W9. Seminar: Kaplan Musculoskeletal A Quiz

16. Aspirin is prescribed for the client. The nurse administers this medication with which liquid? 1. A glass of milk 2. A glass of orange juice 3. A glass of diet soda 4. A small amount of water

1 1) CORRECT - take with food, milk, or large glass of water to reduce gastrointestinal upset 2) vitamin C will increase the absorption of iron 3) caffeine may increase the absorption of aspirin 4) take with a large glass of water

11. The clinic nurse counsels a client complaining of low back pain. Which client statements requires a follow-up by the nurse? 1. "I work full time as a checker at the local grocery store." 2. "I sleep on a firm mattress." 3. "I walk for 30 minutes each day." 4. "I sleep on my side with my knees and hips flexed."

1 1) CORRECT - clients with low back pain should avoid standing for prolonged periods of time; important to follow-up on this statement by determining how long the client stands each day and how frequently the client is able to rest. 2) client with low back pain should sleep on a firm mattress or place boards between mattress and box springs for added support; lying on floor with feet elevated on bed or chair will also support back 3) daily exercise is appropriate 4) position that promotes good body mechanics

1. Total hip arthroplasty is scheduled for a patient with degenerative joint disease of the left femoral head. It is MOST important for the nurse to place the patient's left leg in which of the following positions? 1. Abducted with toes pointing upward. 2. Elevated on two pillows with knees flexed. 3. Elevated on several pillows with the ankle abducted. 4. Adducted with ankle joint hyperextended.

1 1) CORRECT - major complication of hip replacement is dislocation of the prosthesis; maintain abduction by placing pillow between the legs; do not stoop or cross legs 2) might dislocate prosthesis 3) do not elevate legs 4) will dislocate prosthesis

29. The nurse in the outpatient clinic is instructing a client receiving probenecid (Benemid). It is MOST important for the nurse to make which of the following statements? 1. "Drink 6-8 glasses of water each day." 2. "Take the medication on an empty stomach." 3. "You may take aspirin for minor pain." 4. "You are permitted to drink wine with dinner."

1 1) CORRECT - probenecid (Benemid) is an antigout medication that increases the excretion of uric acid; increased fluids will increase the excretion or uric acid; side effects include nausea, rash, and constipation 2) take with milk, food, or antacids to decrease GI distress 3) clients with gout should avoid all products containing aspirin 4) avoid alcohol because it increases urate levels

30. The home care nurse makes a home visit for a client diagnosed with osteoarthritis. The nurse asks the client's spouse if the client having any problems. The nurse should further assess if the spouse makes which statement? 1. "I can tell that my husband has been worrying because he is wringing his hands." 2. "Last night, my husband carried a big bowl of vegetables to the table using both hands." 3. "My husband bends from the knees when he picks the papers up from the floor." 4. "My husband only uses a small pillow under his head when he sleeps at night."

1 1) CORRECT - to protect joints, the client should avoid a twisting or wringing motion of the hands 2) using both hands to hold or carry objects protects the joints 3) do not bend from the waist 4) using a large pillow or multiple pillows can cause flexion contracture of the neck, which will cause increased discomfort.

7. The nurse is caring for a patient with degenerative joint disease (osteoarthritis). The physician orders celecoxib (Celebrex). The nurse is MOST concerned if the patient makes which of the following statements? 1. "I'm allergic to aspirin." 2. "I should take this medication with food." 3. "This medication will reduce joint discomfort." 4. "I will contact the health care provider if I have any weight gain."

1 1) CORRECT- COX-2 inhibitor; avoid using if client allergic to aspirin, sulfa, or other NSAIDS; contact health care provider 2) causes fatigue, nausea, vomiting, anorexia, dry mouth, constipation 3) COX-2 inhibitor blocks enzyme responsible for inflammation without blocking the COX-1 enzyme 4) may decrease effectiveness of ACE inhibitors, thiazide diuretics, furosemide

27. The nurse evaluates care given to a patient after a left below-the-knee amputation. The nurse should intervene if which of the following is observed? 1. A tourniquet is placed in the patient's bedside table. 2. The patient lies on his stomach several times per day. 3. The nurse uses a transfer belt when patient transfers from bed to chair. 4. The patient sits in a chair frequently for short periods of time.

1) CORRECT - tourniquet is placed in plain sight on the patient's bedside table; hemorrhage due to loosened suture is a threatening problem; if hemorrhage occurs, apply tourniquet and notify physician immediately 2) appropriate action; will prevent flexion contracture of the hip 3) appropriate action; center of gravity is altered due to amputation; patient should wear well-fitting shoe with non-skin sole; stabilize patient with transfer belt 4) to prevent flexion contracures of the hip, patient should not sit for long periods of time.

22. The nurse prepares a patient for a total hip replacement. Which of the following observations by the nurse necessitates contacting the physician? 1. The patient's hemoglobin is 15 g/dL. 2. The patient complains of burning on urination. 3. The patient complains of periodic heartburn. 4. The patient's platelet count is 250,000/mm3

2 1) appropriate range; measures oxygen-carrying capacity of the blood 2) CORRECT - indicates urinary tract infection; an infection from any source in the body is a contraindication to a total joint replacement 3) no reason to contact physician 4) range is 150,000-400,000/mm3

12. A client is evaluated in the clinic for rheumatoid arthritis. Which of the following findings should assume the highest priority for the nurse when assessing and planning the client's care? 1. Subcutaneous nodules on the client's right and left forearms. 2. Slight contracture of the right wrist. 3. Mild erythema of finger joints. 4. Bruised area about 3 mm in diameter on right forearm.

2 1) are usually round, nontender, and disappear; unless they become infected, they do not present a problem 2) CORRECT- indicates inadequate pain management; give prescribed medications as ordered on time to ensure constant blood levels; alternate rest and activity; position joints properly; ice applied for acute inflammation; heat (showers and hot packs) used to relieve stiffness 3) indicates inflammation; rheumatoid arthritis usually affects upper extremities first 4) nurse should follow-up on bruising, contracture takes priority; other symptoms of rheumatoid arthritis includes 5) fatigue, generalized weakness, anorexia, weight loss, and low-grade fever

24. The nurse cares for a client in Buck's traction. It is MOST important for the nurse to take which action? 1. Encourage the client to limit body movements. 2. Allow weights to hang freely at all times. 3. Remove weights immediately when client reports discomfort. 4. Give pain medication regularly.

2 1) clients can move, but they should maintain the leg in appropriate alignment; no twisting from side-to-side; encourage movement of unaffected areas 2) CORRECT - important nursing responsibility to maintain traction; the client needs to be repositioned frequently to maintain the proper reduction of a fracture; the weights are never removed 3) weights are not removed unless there is an order; inspect skin every 8 hours for irritation and inflammation; reports of severe pain may indicate that weights are too heavy or client needs to be realigned 4) may be given analgesics, antiinflammatories, and/or muscle relaxants; priority is to allow weights to hang freely

10. The nurse cares for an elderly patient eight days after an open reduction and internal fixation of the right hip. The nurse should intervene if which observed is made? 1. The client ate half of the food on the breakfast tray. 2. The client is not wearing elastic stockings. 3. The client transfers from the bed to bedside commode with assistance. 4. The client required pain medication three times per day.

2 1) encourage client to drink fluids; eating part of breakfast is acceptable 2) CORRECT - DVT is the most common complication; client should wear elastic stockings or use sequential compression device; encourage fluids 3) appropriate behavior; getting client up will help prevent atelectasis 4) assess type and location of pain; administer prescribed analgesics as needed; mild pain easier to control than severe pain

20. A patient diagnosed with type 1 diabetes is scheduled for a right below-the-knee amputation due to a gangrenous toe. The patient asks the nurse why the amputation is so extensive. The nurse's response should be based on which of the following? 1. A below-the-knee amputation ensures enough skin to form a flap over the stump. 2. A below-the-knee amputation results in better circulation and healing. 3. A below-the-knee amputation facilitates earliest prosthesis training. 4. A blow-the-knee amputation significantly reduces edema of the residual limb.

2 1) if infection is present, an open amputation will be performed to allow drainage of exudate; if closed method of amputation performed, skin flap is pulled over bone end and sutured into place; skin flap should be pink or not discolored, and warm (not hot) to touch 2) CORRECT- the level of an amputation is based on the aequacy of circulation; to leave tissues that are poorly supplied with blood would cause poor healing and could lead to the development of gangrene 3) may be fitted with temporary prosthesis at the time of surgery 4) limb is wrapped with elastic bandage to prevent edema and to shape the limb

15. During an acute bout of gouty arthritis, the nurse should expect the patient's affected foot to appear. 1. pale. 2. red. 3. mottled. 4. cyanotic

2 1) indicates decreased blood flow 2) CORRECT - gout is systemic disease caused by inflammation due to urate deposits in the joints; symptoms include redness due to joint inflammation; joint is extremely painful; inspect joint only; too painful to touch. 3) area of discoloration 4) blue, gray, or purple discoloration of the skin; due to decreased oxygen and increased carbon dioxide

3. Prednisone 2 mg qd is prescribed for a client with rheumatoid arthritis. What important points should the nurse include when teaching the client about this medication? 1. The health care provider will increase the dose until there is complete relief of symptoms. 2. The dosage of prednisone must be increased and decreased gradually. 3. Some people experience incontinence as a side effect of this medication. 4. Prednisone is a dangerous medication and must be carefully monitored.

2 1) it is expected that the client will experience a reduction in joint pain but not necessarily achieve complete relief of symptoms. 2. ) CORRECT - corticosteroid that acts as an antiinflammatory; long-term effect of chronic steroid therapy includes osteoporosis, cataracts, hypertension, and diabetes; it is important to withdraw this medication gradually to minimize the reaction of the body to the sudden loss of exogenous steroids; with prolonged steroid administration, the adrenal glands are suppressed 3) side effects include euphoria, insomnia, and peptic ulcers 4) important to assess for fluid retention, increased blood pressure, decreased potassium, elevated glucose, moon-face, bruising

5. Three hours after arriving at the orthopedic unit, a patient complains about a hot feeling under the cast. Which action should the nurse take FIRST? 1. Instruct the patient to lie still since the cast is newly applied. 2. Check the circulation in the casted extremity and change the patient's position. 3. Take the patient's temperature and observe for other signs of infection 4. Medicate the patient for pain and notify the doctor of the complaint.

2 1) patient's complain indicates neurovascular compromise; requires follow-up by the nurse; this answer indicates that there is no problem 2) CORRECT- heat is a sign of pressure; checking the circulation is appropriate since pressure can limit circulation; it is possible that changing the position might relieve the pressure 3) check initially for neurovascular compromise; watch for danger signs, such as blueness or paleness, pain, numbness, or tingling sensations on the affected area; infection caused by breakdown of skin under cast 4) nurse validates the patient's complaints before implementing care

2. The nurse cares for a patient after a total hip replacement due to degenerate joint disease. The nurse should intervene if which of the following is observed? 1. The patient uses an incentive spirometer every 2 hours. 2. The patient is positioned with a pillow between the legs. 3. The patient's heels are lying on the bed with toes pointed upward. 4. The patient moves slowly when getting out of bed.

3 1) appropriate action; will prevent atelectasis 2) appropriate action; will prevent dislocation of the prosthesis 3) CORRECT - elderly are prone to pressure sores; keep heels off bed to prevent pressure sores 4) appropriate action; will prevent orthostatic hypotension

26. A nurse witnesses a car hit a pedestrian in the parking lot. As the nurse approaches the pedestrian, the pedestrian cries out, "I think my leg is broken!" Which action does the nurse take FIRST? 1. Asks the client to move the ankle and foot on the affected side. 2. Inspects the client for evidence of bleeding. 3. Cuts away the client's pant leg on the affected side 4. Immobilizes the affected leg.

3 1) assess motor function by asking client to move leg distal to fracture; must first inspect area to determine if any bleeding; take care of bleeding before assessing motor function 2) first expose extremity by cutting away clothing; if bleeding, apply direct pressure to the area; also apply pressure over the artery closest to the fracture 3) CORRECT- must be able to inspect the injury for bleeding, swelling, or any deformity 4) first step of physical assessment is inspection

28. The nurse cares for the elderly client diagnosed with a fractured femur. The nurse recognizes which observation is an EARLY sign of fat embolism? 1. Chest pain and dyspnea. 2. Increased respirations, pulse, and temperature. 3. Altered mental status. 4. Petechiae.

3 1) fat embolism is a complication of fracture of long bones or of multiple fractures; occurs within 48 hours after the fracture; chest pain and dyspnea will occur after altered mental status 2) will occur after altered mental status 3) CORRECT - earliest sign due to low arterial oxygen levels; fat embolism more common in men between ages of 20 and 40 and adults between the ages of 70 and 80 4) characteristic of fat embolism but not early sign; treatment includes bedrest, oxygen, gentle handling, and hydration.

13. The nurse cares for a patient after a right below-the-knee amputation. The nurse is MOST concerned if which of the following is observed? 1. The patient periodically naps. 2. The patient complains of a throbbing headache. 3. The patient complains of persistent pain at the operative site. 4. The nurse palpates a pulse above the operative site.

3 1) indicates that the patient is resting comfortably and that pain is controlled 2) would require follow-up, but does not indicate a complication 3) CORRECT - redness, swelling, and pain indicate inflammation and infection; nurse should inspect the limb and drainage, and notify the physician of any signs of infection 4) assess the closet proximal pulse and compare to other extremity

32. A football quarterback suffers arm and leg muscle injuries when repeatedly injured and is given methocarbamol for the injuries. When following up with the client, the nurse is most concerned if the client states which symptom is being experienced? 1. Metallic taste in the mouth. 2. Brown urine. 3. Nasal congestion. 4. Drowsiness.

3 1) methocarbamol is a centrally acting muscle relaxant; can cause the client to have a metallic taste; can be given with food to decrease GI irritation 2) urine can turn black, brown, or green; not a reason to discontinue medication 3) CORRECT - could indicate an allergic reaction; should notify health care provider if skin rash, itching, fever, or nasal congestion occurs 4) drowsiness and light-headedness can result from the muscle relaxation produced by the medication; avoid alcohol or other CNS depressants when taking metocarbamol

4. The nurse in the outpatient clinic is measuring the height of an older woman. The client expresses surprise that she is 1 inch shorter than she used to be. Which of the following statements by the nurse is BEST? 1. "You have degenerative joint disease of the knees and that will cause your height to decrease." 2. "You have lost height because you have bursitis of the left shoulder." 3. "You are shorter as a result of Paget's disease." 4. "Maybe it is because you were diagnosed with juvenile rheumatoid arthritis."

3 1) osteoarthritis will not cause a decrease in height 2) bursitis is inflammation of connective tissue sac between muscles, tendons, and bones; caused by repetitive motion and overuse; interventions include rest, immobilization of affected joint, pain medication, heat/cold packs 3) CORRECT- kyphosis and bowing of the legs are characteristics of Paget's disease, both of which will decrease the patient's height; second most common bone disease of older adults after osteoporosis 4) will not decrease the height after adulthood

6. The nurse cares for a client with newly applied plastic cast to the lower extremity. The nurse should take which action? 1. Set up a fan to blow on the cast and turn the patient frequently. 2. Rest the casted leg on the mattress and avoid handling it until it has dried. 3. Elevate the leg on pillows and leave the cast open to air. 4. Cover the cast lightly with a sheet and remove it frequenlty.

3 1) patient should be turned q 1-2 hours; cast should be exposed to air; use palms of hands (not fingertips) to handle cast 2) resting cast on a firm mattress is appropriate, but patient should be turned every 1-2 hours to ensure that cast dries on all sides 3) CORRECT - elevation of the extremity will prevent edema; elevation on pillows will prevent the cast from having contact with a hard surface that might cause pressure; leaving the cast open to air will facilitate drying 4) do not cover cast

18. A patient asks the nurse, "What is the difference between rheumatoid arthritis and osteoarthritis?" 1. "Rheumatoid arthritis is progressive and osteoarthritis is not." 2. "Rheumatoid arthritis is often treated surgically and osteoarthritis is not." 3. "Rheumatoid arthritis is a systemic disease and osteoarthritis is not." 4. "There is very little clinical difference between rheumatoid arthritis and osteoarthritis."

3 1) rheumatoid arthritis is a chronic, progressive, systemic inflammatory process; degenerative joint disease (osteoarthritis) is the most common connective tissue disease and is characterized by the progressive deterioration of articular cartilage in peripheral and axial joints 2) both types of arthritis are initially treated with medication; if pain cannot be managed by medication, joint replacements may be performed 3) CORRECT - osteoarthritis is a "wear and tear" disease; rheumatoid arthritis is a systemic inflammatory disease that affects the synovial joints as well as the blood vessels causing vasculitis; since it affects connective tissue, can affect any body system with connective tissue 4) not a true statement

9. The nurse performs discharge teaching for a patient diagnosed with a fractured left femur that is in a cast. The patient asks how to keep the muscles of the leg strong during the time the cast is on the left leg. Which response by the nurse is BEST? 1. "It is important to perform active range of motion every day with your left leg." 2. "I'll teach your mother to perform active assistive range-of-motion exercises." 3. "Perform left leg lifts with a 2-lb weight attached to your ankle." 4. "I'll teach you how to do isometric exercises."

4 1) active range of motion increases mobility of the joint; will not affect the muscles; active range of motion is performed by the patient without assistance 2) increases mobility of joint and is performed by patient with assistance of another person 3) describes active resistive range of motion; will increase muscle tone, but not appropriate for fractured leg 4) CORRECT- the only safe method of enhancing muscle strength and venous return in a casted extremity is by isometrics, such as quadriceps setting or straight leg raises.

31. The nurse counsels a client receiving alendronate (Fosamax). What is the MOST important instruction for the nurse to include to prevent esophageal ulceration? 1. Take Fosamax in the morning before eating food or taking other medications. 2. Take Fosamax with calcium and vitamin D. 3. If a dose is missed, skip the dose that day. 4. Swallow the medication with a full glass of water and remain upright for 30 minutes.

4 1) alendronate (Fosamax) is a bone resorption inhibitor used in the treatment of osteoporosis and Paget's disease; important to take the medication before eating, but that alone will not prevent esophageal ulceration 2) although adding calcium and vitamin D may be suggested by the physician, thses supplements are for adding to bone strength, not preventing a side effect. 3) appropriate action, but will not prevent esophageal ulceration; return to her regular regime the next day 4) CORRECT - prevents possible ulceration

17. The nurse cares for a client in balanced suspension traction. The client reports pain in the affected extremity, and the nurse administers the prescribed medication. One hour later the client states, "I don't know why, but the pain isn't getting any better." Which action does the nurse take FIRST? 1. contacts the health care provider. 2. Offers the client a back rub. 3. Assesses the level of the client's pain. 4. Performs a neurovascular assessment.

4 1) assess before contacting the health care provider 2) back rub is an appropriate measure to help relieve pain, but nurse should assess cause before implementing 3) need to determine the cause of the pain 4) CORRECT - an early sign of acute compartment syndrome is a sudden inability of pain medication to relieve pain

14. An elderly client undergoes an open reduction and internal fixation of the left femoral head after a fracture. Which action by the nurse is BEST? 1. Offer the client a low-residue diet. 2. Turn the client to the unoperated side. 3. Instruct the client to exercise the arms. 4. Encourage the client to cough and deep breathe every 2 hours.

4 1) client progressed to a regular diet 2) depending on the health care provider's orders, may lie on either side; place pillow between legs to prevent adduction, which causes dislocation of the hip; do not flex operative hip 45-60 degress 3) use of overhead trapeze will strengthen arms and shoulders in preparation for ambulation 4) CORRECT - the respiratory complication of atelectasis is a common occurrence within the first 24 hours postoperatively; to prevent this complication, it is essential for an elderly client to cough and breathe deeply.

25. The nurse makes a home care visit to the client with a fractured right femur. The nurse assesses the client's safety when using crutches. The nurse intervenes if which observation is made? 1. When standing, the crutch tips are placed 6 inches in front of and 6 inches to the side of each foot. 2. The client ambulates using a three-point gait. 3. When going down steps, the client stands on the unaffected leg and places the crutches on the next step. 4. Before sitting in a chair, client stands on the unaffected leg and transfers both crutches in the hand opposite the unaffected leg.

4 1) describes tripod position, which is the basic crutch stance 2) appropriate gait when required to bear weight on one foot; two-point gait requires partial weight bearing on both feet 3) stand on unaffected leg, place crutches on stairs, transfer weight to the crutches, and move affected leg forward; affected leg is moved to the stairs with the crutches 4) CORRECT- to sit, position client in front of the chair with backs of legs touching the chair; transfer both crutches to the hand on the unaffected side of the body; support weight on unaffected leg and crutches and lower to the chair.

19. The nurse provides care for a client after an amputation with an immedicate prosthetic fitting. The nurse includes which activity in the client's plan of care? 1. Assess drainage from the in-site drains. 2. Observe dressing for sings of excessive bleeding. 3. Elevate the residual limb for no less than 40 hours. 4. Provide cast care on the affected extremity.

4 1) drains may be used to control hematomas if a soft dressing (dressing, and elastic bandage or residual limb sock) is used 2) accomplished with a soft dressing 3) elevation of residual limb will cause contractures; if residual limb requires elevation, elevate the foot of the bed 4) CORRECT - closed rigid cast prevents bleeding, supports soft tissues to control pain, and will prevent contracture; because there is a rigid plaster cast, cast care is required.

23. The nurse assesses a patient with a diagnosis of osteoarthritis. The nurse expects to observe which of the following sings/symptoms? 1. Pain on abduction of the hips, waddling gait. 2. Fever, rash, and nodules over bony prominence. 3. Swollen, reddened, painful joint with limitation of motion. 4. Stiffness of the hips, knees, vertebrate, and fingers.

4 1) not indicative of osteoarthritis 2) fever and rash consistent with systemic lupus erythematosus 3) osteoarthritis causes joints to be enlarged but not usually hot and inflamed; inflammation of joints indicates rheumatoid arthritis 4) CORRECT - osteoarthritis is a "wear and tear" disease characterized by stiffness in the joints, usually in the hips, vertebrae, and fingers

8. Which of the following nursing interventions is MOST appropriate for a patient diagnosed with rheumatoid arthritis? 1. Provide support of flexed joints with pillows and pads. 2. Position the patient on the abdomen several times a day. 3. Massage the inflamed joints alternately with oil and alcohol. 4. Assist the patient with heat application and range-of-motion exercises.

4 1) place joints in functional position; when patient lying down, place small pillow under patient's head or neck, but do not use other pillows for support-will cause flexion 2) is recommended if patient can tolerate position 3) apply cold if joints inflamed; heat used to manage pain; make sure that the hot pack is not too heavy or too hot 4) CORRECT- the goal of these interventions is to reduce swelling, increase circulation, and diminish stiffness while preserving joint mobility; this is critical for a patient with rheumatoid arthritis

21. In teaching a patient with a below-the-knee amputation to care for the residual limb at home, the nurse should advise the patient to do which of the following? 1. Apply cream daily to the residual limb. 2. Cover the residual limb with a nylon sock. 3. Keep the residual limb elevated. 4. Expose the residual limb to air.

4 1) wash residual limb and dry gently; assess for areas of breakdown 2) residual limb sock made of cotton, which absorbs perspiration and prevents direct contact between skin and prosthetic; change sock daily 3) will cause contractures; prevent external rotation and flexion of residual limb; if limb is elevated to prevent edema, raise the foot of the bed 4) CORRECT- air exposure will facilitate healing of residual limb