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Flashcards in Musculoskeletal Deck (150)
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1

The nurse is caring for an elderly client diagnosed with a herniated nucleus pulposus of L4-L5. Which scientific rationale explains the incidence of a ruptured disc in the elderly?
1. The client did not use good body mechanics when lifting an object.
2. There is an increased blood supply to the back as the body ages.
3. Older clients develop atherosclerotic joint disease as a result of fat deposits.
4. Clients develop intervertebral disc degeneration as they age.

4. Less blood supply, degeneration of the disc, and arthritis are reasons elderly people develop back problems.

2

The 34-year-old male client presents to the outpatient clinic complaining of numbness and pain radiating down the left leg. Which further data would the nurse assess?
1. Posture and gait.
2. Bending and stooping.
3. Leg lifts and arm swing.
4. Waist twists and neck mobility.

1. Posture and gait will be affected if the client is experiencing sciatica, pain radiating down a leg resulting from pressure on the sciatic nerve.

3

The occupational health nurse is preparing an in-service for a group of workers in a warehouse. Which information should be included to help prevent on-the job-injuries?
1. Increase sodium and potassium in the diet during the winter months.
2. Use the large thigh muscles when lifting and hold the weight near the body.
3. Use soft-cushioned chairs when performing desk duties.
4. Have the employee arrange for assistance with household chores.

2. These are instructions to prevent back injuries as a result of poor body mechanics.

4

The occupational health nurse is planning health promotion activities for a group of
factory workers. Which activity would be an example of primary prevention for clients
at risk for low back pain?
1. Teach back exercises to workers after returning from an injury.
2. Place signs in the work area about how to perform first aid.
3. Start a weight-reduction group that would meet at lunchtime.
4. Administer a nonnarcotic analgesic to a client complaining of back pain.

3. Excess weight increases the workload on the vertebrae. Weight loss activities would help to prevent back injury.

5

The client with a cervical neck injury as a result of a motor-vehicle injury is complaining
of unrelieved pain after administration of a narcotic analgesic. Which alternative method of pain control would be an independent nursing action?
1. Medicate the client with a muscle relaxant.
2. Heat alternating with ice applied by a physical therapist.
3. Watch television or listen to music.
4. Discuss surgical options with the health-care provider.

3. This is distraction and is an alternative method often recommended for the promotion of client comfort

6

The client diagnosed with cervical neck disc degeneration has undergone a laminectomy.
Which interventions should the nurse implement?
1. Position the client prone with the knees slightly elevated.
2. Assess the client for difficulty speaking or breathing.
3. Measure the drainage in the Jackson-Pratt bulb every day.
4. Encourage the client to postpone the use of narcotic medications.

2. The surgical position of the wound places the client at risk for edema of tissues in the neck. Difficulty speaking or breathing would alert the nurse to a potentially life-threatening problem.

7

The client is 12-hours post-lumbar laminectomy. Which nursing interventions should
be implemented?
1. Assess ability to void and log roll every two (2) hours.
2. Medicate with IV steroids and keep the bed in a Trendelenburg position.
3. Place sand bags on each side of the head and give cathartic medications.
4. Administer IV anticoagulants and place on O2 at eight (8) L/min.

1. The lumbar nerves innervate the lower abdomen. The bladder is in the lower abdomen. The client will be required to lie flat, and this is a difficult position for many clients, especially males, to be in to void. Clients are log rolled every 2 hours.

8

The nurse is working with an unlicensed nursing assistant. Which action by the assistant
warrants immediate intervention?
1. The assistant feeds a client 2 days postoperative cervical laminectomy a regular diet.
2. The assistant calls for help when turning to the side a client who is post-lumbar
laminectomy.
3. The assistant is helping the client who weighs 300 pounds and diagnosed with back
pain to the chair.
4. The assistant places the call light within reach of the client who had a disc fusion.

3. The legs of any client diagnosed with back pain can give out and collapse at any time, but a large client diagnosed with back pain would be at increased risk of injuring the assistant as well as the client. The nurse should intervene before the client or assistant become injured.

9

The nurse is caring for clients on an orthopedic floor. Which client should be assessed first?
1. The client diagnosed with back pain who is complaining of a “4” on a 1–10 scale.
2. The client who has undergone a myelogram who is complaining of a slight
headache.
3. The client 2 days postop disc fusion that has a T 100.4, P 96, R 24, and BP 138/78.
4. The client diagnosed with back pain who is being discharged and whose ride is here.

3. This client is postop and now has a fever. This client should be assessed and the HCP should be notified.

10

The nurse is administering 0730 medications to clients on a medical orthopedic unit.
Which medication would be administered first?
1. The daily cardiac glycoside to a client diagnosed with back pain and heart failure.
2. The routine insulin to a client diagnosed with neck strain and Type 1 diabetes.
3. The oral proton pump inhibitor to a client scheduled for a laminectomy this A.M.
4. The fourth dose of IV antibiotic for a client diagnosed with a surgical infection.

2. Clients with Type 1 diabetes are insulin dependent. This medication should be administered before the client eats.

11

The nurse writes the problem of “pain” for a client diagnosed with lumbar strain. Which nursing interventions should be included in the plan of care? Select all that apply.
1. Assess pain on a 1–10 scale.
2. Administer pain medication PRN.
3. Provide a regular bed pan for elimination.
4. Assess surgical dressing every four (4) hours.
5. Perform a position change by the log roll method every two (2) hours.

1. An objective method of quantifying the client's pain should be used.

2. Once the nurse has determined that the client is stable and not experiencing complications, the nurse can medicate the client.

12

The nurse working on a medical-surgical floor feels a pulling in the back when lifting
a client up in the bed. Which should be the first action taken by the nurse?
1. Continue working until the shift is over and then try to sleep on a heating pad.
2. Go immediately to the emergency department for treatment and muscle relaxants.
3. Inform the charge nurse and nurse manager on duty and document the occurrence.
4. See a private health-care provider on the nurse’s off time but charge the hospital.

3. The first action is to notify the charge nurse so that a replacement can be arranged to take over care of the clients. The nurse should notify the nurse manager or house supervisor. An occurrence report should be completed documenting the situation. This provides the nurse with the required documentation to begin a worker's compensation case for payment of medical bills.

13

The occupational health nurse is teaching a class on the risk factors for developing
osteoarthritisoa (OA). Which is a modifiable risk factor for developing OA?
1. Being overweight.
2. Increasing age.
3. Previous joint damage.
4. Genetic susceptibility.

1. Obesity is a well-recognized risk factor for
the development of OA and it is modifiable
in that the client can lose weight.

14

The client is diagnosed with osteoarthritis. Which sign/symptom would the nurse
expect the client to exhibit?
1. Severe bone deformity.
2. Joint stiffness.
3. Waddling gait.
4. Swan neck fingers.

2. Pain, stiffness, and functional impairment
are the primary clinical manifestations of
OA. Stiffness of the joints is commonly experienced
after resting but usually lasts less
than 30 minutes and decreases with movement.

15

The client diagnosed with OA is a resident in a long-term care facility. The resident is
refusing to bathe because she is hurting. Which instruction should the nurse give the
unlicensed nursing assistant?
1. Allow the client to stay in bed until the pain becomes bearable.
2. Tell the assistant to give the client a bed bath this morning.
3. Try to encourage the client to get up and go to the shower.
4. Notify the family that the client is refusing to be bathed.

3. Pain will decrease with movement, and
warm or hot water will help decrease the
pain. The worse thing the client can do is
not move.

16

The client has been diagnosed with OA for the last seven (7) years and has tried multiple
medical treatments and alternative treatments but still has significant joint pain.
Which psychosocial client problem would the nurse identify?
1. Severe pain.
2. Body-image disturbance.
3. Knowledge deficit
4. Depression.

4. The client experiencing chronic pain often
experiences depression and hopelessness.

17

The client diagnosed with OA is prescribed a nonsteroidal anti-inflammatory drug (NSAID). Which instruction should the nurse teach the client?
1. Take the medication on an empty stomach.
2. Make sure the client tapers the medication when discontinuing.
3. Apply the medication topically over the affected joints.
4. Notify the health-care provider if vomiting blood.

4. NSAIDs are well known for causing gastric
upset and increasing the risk for peptic
ulcer disease, which could cause the client
to vomit blood.

18

Which client goal would be most appropriate for a client diagnosed with OA?
1. Perform passive range-of-motion exercises.
2. Maintain optimal functional ability.
3. Client will walk three (3) miles every day.
4. Client will join a health club.

2. The two main goals of treatment for OA
are pain management and optimizing functional
ability of the joints to ensure movement
of the joints.

19

Which member of the health-care team should the nurse refer the client diagnosed with OA who is complaining of not being able to get in and out of the bathtub?
1. Physiatrist.
2. Social worker.
3. Physical therapist.
4. Counselor.

3. The physical therapist is able to help the
client with transferring, ambulation, and
other lower-extremity difficulties.

20

The nurse is discussing the importance of an exercise program for pain control to a
client diagnosed with OA. Which intervention should the nurse include in the teaching?
1. Wear supportive tennis shoes with white socks when walking.
2. Carry a complex carbohydrate while exercising.
3. Alternate walking briskly and jogging when exercising.
4. Walk at least 30 minutes three (3) times a week.

1. Safety should always be discussed when
teaching about exercises. Supportive shoes
will prevent shin splints. Colored socks
have dye that may cause athlete’s foot,
which is why white socks are recommended.

21

The HCP prescribes glucosamine and chondroitin for a client diagnosed with OA.
What is the scientific rationale for prescribing this medication?
1. It will help decrease the inflammation in the joints.
2. It improves tissue function and retards breakdown of cartilage.
3. It is a potent medication that decreases the client’s joint pain.
4. It increases the production of synovial fluid in the joint.

2. This is the rationale for administering
these medications.

22

The nurse is admitting the client with OA to the medical floor. Which statement by
the client indicates an alternative form of treatment for OA?
1. “I take medication every two (2) hours for my pain.”
2. “I use a heating pad when I go to bed at night.”
3. “I wear a copper bracelet to help with my OA.”
4. “I always wear my ankle splints when I sleep.”

3. Alternative forms of treatment have not
been proved efficacious in the treatment of
a disease. The nurse should be nonjudgmental
and open to discussions about alternative
treatment, unless it interferes with
the medical regimen.

23

The client is complaining of joint stiffness, especially in the morning. Which diagnostic
tests would the nurse expect the health-care provider to order to R/O osteoarthritis?
1. Full body magnetic resonance imaging scan.
2. Serum studies for synovial fluid amount.
3. X-ray of the affected joints.
4. Serum erythrocyte sedimentation rate (ESR).

3. X-rays reveal loss of joint cartilage, which
appears as a narrowing of the joint space in
clients diagnosed with OA.

24

The nurse is caring for the following clients. After receiving the shift report, which
client should the nurse assess first?
1. The client with a total knee replacement who is complaining of a cold foot.
2. The client diagnosed with osteoarthritis who is complaining of stiff joints.
3. The client who needs to receive a scheduled intravenous antibiotic.
4. The client diagnosed with back pain who is scheduled for a lumbar myelogram.

1. A cold foot on a client who has had surgery
may indicate a neurovascular compromise
and must be assessed first.

25

The nurse is discussing osteoporosis with a group of women. Which factor will the
nurse identify as a nonmodifiable risk factor?
1. Calcium deficiency.
2. Tobacco use.
3. Female gender.
4. High alcohol intake.

3. A nonmodifiable risk factor is a factor that
the client cannot do anything to alter or
change. Approximately 50% of all women will experience an osteoporosis-related
fracture in their lifetime.

26

The client diagnosed with osteoporosis asks the nurse, “Why does smoking cigarettes
cause my bones to be brittle?” Which response by the nurse would be most appropriate?
1. “Smoking causes nutritional deficiencies that contribute to osteoporosis.”
2. “Tobacco causes an increase in blood supply to the bones, causing osteoporosis.”
3. “Smoking low-tar cigarettes will not cause your bones to become brittle.”
4. “Nicotine impairs the absorption of calcium, causing decreased bone strength.”

4. Nicotine slows the production of osteoblasts
and impairs the absorption of calcium,
contributing to decreased bone density.

27

Which signs/symptoms would make the nurse suspect that the client has developed
osteoporosis?
1. The client has lost one (1) inch in height.
2. The client has lost 12 pounds in the last year.
3. The client’s hands are painful to the touch.
4. The client’s serum uric acid level is elevated.

1. The loss of height occurs as vertebral bodies collapse.

28

The client is being evaluated for osteoporosis. Which diagnostic test is the most accurate
when diagnosing osteoporosis?
1. X-ray of the femur.
2. Serum alkaline phosphatase.
3. Dual-energy x-ray absorptiometry (DEXA).
4. Serum bone Gla-protein test.

3. This test measures bone density in the lumbar spine or hip and is considered to be highly accurate.

29

Which foods should the nurse recommend to a client when discussing sources of
dietary calcium?
1. Yogurt and dark-green, leafy vegetables.
2. Oranges and citrus fruits.
3. Bananas and dried apricots.
4. Wheat bread and bran.

1. The best dietary sources of calcium are milk and other dairy products. Other sources include oysters; canned sardines or salmon; beans; cauliflower; and dark-green,
leafy vegetables.

30

Which intervention is an example of a secondary nursing intervention when discussing
osteoporosis?
1. Obtain a bone density evaluation test.
2. Perform non–weight-bearing exercises regularly.
3. Increase the intake of dietary calcium.
4. Refer clients to a smoking cessation program.

1. This is an example of a secondary nursing
intervention, which includes screening for
early detection.

31

The female client diagnosed with osteoporosis tells the nurse that she is going to
perform swim aerobics for 30 minutes every day. Which response would be most
appropriate by the nurse?
1. Praise the client for committing to do this activity.
2. Explain that walking 30 minutes a day is a better activity.
3. Encourage the client to swim every other day instead of daily.
4. Discuss that sedentary activities help prevent osteoporosis.

2. Weight-bearing activity, such as walking, is
beneficial in preventing or slowing bone
loss. The mechanical force of weight-bearing
exercises promotes bone growth.

32

The client newly diagnosed with osteoporosis is prescribed calcitonin by nasal spray.
Which assessment data would indicate an adverse effect of the medication?
1. The client complains of nausea and vomiting.
2. The client is drinking two (2) glasses of milk a day.
3. The client has a runny nose and nasal itching.
4. The client has had numerous episodes of nosebleeds.

4. Nosebleeds are adverse effects and should be reported to the client's HCP.

33

The nurse is teaching a class to pregnant teenagers. Which information is most important
when discussing ways to prevent osteoporosis?
1. Take at least 1200 mg of calcium supplements a day.
2. Eat foods low in calcium and high in phosphorus.
3. Osteoporosis does not occur until around age 50 years.
4. Remain as active as possible until the baby is born.

1. The National Institutes of Health recommend a daily calcium intake of 1200 to 1500 mg per day for adolescents, young adults, and pregnant and lactating women.

34

The 84-year-old client is a resident in a long-term care facility. Which intervention
should be implemented to help prevent complications secondary to osteoporosis?
1. Keep the bed in the high position.
2. Perform passive range-of-motion exercises.
3. Turn the client every two (2) hours.
4. Provide nighttime lights in the room.

4. Nighttime lights will help prevent the client from falling; fractures are the number one complication of osteoporosis.

35

The client is taking calcium carbonate (Tums) to help prevent further development of
osteoporosis. Which teaching should the nurse implement?
1. Encourage the client to take Tums with at least eight (8) ounces of water.
2. Teach the client to take Tums with the breakfast meal only.
3. Instruct the client to take Tums 30 to 60 minutes before a meal.
4. Discuss the need to get a monthly serum calcium level.

3. Free hydrochloric acid is needed for calcium absorption; therefore, Tums should be taken on an empty stomach.

36

The client must take three (3) grams of calcium supplement a day. The medication
comes in 500 mg/tablets. How many tablets will the client need to take daily?_______

Six (6) tablets. 1000 mg is equal to one (1) gram.
Therefore three (3) grams is equal to 3000 mg. If
one (1) tablet is 500 mg, the client will need six (6)
tablets to get the total amount of calcium needed
daily:
3000 ÷ 500  6

37

The nurse instructs the client with a right BKA to lie on the stomach for at least 30
minutes a day. The client asks the nurse, “Why do I need to lie on my stomach?”
Which statement would be the most appropriate statement by the nurse?
1. “This position will help your lungs expand better.”
2. “Lying on your stomach will help prevent contractures.”
3. “Many times this will help decrease pain in the limb.”
4. “The position will take pressure off your backside.”

2. The prone position will help stretch the
hamstring muscle, which will help prevent
flexion contractures that may lead to problems
when fitting the client for a prosthesis.

38

The recovery room nurse is caring for a client that has just had a left BKA. Which
intervention should the nurse implement?
1. Assess the client’s surgical dressing every two (2) hours.
2. Do not allow the client to see the residual limb.
3. Keep a large tourniquet at the client’s bedside.
4. Perform passive range-of-motion exercises to the right leg.

3. The large tourniquet can be used if the
residual limb begins to hemorrhage either
internally or externally.

39

The 62-year-old client diagnosed with Type 2 diabetes who has a gangrenous right toe
is being admitted for a BKA amputation. Which nursing intervention should the nurse
implement?
1. Assess the client’s nutritional status.
2. Refer the client to an occupational therapist.
3. Determine if the client is allergic to IVP dye.
4. Start a 22-gauge Angiocath in the right arm.

1. For wound healing, a balanced diet with adequate protein and vitamins is essential, along with meals appropriate for Type 2 diabetes.

40

The male nurse is helping his friend cut wood with an electric saw. His friend cut two
fingers of his left hand off with the saw. Which action should the nurse implement
first?
1. Wrap the left hand with towels and apply pressure.
2. Instruct the neighbor to hold his hand above his head.
3. Apply pressure to the radial artery of the left hand.
4. Go into the neighbor’s house and call 911.

3. Applying direct pressure to the artery above the amputated parts will help decrease the bleeding immediately and is the first intervention the nurse should implement. Then the nurse should instruct the client to hold the hand above the head, apply towels, and call 911.

41

A person’s right thumb was accidentally severed with an axe. The amputated right
thumb was recovered. Which action would preserve the thumb so that it could possibly
be reattached in surgery?
1. Place the right thumb directly on some ice.
2. Put the right thumb in a glass of warm water.
3. Wrap the thumb in a clean piece of material.
4. Secure the thumb in a plastic bag and place on ice.

4. Placing the thumb in a plastic bag will protect
it and then placing the plastic bag on ice
will help preserve the thumb so that it may
be reconnected in surgery. Do not place the
amputated part directly on ice because this
will cause necrosis of viable tissue.

42

The Jewish client with peripheral vascular disease is scheduled for a left AKA. Which
question would be most important for the operating room nurse to ask the client?
1. “Have you made any special arrangements for your amputated limb?”
2. “What types of food would you like to eat while you’re in the hospital?”
3. “Would like the rabbi to visit you while you are in the recovery room?”
4. “Will you start checking your other foot at least once a day for cuts?”

1. The Jewish faith believes that all body parts
must be buried together. Therefore many
synagogues will keep amputated limbs until
death occurs.

43

The client is three (3) hours postoperative left AKA. The client tells the nurse, “My
left foot is killing me. Please do something.” Which intervention should the nurse
implement?
1. Explain to the client that his left leg has been amputated.
2. Medicate the client with a narcotic analgesic immediately.
3. Instruct the client on how to perform biofeedback exercises.
4. Place the client’s residual limb in the dependent position.

2. Phantom pain is caused by severing the
peripheral nerves. The pain is real to the
client, and the nurse needs to medicate the
client immediately.

44

The nurse is caring for a client with a right below the knee amputation. There is a large
amount of bright red blood on the client’s residual limb dressing. Which intervention
should the nurse implement first?
1. Notify the client’s surgeon immediately.
2. Assess the client’s blood pressure and pulse.
3. Reinforce the dressing with additional dressing.
4. Check the client’s last hemoglobin and hematocrit level.

2. Determining if the client is hemorrhaging
would be the first intervention. The nurse
should check for signs of hypovolemic
shock, decreased BP, and increased pulse.

45

The nurse is caring for clients on a surgical unit. Which nursing task would be most
appropriate for the nurse to delegate to an unlicensed nursing assistant?
1. Help the client with a 2-day postop amputation put on the prosthesis.
2. Request the assistant double-check a unit of blood that is being hung.
3. Change the surgical dressing on the client with a Syme amputation.
4. Ask the assistant to take the client to the physical therapy department.

4. The nursing assistant could take a client to another department in the hospital.

46

The client with a right AKA is being taught how to toughen the residual limb. Which
intervention should the nurse implement?
1. Instruct the client to push the residual limb against a pillow.
2. Demonstrate how to apply an elastic bandage around the residual limb.
3. Encourage the client to apply vitamin B12 to the surgical incision.
4. Teach the client to elevate the residual limb at least three times a day.

1. Applying pressure to the end of the residual limb will help toughen the limb. Gradually pushing the residual limb against harder and harder surfaces is done in preparation for prosthesis training.

47

The 27-year-old client has a right above-the-elbow amputation secondary to a boating
accident. Which statement by the rehabilitation nurse indicates the client has accepted
the amputation?
1. “I am going to sue the guy that hit my boat.”
2. “The therapist is going to help me get retrained for another job.”
3. “I decided not to get a prosthesis. I don’t think I need it.”
4. “My wife is so worried about me and I wish she wouldn’t.”

2. Looking toward the future and problem solving indicate that the client is accepting the loss.

48

The 32-year old male client with a traumatic left AKA is being discharged from the
rehabilitation department. Which discharge instructions should be included in the
teaching? Select all that apply.
1. Report any pain that is not relieved with analgesics.
2. Eat a well-balanced diet and increase protein intake.
3. Be sure to attend all outpatient rehabilitation appointments.
4. Encourage the client to attend a support group for amputations.
5. Stay at home as much as possible for the first couple of months.

1. Pain not relieved with analgesics could
indicate complications or could be phantom
pain.
2. A well-balanced diet promotes wound healing,
especially a diet high in protein.
3. The client must keep appointments in outpatient
rehabilitation to continue to improve
physically and emotionally.
4. A support group may help the client adjust
to life with an amputation.

49

The client is taken to the emergency department with an injury to the left arm. Which
action should the nurse take first?
1. Assess the nail beds for capillary refill time.
2. Remove the client’s clothing from the arm.
3. Call radiology for a STAT x-ray of the extremity.
4. Prepare the client for the application of a cast.

1. The nurse should assess the nail beds for
the capillary refill time. A prolonged time
(greater than three [3] seconds) indicates
impaired circulation to the extremity.

50

The nurse is preparing the plan of care for the client with an open fracture of the right
arm. Which problem has the highest priority?
1. Anger related to the inability to perform ADLs.
2. Sleep disturbances related to loss of work.
3. Infection related to exposed tissue.
4. Altered body image related to scarring.

3. The definition of an open fracture is a bone
that has penetrated the skin. The highestpriority
problem is infection because the
skin is the barrier that keeps bacteria from
entering the surrounding tissue.

51

Which interventions should the nurse implement for the client diagnosed with an open
fracture of the left ankle? Select all that apply.
1. Apply an immobilizer snugly to prevent edema.
2. Apply an ice pack for 10 minutes and remove for 20 minutes.
3. Place the extremity in the dependent position to allow drainage.
4. Obtain an x-ray of the ankle after applying the immobilizer.
5. Administer tetanus, 0.5 mL intramuscularly, in the deltoid.

2. Ice packs should be applied ten (10) minutes
on and twenty (20) minutes off. This
allows for vasoconstriction and decreases
edema. Ice is a nonpharmacological pain
management technique.

5. Any time trauma occurs, tetanus should be
considered. In an open fracture, this is an
appropriate treatment.

52

When assessing a client with a fractured left tibia and fibula, which data should the
nurse report to the health-care provider immediately?
1. Localized edema and discoloration occurring hours after the injury.
2. Generalized weakness and increasing sensitivity to touch.
3. Capillary refill time of nine (9) seconds and increasing pain.
4. Pain relieved after taking four (4) mg hydromorphone, a narcotic analgesic.

3. The normal capillary refill time (CRT) is less than 3 seconds. A prolonged refill time and increasing pain indicate circulation impairment. This needs to be reported before compartment syndrome occurs.

53

The unlicensed nursing assistant (NA) notifies the nurse of the vital signs of a 28-yearold
male client admitted the previous day with a fractured femur. The NA reports a
temperature of 101F; pulse 115; respiratory rate 28; copious amounts of thick, white
sputum; and “globs” floating in the urinal. What intervention should the nurse implement
first?
1. Assess the client for dyspnea, breath sounds, and altered mental status.
2. Draw blood for arterial blood gases and order a portable chest x-ray.
3. Call the health-care provider for an order to administer an antibiotic.
4. Instruct the assistant to encourage the client to deep breathe.

1. The nurse should assess the client for signs
of hypoxia from a fat embolism. The symptoms
listed in this question indicate a fat
embolism. Dyspnea, adventitious breath
sounds, and confusion indicate hypoxia.
Young males are more likely to suffer from
a fat embolism, especially from fractured
femurs.

54

During the morning assessment, the nurse determines that the 80-year-old client
admitted with a fractured right femoral neck is confused. Which action should the
nurse implement first?
1. Check for a positive Homans’ sign.
2. Encourage the client to take deep breaths and cough.
3. Assess the left pedal pulse.
4. Monitor the client’s Buck’s traction.

2. Encouraging the client to take deep breaths
and cough would aid in the exchange of
gases. Mental changes are early signs of
hypoxia in the elderly client.

55

The client admitted with a diagnosis of a fractured hip is complaining of severe pain.
Which pain management technique would be best for the nurse to implement for this
client?
1. Adjust the patient-controlled analgesia (PCA) machine for a lower dose.
2. Ensure that the weights of the Buck’s traction are off the floor and hang freely.
3. Raise the head of the bed to 45 degrees and the foot to 15 degrees.
4. Turn the client to the affected leg using pillows to support the other leg.

2. Weights from traction should be off the
floor and hanging freely. Buck’s traction is
used to reduce muscle spasms preoperatively
in clients who have fractured hips.

56

When preparing the discharge teaching for the 12-year-old with a fractured humerus,
which information should the nurse include regarding cast care?
1. Keep the arm at heart level.
2. Handle the cast with the tips of the fingers only.
3. Apply an ice pack to any area that itches.
4. Foul smells are expected occurrences.

3. Applying ice packs to the cast will relieve
itching and nothing should be placed down
a cast to scratch. Skin becomes fragile
inside the cast and is torn easily. Alteration
in the skin’s integrity can become infected.

57

Which statement by the client diagnosed with a fractured ulna would indicate that the
nurse needs to do further teaching?
1. “I need to eat a high-protein diet to ensure healing.”
2. “I need to wiggle my fingers every hour to increase circulation.”
3. “I need to take my pain medication before my pain is too bad.”
4. “I need to keep this immobilizer on when lying down only.”

4. The immobilizer should be kept on at all times. This indicates that the client does not understand the teaching and needs the nurse to provide more instruction.

58

When preparing the nursing care plan for a client with a fractured lower extremity,
which would be the most appropriate treatment outcome for the nurse to include?
1. The client will maintain function of the leg.
2. The client will ambulate with assistance.
3. The client will be turned every two (2) hours.
4. The client will have no infection.

1. The expected outcome for a client with a fracture is maintaining the function of the extremity.

59

While caring for a client diagnosed with a fracture of the right distal humerus, what
data would the nurse assess that would indicate a complication? Select all that apply.
1. Numbness and mottled cyanosis.
2. Paresthesia and paralysis.
3. Proximal pulses and point tenderness.
4. Coldness of the extremity and crepitus.
5. Palpable radial pulse and functional movement.

1. The nurse should assess for numbness and
mottled cyanosis, which might indicate
nerve damage.
2. The presence of paresthesia and paralysis
indicate impaired circulation.
4. Coldness indicates decreased blood supply.
Crepitus indicates air in subcutaneous
tissue and is not expected.

60

An 88-year-old client is admitted to the orthopedic floor with the diagnosis of fractured
pelvis. What intervention should the nurse implement first?
1. Insert an indwelling catheter.
2. Administer a Fleet’s enema.
3. Assess abdomen for bowel sounds.
4. Apply Buck’s traction.

3. Assessing the bowel sounds should be the
first intervention to determine if an ileus
has occurred. This is a common complication
of a fractured pelvis.

61

The nurse is preparing the preoperative client for a total hip replacement (THR).
Which information should the nurse include concerning postoperative care?
1. Keep abduction pillow in place between legs at all times.
2. Cough and deep breathe at least every four (4) to five (5) hours.
3. Turn to both sides every two (2) hours to prevent pressure ulcers.
4. Sit in a high-seated chair for a flexion of less than 90 degrees.

4. Using a high-seated toilet and chair will
help prevent dislocation by limiting the
flexion to less than 90 degrees.

62

The client that is one (1) day postoperative total hip replacement complains of hearing
a “popping sound” when turning. What assessment data should the nurse report
immediately to the surgeon?
1. Dark red–purple discoloration.
2. Equal length of lower extremities.
3. Groin pain in the affected leg.
4. Edema at the incision site.

3. Groin pain or increasing discomfort in the
affected leg and the “popping sound” indicate
that the leg has dislocated and should
be reported immediately to the HCP for a
possible closed reduction.

63

The nurse is preparing the client who received a total hip replacement for discharge.
Which statement would indicate that further teaching is needed?
1. “I should not cross my legs because my hip may come out of the socket.”
2. “I will call my HCP if I have a sudden increase in pain.”
3. “I will sit on a chair with arms and a firm seat.”
4. “After three (3) weeks, I don’t have to worry about infection.”

4. Infections are possible months after surgery.
Clients should monitor temperatures
and report any signs of infection.

64

When assessing the wound of a client who had a total hip replacement, the nurse finds
small, fluid-filled lesions on the right side of the dressing. What explanation is the most
probable rationale for this occurrence?
1. These were caused by the cautery unit in the operating room.
2. These are papular wheals from herpes zoster.
3. These are blisters from the tape used to anchor the dressing.
4. These macular lesions are from a latex allergy.

3. Fluid-filled blisters are from a reaction to
the tape and usually occur along the edge
of the tape.

65

Which topics should the nurse include in the discharge teaching plan for a client after
having a total hip replacement? Select all that apply.
1. Weight-bearing limits.
2. Use of assistive devices.
3. Gradual increase in activity.
4. Medication therapy.
5. Periods of rest.

1. Clients need to understand the amount of
weight bearing to prevent injury.
2. Teaching the safe use of assistive devices is
necessary prior to discharge.
3. Increases in activity should occur slowly to
prevent complications.
4. Using medication therapy, including analgesics,
anti-inflammatory agents, or muscle
relaxants, should be taught so that client is
comfortable while ambulating.
5. The client should be encouraged to rest
periodically to promote healing and increase
energy.

66

The nurse is preparing a plan of care for the client who has had a total hip replacement.
Which outcome would be most appropriate for this client?
1. The client has limited amount of pain relief.
2. The client will have limited ability to ambulate.
3. The client will have hip instability for several months.
4. The client will have adequate hip joint motion.

4. The hip should have functional motion.

67

When assessing the client six (6) hours after having a right total knee replacement,
which data should the nurse report to the surgeon?
1. A total of 100 mL of red drainage in the autotransfusion drainage system.
2. Pain relief after using the patient-controlled analgesia (PCA) pump.
3. Cool toes, distal pulses palpable, and pale nail beds bilaterally.
4. Urinary output of 60 mL of clear yellow urine in three (3) hours.

4. The urinary output is not adequate; therefore
the surgeon needs to be notified. This
is only 20 mL per hour. The minimum
should be 30 mL per hour.

68

When preparing the client for the transition to home rehabilitation after having a total
knee replacement, which information regarding discharge teaching would the nurse
include?
1. Deep breathe and cough every two (2) hours.
2. Procedure for emptying Jackson-Pratt drainage.
3. Burning or frequency of urination is expected.
4. Modify the home for altered mobility.

4. Modification of the home is essential to the
rehabilitation of the client using assistive
devices for ambulation. The postoperative
goals for this client are to maximize mobility
and promote health.

69

When developing the plan of care for the client having a total knee repair, which of the
expected outcomes would the nurse include? Select all that apply.
1. The client has effective pain management.
2. The client does not smoke or use tobacco products.
3. The client ambulates within the weight-bearing limits.
4. The client participates in activities of daily living.
5. The client is able to return to his or her previous lifestyle.

1. The client needs to have the pain managed
so that the client can be as active as possible.
This will help avoid complications of
immobility.
2. Clients should not be able to smoke after
surgery because smoking increases the risk
for pulmonary complications. Most hospitals
do provide smoking areas outside the
building.
3. The client must ambulate within the
weight-bearing restrictions so that the knee
will not be injured, which may delay healing.
4. All clients should be encouraged to do as
much self-care as possible to assist with
self-esteem.
5. Not all clients will able to return to their
previous life roles and activities but it is the
goal. They should be assisted with coping
skills so that they will be able to adapt to
any changes.

70

The nurse is caring for the client who had a total knee replacement (TKR). Which data
would the nurse observe to determine if the nursing interventions are effective?
1. The client’s lungs have bilateral crackles.
2. The client’s knee has flexion of 45 degrees.
3. The client participates in self-care activities.
4. The client has reduced pain using a single approach.

3. Clients should participate in care, in decision-
making, and in activities that promote
mobility and adaptation to the life changes
postoperatively

71

The nurse is assessing the client who is immediately postoperative from a total knee
replacement. Which assessment data would warrant immediate intervention?
1. T 99F, HR 80, RR 20, and BP 128/76.
2. Pain in the unaffected leg during dorsiflexion of the ankle.
3. Bowel sounds heard intermittently in four quadrants.
4. Diffuse, crampy abdominal pain.

2. Pain with dorsiflexion of the ankle indicates
deep vein thrombosis. This can be from immobility
or surgery; therefore pain should
be assessed on both legs.

72

The nurse is working on an orthopedic floor. Which client should the nurse assess first
after the change of shift report?
1. The 84-year-old female with a fractured right femoral neck in Buck’s traction.
2. The 64-year-old female who had a left total knee replacement with confusion.
3. The 88-year-old male who had a right total hip replacement with an abduction
pillow.
4. The 50-year-old postoperative client who has a continuous passive motion (CPM)
device.

2. This is an abnormal occurrence from this
information. This client should be seen first
because confusion is a symptom of hypoxia.

73

The 50-year-old client came to the health-care provider’s office for an annual physical
examination. Which information should the nurse assess to rule out osteoporosis? Select
all that apply.
1. Family history of osteoporosis.
2. Estrogen or androgen deficit.
3. Use of tobacco products.
4. Level and amount of exercise.
5. Alcohol intake.

1. Clients are more prone to have osteoporosis
if there is a genetic predisposition.
2. Clients who are deficient in either estrogen
or androgen are at risk for osteoporosis.
3. Clients who smoke are more at risk for
osteoporosis.
4. Regular, weight-bearing exercise promotes
healthy bones.
5. Clients who consume alcohol and have
diets low in calcium are at a higher risk for
osteoporosis.

74

In preparing a plan of care for a client diagnosed with carpal tunnel syndrome, which
intervention should the nurse include?
1. Teach hyperextension exercises to increase flexibility.
2. Monitor safety during occupational hazards.
3. Prepare for the insertions of pins or screws.
4. Monitor dressing and drain after the fasciotomy.

2. The nurse should monitor for potential
injuries resulting from the alterations in
motor, sensory, and autonomic function of
the first three digits of the hand and palmar
surface of the fourth. These alterations can
interfere with pinching or grasping, which,
in turn, increases the risk for injury in
clients whose occupations require the use
of equipment such as jackhammers and
computers.

75

When the manager is completing the client assignments for the next shift, which nurse
should the manager assign to the client recovering from a repair of the hallux valgus?
1. A new graduate nurse.
2. An experienced nurse.
3. A nurse practitioner.
4. An unlicensed nursing assistant.

1. A new graduate is the best choice for this
client. The client’s surgery is not a highrisk
procedure but would require assessment
and pain management.

76

The client has been scheduled for a computed tomography (CT) scan. Which information
is most important for the nurse to obtain before the procedure?
1. The assessment of the client’s pain.
2. Vital signs are within normal limits.
3. Whether client has allergies to seafood.
4. Type of intravenous fluid being administered.

3. This is the most important information the
nurse should obtain. Any client who is
allergic to seafood cannot be injected with
the iodine-based contrast. This contrast
would cause an allergic response that could
endanger the client’s life.

77

The student nurse asks the emergency department nurse why the nurse is careful to
maintain asepsis when caring for the client with an open fracture of the right humerus.
Which rationale explains the nurse’s actions?
1. It is a policy to prevent the transmission of blood borne pathogens.
2. Clients who have open fractures are at a high risk for osteomyelitis.
3. Failure to maintain asepsis may result in a malpractice lawsuit.
4. The client has compromised immunity based on the laboratory values.

2. The open skin and exposure of the bone is
a direct pathway for infection and osteomyelitis.

78

While working in the day surgery department, the nurse is caring for the client two (2)
hours after having a right knee arthroscopy. Which intervention should the nurse implement?
1. Encourage the client to perform range-of-motion exercises.
2. Monitor the amount and color of the urinary output hourly.
3. Check the client’s pulses distally and assess the toes.
4. Monitor the client’s vital signs every eight (8) hours.

3. Pulses and circulation checks should be
done every one (1) to two (2) hours postoperatively.

79

The nurse is responsible for teaching the client to take Fosamax, a bisphosphonate.
Which information should the nurse include?
1. Take this medication with a full glass of water.
2. Take with breakfast to prevent gastrointestinal upset.
3. Use sunscreen to prevent sensitivity to sunlight.
4. This medication increases calcium reabsorption.

1. The client needs to take this medication
with a full glass of water and remain upright
for at least 30 minutes to reduce the risk of
esophagitis.

80

The school nurse is completing spinal screenings. Which data would require a referral
to an HCP?
1. Bilateral arm lengthens while bending over at the waist.
2. A deformity that resolves when the head is raised.
3. Equal spacing of the arms and body at the waist.
4. A right arm lower than the left while bending over at the waist.

4. Unequal arm length may indicate scoliosis,
and further assessment is needed by an
HCP.

81

The nurse is working in the clinic and assesses the client with complaints of pain and
numbness in the left hand and fingers. What data should the nurse look for when
assessing this client to determine the cause of the complaints?
1. Symmetric movements of elbows and shoulders.
2. A capillary refill time of less than three (3) seconds.
3. A history of any repetitive movements during work or leisure.
4. Bilateral anterior and posterior deep-tendon reflexes.

3. This information would assist with the diagnosis of carpal tunnel syndrome. Clients with this disorder experience pain and numbness.

82

The nurse is teaching the client diagnosed with osteoporosis about the medication
calcitonin, a thyroid hormone. Which data would indicate that the teaching has been
effective?
1. The client states, “I should change nostrils from day to day.”
2. The client states, “I need to drink a lot of water when I take my medicine.”
3. The client demonstrates how to dilute the medication with vitamin D.
4. The client states, “This will help the calcium leave my bones.”

1. This should be taught so that when the client takes the medication intranasally it will decrease irritation from administration.

83

The client asks the nurse, “Why am I having this bone scan?” Which statement would
be the nurse’s best response?
1. “You seem anxious. Tell me about your anxieties.”
2. “Why are you concerned? Your HCP ordered it.”
3. “I’ll have the radiologist come back to explain it again.”
4. “A bone scan looks for cancer or infection inside the bones.”

4. This statement simply answers the client’s
question.

84

The client is scheduled for a magnetic resonance imaging (MRI) scan. Which intervention
should the nurse delegate to the unlicensed nursing assistant?
1. Prepare the client by removing all metal objects.
2. Inject the contrast into the intravenous site.
3. Administer a sedative to the client to decrease anxiety.
4. Explain why the client cannot have any breakfast.

1. Metal objects such as jewelry and zippers
can interfere with the magnetic imaging
and pose a danger to the client as a result of
the magnetic properties of the equipment.
Clients with pacemakers should not have
an MRI because the magnet will disrupt the
unit’s program. This intervention can be
delegated to the unlicensed nursing assistant.

85

A client is admitted to the orthopedic floor after having sustained a fractured femur in
a motor-vehicle accident. Which data would require immediate intervention by the
nurse? Select all that apply.
1. The client becomes restless and irritable.
2. The client has tachypnea and tachycardia.
3. The client has petechiae over the neck and chest.
4. The client has a high arterial oxygen level.
5. The client has yellow globules floating in the urine.

1. The first sign of a fat embolism syndrome is
an altered mental status. This requires an
immediate response to save this client’s life.
The health-care provider should be notified.
2. The client will experience rapid heart rate
and rapid respiratory rates as a compensatory
response to hypoxia. The nurse should
recognize this situation and intervene. The
health-care provider should be notified.
3. Petechiae are macular, red–purple pinpoint
bleeding under the skin. The appearance of
petechiae is a classic sign of fat embolism
syndrome.
5. Yellow globules in the urine are fat globules
released from the bone as it breaks.
This should be reported immediately.

86

The nurse is caring for the client diagnosed with fat embolism syndrome. Which HCP
order would the nurse question?
1. Administer intravenous heparin.
2. Administer intravenous fluids.
3. Keep the O2 saturation higher than 93%.
4. Administer a loop diuretic.

4. The nurse should question this order. This
will decrease the client’s hydration and may
result in further embolism.

87

The client has been admitted to the hospital for repair of a fractured femoral neck.
Which would be the expected short-term goal for this client?
1. The client will be turned every two (2) hours to prevent skin breakdown.
2. The client will have a decrease in muscle spasms and pain in the affected leg.
3. The client will have no objective or subjective signs or symptoms of infection.
4. The client will be able to ambulate down the hallway to the nurse’s station.

2. This is an expected outcome for a preoperative
client with a fractured femoral neck.
This injury causes painful muscle spasms.
Buck’s traction is applied to decrease or
prevent spasms by maintaining the position
and alignment of the bone fragments.

88

The nurse is preparing to administer subcutaneous Lovenox, a low molecular weight
heparin. Which intervention should the nurse implement?
1. Monitor the client’s serum aPTT.
2. Encourage oral and intravenous fluids.
3. Give with food to protect the stomach.
4. Administer in the “love handles.”

4. Administering this medication in the prescribed
areas would ensure safety and decrease
the risk of abdominal trauma.

89

When caring for the client with a fractured right hip who has Buck’s traction, which
intervention should the nurse include in the plan of care?
1. Assess the insertion sites for signs and symptoms of infection.
2. Monitor for drainage or odor from under the plaster covering the pins.
3. Monitor the condition of the skin beneath the Velcro™ boot every eight (8) hours.
4. Take weights off for one (1) hour every eight (8) hours and as needed.

3. In Buck’s traction a Velcro boot is used to
attach the ropes to weights to maintain
alignment. Skin covered by the boot can
become irritated and break down. The
nurse should monitor the skin around the
boot for redness and breakdown at least
once every eight (8) hours while maintaining
traction to the leg manually.

90

When caring for a client with a spica cast for a hip injury, what intervention should the
nurse include in the plan of care?
1. Assess client’s popliteal pulses every shift.
2. Elevate the leg on pillows and apply ice packs.
3. Teach the client how to ambulate with a tripod walker.
4. Assess the client for distention and vomiting.

4. The nurse should assess the client for signs
and symptoms of cast syndrome—vomiting
after meals, epigastric pain, and abdominal
distention. This is caused by a partial bowel
obstruction from compression and can lead
to complete obstruction. The client may
still have bowel sounds present with this
syndrome.

91

When preparing the client in a short leg cast for discharge, which data indicate that the
client needs further teaching?
1. “I need to keep my leg elevated on two pillows for the first 24 hours.”
2. “I should apply ice packs for one (1) hour and remove them for one (1) hour.”
3. “I need to contact the health-care provider if I have any numbness or pale toenails.”
4. “I can put a coat hanger down the cast to scratch gently if I have severe itching.”

4. Clients should be taught that putting
objects down the cast to scratch an itch can
cause breaks in skin integrity that may become
infected.

92

Which psychosocial client problem would be most likely in a client with an external
fixator device?
1. Ineffective coping.
2. Alteration in body image.
3. Grieving.
4. Social isolation.

2. Many clients with an external fixator have
alterations in body image because of the
large bulky frame that makes dressing difficult
and because of the scarring that occurs
from the trauma and treatment. The length
of healing is prolonged, so returning to the
client’s normal routine is delayed.

93

A client recovering from a total hip replacement has developed a deep vein thrombosis.
The health-care provider has ordered a continuous infusion of heparin, an anticoagulant,
to infuse at 1200 units per hour. The bag comes with 20,000 unit of heparin
in 500 mL of 0.9% normal saline. At what rate should the nurse set the pump?______

30 mL per hour. Divide the amount of heparin
by the volume of fluid to get the concentration.
Divide the dose ordered by the concentration for
the amount of milliliters per hour to set the pump.
20000/500 =40 units of heparin per 1 mL
1200/40 = 30 mL per hour

94

When conducting rounds at change of shift, the nurse assesses the client with a fractured
humerus. Which data would warrant immediate intervention by the nurse?
1. Capillary refill time of that arm is less than three (3) seconds.
2. Pain relieved by the patient-controlled anesthesia machine.
3. Edema under the dressing that caused the nails to be white.
4. Warm and dry skin on the fingers distally to the elastic bandage.

3. Cool, white nails indicate impaired circulation
to the arm from edema. Without
immediate intervention, the client could
develop compartment syndrome.

95

The client with a right open fractured elbow has a long arm cast and is complaining of
unrelenting severe pain and feeling as if the fingers are asleep. Which complication
should the nurse suspect that the client is experiencing?
1. Fat embolism.
2. Compartment syndrome.
3. Pressure ulcer under cast.
4. Surgical incision infection.

2. These are the classic signs/symptoms of
compartment syndrome.

96

The elderly client is admitted to the hospital for severe back pain. Which data should
the nurse assess first during the admission assessment?
1. The client’s use of herbs.
2. The client’s current pain level.
3. The client’s sexual orientation.
4. The client’s ability to care for self.

2. Pain assessment and management are
the most important issues if the client is
breathing and has circulation. Lack of pain
management decreases the attention of the
client during the admission process. Pain is
called the fifth vital sign.

97

25. Which information should the nurse teach the client regarding sports injuries?
1. Apply heat intermittently for the first 48 hours.
2. An injury is not serious if the extremity can be moved.
3. Only return to health-care provider if the foot becomes cold.
4. Keep the injury immobilized and elevated for 24 to 48 hours.

4. The leg should be iced, elevated, and
immobilized for 48 hours.

98

The emergency department nurse is caring for a client with a compound fracture of
the right ulna. Which interventions should the nurse implement? List in order of
priority.
1. Apply a sterile, normal, saline-soaked gauze to the arm.
2. Send the client to radiology for an x-ray of the arm.
3. Assess the fingers of the client’s right hand.
4. Stabilize the arm at the wrist and the elbow.
5. Administer a tetanus toxoid injection.

The order should be 4, 1, 3, 2, 5.
4. The nurse first should stabilize the arm to
prevent further injury.
1. A compound fracture is one in which the
bone protrudes through the skin. The
nurse should apply sterile, saline-soaked
gauze to protect the area from the intrusion
of bacteria.
3. The nurse should assess the client’s circulation
to the part distal to the injury. This is
done after the first two interventions because
life-threatening complications could
occur if stabilization and protection from
infection are not addressed first.
2. An x-ray will be needed to determine the
extent of the injury.
5. A tetanus toxoid injection should be
administered, but this can be done last.

99



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.

100

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.

101

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." Incorrect
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.

102

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.

103

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.

104

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.

105

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.

106

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.

107

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. Incorrect
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.

108

While completing an admission history for a 73-year-old man with osteoarthritis admitted for knee arthroplasty, the nurse asks about the patient's perception of the reason for admission. The nurse expects the patient to relate which response to this question?

A. Recent knee trauma
B. Debilitating joint pain
C. Repeated knee infections
D. Onset of "frozen" knee joint

B. Debilitating joint pain

The most common reason for knee arthroplasty is debilitating joint pain despite attempts to manage it with exercise and drug therapy. Recent knee trauma, repeated knee infections, and onset of "frozen" knee joint are not primary indicators for a knee arthroplasty.

109

The nurse is caring for a patient with osteoarthritis who is about to undergo total left knee arthroplasty. The nurse assesses the patient carefully to be sure that there is no evidence of what in the preoperative period?

A. Pain Incorrect
B. Left knee stiffness
C. Left knee infection
D. Left knee instability

C. Left knee infection

It is critical that the patient be free of infection before a total knee arthroplasty. An infection in the joint could lead to even greater pain and joint instability, requiring extensive surgery. For this reason, the nurse monitors the patient for signs of infection, such as redness, swelling, fever, and elevated white blood cell count. Pain, knee stiffness, or instability may be present with osteoarthritis.

110

The nurse formulates a nursing diagnosis of impaired physical mobility related to decreased muscle strength for a 78-year-old patient following left total knee replacement. What would be an appropriate nursing intervention for this patient?

A. Promote vitamin C and calcium intake in the diet. Incorrect
B. Provide passive range of motion to all of the joints q4hr.
C. Encourage isometric quadriceps-setting exercises at least qid.
D. Keep the left leg in extension and abduction to prevent contractures.

C. Encourage isometric quadriceps-setting exercises at least qid.

Emphasis is placed on postoperative exercise of the affected leg, with isometric quadriceps setting beginning on the first day after surgery along with a continuous passive motion (CPM) machine. Vitamin C and calcium do not improve muscle strength, but they will facilitate healing. The patient should be able to do active range of motion to all joints. Keeping the leg in one position (extension and abduction) potentially will result in contractures.

111

The patient is brought to the emergency department after a car accident and has a femur fracture. What nursing intervention should the nurse implement to prevent a fat embolus in this patient?

A. Administer enoxaparin (Lovenox).
B. Provide range-of-motion exercises.
C. Apply sequential compression boots.
D. Immobilize the fracture preoperatively.

D. Immobilize the fracture preoperatively.

To prevent fat emboli, the nurse immobilizes the long bone to reduce movement of the fractured bone ends and decrease the risk of a fat embolus from the bone before surgical reduction. Enoxaparin is used to prevent blood clots not fat emboli. Range of motion and compression boots will not prevent a fat embolus in this patient.

112

An injured soldier had an amputation of his left leg and is reporting shooting pain and heaviness in the area of his missing leg. What would be the best response by the nurse for this patient?

A. Use mirror therapy.
B. Give opioid analgesics.
C. Rebandage the residual limb.
D. Show the patient the leg is gone.

A. Use mirror therapy.

Mirror therapy has been shown to reduce phantom limb pain in some patients. Opioid analgesics, rebandaging the residual limb, and showing the patient that the leg is gone will not decrease phantom limb pain.

113

The patient had a lumbar spine arthrodesis. What should the nurse include in discharge teaching (select all that apply)?

A. Do not smoke cigarettes.
B. You should not walk for 3 weeks.
C. You must wear your brace at all times.
D. You may drive as soon as you feel like it.
E. Do not bend your spine until your follow-up appointment.

A. Do not smoke cigarettes.
E. Do not bend your spine until your follow-up appointment.

After a spinal fusion, the patient should not smoke cigarettes as nonunion tends to occur more often with smokers. Preventing pressure by not bending or twisting the spine or lifting more than 10 pounds will facilitate healing. The amount of time that is needed will be determined by the surgeon at follow-up appointments, but healing usually takes 6 to 9 months. An important aspect of healing is progressively increasing walking, which increases circulation of nutrients and oxygen for healing. If a brace is ordered to protect the surgical area, the surgeon will order how often the patient should wear it. Driving is not done until the surgeon allows it and the patient is no longer taking opioids for pain.

114

The nurse is completing a neurovascular assessment on the patient with a tibial fracture and a cast. The feet are pulseless, pale, and cool. The patient says they are numb. What should the nurse suspect is occurring?

A. Paresthesia
B. Pitting edema
C. Poor venous return
D. Compartment syndrome

D. Compartment syndrome

The nurse should suspect compartment syndrome with one or more of the following six Ps: paresthesia, pallor, pulselessness, pain distal to the injury and unrelieved with opioids, pressure increases in the compartment, and paralysis. Although paresthesia and poor venous return are evident, these are just some of the manifestations of compartment syndrome.

115

A 21-year-old female soccer player has injured her anterior crucial ligament (ACL) and is having reconstructive surgery. The nurse knows that the patient will need more teaching when the patient makes which statement?

A. "I probably won't be able to play soccer for 6 to 8 months."
B. "They will have me do range of motion with my knee soon after surgery."
C. "I can't wait to get this done now so I can play soccer for the next tournament."
D. "I will need to wear an immobilizer and progressively bear weight on my knee."

C. "I can't wait to get this done now so I can play soccer for the next tournament."

When the athlete has ACL reconstructive surgery, the patient does not understand the severity when planning to be back to playing soccer soon, as safe return will not occur for 6 to 8 months after initial range of motion, immobilization, and progressive weight bearing with physical therapy occurs.


116

This morning a 21-year-old male patient had a long leg cast applied and wants to get up and try out his crutches before dinner. The nurse will not allow this. What is the best rationale that the nurse should give the patient for this decision?

A. The cast is not dry yet, and it may be damaged while using crutches.
B. The nurse does not have anyone available to accompany the patient.
C. Rest, ice, compression, and elevation are in process to decrease pain.
D. Excess edema and other problems are prevented when the leg is elevated for 24 hours.

D. Excess edema and other problems are prevented when the leg is elevated for 24 hours.

For the first 24 hours after a lower extremity cast is applied, the leg will be elevated on pillows above the heart level to avoid excessive edema and compartment syndrome. The cast will also be drying during this 24-hour period. RICE is used for soft tissue injuries, not with long leg casts.



117

The patient had frostbite on the distal areas of the toes on both feet. The patient is scheduled for amputation of the damaged tissue. Which assessment finding or diagnostic study is the most objective indicator for locating the level of the patient's injury?

A. Arteriography showing blood vessels
B. Peripheral pulse assessment bilaterally
C. Patches of black, indurated, and cold tissue
D. Bilateral pale and cool skin below the ankles

A. Arteriography showing blood vessels

Arteriography is the most objective study to determine viable tissue for salvage based on perfusion because actual blood flow through the tissues is observed in real time. It is considered the gold standard for evaluating arterial perfusion. Bilateral peripheral pulse assessment, areas of black, indurated, and cold tissue, and bilateral pale and cool skin all identify the lack of tissue perfusion, but not the specific area where tissue perfusion stops and amputation needs to occur.

118


The nurse is completing discharge teaching with an 80-year-old male patient who underwent right total hip arthroplasty. The nurse identifies a need for further instruction if the patient states the need to

A. avoid crossing his legs.
B. use a toilet elevator on toilet seat.
C. notify future caregivers about the prosthesis.
D. maintain hip in adduction and internal rotation.

D. maintain hip in adduction and internal rotation.

The patient should not force hip into adduction or force hip into internal rotation as these movements could displace the hip replacement. Avoiding crossing the legs, using a toilet elevator on a toilet seat, and notifying future caregivers about the prosthesis indicate understanding of discharge teaching.

119

The nurse is caring for a 75-year-old woman who underwent left total knee arthroplasty and has a new order to be "up in chair today before noon." What action should the nurse take to protect the knee joint while carrying out the order?

A. Administer a dose of prescribed analgesic before completing the order.
B. Ask the physical therapist for a walker to limit weight bearing while getting out of bed.
C. Keep the continuous passive motion machine in place while lifting the patient from bed to chair.
D. Put on a knee immobilizer before moving the patient out of bed and keep the surgical leg elevated while sitting.

D. Put on a knee immobilizer before moving the patient out of bed and keep the surgical leg elevated while sitting.

The nurse should apply a knee immobilizer for stability before assisting the patient to get out of bed. This is a standard measure to protect the knee during movement following surgery. Although an analgesic should be given before the patient gets up in the chair for the first time, it will not protect the knee joint. Full weight bearing is begun before discharge, so a walker will not be used if the patient did not need one before the surgery. The CPM machine is not kept in place while the patient is getting up to the chair.

120

The nurse is caring for a 76-year-old man who has undergone left knee arthroplasty with prosthetic replacement of the knee joint to relieve the pain of severe osteoarthritis. Postoperatively the nurse expects what to be included in the care of the affected leg?

A. Progressive leg exercises to obtain 90-degree flexion
B. Early ambulation with full weight bearing on the left leg
C. Bed rest for 3 days with the left leg immobilized in extension
D. Immobilization of the left knee in 30-degree flexion for 2 weeks to prevent dislocation

A. Progressive leg exercises to obtain 90-degree flexion

Although early ambulation is not done, the patient is encouraged to engage in progressive leg exercises until 90-degree flexion is possible. Because this is painful after surgery, the patient requires good pain management and often the use of a CPM machine. The patient's knee is unlikely to dislocate.

121

During a health screening event which assessment finding would alert the nurse to the possible presence of osteoporosis in a white 61-year-old female?

A. The presence of bowed legs
B. A measurable loss of height
C. Poor appetite and aversion to dairy products
D. Development of unstable, wide-gait ambulation

B. A measurable loss of height

A gradual but measurable loss of height and the development of kyphosis or "dowager's hump" are indicative of the presence of osteoporosis in which the rate of bone resorption is greater than bone deposition. Bowed legs may be caused by abnormal bone development or rickets but is not indicative of osteoporosis. Lack of calcium and Vitamin D intake may cause osteoporosis but are not indicative it is present. A wide gait is used to support balance and does not indicate osteoporosis.

122

The nurse is reinforcing health teaching about osteoporosis with a 72-year-old patient admitted to the hospital. In reviewing this disorder, what should the nurse explain to the patient?

A. With a family history of osteoporosis, there is no way to prevent or slow bone resorption.
B. Continuous, low-dose corticosteroid treatment is effective in stopping the course of osteoporosis.
C. Estrogen therapy must be maintained to prevent rapid progression of the osteoporosis.
D. Even with a family history of osteoporosis, the calcium loss from bones can be slowed by increased calcium intake and exercise.

D. Even with a family history of osteoporosis, the calcium loss from bones can be slowed by increased calcium intake and exercise.

The rate of progression of osteoporosis can be slowed if the patient takes calcium supplements and/or foods high in calcium and engages in regular weight-bearing exercise. Corticosteroids interfere with bone metabolism. Estrogen therapy is no longer used to prevent osteoporosis because of the associated increased risk of heart disease and breast and uterine cancer.

123

When the patient is diagnosed with muscular dystrophy, what information should the nurse include in the teaching about this disorder?

A. Prolonged bed rest will be used to decrease fatigue.
B. An orthotic jacket will limit mobility and may contribute to deformity.
C. Continuous positive airway pressure will be used to facilitate sleeping.
D. Remain active to prevent skin breakdown and respiratory complications.

D. Remain active to prevent skin breakdown and respiratory complications.

With muscular dystrophy, it is important for the patient to remain active for as long as possible. Prolonged bed rest should be avoided because immobility leads to further muscle wasting. An orthotic jacket may be used to provide stability and prevent further deformity. Continuous positive airway pressure (CPAP) is used as respiratory function decreases, before mechanical ventilation is needed to sustain respiratory function.

124

The 24-year-old male patient who was successfully treated for Paget's disease has come to the clinic with a gradual onset of pain and swelling around the left knee. The patient is diagnosed with osteosarcoma without metastasis. The patient wants to know why he will be given chemotherapy before the surgery. What is the best rationale the nurse should tell the patient?

A. The chemotherapy is being used to save your left leg.
B. Chemotherapy is being used to decrease the tumor size.
C. The chemotherapy will increase your 5-year survival rate.
D. Chemotherapy will help decrease the pain before and after surgery.

B. Chemotherapy is being used to decrease the tumor size.

Preoperative chemotherapy is used to decrease tumor size before surgery. The chemotherapy will not save his leg if the lesion is too big or there is neurovascular or muscle involvement. Adjunct chemotherapy after amputation or limb salvage has increased 5-year survival rate in people without metastasis. Chemotherapy is not used to decrease pain before or after surgery.

125

The nurse is caring for a patient hospitalized with exacerbation of chronic bronchitis and herniated lumbar disc. Which breakfast choice would be most appropriate for the nurse to encourage the patient to check on the breakfast menu?

A. Bran muffin
B. Scrambled eggs
C. Puffed rice cereal
D. Buttered white toast

A. Bran muffin

Each meal should contain one or more sources of fiber, which will reduce the risk of constipation and straining with defecation, which increases back pain. Bran is typically a high-fiber food choice and is appropriate for selection from the menu. Scrambled eggs, puffed rice cereal, and buttered white toast do not have as much fiber.

126

The nurse is planning health promotion teaching for a 45-year-old patient with asthma, low back pain from herniated lumbar disc, and schizophrenia. What does the nurse determine would be the best exercise to include in an individualized exercise plan for the patient?

A. Yoga
B. Walking
C. Calisthenics
D. Weight lifting

B. Walking

The patient would benefit from an aerobic exercise that takes into account the patient's health status and fits the patient's lifestyle. The best exercise is walking, which builds strength in the back and leg muscles without putting undue pressure or strain on the spine. Yoga, calisthenics, and weight lifting would all put pressure on or strain the spine.

127

Which nursing intervention is most appropriate when turning a patient following spinal surgery?

A. Placing a pillow between the patient's legs and turning the body as a unit
B. Having the patient turn to the side by grasping the side rails to help turn over
C. Elevating the head of bed 30 degrees and having the patient extend the legs while turning
D. Turning the patient's head and shoulders and then the hips, keeping the patient's body centered in the bed

A. Placing a pillow between the patient's legs and turning the body as a unit

Placing a pillow between the legs and turning the patient as a unit (logrolling) helps to keep the spine in good alignment and reduces pain and discomfort following spinal surgery. Having the patient turn by grasping the side rail to help, elevating the head of the bed, and turning with extended legs or turning the patient's head and shoulders and then the hips will not maintain proper spine alignment and may cause damage.

128

The nurse has reviewed proper body mechanics with a patient with a history of low back pain caused by a herniated lumbar disc. Which statement made by the patient indicates a need for further teaching?

A. "I should sleep on my side or back with my hips and knees bent."
B. "I should exercise at least 15 minutes every morning and evening."
C. "I should pick up items by leaning forward without bending my knees."
D. "I should try to keep one foot on a stool whenever I have to stand for a period of time."

C. "I should pick up items by leaning forward without bending my knees."

The patient should avoid leaning forward without bending the knees. Bending the knees helps to prevent lower back strain and is part of proper body mechanics when lifting. Sleeping on the side or back with hips and knees bent and standing with a foot on a stool will decrease lower back strain. Back strengthening exercises are done twice a day once symptoms subside.

129

The nurse is admitting a patient to the nursing unit with a history of a herniated lumbar disc and low back pain. In completing a more thorough pain assessment, the nurse should ask the patient if which action aggravates the pain?

A. Bending or lifting
B. Application of warm moist heat
C. Sleeping in a side-lying position
D. Sitting in a fully extended recliner


A. Bending or lifting

Back pain that is related to a herniated lumbar disc often is aggravated by events and activities that increase the stress and strain on the spine, such as bending or lifting, coughing, sneezing, and lifting the leg with the knee straight (straight leg-raising test). Application of moist heat, sleeping position, and ability to sit in a fully extended recliner do not aggravate the pain of a herniated lumbar disc.

130

The nurse determines that dietary teaching for a 75-year-old patient with osteoporosis has been successful when the patient selects which highest-calcium meal?

A. Chicken stir-fry with 1 cup each onions and green peas, and 1 cup of steamed rice
B. Ham and Swiss cheese sandwich on whole wheat bread, steamed broccoli, and an apple
C. A sardine (3 oz) sandwich on whole wheat bread, 1 cup of fruit yogurt, and 1 cup of skim milk
D. A two-egg omelet with 2 oz of American cheese, one slice of whole wheat toast, and a half grapefruit



C. A sardine (3 oz) sandwich on whole wheat bread, 1 cup of fruit yogurt, and 1 cup of skim milk

The highest calcium content is present in the lunch containing milk and milk products (yogurt) and small fish with bones (sardines). Chicken, onions, green peas, rice, ham, whole wheat bread, broccoli, apple, eggs, and grapefruit each have less than 75 mg of calcium per 100 g of food. Swiss cheese and American cheese have more calcium, but not as much as the sardines, yogurt, and milk.

131

The nurse is caring for a patient admitted to the nursing unit with osteomyelitis of the tibia. Which symptom will the nurse most likely find on physical examination of the patient?

A. Nausea and vomiting
B. Localized pain and warmth
C. Paresthesia in the affected extremity
D. Generalized bone pain throughout the leg

B. Localized pain and warmth

Osteomyelitis is an infection of bone and bone marrow that can occur with trauma, surgery, or spread from another part of the body. Because it is an infection, the patient will exhibit typical signs of inflammation and infection, including localized pain and warmth. Nausea and vomiting and paresthesia of the extremity are not expected to occur. Pain occurs, but it is localized, not generalized throughout the leg.

132

A 54-year-old patient with acute osteomyelitis asks the nurse how this problem will be treated. Which response by the nurse is most appropriate?

A. "IV antibiotics are usually required for several weeks."
B. "Oral antibiotics are often required for several months."
C. "Surgery is almost always necessary to remove the dead tissue that is likely to be present."
D. "Drainage of the foot and instillation of antibiotics into the affected area is the usual therapy."

A. "IV antibiotics are usually required for several weeks."

The standard treatment for acute osteomyelitis consists of several weeks of IV antibiotic therapy. This is because bone is denser and less vascular than other tissues, and it takes time for the antibiotic therapy to eradicate all of the microorganisms. Surgery may be used for chronic osteomyelitis, which may include debridement of the devitalized and infected tissue and irrigation of the affected bone with antibiotics.

133

A 67-year-old patient hospitalized with osteomyelitis has an order for bed rest with bathroom privileges with the affected foot elevated on two pillows. The nurse would place highest priority on which intervention?

A. Ambulate the patient to the bathroom every 2 hours.
B. Ask the patient about preferred activities to relieve boredom.
C. Allow the patient to dangle legs at the bedside every 2 to 4 hours.
D. Perform frequent position changes and range-of-motion exercises.

D. Perform frequent position changes and range-of-motion exercises.

The patient is at risk for atelectasis of the lungs and for contractures because of prescribed bed rest. For this reason, the nurse should place the priority on changing the patient's position frequently to promote lung expansion and performing range-of-motion (ROM) exercises to prevent contractures. Assisting the patient to the bathroom will keep the patient safe as the patient is in pain, but it may not be needed every 2 hours. Providing activities to relieve boredom will assist the patient to cope with the bed rest, and dangling the legs every 2 to 4 hours may be too painful. The priority is position changes and ROM exercises.

134

The nurse identifies a nursing diagnosis of pain related to muscle spasms for a 45-year-old patient who has low back pain from a herniated lumbar disc. What would be an appropriate nursing intervention to treat this problem?

A. Provide gentle ROM to the lower extremities.
B. Elevate the head of the bed 20 degrees and flex the knees.
C. Place the bed in reverse Trendelenburg with the feet firmly against the footboard.
D. Place a small pillow under the patient's upper back to gently flex the lumbar spine.

B. Elevate the head of the bed 20 degrees and flex the knees.

The nurse should elevate the head of the bed 20 degrees and flex the knees to avoid extension of the spine and increasing the pain. The slight flexion provided by this position often is comfortable for a patient with a herniated lumbar disc. ROM to the lower extremities will be limited to prevent extremes of spinal movement. Reverse Trendelenburg and a pillow under the patient's upper back will more likely increase pain.

135

The nurse is admitting a patient who complains of a new onset of lower back pain. To differentiate between the pain of a lumbar herniated disc and lower back pain from other causes, what would be the best question for the nurse to ask the patient?

A. "Is the pain worse in the morning or in the evening?"
B. "Is the pain sharp or stabbing or burning or aching?"
C. "Does the pain radiate down the buttock or into the leg?"
D. "Is the pain totally relieved by analgesics, such as acetaminophen (Tylenol)?"

C. "Does the pain radiate down the buttock or into the leg?"

Lower back pain associated with a herniated lumbar disc is accompanied by radiation along the sciatic nerve and can be commonly described as traveling through the buttock, to the posterior thigh, or down the leg. This is because the herniated disc causes compression on spinal nerves as they exit the spinal column. Time of occurrence, type of pain, and pain relief questions do not elicit differentiating data.

136

A nurse is working with a 73-year-old patient with osteoarthritis (OA). In assessing the patient's understanding of this disorder, the nurse concludes teaching has been effective when the patient uses which description of the condition?

A. Joint destruction caused by an autoimmune process
B. Degeneration of articular cartilage in synovial joints
C. Overproduction of synovial fluid resulting in joint destruction
D. Breakdown of tissue in non–weight-bearing joints by enzymes



















B. Degeneration of articular cartilage in synovial joints

OA is a degeneration of the articular cartilage in diarthrodial (synovial) joints from damage to the cartilage. The condition has also been referred to as degenerative joint disease. OA is not an autoimmune disease. There is no overproduction of synovial fluid causing destruction or breakdown of tissue by enzymes.

137

The nurse is caring for four newly diagnosed patients with various connective tissue disorders. The nurse should be most aware of safety issues and interstitial lung involvement in the patient with which diagnosis?

A. Polymyositis
B. Reactive arthritis
C. Sjögren's syndrome
D. Systemic lupus erythematosus (SLE)

A. Polymyositis Correct

Polymyositis is an inflammatory disease affecting striated muscle and resulting in muscle weakness that increases the patient's risk of falls and injury. Weakened pharyngeal muscles increase the risk for aspiration with interstitial lung disease in up to 65% of patients. The treatment of polymyositis starts with high-dose corticosteroids that cause immunosuppression. If this does not work, other immunosuppressive drugs may be used. Reactive arthritis (Reiter's syndrome) occurs with urethritis, conjunctivitis, and mucocutaneous lesions with the asymmetric arthritis involving large joints of the lower extremities and toes. This patient is not at increased risk for safety problems. Sjögren's syndrome decreases moisture produced by exocrine glands, especially in the mouth and eyes and is without increased risk of injury or interstitial lung involvement. Systemic lupus erythematosus (SLE) is a multisystem inflammatory autoimmune disorder treated with NSAIDs, antimalarial agents. Safety would not be an important issue early in the disease.

138

The patient with fibromyalgia is suffering with pain at 12 of the 18 identification sites, including the neck and upper back and the knees. The patient also reports nonrefreshing sleep, depression, and being anxious when dealing with multiple tasks. The nurse should teach this patient about what treatments (select all that apply)?

A. Low-impact aerobic exercise
B. Relaxation strategy (biofeedback)
C. Antiseizure drug pregabalin (Lyrica)
D. Morphine sulfate extended-release tablets
E. Serotonin reuptake inhibitor (e.g., sertraline [Zoloft])

A B C E
Because the treatment of fibromyalgia is symptomatic, this patient will be prescribed something for pain, such as pregabalin, and a serotonin reuptake inhibitor for depression. Low- impact aerobic exercise will prevent muscle atrophy without increasing pain at the knees. Relaxation can help decrease the patient's stress and anxiety. Long-acting opioids are generally avoided unless pain cannot be relieved by other medications.

139

The 40-year-old African American woman has had Raynaud's phenomenon for some time. She is now reporting red spots on the hands, forearms, palms, face, and lips. What other manifestations should the nurse assess for when she is assessing for scleroderma (select all that apply)?

A. Calcinosis
B. Weight loss
C. Sclerodactyly
D. Difficulty swallowing
E. Weakened leg muscles

A. C. D.

This 40-year-old African American woman is at risk for scleroderma. The acronym CREST represents the clinical manifestations. C: calcinosis, painful calcium deposits in the skin; R: Raynaud's phenomenon; E: Esophageal dysfunction, difficulty swallowing; S: sclerodactyly, tightening of skin on fingers and toes; T: telangiectasia. Weight loss and weakened leg muscles are associated with polymyositis and dermatomyositis not scleroderma.

140

Because the incidence of Lyme disease is very high in Wisconsin, the public health nurse is planning to provide community education to increase the number of people who seek health care promptly after a tick bite. What information should the nurse provide when teaching people who are at risk for a tick bite?

A. The best therapy for the acute illness is an IV antibiotic.
B. Check for an enlarging reddened area with a clear center.
C. Surveillance is necessary during the summer months only.
D. Antibiotics will prevent Lyme disease if taken for 10 days.

B. Check for an enlarging reddened area with a clear center.

Following a tick bite, the expanding "bull's eye rash" is the most characteristic symptom that usually occurs in 3 to 30 days. There may also be flu-like symptoms and migrating joint and muscle pain. Active lesions are treated with oral antibiotics for 2 to 3 weeks, and doxycycline is effective in preventing Lyme disease when given within 3 days after the bite of a deer tick. IV therapy is used with neurologic or cardiac complications. Although ticks are most prevalent during summer months, residents of high-risk areas should check for ticks whenever they are outdoors.

141


A nurse is assessing the recent health history of a 63-year-old patient with osteoarthritis (OA). The nurse determines that the patient is trying to manage the condition appropriately when the patient describes which activity pattern?

A. Bed rest with bathroom privileges
B. Daily high-impact aerobic exercise
C. Regular exercise program of walking
D. Frequent rest periods with minimal exercise






C. Regular exercise program of walking

A regular low-impact exercise, such as walking, is important in helping to maintain joint mobility in the patient with osteoarthritis. A balance of rest and activity is needed. High-impact aerobic exercises would cause stress to affected joints and further damage.

142

The nurse is admitting a patient who is scheduled for knee arthroscopy related to osteoarthritis (OA). Which finding should the nurse expect to be present on examination of the patient's knees?

A. Ulnar drift
B. Pain with joint movement
C. Reddened, swollen affected joints
D. Stiffness that increases with movement

B. Pain with joint movement

OA is characterized predominantly by joint pain upon movement and is a classic feature of the disease. Ulnar drift occurs with rheumatoid arthritis (RA) not osteoarthritis. Not all joints are reddened or swollen. Only Heberden's and Bouchard's nodes may be. Stiffness decreases with movement.

143

The patient developed gout while hospitalized for a heart attack. When doing discharge teaching for this patient who takes aspirin for its antiplatelet effect, what should the nurse include about preventing future attacks of gout?

A. Limit fluid intake.
B. Administration of probenecid (Benemid)
C. Administration of allopurinol (Zyloprim)
D. Administration of nonsteroidal antiinflammatory drugs (NSAIDs)

C. Administration of allopurinol (Zyloprim)

To prevent future attacks of gout, the urate-lowering drug allopurinol may be administered. Increased fluid will be encouraged to prevent precipitation of uric acid in the renal tubules. This patient will not be able to take the uricosuric drug probenecid because the aspirin the patient must take will inactivate its effect, resulting in urate retention. NSAIDs for pain management will not be used, related to the aspirin, because of the potential for increased side effects.

144

A nurse assesses a 38-year-old patient with joint pain and stiffness who was diagnosed with Stage III rheumatoid arthritis (RA). What characteristics should the nurse expect to observe (select all that apply)?

A. Nodules present
B. Consistent muscle strength
C. Localized disease symptoms
D. No destructive changes on x-ray
E. Subluxation of joints without fibrous ankylosis

A. Nodules present
E. Subluxation of joints without fibrous ankylosis


In Stage III severe RA, there may be extraarticular soft tissue lesions or nodules present, and there is subluxation without fibrous or bony ankylosis. The muscle strength is decreased because there is extensive muscle atrophy. The manifestations are systemic not localized. There is x-ray evidence of cartilage and bone destruction in addition to osteoporosis.

145

A female patient's complex symptomatology over the past year has led to a diagnosis of systemic lupus erythematosus (SLE). Which statement demonstrates the patient's need for further teaching about the disease?

A. "I'll try my best to stay out of the sun this summer."
B. "I know that I probably have a high chance of getting arthritis."
C. "I'm hoping that surgery will be an option for me in the future."
D. "I understand that I'm going to be vulnerable to getting infections."

C. "I'm hoping that surgery will be an option for me in the future."

Surgery is not a key treatment modality for SLE, so this indicates a need for further teaching. SLE carries an increased risk of infection, sun damage, and arthritis.

146

Which patient statement most clearly suggests a need to assess the patient for ankylosing spondylitis (AS)?

A. "My right elbow has become red and swollen over the last few days."
B. "I wake up stiff every morning, and my knees just don't want to bend."
C. "My husband tells me that my posture has become so stooped this winter."
D. "My lower back pain seems to be getting worse all the time, and nothing seems to help."

D. "My lower back pain seems to be getting worse all the time, and nothing seems to help."


AS primarily affects the axial skeleton. Based on this, symptoms of inflammatory spine pain are often the first clues to a diagnosis of AS. Knee or elbow involvement is not consistent with the typical course of AS. Back pain is likely to precede the development of kyphosis.

147

When reinforcing health teaching about the management of osteoarthritis (OA), the nurse determines that the patient needs additional instruction after making which statement?

A. "I should take the Naprosyn as prescribed to help control the pain."
B. "I should try to stay standing all day to keep my joints from becoming stiff."
C. "I can use a cane if I find it helpful in relieving the pressure on my back and hip."
D. "A warm shower in the morning will help relieve the stiffness I have when I get up."

B. "I should try to stay standing all day to keep my joints from becoming stiff."

It is important to maintain a balance between rest and activity to prevent overstressing the joints with OA. Naproxen (Naprosyn) may be used for moderate to severe OA pain. Using a cane and warm shower to help relieve pain and morning stiffness are helpful.

148

The nurse is caring for a patient who has osteoarthritis (OA) of the knees. The nurse teaches the patient that the most beneficial measure to protect the joints is to do what?

A. Use a wheelchair to avoid walking as much as possible.
B. Sit in chairs that cause the hips to be lower than the knees.
C. Eat a well-balanced diet to maintain a healthy body weight.
D. Use a walker for ambulation to relieve the pressure on the hips.

C. Eat a well-balanced diet to maintain a healthy body weight.

Because maintaining an appropriate load on the joints is essential to the preservation of articular cartilage integrity, the patient should maintain an optimal overall body weight or lose weight if overweight. Walking is encouraged. The chairs that would be best for this patient have a higher seat and armrests to facilitate sitting and rising from the chair. Relieving pressure on the hips is not important for OA of the knees.

149

The nurse in an industrial plant receives a client with a traumatic amputation of a finger. Which action is most appropriate to perserve the amputated finger?
A. place the finger in a plastic bag and place the bag on cold normal saline
B. wrap the finger in Vaseline-saturated gauze 4x4 sponges
C. put the digit on crushed ice in a plastic covered container
D. place the digit on a saline soaked 4x4 and put it in a plastic bag

A. place the finger in a plastic bag and place the bag on normal saline.

150

A client is five hours postoperatve total knee replacement. Which assessment result requires the nurse to notify the physician?
A. temperature of 100 degrees Fahrenheit
B. Hematocrit of 24%
C. dime sized serous drainage on dressing
D. 300mL Foley output in five hours

B. Hematocrit of 24%. The client has an abnormal Hct and might need a blood transfusion.