedimentation rate and positive rheumatoid factor are expected in rheumatoid arthritis. The blood glucose is normal.

When caring for a patient with gout and a red and painful left great toe, which nursing action will be included in the plan of care? a. Gently palpate the toe to assess swelling. b. Use pillows to keep the left foot elevated. c. Use a footboard to hold bedding away from the toe. d. Teach patient to avoid use of acetaminophen (Tylenol).

ANS: C Since any touch on the area of inflammation may increase pain, bedding should be held away from the toe and touching the toe will be avoided. Elevation of the foot will not reduce the pain, which is caused by the urate crystals. Acetaminophen can be used for pain relief.

5. When taking a patient history during assessment of the musculoskeletal system, the nurse identifies an increased risk for the patient who reports a. that a parent became much shorter with aging. b. a sprained ankle 2 years previously. c. a family history of tuberculosis. d. taking over-the-counter (OTC) ibuprofen (Advil) for occasional aches.

Answer: A Rationale: A family history of height loss with aging may indicate osteoporosis, and the patient may need to consider preventative actions, such as calcium supplements. A sprained ankle 2 years previously will not cause any current or future musculoskeletal problems. A family history of tuberculosis is not a risk factor. Occasional nonsteroidal antiinflammatory drug (NSAID) use does not indicate any increased musculoskeletal risk. Cognitive Level: Application Text Reference: p. 1621 Nursing Process: Assessment NCLEX: Health Promotion and Maintenance

10. A patient is seen at the urgent care center following a blunt injury to the left knee. The knee is grossly swollen and very painful, but the skin is intact. During an arthrocentesis on the patient's knee, the nurse would expect the aspirated fluid to appear a. sanguineous. b. purulent and thick. c. straw colored. d. white, thick, and ropelike.

Answer: A Rationale: The patient's clinical manifestations suggest hemarthrosis, and the appearance of blood in the synovial fluid is expected. Purulent fluid occurs when there is a joint infection. Straw-colored fluid is normal and will not be expected when the knee is swollen and painful. Thick fluid suggests infection. Cognitive Level: Comprehension Text Reference: p. 1628 Nursing Process: Assessment NCLEX: Physiological Integrity

6. Which information obtained during the nurse's assessment of the patient's nutritional-metabolic pattern may indicate the risk for musculoskeletal problems? a. The patient is 5 ft 2 in and weighs 180 lb. b. The patient prefers whole milk to nonfat milk. c. The patient dislikes fruits and vegetables. d. The patient takes a multivitamin daily.

Answer: A Rationale: The patient's height and weight indicate obesity, which places stress on weight-bearing joints. The use of whole milk, avoiding fruits and vegetables, and use of a daily multivitamin are not risk factors for musculoskeletal problems. Cognitive Level: Application Text Reference: p. 1621 Nursing Process: Assessment NCLEX: Health Promotion and Maintenance

16. When evaluating the effectiveness of treatment for a patient who is being treated for Paget's disease with calcitonin (Cibacalcin) and ibandronate (Boniva), the nurse will ask the patient about a. weight loss. b. skeletal pain. c. decreased appetite. d. frequent cough.

Answer: B Rationale: Bone pain is one of the common early manifestations of Paget's disease, and the nurse should ask about improvement in pain levels to determine whether the treatment is effective. Weight loss, anorexia, and frequent cough are not symptoms of Paget's disease. Cognitive Level: Application Text Reference: p. 1690 Nursing Process: Evaluation NCLEX: Physiological Integrity

17. A patient is receiving gentamicin (Garamycin) 80 mg IV twice daily for acute osteomyelitis. Which action should the nurse take before administering the gentamicin? a. Obtain the patient's oral temperature. b. Review the patient's BUN and creatinine levels. c. Ask the patient about any nausea. d. Change the wet-to-dry dressing.

Answer: B Rationale: Gentamicin is nephrotoxic and can cause renal failure. Monitoring the patient's temperature before gentamicin administration is not necessary. Nausea is not a common side effect of IV gentamicin. There is no need to change the dressing before gentamicin administration. Cognitive Level: Application Text Reference: p. 1670 Nursing Process: Assessment NCLEX: Physiological Integrity

12. An assessment finding that alerts the nurse to the presence of osteoporosis in a middle-aged patient is a. the presence of bowed legs. b. measurable loss of height. c. an aversion to dairy products. d. statements about frequent falls.

Answer: B Rationale: Osteoporosis occurring in the vertebrae produces a gradual loss of height. Bowed legs are associated with osteomalacia. Low intake of dairy products is a risk factor for osteoporosis, but it does not indicate that osteoporosis is present. Frequent falls increase the risk for fractures but are not an indicator of osteoporosis. Cognitive Level: Comprehension Text Reference: p. 1687 Nursing Process: Assessment NCLEX: Physiological Integrity

2. The nurse is assessing the passive range of motion of a patient's shoulder. The patient complains of pain during circumduction when the nurse moves the arm behind the patient. Which question should the nurse ask? a. "Do you ever have trouble making it to the toilet?" b. "Do you have difficulty in putting on a jacket?" c. "Are you able to feed yourself without difficulty?" d. "How well are you able to sleep at night?"

Answer: B Rationale: The patient's pain will make it more difficult to accomplish tasks like putting on a shirt or jacket. This pain should not impact the patient's ability to feed himself or herself or use the toilet because these tasks do not involve moving the arm behind the patient. The arm will not usually be positioned behind the patient during sleeping. Cognitive Level: Application Text Reference: pp. 1620-1622 Nursing Process: Assessment NCLEX: Health Promotion and Maintenance

8. While testing the patient's muscle strength, the nurse finds that the patient can flex the arms when no resistance is applied but is unable to flex when the nurse applies light resistance. The nurse should documents the patient's muscle strength as level a. 1. b. 2. c. 3. d. 4.

Answer: C Rationale: A level 3 indicates that the patient is unable to move against resistance but can move against gravity. Level 1 indicates minimal muscle contraction, level 2 indicates that the arm can move when gravity is eliminated, and level 4 indicates active movement with some resistance. Cognitive Level: Comprehension Text Reference: p. 1622 Nursing Process: Assessment NCLEX: Health Promotion and Maintenance

7. When the nurse is assessing a new patient in the clinic, which information about the patient's medications will be of most concern? a. The patient takes hormone replacement therapy (HRT) to prevent "hot flashes." b. The patient takes a daily multivitamin and calcium supplement. c. The patient has severe asthma and requires frequent therapy with steroids. d. The patient has migraine headaches which are treated with NSAIDs.

Answer: C Rationale: Corticosteroid use may lead to skeletal problems such as avascular necrosis and osteoporosis. The use of HRT and calcium supplements will help prevent osteoporosis. NSAID use does not increase the risk for musculoskeletal problems. Cognitive Level: Application Text Reference: p. 1619 Nursing Process: Assessment NCLEX: Health Promotion and Maintenance

13. A 58-year-old woman who has been menopausal for 5 years is diagnosed with osteoporosis following densitometry testing. The woman has been concerned about her risk for osteoporosis because her mother has the condition. In teaching the woman about her osteoporosis, the nurse explains that a. with a family history of osteoporosis, there is no way to prevent or slow gradual bone resorption. b. estrogen replacement therapy must be started to prevent rapid progression of her osteoporosis. c. even with a family history of osteoporosis, the calcium loss from bones can be slowed by increased calcium intake and exercise. d. continuous, low-dose corticosteroid treatment is effective in stopping the course of osteoporosis.

Answer: C Rationale: Progression of osteoporosis can be slowed by increasing calcium intake and weight-bearing exercise. Estrogen replacement therapy does help to prevent osteoporosis, but it is not the only treatment and is not appropriate for some patients. Corticosteroid therapy increases the risk for osteoporosis. Cognitive Level: Application Text Reference: p. 1689 Nursing Process: Implementation NCLEX: Physiological Integrity

4. During assessment of the musculoskeletal system of a 74-year-old woman, the nurse notes that the patient has lost 1 inch in height since the previous visit two years ago. The nurse will plan to teach the patient about a. diskography studies. b. magnetic resonance imaging (MRI). c. dual-energy x-ray absorptiometry (DEXA). d. myelographic testing.

Answer: C Rationale: The decreased height and the patient's age suggest that the patient may have osteoporosis and that bone density testing is needed. Diskography, MRI, and myelography are typically done for patients with current symptoms caused by musculoskeletal dysfunction and are not the initial diagnostic test for osteoporosis. Cognitive Level: Application Text Reference: pp. 1619, 1625 Nursing Process: Planning NCLEX: Health Promotion and Maintenance

15. When administering alendronate (Fosamax) to a patient, the nurse will first a. administer the ordered calcium carbonate. b. be sure the patient has recently eaten. c. assist the patient to sit up at the bedside. d. ask about any leg cramps or hot flashes.

Answer: C Rationale: To avoid esophageal erosions, the patient taking bisphosphonates should be upright for at least 30 minutes after taking the medication. Fosamax should be taken on an empty stomach, not after taking other medications or eating. Leg cramps and hot flashes are not side effects of bisphosphonates. Cognitive Level: Application Text Reference: p. 1689 Nursing Process: Implementation NCLEX: Physiological Integrity

9. A patient with a herniated intravertebral disk undergoes a laminectomy and diskectomy. Following the surgery, the nurse should position the patient on the side by a. elevating the head of the bed 30 degrees and having the patient extend the legs while turning to the side. b. turning the patient's head and shoulders and then the hips, keeping the patient centered in the bed. c. having the patient turn by grasping the side rails and pulling the shoulders over. d. placing a pillow between the patient's legs and turning the entire body as a unit.

Answer: D Rationale: Logrolling is used to maintain correct body alignment after laminectomy. The other positions will create misalignment of the spine. Cognitive Level: Application Text Reference: p. 1683 Nursing Process: Implementation NCLEX: Physiological Integrity

13. A patient has a new order for open magnetic resonance imaging (MRI) to evaluate for right femur osteomyelitis. Which information obtained by the nurse indicates that the nurse should consult with the health care provider before scheduling an MRI? a. The patient is claustrophobic. b. The patient wears a hearing aid. c. The patient is allergic to shellfish. d. The patient has a pacemaker.

Answer: D Rationale: Patients with permanent pacemakers cannot have MRI. An open MRI will not cause claustrophobia. The patient will need to be instructed to remove the hearing aid before the MRI, but this does not require consultation with the health care provider. Contrast medium will not be used, so shellfish allergy is not a contraindication to MRI. Cognitive Level: Application Text Reference: p. 1625 Nursing Process: Assessment NCLEX: Physiological Integrity

10. Following a laminectomy with a spinal fusion, a patient reports numbness and tingling of the right lower leg. The first action indicated by the nurse is to a. report the patient's complaint to the surgeon. b. check the vital signs for indications of hemorrhage. c. turn the patient to the side to relieve pressure on the operative area. d. check the chart for preoperative neuromuscular assessment data.

Answer: D Rationale: The postoperative movement and sensation of the extremities should be unchanged (or improved) from the preoperative assessment. If the numbness and tingling are new, this information should be immediately reported to the surgeon. Numbness and tingling are not symptoms associated with hemorrhage at the site. Turning the patient will not relieve the numbness. Cognitive Level: Application Text Reference: p. 1683 Nursing Process: Implementation NCLEX: Physiological Integrity

In reviewing bone remodeling, what should the nurse know about the involvement of bone cells? a. Osteoclasts add canaliculi. b. Osteoblasts deposit new bone. c. Osteocytes are mature bone cells. d. Osteons create a dense bone structure.

B Bone remodeling is achieved when osteoclasts remove old bone and osteoblasts deposit new bone. Osteocytes are mature bone cells, and osteons or Haversian systems create a dense bone structure, but these are not involved with bone remodeling.

The home care nurse visits an 84-year-old woman with pneumonia after her discharge from the hospital. Which assessment finding would the nurse expect because of age-related changes in the musculoskeletal system? a. Positive straight-leg-raising test b. Muscle strength is scale grade 3/5 c. Lateral S-shaped curvature of the spine d. Fingers drift to the ulnar side of the forearm

B Decreased muscle strength is an age-related change of the musculoskeletal system caused by decreased number and size of the muscle cells. The other assessment findings indicate musculoskeletal abnormalities. A positive straight-leg-raising test indicates nerve root irritation from intervertebral disk prolapse and herniation. An ulnar deviation or drift indicates rheumatoid arthritis due to tendon contracture. Scoliosis is a lateral curvature of the spine.

A 57-year-old postmenopausal woman is scheduled for dual-energy x-ray absorptiometry (DXA). Which statement, if made by the patient to the nurse, indicates understanding of the procedure? a. "The bone density in my heel will be measured." b. "This procedure will not cause any pain or discomfort." c. "I will not be exposed to any radiation during the procedure." d. "I will need to remove my hearing aids before the procedure."

B Dual-energy x-ray absorptiometry (DXA) is painless and measures the bone mass of spine, femur, forearm, and total body with minimal radiation exposure. A quantitative ultrasound (QUS) evaluates density, elasticity, and strength of bone using ultrasound of the calcaneus (heel). Magnetic resonance imaging would require removal of objects such as hearing aids that have metal parts.

A 42-year-old man who is scheduled for an arthrocentesis arrives at the outpatient surgery unit and states, "I do not want this procedure done today." Which response by the nurse is most appropriate? a. "When would you like to reschedule the procedure?" b. "Tell me what your concerns are about this procedure." c. "The procedure is safe, so why should you be worried?" d. "The procedure is not painful because an anesthetic is used."

B The nurse should use therapeutic communication to determine the patient's concern about the procedure. The nurse should not provide false reassurance. It is not appropriate for the nurse to assume the patient is concerned about pain or to assume the patient is asking to reschedule the procedure.

A female patient with a long-standing history of rheumatoid arthritis has sought care because of increasing stiffness in her right knee that has culminated in complete fixation of the joint. The nurse would document the presence of which problem? A. Atrophy B. Ankylosis C. Crepitation D. Contracture

B. Ankylosis Ankylosis is stiffness or fixation of a joint, whereas contracture is reduced movement as a consequence of fibrosis of soft tissue (muscles, ligaments, or tendons). Atrophy is a flabby appearance of muscle leading to decreased function and tone. Crepitation is a grating or crackling sound that accompanies movement.

A client returns to PACU after an arthroscopy to repair several knee ligaments. What is the nurse's priority when caring for this client? A. Take vitals every hour B. Check for swelling & bleeding C. Perform frequent neurovascular assessments D. Ensure that the surgical dressing is intact

C

A client who had an elective below-the-knee amputation reports pain in the part of his leg that was amputated. What is the nurse's best response to his pain? A. "the pain will go away in a few days or so." B. "that's phantom limb pain and every amputee has that." C. "on a scale of 0-10, how would you rate your pain?" D. "the pain is not real, so we don't treat it."

C

What health teaching by the nurse is the most important for clients diagnosed with discoid lupus erythematosus and managing the disease using topical steroid cream? A."take calcium supplements to prevent osteoporosis from the steroid. " B. "Stay away from crowds and people with infections." C. "Avoid being in the sun to prevent flare ups." D. "Use heavy powder makeup to cover skin lesions. "

C

A 54-year-old patient admitted with cellulitis and probable osteomyelitis received an injection of radioisotope at 9:00 AM before a bone scan. The nurse should plan to send the patient for the bone scan at what time? a. 9:30 PM b. 10:00 AM c. 11:00 AM d. 1:00 PM

C A technician usually administers a calculated dose of a radioisotope 2 hours before a bone scan. If the patient was injected at 9:00 AM, the procedure should be done at 11:00 AM. 10:00 AM would be too early; 1:00 PM and 9:30 PM would be too late.

A 63-year-old woman has been taking prednisone (Deltasone) daily for several years after a kidney transplant to prevent organ rejection. What is most important for the nurse to assess? a. Staggering gait b. Ruptured tendon c. Back or neck pain d. Tardive dyskinesia

C Osteoporosis with resultant fractures is a frequent and serious complication of systemic corticosteroid therapy. The ribs and vertebrae are affected the most, and patients should be observed for signs of compression fractures (back and neck pain). Phenytoin (Dilantin) is an antiseizure medication. An adverse effect of phenytoin is an ataxic (or staggering) gait. A rare adverse effect of ciprofloxacin (Cipro) and other fluoroquinolones is tendon rupture, usually of the Achilles tendon. The highest risk is in people age 60 and older and in people taking corticosteroids. Antipsychotics and antidepressants may cause tardive dyskinesia, which is characterized by involuntary movements of the tongue and face.

11. A patient in the emergency department is diagnosed with a patellar dislocation. The initial patient teaching by the nurse will focus on the need for a. conscious sedation. b. a knee immobilizer. c. gentle knee flexion. d. cast application.

Correct Answer: A Rationale: The first goal of collaborative management is realignment of the knee to its original anatomic position, which will require anesthesia or conscious sedation. Immobilization of the joint will be done after realignment. Later, gentle ROM exercises may be started if the joint is stable. Casting is not usually required for dislocations. Cognitive Level: Application Text Reference: p. 1632 Nursing Process: Implementation NCLEX: Physiological Integrity

A patient is seen at the urgent care center after falling on the right arm and shoulder. It will be most important for the nurse to determine a. whether there is bruising at the shoulder area. b. whether the right arm is shorter than the left. c. the amount of pain the patient is experiencing. d. how much range of motion (ROM) is present.

Correct Answer: B Rationale: A shorter limb after a fall indicates a possible dislocation, which is an orthopedic emergency. The nurse will expect bruising and pain at the area, even without an injury that requires surgery. The shoulder should be immobilized until it is evaluated by the health care provider.

10. A patient with a comminuted fracture of the right femur has Buck's traction in place while waiting for surgery. To assess for pressure areas on the patient's back and sacral area and to provide skin care, the nurse should a. have the patient lift the buttocks by bending and pushing with the left leg. b. turn the patient partially to each side with the assistance of another nurse. c. place a pillow between the patient's legs and turn gently to each side. d. loosen the traction and have the patient turn onto the unaffected side.

Correct Answer: A Rationale: The patient can lift the buttocks off the bed by using the left leg without changing the right-leg alignment. Turning the patient will tend to move the leg out of alignment. Disconnecting the traction will interrupt the weight needed to immobilize and align the fracture.

When counseling an older patient about ways to prevent fractures, which information will the nurse include? a. Tacking down scatter rugs in the home is recommended. b. Occasional weight-bearing exercise will improve muscle and bone strength. c. Most falls happen outside the home. d. Buying shoes that provide good support and are comfortable to wear is recommended.

Correct Answer: D Rationale: Comfortable shoes with good support will help to decrease the risk for falls. Scatter rugs should be eliminated, not just tacked down. Regular weight-bearing exercise will improve strength, but occasional exercise is not helpful in improving strength. Falls inside the home are responsible for many injuries. Cognitive Level: Application Text Reference: p. 1630 Nursing Process: Implementation NCLEX: Health Promotion and Maintenance

4. When working with a patient whose job involves many hours of word processing, the nurse will teach the patient about the need to a. do stretching and warm-up exercises before starting work. b. wrap the wrists with a compression bandage every morning. c. use acetaminophen (Tylenol) instead of NSAIDs for wrist pain. d. obtain a keyboard pad to support the wrist while word processing.

Correct Answer: D Rationale: Repetitive strain injuries caused by prolonged times working at a keyboard can be prevented by the use of a pad that will keep the wrists in a straight position. Stretching exercises during the day may be helpful, but these would not be needed before starting. Use of a compression bandage is not needed, although a splint may be used for carpal tunnel syndrome. NSAIDs are appropriate to use to decrease swelling. Cognitive Level: Application Text Reference: p. 1633 Nursing Process: Implementation NCLEX: Health Promotion and Maintenance

A patient is scheduled for an electromyogram (EMG). The nurse explains that this diagnostic test involves a. incision or puncture of the joint capsule. b. insertion of small needles into certain muscles. c. administration of a radioisotope before the procedure. d. placement of skin electrodes to record muscle activity.

Correct answer: b Rationale: Electromyography (EMG) is an evaluation of electrical potential associated with skeletal muscle contraction. Small-gauge needles are inserted into certain muscles and attached to leads that record electrical activity of muscle. Results provide information related to lower motor neuron dysfunction and primary muscle disease.

The bone cells that function in the resorption of bone tissue are called a. osteoids. b. osteocytes. c. osteoclasts. d. osteoblasts.

Correct answer: c Rationale: Osteoclasts participate in bone remodeling by assisting in the breakdown of bone tissue.

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. hypertension. b. thyroid problems. c. diabetes mellitus. d. chronic bronchitis.

Correct answer: c Rationale: The nurse should question the patient about past medical problems because certain illnesses are known to affect the musculoskeletal system directly or indirectly. These diseases include tuberculosis, poliomyelitis, diabetes mellitus, parathyroid problems, hemophilia, rickets, soft tissue infection, and neuromuscular disabilities.

To prevent muscle atrophy, the nurse teaches the patient with a leg immobilized in traction to perform (select all that apply) a. flexion contractions. b. tetanic contractions. c. isotonic contractions. d. isometric contractions. e. extension contractions.

Correct answer: d Rationale: Isometric contractions increase the tension within a muscle but do not produce movement. Repeated isometric contractions make muscles grow larger and stronger. Muscular atrophy (i.e., decrease in size) occurs with the absence of contraction that results from immobility.

When grading muscle strength, the nurse records a score of 3, which indicates a. no detection of muscular contraction. b. a barely detectable flicker of contraction. c. active movement against full resistance without fatigue. d. active movement against gravity but not against resistance.

Correct answer: d Rationale: Muscle strength score of 3 indicates active movement only against gravity and not against resistance (see Table 62-4).

The increased risk for falls in the older adult is most likely due to a. changes in balance. b. decrease in bone mass. c. loss of ligament elasticity. d. erosion of articular cartilage.

Correct answer: a Rationale: Aging can cause changes in a person's sense of balance, making the person unsteady, and proprioception may be altered. The risk for falls also increases in older adults partly because of a loss of strength.

A normal assessment finding of the musculoskeletal system is a. no deformity or crepitation. b. muscle and bone strength of 4. c. ulnar deviation and subluxation. d. angulation of bone toward midline.

Correct answer: a Rationale: Normal physical assessment findings of the musculoskeletal system include normal spinal curvatures; no muscle atrophy or asymmetry; no joint swelling, deformity, or crepitation; no tenderness on palpation of muscles and joints; full range of motion of all joints without pain or laxity; and muscle strength score of 5.

A patient with tendonitis asks what the tendon does. The nurse's response is based on the knowledge that tendons a. connect bone to muscle. b. provide strength to muscle. c. lubricate joints with synovial fluid. d. relieve friction between moving parts.

Correct answer: a Rationale: Tendons are composed of dense, fibrous connective tissue that contains bundles of closely packed collagen fibers arranged in the same plane for additional strength. They connect the muscle sheath to adjacent bone.

While performing passive range of motion for a patient, the nurse puts the ankle joint through the movements of (select all that apply) a. flexion and extension. b. inversion and eversion. c. pronation and supination d. flexion, extension, abduction, and adduction. e. pronation, supination, rotation, and circumduction.

Correct answers: a, b Rationale: Common movements that occur at the ankle include inversion, eversion, flexion, and extension.

The nurse is caring for a client with fresh application of a plaster leg cast. The nurse should plan to prevent the development of compartment syndrome by which action? 1. Elevating the limb and applying ice to the affected leg 2. Elevating the limb and covering the limb with bath blankets 3. Keeping the leg horizontal and applying ice to the affected leg 4. Placing the leg in a slightly dependent position and applying ice

Elevating the limb and applying ice to the affected leg

A client has sustained a closed fracture and has just had a cast applied to the affected arm. The client is complaining of intense pain. The nurse has elevated the limb, applied an ice bag, and administered an analgesic, which was ineffective in relieving the pain. The nurse interprets that his pain may be caused by which condition? 1. Infection under the cast 2. The anxiety of the client 3. Impaired tissue perfusion 4. The newness of the fracture

Impaired tissue perfusion

The nurse is one of several people who witness a vehicle hit a pedestrian at a fairly low speed on a small street. The individual is dazed and tries to get up, and the leg appears fractured. The nurse should plan to perform which action? 1. Try to manually reduce the fracture 2. Assist the person to get up and walk to the sidewalk 3. Leave the person for a few moments to call an ambulance 4. Stay with the person and encourage the person to remain still

Stay with the person and encourage them to remain still

The nurse has provided instructions regarding specific leg exercises for the client immobilized in right skeletal lower leg traction. The nurse determines that the client needs further teaching if the nurse observes the client doing which activity? 1. Pulling up on the trapeze 2. Flexing and extending the feet 3. Doing quadriceps-setting and gluteal-setting exercises 4. Performing active range of motion (ROM) to the right ankle and knee.

Performing active range of motion (ROM) to the right ankle and knee

A client is complaining of skin irritation from the edges of a cast applied the previous day. The nurse should plan for which intervention? 1. Massage the skin at the rim of the cast 2. Petaling the cast edges with adhesive tape 3. Using a rough file to smooth the cast edges 4. Applying lotion ot the skin at the rim of the cast

Petaling the cast edges with adhesive tape

Baclofen (Lioresal) is prescribed for a client with a spinal cord injury who is experiencing muscle spasms, and the nurse prepares a list of the associated side effects of the medication and reviews the list with the client. Which side effect identified by the client indicates a need for further teaching?

Photosensitivity

The nurse is checking the casted extremity of a client. The nurse should check for which sign of indicative of infection? 1. Dependent edema 2. Diminished distal pulse 3. Presence of a "hot spot" on the cast 4. Coolness and pallor of the extremity

Presence of a "hot spot" on the cast

Identify pain relief interventions for clients with arthritis.

Warm, moist heat (compresses, baths, showers); diversionary activities (imaging, distraction, self-hypnosis, biofeedback); and medications.