Neuromusculoskeletal

A client with rheumatoid arthritis is to begin taking ibuprofen (Motrin) 800 mg by mouth three times a day. The nurse provides education about the medication's side effects. The nurse concludes that the teaching was effective when the client states: 1. "I need to have my blood work checked every month." 2. "I need to balance exercise with rest." 3. "I need to change positions slowly." 4. "I need to take the medication between meals."

1. "I need to have my blood work checked every month."

The nurse is caring for a client who is admitted with a crushing injury to the spinal cord above the level of phrenic nerve origin. What is the result of this type of injury? 1. Ventricular fibrillation 2. Vagus nerve dysfunction 3. Retention of sensation and paralysis of the lower extremities 4. Lack of diaphragmatic contractions and respiratory paralysis

4. Lack of diaphragmatic contractions and respiratory paralysis

A client is admitted to the hospital with a diagnosis of acute Guillain-Barré syndrome. What frequent assessment does the nurse determine is most important for a client with this syndrome? 1. Urinary output 2. Sensation to touch 3. Neurological status 4. Respiratory exchange

4. Respiratory exchange **The respiratory center in the medulla oblongata can be affected with acute Guillain-Barré syndrome, which can lead to death from respiratory failure.

A client with a head injury is admitted to the hospital. Which client response indicates increasing intracranial pressure? 1. Hypervigalence 2. Constricted pupils 3. Increased heart rate 4. Widening pulse pressure

4. Widening pulse pressure

When caring for a pt with head injury that may have involved the medulla, the nurse bases assessments on the knowledge that the medulla controls a variety of functions ( select all that apply) 1. Breathing 2. Pulse rate 3. Fat metabolism 4. Blood vessel diameter 5. Temperature regulation

Breathing pulse rate blood vessel diameter

A client develops a seizure disorder as a result of a traumatic fall. When the client returns to the clinic for a routine visit, the client states, "I have not had a seizure in two years. When can I stop taking my anti-seizure medications?" What is the nurse's best response? 1. "A gradual reduction in seizure medication may be considered." 2. "You will require medication for the rest of your life." 3. "Enough time has passed since the last seizure. The medication probably will be discontinued at this visit." 4. "A minimum of 10 years without seizures is necessary before discontinuation of medications is considered."

1. "A gradual reduction in seizure medication may be considered."

After an amputation, the client's residual limb is bandaged snugly throughout the postoperative period. What should the nurse identify as the primary reason for this intervention? 1. Promotes shrinkage. 2. Prevents injury to the area. 3. Prevents suture line infection. 4. Promotes drainage of secretions.

1. Promotes shrinkage. **Wrapping of the residual limb applies pressure that prevents swelling and shapes it for the fitting of a prosthesis in the future.

A client has expressive aphasia. The client's family members ask how they can help the client regain as much speech function as possible. The nurse instructs them to: 1. Speak louder than usual during visits while looking directly at the client 2. Tell the client to use the correct words when speaking 3. Give positive reinforcement for correct communication 4. Encourage the client to speak while being patient with each attempt

4. Encourage the client to speak while being patient with each attempt

A client who had a brain attack (CVA) two weeks ago is having problems communicating. The nurse shows the client a picture of a baseball and asks the client to identify it and its characteristics. The client describes its color, size, and purpose but cannot identify it as a ball. The nurse documents this response as: 1. Anomia 2. Apraxia 3. Dysarthria 4. Dysphagia

1. Anomia

After a short hospitalization for an episode of a transient ischemic attack (TIA) related to hypertension, a client is discharged on a regimen that includes chlorothiazide (Diuril). What should the nurse instruct the client to do regarding nutrition? (Select all that apply.) 1. Eat more citrus fruits 2. Take protein supplements 3. Return to previous eating habits 4. Increase intake of dairy products 5 . Increase intake of dried cooked beans

1. Eat more citrus fruits 5 . Increase intake of dried cooked beans

Which medication should the nurse anticipate will be prescribed to relieve anxiety and apprehension in a client with pulmonary edema? 1. Morphine 2. Phenobarbital 3. Hydroxyzine (Atarax) 4. Chloral hydrate

1. Morphine

X-ray films reveal that a client has sustained an intracapsular fracture of the left hip as a result of a fall. The client is placed temporarily in Buck's traction. When providing care, the nurse should: 1.Monitor for tenderness in the left calf area 2. Turn the client from side to side every two hours 3. Raise the head of the bed to a semi-Fowler position 4. Put the client's lower extremities through passive range-of-motion exercises

1.Monitor for tenderness in the left calf area **Thrombophlebitis is a common complication of immobility in situations related to the application of traction.

What should the nurse take into consideration when planning nursing care for a patient experiencing an acute episode of rheumatoid arthritis? 1. Inflammation of the synovial membrane really occurs. 2. Bony ankylosis of a joint is irreversible and causes immobility. 3. Complete immobility is desired during the acute phase of inflammation. 4. Redness and swelling of a choice signified that irreversible damage has occurred.

2. Bony and ankylosis of a joint is irreversible and causes immobilitym

A nurse is precepting an orientee (newly hired nurse). The nurse observes the orientee caring for an unconscious client with increasing intracranial pressure. The nurse should question which intervention that the orientee performs? 1. Lubricating the skin with baby oil 2. Suctioning the oropharynx routinely 3. Elevating the head of the bed 20 degrees 4. Cleansing the eyes every four hours with normal saline

2. Suctioning the oropharynx routinely **Although suctioning is done to maintain an airway, it is not done routinely because it increases intracranial pressure.

A client with multiple sclerosis is in remission. Which diversional activity should the nurse encourage that best meets the client's needs while in remission? 1. Hiking 2. Swimming 3. Sewing classes 4. Watching television

2. Swimming

The nurse is caring for a client who has undergone a total hip replacement. The nurse recognizes which clinical manifestations indicate a pulmonary embolism? (select all that apply) 1. Flushing of the face 2. Unilateral chest pain 3. elevation of temperature 4. Sudden onset of shortness of breath 5. pain rating increased from 2 to 8 in the hip

2. Unilateral chest pain 4. sudden onset of shortness of breath

A client with glaucoma asks a nurse about future treatment and precautions. What information should the nurse's explanation include? 1. Avoidance of cholinergics 2. Surgical replacement of lens 3. Continuation of therapy for life 4. Prevention of high blood pressure

3. Continuation of therapy for life

A client with pain and paresthesia of the left leg is scheduled for an electromyogram. What should the nurse discuss with the client before the test is performed? 1. Bed rest must be maintained after the procedure. 2. The involved area will be shaved before the procedure. 3. Needles will be inserted into the affected muscles during the test. 4. Monitoring of the heart rate and rhythm will be done throughout the test.

3. Needles will be inserted into the affected muscles during the test.

A client with a history of hypertension is admitted to the hospital immediately after a brain attack (CVA). The client is unconscious and the vital signs are temperature 98°F, pulse 78, respiration 16, and blood pressure 120/80. Which nursing concern below is a priority for this client? 1. Injury 2. Constipation 3. Respiratory distress 4. Decreased fluid volume

3. Respiratory distress

A nurse is monitoring a client who is having a computed tomography (CT) scan of the brain with contrast. Which response indicates that the client is having an untoward reaction to the contrast medium? 1. Pelvic warmth 2. Feeling flushed 3. Shortness of breath 4. Salty taste in the mouth

3. Shortness of breath **An untoward response to the iodinated dye used as a contrast is anaphylaxis. Anaphylaxis is manifested by respiratory distress, hypotension, and shock; counteractive measures must be instituted.

A nurse raises three of four of the client's bedside rails at night. Which psychosocial outcome does the nurse hope to achieve through the use of side rails? 1. Prevent falls 2. Increase independence 3. Support a sense of security 4. Avoid an alteration in proprioception

3. Support a sense of security

When a client who had an above-the-knee amputation (AKA) complains of phantom limb sensations, the nursing staff should: 1. Reassure the client that these sensations will pass 2. Explain the psychological component involved to the client 3. Encourage the client to get involved in diversional activities 4. Describe the neurological mechanisms in language that the client understands

4. Describe the neurological mechanisms in language that the client understands **Explanation of the underlying mechanism usually helps calm anxiety about a phantom pain experience.

A client with the diagnosis of multiple sclerosis (MS) develops increased visual problems, progressive muscular weakness, and frequent episodes of emotional lability. The difficulties experienced are very distressing to the client. The client bursts into tears for no apparent reason while having a discussion with the nurse. What is the nurse's best response? 1. Tell the client that there is no reason to cry 2. Ascertain why the client is upset and crying 3. Assure the client that it is normal to be upset 4. Let the client cry and then resume the discussion

4. Let the client cry and then resume the discussion **Emotional outbursts are common and fleeting in these clients; it is best not to place any emphasis on them. The client is unable to control this emotion, and focusing on it may exaggerate the outburst.

A nurse obtains the nursing history from a client who has open-angle (chronic) glaucoma. The nurse anticipates that the client will report: 1. Flashes of light 2. Sensitivity to light 3. Seeing floating specks 4. Loss of peripheral vision

4. Loss of peripheral vision

A client's tibia is fractured in a motor vehicle accident, and a cast is applied. The nurse should assess for which manifestation indicating damage to major blood vessels caused by the fractured tibia? 1. Increased blood pressure 2. Prolonged edema in the thigh 3. Increased skin temperature of the foot 4. Prolonged reperfusion of the toes after blanching

4. Prolonged reperfusion of the toes after blanching **Damage to the blood vessels may decrease circulatory perfusion of the toes. Damage to the major blood vessels will more likely cause a decrease in blood pressure. The fracture is between the knee and the ankle, not in the thigh. Decreased circulatory perfusion of the foot causes the skin temperature to decrease.

A client has a shoulder immobilizer after surgical repair of a fractured humerus. What should be included in the nurse's instruction to the client about the appropriate use of the immobilizer? 1. Place the elbow on a pillow when sitting in a chair. 2. Adjust the upper arm and wristbands so they are slack. 3. Loosen the chest band to exercise the shoulder periodically. 4. Release the wristband to exercise the forearm and hand routinely.

4. Release the wristband to exercise the forearm and hand routinely.

Which client intervention should the nurse perform to prevent the development of lower extremity contractures? 1. Deep massage 2. active exercise 3. use of a tilt board 4. proper positioning

4. proper positioning

A client is to have a computed tomography (CT) scan with contrast to assess a potential brain tumor. The nurse should teach the client what common expected responses to the contrast material? (Select all that apply.) 1. Visual disturbances 2. Flushing of the face 3. Sensation of warmth 4. Lemony taste in the mouth 5. Small petechiae on the arms

2. Flushing of the face 3. Sensation of warmth

A nurse teaches self-care to a client who had a cast applied for a fracture of the right ulna and radius. The nurse instructs the client to notify the primary health care provider immediately if the client experiences: 1. Slight stiffness of the fingers 2. Increasing pain at the injury site 3. Small amount of bloody drainage on the cast 4. Bounding radial pulse in the affected extremity

2. Increasing pain at the injury site

The nurse teaches a premenopausal obese client about strategies to prevent osteoporosis. Which strategy identified by the client indicates that the teaching is effective? 1. Starts a rapid, strict weight reduction diet. 2. Joins a tennis league and practices every day. 3. Takes 1200 IU of vitamin D a day. 4. Signs up for a swimming class three times a week.

2. Joins a tennis league and practices every day.

A client receiving morphine is being monitored by the nurse for signs and symptoms of overdose. Which clinical findings support a conclusion of overdose? (Select all that apply.) 1. Polyuria 2. Lethargy 3. Bradycardia 4. Dilated pupils 5. Slow respirations

2. Lethargy 3. Bradycardia 5. Slow respirations

A nurse is caring for a client with glaucoma. What rationale associated with the need for treatment of this condition should the nurse include in a teaching program? 1. Total blindness is inevitable 2. Lost vision cannot be restored 3. Use of both eyes usually is restricted 4. Surgery will help the problem only temporarily

2. Lost vision cannot be restored

Patients who have cast applied to the lower extremities must be monitored for complications. Which finding during assessment of the extremities of these patients is indicated of a complication? (select all that apply) 1. Warmth 2. numbness 3. skin disquamation 4. generalized discomfort 5. prolonged capillary refill

2. Numbness 5. prolonged capillary refill

client with rheumatoid arthritis calls the outpatient clinic to report that pain with exercising has increased. To decrease pain, the nurse should suggest: 1. For morning stiffness, take a tub bath rather than a hot shower 2. Apply an ice pack directly to the involved joint for no more than 20 minutes at a time 3. Decrease the number of repetitions of the exercises 4. Cease exercising for a day

3. Decrease the number of repetitions of the exercises

A nurse is caring for a client who is hospitalized because of injuries sustained in a major automobile collision. As the client is describing the accident to a friend, the client becomes very restless, and his pulse and respirations increase sharply. Which factor probably is related to the client's physical responses? 1. Client's method of seeking sympathy 2. Bleeding from an undiscovered injury 3. Delayed psychological response to trauma 4. Parasympathetic nervous system response to anxiety

3. Delayed psychological response to trauma

A health care provider prescribes mannitol (Osmitrol) for a client with a head injury. The nurse concludes that the purpose of the medication is to relieve cerebral edema by: 1. Decreasing the production of cerebrospinal fluid 2. Limiting the metabolic requirements of the brain 3. Drawing fluid from brain cells into the bloodstream 4. Preventing uncontrolled electrical discharges in the brain

3. Drawing fluid from brain cells into the bloodstream

A back brace is prescribed for a client who had a laminectomy. What instruction should the nurse include in the teaching plan? 1. Apply the brace before getting out of bed 2. Put the brace on while in the sitting position 3. Use the brace when the back begins to feel tired 4. Wear the brace when performing twisting exercises

1. Apply the brace before getting out of bed **Appling the brace before getting out of bed is done while in the supine position before the body is subjected to the force of gravity in a vertical position.

A client has a diagnosis of myasthenia gravis. The nurse recalls that associated clinical manifestations include: 1. Blurred vision along with episodes of vertigo 2. Tremors of the hands when attempting to lift objects 3. Partial improvement of muscle strength with mild exercise 4. Involvement of the distal muscles rather than the proximal muscles

1. Blurred vision along with episodes of vertigo

A client with rheumatoid arthritis arrives in the clinic stating, "I don't take any medications because they are too expensive." The client reports that family members are arranging for the medications to be obtained from another country. What is the nurse's best response? 1. Discuss alternative solutions with the client 2. Encourage the client to use any method possible to obtain the medications 3. Contact the primary health care provider immediately to discuss the client's plan 4. Explain that medical regimens must be followed to continue to receive care in the clinic

1. Discuss alternative solutions with the clientz

A client returns from surgery after a total hip arthroplasty. A pillow to maintain abduction is in place. Under what conditions should the nurse remove this pillow? 1. During the client's bed bath 2. When the client is sitting in a chair 3. When the client needs a change of position 4. Once the client's operative pain has ceased

1. During the client's bed bath **Until a health care provider's prescription is written to discontinue use of the pillow, it is removed only for purposes of mobility (e.g., physical therapy, hygiene); adduction to or beyond the midline is not permitted for several months to prevent dislocation of the prosthesis.

A client sustains a fracture of the femur after jumping from the second story of a building during a fire. The client is placed in Buck's traction until an open reduction and internal fixation is performed. The client keeps slipping down in bed. To alleviate this problem the nurse should: 1. Elevate the foot of the bed 2. Shorten the rope on the weights 3. Release the traction so the client can be repositioned 4. Move the client toward the head of the bed every couple of hours

1. Elevate the foot of the bed

A nurse receives a change-of-shift report for a client who had a total hip replacement 24 hours ago. After reviewing the client's clinical record (shown here) and completing a physical assessment, the nurse should conclude that the client is experiencing which complication? 1. Fat embolism 2. Urinary retention 3. Hypovolemic shock 4. Pulmonary embolism

1. Fat embolism **The client most likely is experiencing fat embolism syndrome (FES) . The average time of onset of FES is 18 to 24 hours after injury to long bones or crushing injury. Fat globules and tissue thromboplastin exit from bone marrow and local tissue as a result of injury. Fat molecules enter venous circulation, move to lungs, and embolize small capillaries. Petechial rash on neck, chest, conjunctivae, or axillae is a classic sign of FES (occurs in 50% to 60% of clients with FES).

A family member of a client with a hemorrhagic stroke asks about anticoagulant therapy. The nurse explains that anticoagulant therapy for the client: 1. Is contraindicated because it will increase bleeding 2. May be necessary to prevent pulmonary thrombosis 3. Is inadvisable because it may mask signs and symptoms 4. Will be started if necessary to enhance cerebral circulation

1. Is contraindicated because it will increase bleeding **Administration of an anticoagulant to a client who is bleeding will interfere with clotting and increase bleeding

A nurse is providing postoperative teaching to a client who is scheduled to have an above-the-knee amputation. The client will use crutches during the postoperative period. Which activity will prepare the client for crutch walking? 1. Lifting weights 2. Changing bed positions 3. Caring for the residual limb 4. Performing phantom limb exercises

1. Lifting weights

A client had a right above-the-knee amputation secondary to trauma sustained in a motor vehicle accident. Six days after surgery, the client falls while attempting to transfer to a chair unassisted. The nurse concludes that this fall is most likely the result of: 1. Loss of balance 2. Phantom limb pain 3.Orthostatic hypotension 4. Decreased muscle strength

1. Loss of balance **The loss of the limb has altered the client's wide base of support and center of gravity and most likely contributed to the fall.

A client is admitted to the hospital with a diagnosis of Parkinson disease. Which common signs of Parkinson disease does the nurse expect to identify when completing a nursing admission history and physical? (Select all that apply.) 1. Muscle rigidity 2. Blank facial expression 3. Leaning toward the affected side 4. intention tremors with movement 5. Hyperextension of the affected extremit

1. Muscle rigidity 2. Blank facial expression

Carbidopa-levodopa sinemet is prescribed for a patient with Parkinson's disease. The nurse assesses for which adverse responses that are associated with this medication? (select all that apply) 1. Nausea 2. lethargy 3. bradycardia 4. polycythemia 5. emotional changes

1. Nausea 5. emotional changes

A client has carotid atherosclerotic plaques, and a right carotid endarterectomy is performed. Two hours after surgery the client demonstrates progressive hypotension. The nurse should: 1. Notify the health care provider 2. Increase the intravenous (IV) flow rate 3. Raise the head of the bed 4. Place the client in the Trendelenburg position

1. Notify the health care provider

The nurse is caring for a client with increased intracranial pressure (ICP). What clinical manifestations are associated with increased ICP? (Select all that apply.) 1. Psychotic behaviors 2. Jacksonian seizures 3. Nausea and vomiting 4. Rapid pulse 5. Hypotension

1. Psychotic behaviors 2. Jacksonian seizures 3. Nausea and vomiting

While setting up a client's food tray, the nurse identifies tremoring of the hand when it lies in the client's lap. The tremor disappears when the client reaches for silverware. What type of tremor should the nurse document in the client's medical record? 1. Resting tremor 2. Intention tremor 3. Voluntary tremor 4. Idiopathic tremor

1. Resting tremor **A resting tremor (nonintention tremor) typically is present when the hand is not involved in a purposeful activity.

A client with a history of tuberculosis reports difficulty hearing. Which medication should the nurse consider is related to this response? 1. Streptomycin 2. Pyrazinamide 3. Isoniazid (INH) 4. Ethambutol (Myambutol)

1. Streptomycin

The nurse is caring for a client who was just admitted to the hospital with the diagnosis of head trauma. Which clinical indicators should the nurse consider as evidence of increasing intracranial pressure? Select all that apply. 1. Vomiting 2. Anorexia 3. Irritability 4. Hypotension 5. Decreased level of consciousness

1. Vomiting 2. Anorexia 3. Irritability 5. Decreased level of consciousness

A client who had a tonic-clonic seizure of unknown etiology is to begin taking phenytoin (Dilantin). The nurse should instruct the client to: 1. Take the medication on an empty stomach 2. Brush the teeth and gums three times daily 3. Stop taking the drug if abdominal pain occurs 4. Note any change in pulse and respiratory rates

2. Brush the teeth and gums three times daily

A client has a tonic-clonic seizure that involves all extremities. The nurse anticipates that the health care provider will prescribe the intravenous administration of: 1. Naloxone (Narcan) 2. Diazepam (Valium) 3. Epinephrine HCl (Adrenalin) 4. Atropine sulfate (Atropine

2. Diazepam (Valium) **Parenterally administered diazepam is a benzodiazepine that has muscle relaxant and anticonvulsant effects that help limit massive muscular spasms.

A client with a history of seizures is admitted with a partial occlusion of the left common carotid artery. The client has been taking phenytoin (Dilantin) for 10 years. When planning care for this client, what should the nurse do first? 1. Place an airway and restraints at the bedside. 2. Obtain a history of seizure type and incidence. 3. Ask the client to remove any dentures and eyeglasses. 4. Observe the client for increased restlessness and agitation.

2. Obtain a history of seizure type and incidence.

A client is recuperating from a spinal cord injury at the T4 level and depends on a wheelchair for mobility. What should the nurse teach the client to prepare for use of a wheelchair? 1. Leg lifts to prevent hip contractures 2. Push-ups to strengthen arm muscles 3. Balancing exercises to promote equilibrium 4. Quadriceps-setting exercises to maintain muscle tone

2. Push-ups to strengthen arm muscles **Arm strength is necessary for transfers and activities of daily living and for the use of crutches or a wheelchair.

A client has rotator cuff surgery. What should be included when the nurse performs a neurovascular assessment of the affected extremity immediately after surgery? (Select all that apply.) 1. Pulse rate 2. Skin color 3. Presence of edema 4. Movement of the hand 5. Sensations in the extremity

2. Skin color

A nurse is caring for an anxious, fearful client. Which client response indicates sympathetic nervous system control? 1. Dry skin 2. Skin pallor 3. Constriction of pupils 4. Pulse rate of 60 beats/min

2. Skin pallor

A client who is to have a total hip arthroplasty with an uncemented prosthesis asks, "When will I be able to get up and walk?" On what information should the nurse base an answer? 1. Full weight-bearing is permitted after two weeks. 2. Partial weight-bearing begins the day after surgery. 3. Full weight-bearing may begin the day after surgery. 4. Partial weight-bearing progresses to full weight-bearing after two weeks.

3. Full weight-bearing may begin the day after surgery.

A client who is receiving radiation therapy for bone cancer lives alone and works full time. What should the nurse encourage this client to do? 1. Perform regularly scheduled aerobic activity daily. 2. Take a leave of absence from work when receiving therapy. 3. Include rest periods during the day while receiving radiation. 4. Continue the activities usually performed before becoming ill.

3. Include rest periods during the day while receiving radiation.

A client who had a brain attack (cerebral vascular accident) several months ago is readmitted to the hospital for a complication of immobility. The nurse reviews the client's laboratory test results, obtains vital signs, and performs a physical assessment. Data reveal elevated white blood cells (WBCs), fever of 101.2, and crackles upon auscultation of the bases bilaterally. Based on the results of the client's work-up, which prescribed medication should the nurse consider the priority at this time? 1. Warfarin (Coumadin) 2. Ferrous sulfate (Feosol) 3. Levofloxacin (Levaquin) 4. Acetaminophen (Tylenol)

3. Levofloxacin (Levaquin)

A client diagnosed with Bell's palsy has many questions about the course of the disorder. The nurse explains that: 1. Pain occurs with transient ischemic attacks (TIAs) 2. Cool compresses decrease facial involvement 3. Most clients recover from the effects in several weeks 4. Body changes should be expected with residual effect

3. Most clients recover from the effects in several weeks