Pain Medication for Hip Fracture
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Mr. Hayward has a hip fracture. The nurse checks his medical record while at the? nurses' station. Which medication should the nurse anticipate will be prescribed for Mr.? Hayward? Steroids to reduce inflammation Sodium bicarbonate to correct acidosis Diuretics to increase urinary output Pain medications to reduce discomfort
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Pain medications to reduce discomfort Rationale Administer pain medications to clients with hip fractures to reduce discomfort.? Diuretics, steroids, and sodium bicarbonate are not indicated.
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A client is diagnosed with lumbar scoliosis. Which interventions should the nurse include in this client?'s plan of? care? ?(Select all that? apply.) Remind to keep scheduled? follow-up appointments Review prescribed exercises Encourage rest Provide emotional support Provide information about back braces
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Remind to keep scheduled? follow-up appointments Review prescribed exercises Provide emotional support Provide information about back braces Rationale Nursing interventions for the client with scoliosis? include: providing emotional? support, reviewing prescribed? exercises, information about back? bracing, and reviewing the importance of regular checkups. Rest is not an intervention identified for scoliosis.
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A victim of an automobile crash is diagnosed with fractures of the axial skeleton. For which bone fractures should the nurse anticipate providing care for this? client? ?(Select all that? apply.) Vertebra Lower leg Arm Femur Ribs
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Vertebra Ribs Rationale The axial skeleton is made up of the? ribs, sternum, vertebral? column, and skull. The appendicular skeleton is made up of the pectoral? girdles, upper? limbs, pelvic? girdle, and lower limbs.
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A client with eroding cartilage of the left knee asks why bruising is absent because bruising was present when she injured her knee a few months ago. How should the nurse respond to this? client? "The cartilage has eroded all blood vessels." "Cartilage does not contain blood vessels." "This injury damaged the blood vessels." "Cartilage is eroded because blood vessels are harmed."
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"Cartilage does not contain blood vessels." Rationale Ligaments and tendons contain blood? vessels, but cartilage does not. Because of? this, bruising will be absent with cartilage erosion. The previous injury caused a bruise because either ligaments or tendons were injured. Cartilage erosion does not damage blood vessels. Cartilage does not erode blood vessels. Cartilage does not erode because blood vessels are harmed.
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The nurse is planning care for an older client with muscle atrophy and limited mobility. What actions should the nurse plan to promote comfort for this? client? ?(Select all that? apply.) Pad joints Protect bony prominences Coach in isometric exercises Encourage ambulation Teach? range-of-motion exercises
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Pad joints Protect bony prominences Rationale When promoting? comfort, the nurse should support and pad joints and bony prominences. Encouraging ambulation might not be appropriate because the client has muscle atrophy and limited mobility. Isometric exercises are used to maintain strength when a joint is immobilized.? Range-of-motion exercises are passive exercises that help maintain joint mobility. These exercises will not necessarily promote comfort in the client with limited mobility.
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The nurse identifies that a client who sits for 10 hours a day during work is at risk for hip contracture formation. What should the nurse instruct the client to? do, in order to reduce this? risk? ?(Select all that? apply.) Perform stretching exercises as instructed by the physical therapist Consider losing weight and increasing activity Follow the prescribed exercises provided by the physical therapist Clear all walkways from obstructions in the home Remove scatter rugs from the home
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Perform stretching exercises as instructed by the physical therapist Follow the prescribed exercises provided by the physical therapist Clear all walkways from obstructions in the home Remove scatter rugs from the home Rationale For the client at risk for developing? contractures, the nurse needs to help reduce this risk by encouraging the client to perform exercise and stretches as prescribed by the physical therapist. The nurse should also make sure that the client?'s environment is safe by eliminating scatter rugs and clearing walkways from obstructions.
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The nurse notifies the healthcare provider about the need to cancel a scheduled MRI of the spine. What client information did the nurse use to determine the need to cancel the? MRI? ?(Select all that? apply.) Right total knee replacement Pins in left fibula Pacemaker present Cochlear implant in right ear Left total knee replacement
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Pacemaker present Cochlear implant in right ear Rationale Orthopedic implants such as joint replacements and pins that are not metal are considered safe for an MRI. However individuals with metal implants in their body may not be able to have a MRI performed because MRI is performed using a strong magnetic field to create the images. Metal Implants could cause problem if subjected to high magnetic forces. Patient should always check with physicians to ensure that metal implants are safe for an MRI Reference? Cluette, J.? (2014). Can I have an MRI with a metal implant or joint? Replacement? Retrieved from? orthopedics.about.com/od/hipkneereplacement/f/mri.htm
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During a home? visit, the nurse observes a client with back pain shouting at her children and banging cabinet doors in the kitchen while looking for a cooking utensil. Which concept should the nurse identify as being affected by this client?'s back? pain? Safety Stress ?Self-esteem Perfusion
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Stress Rationale An individual with a reduction in mobility will experience greater stress because of changes in activity and comfort levels. Although mobility issues affect the safety of individuals at different times in the life? span, there is no indication that the client?'s safety is in jeopardy. There is no indication that the client is experiencing an alteration in perfusion. Although? self-esteem might be impacted by an alteration in? mobility, the client?'s behavior does not support this at this time.
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During the assessment of the musculoskeletal? system, the nurse determines that a client has a right hip contracture. What did the nurse do to make this? assessment? Bent one of the client?'s legs and observed if the extended leg lifted off of the table Applied pressure to the lower area of a bent leg and listened for clicking Moved the tissue over the medial aspect of the knee and tapped on the patella Applied pressure on the knee while pushing the patella against the femur
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Bent one of the client?'s legs and observed if the extended leg lifted off of the table Rationale The Thomas test is used to assess for hip contractures. While the client is lying? down, one leg is brought to the chest while the other leg is extended. If the extended leg rises off of the? table, a hip contracture is present. The other choices assess for knee function. Applying pressure on the knee while pushing the patella against the femur is part of the ballottement test. Applying pressure to the lower area of a bent leg and listening for clicking is part of the McMurray test. Moving the tissue over the medial aspect of the knee while tapping on the patella is done in the bulge test.
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Which nonpharmacologic therapy will the nurse include in teaching clients about? self-care for herniated? discs? Leg press exercises Weight loss Meditation ?Low-phosphate diet
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Weight loss Rationale Being overweight is a risk factor for herniated discs and weight loss is effective at mitigating severity.? Meditation, diet other than how it relates to weight? loss, and leg press exercises are not included in a regimen for herniated discs.? Weight-bearing exercise may increase the risk for further injury if not practiced with professional supervision.
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The nurse is assessing a client with a history of back surgery who describes his occupation as a server carrying large trays overhead on a busy restaurant floor. Which nursing diagnosis would the nurse be likely to make for this? client? Potential for noncompliance with therapeutic regimen Potential for injury related to body mechanics Increased anxiety Increased risk for infection
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Potential for injury related to body mechanics Rationale Occupations involving frequent lifting and twisting carry a high risk for herniated? disc, particularly combined with a personal history of prior back surgery. Nothing in the client?'s history indicates potential for? noncompliance, increased risk for? infection, or anxiety.
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The nurse obtains a health history from a client being evaluated for a herniated disc. What would be included in this focused? history? Drug use Work and recreational activities Ethnicity Diet recall
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Work and recreational activities Rationale Frequent twisting and lifting are significant risk factors for herniated disc so work and recreational activities should be assessed. Substance? abuse, diet and nutrition and genetic risk factors common to specific ethnicities can be important components of a health history but are not particularly pertinent to herniated discs.
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The nurse is discussing the pathophysiology of a herniated disc with students. Which information should be conveyed in the? discussion? ?(Select all that? apply.) Herniation always happens very suddenly. The disc is filled with protein gel. Intervertebral discs have a strong outer layer called the annulus fibrosus. Herniations are most common in the neck. Herniation occurs when there is a defect or tear in the annulus fibrosus.
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The disc is filled with protein gel. Intervertebral discs have a strong outer layer called the annulus fibrosus. Herniation occurs when there is a defect or tear in the annulus fibrosus. Rationale Information that is appropriate to include in the presentation include the name of the outer layer of the? discs, that the disc is filled with? protein, and that herniation occurs when there is a defect or tear in the annulus fibrosus. The educator would not state that herniations are most common in the neck as the correct location is the lumbar. Herniation can occur suddenly or over time.
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A client is seen in the orthopedic spine clinic for a routine follow up for scoliosis. The nurse understands that there are changes that occur with the musculoskeletal system as a result of scoliosis. Which changes occur with? scoliosis? ?(Select all that? apply.) Spinal cord tumors or cysts Vertebra that is compressed on one side Vertebra that are rotated Vertebra that is curved laterally Shortened muscles and ligaments
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Vertebra that is compressed on one side Vertebra that are rotated Vertebra that is curved laterally Shortened muscles and ligaments Rationale Changes that occur with scoliosis include rotated? vertebra; vertebra that is compressed on one? side; vertebra that is curved? laterally; and shortened muscles and ligaments. Spinal cord tumors or cysts do not occur with scoliosis.
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A client is admitted to a? medical-surgical unit with a diagnosis of herniated lumbar disk. The nurse would anticipate which orders from the healthcare? provider? ?(Select all that? apply.) NSAIDs CT scan of the vertebrae Intravenous solumedrol Electromyogram Muscle relaxants
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NSAIDs CT scan of the vertebrae Electromyogram . Muscle relaxants Rationale NSAIDs are ordered to decrease inflammation and reduce pain in clients with herniated disk. Muscle relaxants are used to decrease muscle spasms. Muscle spasms are common in clients with herniated disk. A CT scan will show deformities in the vertebrae and narrowed disk spaces. This will indicate herniated disk and the location of the disk. An electromyogram is used to identify muscle groups affected by nerves damaged from the herniated disk.Solumedrol is used as an? anti-inflammatory medication for clients with? new-onset spinal cord injury. It must be given within 8 hours of injury onset.
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When is curvature of the spine considered? severe? Greater than 100 degrees When it affects other organs At 40 degrees or greater Between 20 and 40 degrees
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At 40 degrees or greater Rationale Curvatures are classified as severe at 40 degrees or greater. Between 20 and 40? degrees, they are classified as moderate. Organ involvement is not a classification criterion. Curvatures greater than 100 degrees are life threatening.
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Which conditions are risk factors for developing a herniated? disc? ?(Select all that? apply.) Frequent heavy lifting Being under weight Female gender History of back injury Smoking
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Frequent heavy lifting History of back injury Smoking Rationale Risk factors for a herniated disc are male? gender, being? overweight, history of back? problems, smoking and frequent heavy lifting. Being underweight and a female are not risk factors for developing a herniated disc.
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Which client factor is an indication for scoliosis? surgery? Active growth Cobb angle greater than 50 degrees Age greater than 16 years Noncompliance with conservative therapy
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Cobb angle greater than 50 degrees Rationale A client exhibiting a Cobb angle greater than 50 degrees is a candidate for surgical intervention. Age is not a factor. The client must be finished growing and the scoliosis proven unresponsive to proper conservative therapy.
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Which pharmacologic therapies are appropriate for a client diagnosed with a herniated? disc? ?(Select all that? apply.) Transcutaneous electrical nerve stimulation? (TENS) Opioids Antispasmodics Gabapentin Epidural injection with corticosteroids
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Opioids Antispasmodics Gabapentin Epidural injection with corticosteroids Rationale Appropriate pharmacologic therapy for a client with a herniated disc includes opioids for? pain, antispasmodics for muscle? spasm, gabapentin for neuropathic? pain, and epidural injection with corticosteroids to decrease inflammation. TENS is not considered a pharmacologic therapy for herniated disc.
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A healthcare provider is concerned about soft tissue injury for a client with an ulnar fracture. Which tests would be used to diagnose this client?'s soft tissue? injuries? ?(Select all that? apply.) MRI Complete blood count Bone scan ?X-ray CT scan
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MRI Complete blood count Ct Scan Rationale A computed tomography scan? (CT) provides a? three-dimensional picture used to evaluate the extent of bone involvement and to what extent the surrounding soft tissues and neurovascular structures are affected. A magnetic resonance image? (MRI) uses radio waves and magnetic fields.? Gadolinium, an injected contrast? media, is used to enhance the visualization of bony and soft tissues. The exam is used to evaluate the bone damage and to determine the amount of soft tissue and neurovascular involvement. A complete blood count and other blood tests can help assess if there is blood loss and tissue damage at the site of injury. An? x-ray shows the location of the bone fracture and the extent of bone involvement. A bone scan detects the extent of the bone? fracture, and detects whether or not the bone has adequate blood supply. These tests do not show soft tissue involvement.
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The nurse is reviewing the records of newly admitted clients in a nursing home. The nurse understands that which clients are at greater risk for? fractures? ?(Select all that? apply.) The client with osteoporosis The client with osteoarthritis The client with Paget disease The client with leukemia The client with bone neoplasms
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The client with osteoporosis The client with Paget disease The client with bone neoplasms Rationale Bone? neoplasms, osteoporosis, and Paget disease are associated with pathological fractures. Osteoarthritis and leukemia are not associated with pathological fractures.
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A pediatric client with a suspected arm fracture is brought to the emergency department. As the healthcare provider removes the splint applied by? EMS, the? client's mother? exclaims, "Why are you taking that? off? Doesn't my child need that? splint?" What is the best response by the? nurse? ?"We will put the splint right back on after we figure out what other treatments your child might? need." ?"The Velcro straps make it easy for us to take the splint off. We are just adjusting it because EMS had to put it on? quickly." ?"A splint is used to stabilize fresh injuries. We have to remove it to see what other treatment your child might? need." ?"We are going to put a less supportive cast on your child. If any swelling? occurs, this will keep the supportive device from getting too? tight."
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"A splint is used to stabilize fresh injuries. We have to remove it to see what other treatment your child might? need." Rationale A splint is an emergency measure used to stabilize fresh injuries and reduce mobility. It is removed to perform diagnostic tests on an injured limb to see if further treatment is necessary. It is not necessarily replaced if a more supportive device like a cast is necessary. Velcro straps do make a splint easy to? remove, but it is not being removed because EMS applied it incorrectly. A cast is more? supportive, not less? supportive, than a splint.
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A? client, concerned about a deformity that resulted from an oblique fracture of the? femur, states,? "I can't believe one leg is shorter than the other now. I look so? strange!" The client has no complaints of pain. Physical assessment by the nurse reveals normal findings except for the shortened leg. The nurse understands that the client is at greatest risk for which potential? problem? Potential for neurovascular impairment Increased risk for body image disruption Diminished tissue perfusion Alterations in skin integrity
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Increased risk for body image disruption Rationale The client is at greatest risk for body image? disruption, as the client is clearly upset about the deformity that resulted from the fracture. Physical assessment reveals normal? findings, so it is less likely that the client has neurovascular? impairment, skin integrity? issues, or diminished tissue perfusion.
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A young adult client is recovering from a fractured radius that occurred 7 weeks ago. The? client's healing is progressing normally. The nurse anticipates that the client is experiencing which process of bone? healing? Bony callus formation Macrophage invasion of wound Hematoma formation Bone remodeling
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Bony callus formation Rationale Bony callus formation occurs after fibrocartilaginous formation and continues for 2-3 months after the injury. Fibrocartilaginous callus formation begins within 48 hours and lays the groundwork for bony callus formation. Macrophage wound invasion and hematoma formation occur immediately after the injury and ends within a few days. Bone remodeling is the last stage after bony callus formation.
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The nurse is caring for a client with a cast and notices that the client does not respond to touch in that limb. How would the nurse describe this? finding? Pallor Paralysis Paresthesia Prickliness
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Paresthesia Rationale Paresthesia, due to nerve? compression, can result in a loss of sensation or a feeling of? "pins and? needles." Pallor is a loss of color in the skin. Paralysis is the inability to move a body part or extremity. Prickliness is not an element of the neurovascular assessment.
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What statements concerning bone fractures are? correct? ?(Select all that? apply.) A bone fracture can be the direct result of excess pressure in the fibrous membrane or fascia. The severity of a bone fracture depends on the force of the action against the bone and bone strength. Diseases such as neoplasms do not cause bone fractures. Bone fractures may result from repetitive forces or twisting. Bone fractures do not result from low bone density.
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Bone fractures may result from repetitive forces or twisting. The severity of a bone fracture depends on the force of the action against the bone and bone strength. Rationale The severity of a bone fracture depends on the force of the action against the bone and bone strength. Low bone density is often a precursor to a fracture. Diseases such as neoplasms? (bone cancer) or osteoporosis may weaken the bones and result in fractures. It is compartment? syndrome, not a bone? fracture, that occurs when excess pressure in the space enclosed by the fascia constricts structures within the? compartment, reducing circulation to muscles and nerves. Bone fractures may result from repetitive forces like? running, twisting, or a direct blow to the bone.
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Which are clinical manifestations of a? fracture? ?(Select all that? apply.) Ecchymosis Fluid excess Swelling Muscle spasms Crepitus
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Ecchymosis Swelling Muscle spasms Crepitus Rationale You may palpate crepitus at the site of the injury if bone pieces grate? together, and there will likely be ecchymosis? (bruising) and swelling at the injury? site, as well as muscle spasms in the injured limb.? Hypovolemia, not fluid? excess, may occur due to blood loss caused by the fracture.
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Which complication of a fracture causes? dyspnea? Compartment syndrome Fat embolism Deep vein thrombosis Infection
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Fat embolism Rationale A fat embolism occurs when fat globules released by injured tissue lodge in the pulmonary? vasculature, resulting in dyspnea. Compartment syndrome is manifested by pain resulting from pressure when fascia constricts. Deep vein thrombosis is a clot that commonly forms in the leg and causes? redness, warmth, leg? pain, cramping, and swelling. Infection causes? warmth, redness,? pain, swelling,? stiffness, fever,? chills, and purulent drainage.
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Which radiologic study is the best method to diagnose a? fracture? MRI ?X-ray Bone scan CT scan
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X-ray Rationale An? x-ray shows the location of a bone fracture and is the best method to simply diagnose a fracture. A CT scan provides a? three-dimensional picture used to evaluate the extent of bone involvement and to what extent the surrounding soft tissues and neurovascular structures are affected. An MRI is used to evaluate the bone damage and to determine the amount of soft tissue and neurovascular involvement. A bone scan detects the extent of the bone? fracture, detects whether or not the bone has adequate blood? supply, and can help to evaluate the planned therapy.
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Which therapy for fractures applies a straightening or pulling force to return or maintain the fractured bones in normal anatomic? position? Splint Electrical bone stimulation Cast Traction
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Traction Rationale Traction applies a straightening or pulling force to return or maintain the fractured bones in normal anatomic position. Splints are used to stabilize fresh injuries. Electrical bone stimulation uses an electrical current to treat nonhealing bone fractures. A cast is molded around the injured limb to provide? support, protection, and immobilization of the fractured bones and surrounding tissue.
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Which neurovascular assessment findings are found in client with a? fracture? ?(Select all that? apply.) Paralysis Paresthesia Perspiration Pain Pulselessness
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Paralysis Paresthesia Pain Pulselessness Rationale Indications of neurovascular compromise as a result of a bone fracture would include the absence of? pain; pulses distal to the injury? site; paleness,? paralysis, or inability to? move; and? paresthesia, or numbness or tingling of the affected? limb, particularly distal to the injury site. Perspiration would not indicate neurovascular compromise secondary to fracture.
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Match the nursing intervention with its category of care. ?Instructions: Use the dropdown menus in the left? column, to select the correct category for each statement in the right column. Category ? Pain management (p) Mobility (M) Prevent infection (P) Neurovascular status (N) Statement Move client gently and slowly. Monitor tightness of the cast. Monitor vital signs. Teach isometric exercises to be performed every 4 hours. Assess discomfort on a scale from 0 to 10. Turn and reposition client on bed rest every 2 hours. Assess wound for? size, color, or drainage. Assess the five? P's every 1 to 2 hours. Administer analgesic medication as prescribed. Elevate injured extremity above level of heart. Support ambulation when able. Administer antibiotics as prescribed.
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p N P M p M P N p N M P Rationale Pain management Move client gently and slowly. Neurovascular status Monitor tightness of the cast. Prevent infection Monitor vital signs. Mobility Teach isometric exercises to be performed every 4 hours. Pain management Assess discomfort on a scale from 0 to 10. Mobility Turn and reposition client on bed rest every 2 hours. Prevent infection Assess wound for? size, color, or drainage. Neurovascular status Assess the five? P's every 1 to 2 hours. Pain management Administer analgesic medication as prescribed. Neurovascular status Elevate injured extremity above level of heart. Mobility Support ambulation when able. Prevent infection Administer antibiotics as prescribed.
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Jillian Adichie is a? 16-year-old girl who fell from a balance beam at a practice meet and landed off the mat onto some protruding hardware. She fractured her left leg. In assessing? Jillian's leg, you notice that the area above her ankle is warm and at an odd angle and the skin is broken. Based on this assessment? alone, how would you initially classify this? injury? Open? (compound) fracture Closed? (simple) fracture Incomplete Complete
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Open? (compound) fracture Rationale Based on the fact that the skin is? broken, you know the fracture is open as opposed to closed. Without visualizing the bone? itself, either by observation or by? x-ray, you would not know if the fracture was complete or incomplete.
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Len Erickson is a? 55-year-old rancher who was involved in a motor vehicle accident that caused severe soft tissue damage to his left leg and an open tibial fracture. Mr. Erickson says the surgeon was just in and told him that he would need surgery to fix his leg using external fixation. He asks you what that means. What is your best? response? ?"You will have metal rods attached to your leg on the outside until the bone? heals." ?"Wires and screws will be attached directly to your bones to put them back? together." ?"Your leg has a lot of tissue damage so we have to use external fixation to fix? it." ?"External fixation has a shorter hospital stay than internal? fixation, which is why? we're using? it."
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"You will have metal rods attached to your leg on the outside until the bone heals." Rationale The best response accurately describes an external fixation device as a metal device attached outside of the leg until the bone heals. Although external fixation is indicated for fractures accompanied with soft tissue damage that prevent internal? fixation, you are not directly answering his question if you respond in this manner. He asked what external fixation meant. Wires and screws attached directly to the bones describes? internal, not? external, fixation. Internal fixation has a shorter hospital stay than external fixation. Even if this were not the? case, talking about hospital stays does not directly answer Mr.? Erickson's question.
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Manuel Barreto is a? 50-year-old man who presented to the emergency department with a broken right radius and ulna sustained when he fell on a patch of ice. You are assessing the 5? P's and ask him to wiggle his fingers on his right arm. He asks why you are doing this. What would you include in your? response? ?"I am checking for? pulse." ?"I am checking for? numbness." ?"I am checking for? paleness." ?"I am checking for? paralysis."
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"I am checking for paralysis." Rationale By asking Mr. Barreto to move his? fingers, you are assuring that there is no neurovascular damage distal to the injury. You would assess pulse by comparing the distal pulses? (radial pulses in this? case) of his affected and unaffected arms. You would assess paleness? (pallor) by observing the color of his fingers. You would assess numbness? (paresthesia) by asking him if his fingers felt numb or tingly.
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The nurse is administering pain medication to a client with a radial fracture. The client asks what the difference is between the opioids being administered and the NSAIDs that the client is used to taking. What is the best response by the? nurse? ?"Unlike NSAIDs, you should request opioids before your pain becomes? severe." ?"Only opioids can be given at a scheduled time around the? clock." ?"Only opioids can be given with a? patient-controlled pump." ?"Unlike NSAIDs, opioids will only be given to you for a limited period of? time."
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?"Unlike NSAIDs, opioids will only be given to you for a limited period of? time." Rationale Both NSAIDs and opioids can be given with a? patient-controlled analgesic? (PCA) pump, given at scheduled times around the? clock, and be requested by the client before pain becomes severe. Unlike? NSAIDs, opioids will only be prescribed for a certain period of time to prevent addiction.
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A client sustained an open femoral fracture during a skiing accident. The nurse understands that this client is at risk for infection. What would the nurse need to do since the client is at risk for? infection? ?(Select all that? apply.) Assess wound for? size, color, or presence of drainage Use aseptic technique with dressing changes Assess temperature every 4 hours Withhold pain medication to assess for manifestations of infection Avoid disturbing pins in external fixation device
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Assess wound for size, color, or presence of drainage use aseptic technique with dressing changes assess temperature every 4 hours Rationale Clients who have open fractures are at risk for infection. The nurse would assess the wound for manifestations of? infection, assess vital? signs, use aseptic technique to change? dressings, provide pin care as? prescribed, and administer antibiotics as prescribed. Pin care varies by? facility, but all pins require care to remove crusts and prevent infection. Pin care may include gently cleansing the pin site daily to weekly with a cleansing? solution, such as sterile saline or chlorhexidine. Withholding pain medication would not be an appropriate intervention for a client with an open fracture. Manifestations of an infection can be assessed in a client receiving pain medication.
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A client is diagnosed with a comminuted fracture. How would the nurse describe this fracture to the? client? ?"The bone is breaking through the? skin." ?"The ends of the broken bones are forced? together." ?"The bone is broken into many? pieces." ?"The fracture travels horizontally across the bone? shaft."
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"The bone is broken into many? pieces." Rationale Rationale In a comminuted? fracture, the bone is broken in many pieces. The bone fragments may cause further injury or complications. An open or compound fracture involves bone breaking through the skin. A transverse fracture is horizontal to the bone shaft. In an impacted or buckle? fracture, the ends of the broken bones are forced together.
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The nurse is caring for a client with a? nonbleeding, closed femur fracture. The healthcare provider wants to evaluate the client for leakage of blood into the surrounding tissue. The nurse anticipates that which test will be ordered for the? client? Bone scan ?X-ray Hematocrit White blood cell count
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Hematocrit Rationale Rationale Red blood cell indices are used to assess for excessive blood loss and evaluate for anemia. As much as 500 mL of blood can leak into the surrounding tissues as a result of a fractured femur. White blood cell counts would be more useful in determining the presence of infection.? X-rays and bone scans are more useful for determining bone damage.
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A female client fell approximately 10 feet off a ladder while hanging decorations on the outside of the house. As the client was? landing, she attempted to catch herself with outstretched arms. EMS personnel are transporting the client to the emergency department and suspect a fracture of the right wrist. Which manifestations would the nurse anticipate observing in the? client? ?(Select all that? apply.) Muscle spasms Deformity Brown or yellow discoloration Crepitus Pain
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Muscle spasms Deformity Crepitus Pain Rationale The manifestations of a fracture include? deformity, swelling,? pain, tenderness,? numbness, guarding,? crepitus, hypovolemic? shock, muscle? spasms, or ecchymosis. A contusion is a swollen and discolored area on the skin. The musculoskeletal injury causes blood to leak into the soft? tissue, resulting in a purple or blue discoloration or a bruise. When the blood? reabsorbs, the area becomes brown and yellow until it disappears. The ecchymosis seen with a fracture will start as purple or blue in? color, not brown or? yellow, until reabsorption begins.
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A client is admitted with a right radial and ulnar fracture after a motorcycle crash. The nurse is concerned that the client may have neurovascular dysfunction. What would the nurse assess to determine if the client has neurovascular? dysfunction? The 5 P?'s The ABCs History of the traumatic event Chronic illness
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The 5 P?'s Rationale Clients with fractures have problems with acute? pain, an increased risk of? infections, mobility? problems, and an increased risk for neurovascular dysfunction. To assess for neurovascular dysfunction the nurse would support the injured extremity when? moving, assess the 5 P?'s ?(pain, pulses,? pallor, paralysis, and? paresthesia), assess the nailbeds and capillary? refill, monitor for? edema, assess for increased? pain, and monitor the tightness of the cast. The nurse would assess the history of traumatic? event, chronic? illness, and the ABCs during the health history? assessment, but these would not assist in assessing for neurovascular dysfunction.
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The nurse is assigned to care for a client who experienced a recent fall. Which manifestation best indicates that the client?'s hip is? fractured? Discomfort when performing? range-of-motion exercises The leg of the injured hip is shorter than the uninjured leg and turned outward Complaints of stiffness when transferring to chair Bruising noted to the injured hip and leg
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The leg of the injured hip is shorter than the uninjured leg and turned outward Rationale The leg of the injured hip is shorter than the uninjured leg and is sometimes turned outward in clients with hip fracture. These clients complain of severe? pain, not? discomfort, when flexing and rotating the hip. Bruising noted to the hip and leg may or may not be related to the fall. Complaints of stiffness may be related to the fall or from lying in bed.
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A client is scheduled for a total hip replacement due to a hip fracture. Which intervention should the nurse incorporate into the preoperative plan of? care? Placing the client in Buck?'s traction Demonstrating crutch walking with a? three-point gait Administering antibiotics as prescribed Applying a leg compression device
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Administering antibiotics as prescribed Rationale Include administering antibiotics as prescribed in the preoperative plan of care. The client does not need to be taught crutch walking. Leg compression is applied? during, not? before, surgery. Buck?'s traction is not needed for this client.
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A client with a hip fracture has undergone surgery for insertion of a hip prosthesis. Which activity should the nurse instruct the client to? avoid? Crossing the legs while sitting Sitting on a high chair Using an abductor pillow while lying on the side Sitting on a raised commode
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Crossing the legs while sitting Rationale Any activity that causes? flexion, adduction, or internal rotation should be avoided. Crossing the legs can lead to dislocation of the hip prosthesis. Using an abductor? pillow, sitting on a high? chair, or using a raised commode prevents hip flexion and adduction.
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A client diagnosed with a hip fracture is scheduled for an arthroplasty. How should the nurse describe this type of surgery to the? client? Insertion of an intramedullary nail into the marrow canal of the bone via an opening made in the greater trochanter Replacement of the ball and socket or head and acetabulum of the hip joint Partial replacement of the ball or head of the femur Percutaneous pinning or compression hip screws that slide within the barrel of the plate
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Replacement of the ball and socket or head and acetabulum of the hip joint Rationale Arthroplasty is a total replacement of the ball and socket or head and acetabulum of the hip joint. Partial hip replacement of the ball or head of the femur is a hemiarthroplasty. Insertion of an intramedullary nail into the marrow canal of the bone via an opening made in the greater trochanter is hardware placed when a client has an extracapsular fracture. Percutaneous pinning or compression hip screws that slide within the barrel of the plate are hardware placed when a client has an intracapsular fracture.
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The nurse is planning a presentation for community members about fractures. Which risk factor associated with hip fractures should the nurse? include? ?(Select all that? apply.) Cancer White women Osteoporosis Older adults Premenopausal women
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Cancer White women Osteoporosis Older adults Rationale: Clients with osteoporosis are at risk of hip fractures. White women are more likely to experience a hip fracture than African American or Asian women. The incidence of hip fractures increases with? age, and a history of cancer also places a client at risk.? Postmenopausal, not? premenopausal, women, are at risk.
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The nurse is caring for a client following the surgical repair of a hip fracture. Which intervention assists in reducing the risk of a deep vein thrombosis? (DVT)? ?(Select all that? apply.) Positioning an abduction pillow between the legs Using an incentive spirometer every hour Administering anticoagulants as prescribed Placing compression stockings Turning the client every 2 hours
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Administering anticoagulants as prescribed Placing compression stockings Rationale To reduce the risk of a? DVT, administer anticoagulants as prescribed and place compression stockings. Using an incentive spirometer reduces the risk of pneumonia. Turning the client every 2 hours prevents skin breakdown. Positioning an abduction pillow between the legs keeps the surgical hip in alignment.
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The nurse is discussing fall prevention methods with Ms. Jacobs. Which intervention helps reduce the risk of falls for this? client? Participating in daily? weight-bearing exercises. Placing throw rugs in all rooms. Scheduling an eye exam every 2 years. Wearing shoes only outside the house.
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Participating in daily? weight-bearing exercises. Rationale Daily? weight-bearing exercises help to reduce falls. Throw rugs should be? removed; shoes should be worn inside and outside the? home; and an eye exam should be scheduled yearly.
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Mrs.? Sims, a? 70-year-old woman, presents at the emergency room with trauma to her right hip. She explains that she was walking to her mailbox when she fell. Which diagnostic test should the nurse anticipate being ordered by the health care? provider? Doppler studies Abdominal ultrasound Complete blood count? (CBC) ?X-ray
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?X-ray Rationale X-ray is the gold standard for diagnosing a hip fracture.? CBC, Doppler? studies, and abdominal ultrasound are not used to diagnose a hip fracture.
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Which information should the nurse include in discharge teaching for a client who had a hip? arthroplasty? "Use an elevated toilet seat." "Place an abduction pillow between the legs only at night." "Restrict motion for 2 weeks." "Extend the operative leg backward."
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"Use an elevated toilet seat." Rationale A client who had a hip arthroplasty should use an elevated toilet seat and shower chair. Instruct the client to avoid restricting movement and extending the operative leg backward. An abduction pillow should be used when? sleeping, which includes during the night and when resting during the day.
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Which intervention is the? first-line treatment of a client with a hip? fracture? Anticoagulants Bed rest Antibiotics Surgery
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Surgery Rationale The? first-line treatment of a client with a hip fracture is surgery.? Antibiotics, anticoagulants, and bed rest are treatment modalities for hip fractures but are not the first line of treatment.
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Clients at risk of falls should be taught how to call emergency services in the event of a fall and injury. Which action should the nurse teach a client to perform after a? fall? Having a family member check on the client twice a week Keeping a phone in the kitchen Attempting to stand on the injured limb Scooting to the phone on one?'s bottom or uninjured side
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Scooting to the phone on one?'s bottom or uninjured side Rationale The client should scoot to the phone on the bottom or uninjured side after a fall with injury. Other measures include having a family member check on the client? daily, not? weekly; and keeping a cell phone with the client at all times. Trying to stand on the injured limb could cause further damage and should not be attempted.
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A client is suspected of having a hip fracture. Which diagnostic test assists in confirming this? diagnosis? Endoscopy Ultrasound Doppler study ?X-ray
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X-ray Rationale X-ray is the diagnostic test to confirm a hip fracture.? Ultrasound, Doppler? study, and endoscopy are not used to confirm a hip fracture.
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How should the nurse position a client following an? arthroplasty? With the extremities in slight abduction by using an abduction splint With weights alongside the hip to keep it from rotating With the feet on two pillows With the lower extremities adducted by using an immobilization binder around both legs
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With the extremities in slight abduction by using an abduction splint Rationale Keep the extremities in slight abduction by using an abduction splint. Elevating the feet on two? pillows, placing weights alongside the hip to keep it from? rotating, and keeping the lower extremities adducted by using an immobilization binder around both legs are not correct positioning.
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Which intervention should the nurse teach a? 70-year-old client to prevent falls and hip? fractures? ?(Select all that? apply.) Having an eye exam every year Avoiding excessive alcohol Participating in? weight-bearing exercises Limiting cigarette smoking Taking 500 mg of calcium every day
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Having an eye exam every year Avoiding excessive alcohol Participating in? weight-bearing exercises Rationale Yearly eye? exams, daily? weight-bearing exercises, and avoiding excessive alcohol are interventions to help reduce falls and prevent hip fractures. Any amount of cigarette smoking places a client at risk of hip? fractures; the client needs to refrain from smoking altogether. A postmenopausal woman should take? 1,500 mg of calcium daily.
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When planning care for a client diagnosed with multiple sclerosis? (MS), which problem should the nurse address to help direct care and enhance? wellness? ?(Select all that? apply.) Risk of hopelessness Impaired physical mobility Risk of fatigue Acute pain Altered urinary elimination patterns
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Risk of hopelessness Impaired physical mobility Risk of fatigue Altered urinary elimination patterns Rationale When planning care for a client diagnosed with multiple? sclerosis, the nurse needs to address the following? problems: impaired physical? mobility, risk of? fatigue, altered urinary elimination? patterns, and risk of hopelessness. Acute pain is not a problem that needs to be addressed when planning care for a client with multiple sclerosis.
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The nurse is formulating the plan of care for a client with multiple sclerosis? (MS) who stays up late at? night, takes long hot? showers, sleeps in a cold? bedroom, loves fresh air all year? round, and naps after lunch. Which lifestyle changes would the nurse suggest for the? client? Turning the bedroom heat off and opening the windows Keeping night hours Turning down the shower?'s temperature Eliminating the? post-lunch nap
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Turning down the shower?'s temperature Rationale Temperature extremes should be avoided by the client with? MS, so the client should have a? warm, not? hot, shower. A heated bedroom with closed windows might help with MS symptoms. Rest is essential to fight? fatigue, so the client should keep the? post-lunch nap. Rather than continuing to keep night? hours, the client might find that getting things done in the morning hours is easier.
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A client in the outpatient clinic is seen because of reported double vision and increasing weakness in the lower extremities. The nurse gathering admitting information anticipates diagnostic testing for multiple sclerosis based on which additional information provided by the? client? The client reports three previous? episodes, each lasting 1? day, and then no problems for at least 1 month. The client reports increasing manifestations over the past week. The client reports pain in the lower back for the past few days. The client reports episodes of rapid heart rate during periods of weakness in the lower extremities.
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The client reports three previous? episodes, each lasting 1? day, and then no problems for at least 1 month. Rationale Multiple sclerosis can cause episodes lasting for more than 24 hours and the episodes occur more than 1 month apart. A? 1-week duration is too short to suspect multiple? sclerosis; multiple sclerosis is diagnosed from manifestations that last over a period of? months; the client reports are not necessarily consistent with multiple sclerosis. Multiple sclerosis does not cause a rapid heart rate. The client could be describing a cardiac disorder that is causing weakness from decreased cardiac output. Back pain for a few days is more consistent with a back injury. The weakness in the legs could be from multiple sclerosis or from a back injury.
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A client has been diagnosed with? relapsing-remitting multiple sclerosis? (MS). How would the nurse best describe the onset of symptoms with this type of? MS? Symptoms will not develop for at least several years after diagnosis. Symptoms will flare up at? times, with periods of partial or complete remission. Symptoms will develop slowly but continuously with no periods of remission. Symptoms will become progressively worse with periods of? flare-ups.
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Symptoms will flare up at? times, with periods of partial or complete remission. Rationale A client with? relapsing-remitting MS will experience periods of? flare-ups followed by periods of partial or complete remission. Clients experience slow but continuous worsening of disease with no remissions with primary progressive MS. Clients experience progressive worsening of the disease with periods of? flare-ups with? progressive-relapsing MS. Symptoms of MS typically develop? immediately, not several years after diagnosis.
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A nurse is preparing teaching about multiple sclerosis manifestations for a client newly diagnosed with the disease. Which manifestation would the nurse include in this? teaching? Difficulty chewing Frequent dry cough Fever Hypertension
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Difficulty chewing A common manifestation of multiple sclerosis is difficulty? chewing; it should be included in client teaching. Frequent dry? cough, fever, and hypertension are not manifestations of multiple sclerosis.
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Which data should the nurse gather when performing a health history on a client with multiple sclerosis? (MS)? ?(Select all that? apply.) Cranial nerve assessment Exposure to environmental hazards Factors that affect symptoms Reflex assessment Onset of symptoms
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Exposure to environmental hazards Factors that affect symptoms Onset of symptoms Rationale When performing a health history on a client with multiple? sclerosis, the nurse needs to obtain information about factors that affect? symptoms, onset of? symptoms, and exposure to environmental hazards. Cranial nerve and reflex assessment is part of the physical examination.
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Which type of multiple sclerosis is most? common? ?Progressive-relapsing Secondary progressive ?Relapsing-remitting Primary progressive
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?Relapsing-remitting Rationale Relapsing-remitting multiple sclerosis is the most? common, affecting? 15% of clients.
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A nurse is assessing a client diagnosed with multiple sclerosis. Which manifestation is consistent with multiple? sclerosis? ?(Select all that? apply.) Lack of coordination Decreased level of consciousness Double vision Spastic movements Tachycardia
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Lack of coordination Double vision spastic movements Rationale Double vision is consistent with multiple? sclerosis; multiple sclerosis causes demyelination and plaque formation in the central nervous? system, including damage to the optic nerve. Spastic movements are consistent with multiple sclerosis because MS is an upper motor neuron? disorder; these disorders involve the central nervous system and cause spasticity. Lack of coordination is consistent with multiple? sclerosis; coordination and balance are controlled in the? cerebellum, and damage to nerve transmission in the cerebellum can cause loss of coordination and poor balance. Decreased level of consciousness is not a manifestation directly related to multiple sclerosis.? Tachycardia, or rapid heart? rate, is not a manifestation of multiple sclerosis.
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Which diagnostic test assists in diagnosing multiple? sclerosis? ?(Select all that? apply.) Electrocardiography Colonoscopy Cystoscopy Lumbar puncture MRI
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Lumbar puncture MRI Rationale MRI and lumbar puncture are diagnostic tests that are useful in diagnosing MS.? Electrocardiography, colonoscopy, and cystoscopy are not used to diagnose MS.
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A client is scheduled for tests to diagnose multiple sclerosis? (MS). For which tests should the nurse prepare the? client? A number of blood draws Multiple urine samples Many trips to the radiology department Cognitive task testing
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Many trips to the radiology department Rationale The diagnosis of MS will use radiology department? testing, such as? MRIs, CT? scans, and PET scans. MRIs will show lesions in the brain and determine disease progression. CT scans will show lesions in the white matter. PET scans will show brain activity and identify abnormalities. Blood? testing, urine? samples, and cognitive task testing do not provide definitive diagnostic results. Next Question
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How many common symptoms does the multiple sclerosis symptom checklist? (MSSC) assess? 11 16 21 26
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26 Rational The MSSC assesses the presence of 26 common MS symptoms.
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When completing the expanded disability status scale? (EDSS), which score indicates that the client is transitioning from? relapsing-remitting multiple sclerosis? (MS) to secondary progressive? MS? 1 3 2.5 4
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4 Rationale An EDSS score of 4 or greater marks the transition from? relapsing-remitting MS to secondary progressive MS.
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Ms.? Jones, a? 53-year-old client with multiple? sclerosis, reports vision difficulties to the nurse. The nurse explains to Ms. Jones that the vision difficulty is likely due to which process caused by multiple? sclerosis? Multiple sclerosis causes clouding in the lens of the eye. Multiple sclerosis causes damage to the retina. Multiple sclerosis causes an increase in pressure within the eye. Multiple sclerosis causes damage to the axons in the optic nerve.
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Multiple sclerosis causes damage to the axons in the optic nerve Rationale Multiple sclerosis causes damage to all areas of the central nervous? system, including the optic nerve. Multiple sclerosis damages axons in the central nervous system. The retina is within the globe of the eye and is not part of the central nervous system. Glaucoma causes an increase in the pressure in the eye. Cataracts cause clouding in the lens of the eye.
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Mrs.? Smith, a? 69-year-old client, reports numbness in hands and? feet, blurred? vision, and vertigo. During the health? history, she reports that she smokes and has a sister with multiple sclerosis. Which diagnostic test will the nurse anticipate being prescribed by the health care? provider? Electrocardiography Chest? x-ray MRI Upper endoscopy
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MRI Rationale The client is experiencing symptoms of multiple sclerosis? (MS). In? addition, the client has several risk factors that trigger the immune response which may result in MS. These risk factors include? age, gender,? smoking, and having a? first-degree relative with MS. The nurse would anticipate that the health care provider will suggest an MRI because it will detect lesions in the central nervous system. Chest? x-ray, electrocardiography, and upper endoscopy are not used to diagnose MS. Next Question
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The nurse is concerned that Mr.? White, a? 60-year-old single? male, who is newly diagnosed with multiple sclerosis? (MS) will not fit in with an outpatient support group. Which of the? client's characteristics do not fit the usual pattern of? MS? The recent timing of his diagnosis and his marital status His age and marital status His gender and marital status His age and gender
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His age and gender Rationale MS typically strikes between the ages of 20 and 50. Women are affected twice as often as men. These two factors combined would make a? 60-year-old male client less likely to find a peer in a support group. A recent diagnosis would not necessarily make the client different from other group members. Marital status has no effect on the likelihood of his finding a peer in the support group.
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A client is newly diagnosed with secondary progressive multiple sclerosis. For which tactile manifestation should the nurse assess the? client? Blurred vision Numbness Color vision deficit ?Short-term memory loss
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Numbness rationale A tactile manifestation associated with MS for which the nurse should assess the client is? numbness, especially in the hands or legs. Blurred vision and color vision deficit are manifestations associated with visual deficits in a client with MS.? Short-term memory loss is a cognitive dysfunction associated with MS.
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When planning care for a client with multiple sclerosis? (MS), which intervention should the nurse? include? Eating a diet low in fiber Practicing Kegel exercises Drinking 500 mL of fluid each day Sleeping for at least 5 hours each night
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Practicing Kegel exercises Rationale When planning care for a client with? MS, the nurse should instruct the client to practice Kegel and other pelvic floor exercises to manage urinary incontinence. The client should eat a diet high in fiber and roughage to reduce constipation. The client needs to obtain more than 5 hours of sleep at night because a client with MS needs adequate sleep at night and frequent rest periods during the day. The client needs to drink more than 500 mL of fluid each day to prevent urinary complications and constipation.
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The nurse is giving a presentation to a community group about common mobility disorders. Which risk factor that may trigger the immune response in multiple sclerosis should the nurse include in the? presentation? ?(Select all that? apply.) Bacterial infection Advancing age Use of alcohol Environmental toxins ?Epstein-Barr virus
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Environmental toxins ?Epstein-Barr virus Rationale Risk factors that may trigger immune responses resulting in MS include? Epstein-Barr viral infection and environmental toxins. Alcohol? intake, advancing? age, and bacterial infections are not risk factors. Clients between the ages of 20 and 40 years are at greater risk of developing MS.
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The nurse and a client with numerous symptoms of multiple sclerosis? (MS) are brainstorming ideas for recreation and leisure time. Which activity should the nurse? recommend? Hiking Eating exotic foods Distraction techniques Reading books
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Distraction techniques Rationale Dragging of the feet and foot drop could cause the client to? fall, eliminating hiking as a reasonable choice. Visual deficits could prove to be an obstacle when reading. Difficulty chewing and dysphagia can occur due to the effects of? MS, which precludes a focus on eating exotic foods. Distraction techniques are a method of stress reduction and should be recommended.
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The nurse is planning care for a client diagnosed with multiple sclerosis? (MS). Which service should be consulted to help maintain or improve the functional status of this? client? ?(Select all that? apply.) Vocational rehabilitation Cognitive therapy Physical therapy Pastoral care Occupational therapy
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Vocational rehabilitation Cognitive therapy Physical therapy Occupational therapy Rationale Vocational rehabilitation should be consulted because this service trains the client to use assistive devices. Physical therapy should be consulted because this service will help to maintain mobility and optimal functioning. Occupational therapy should be consulted because this service will enhance? independence, productivity,? safety, and retention of skills. Cognitive therapy should be consulted because this service will help to improve the? client's ability to? think, reason,? concentrate, and remember. A pastoral care consultation will not help to improve the? client's functional status.
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A client with multiple sclerosis? (MS) asks whether woodworking and carving objects can still be done as a hobby. Which information should the nurse provide the client regarding this? hobby? Assist client in identifying modifications that may be needed. Increase intricate patterns of work Continue to use all the woodworking tools as before Have client remember and describe how all previous projects were assembled.
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Assist client in identifying modifications that may be needed. Rationale Continuing a? long-standing hobby is possible. The client will need help to assist with some planned modifications. The visual blurring of MS combined with spasticity would make working on intricate patterns difficult.? Short-term memory loss and difficulty with word finding may make remembering and describing previous projects difficult.
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A nurse is providing a preventive teaching discussion with a client at risk for osteoarthritis. Which guideline should be included in this discussion related to? exercise? Exercise is not recommended Perform heavy weightlifting exercises three times per week If there is pain with? exercise, keep? going, this is building muscle Participate in regular? exercise, including walking or swimming
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Participate in regular? exercise, including walking or swimming Rationale Participating in regular exercise like? walking, jogging, swimming and cycling can keep joints strong and functional. Heavy weightlifting is not recommended for a client with OA and may actually lead to further joint breakdown. Recommending exercise is proven to prevent? OA; it should not be discouraged. If pain is experienced with? exercise, the client should stop and? rest; continuing may build? muscle, but will break down the joint cartilage. Question is complete.
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The nurse is providing education about home care for a client with osteoarthritis of the knees. Which information should the nurse include during this educational? session? ?(Select all that? apply.) Continuing activity with repetitive movement Installing handrails in bathroom Using assistive devices to minimize stress placed on affected joint Encouraging heavy lifting to maintain muscle strength Taking pain medications as ordered
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Installing handrails in bathroom Using assistive devices to minimize stress placed on affected joint Taking pain medications as ordered Rationale Taking pain medications as ordered will assist with pain management and allow the client to participate in daily activities. Installing handrails in the bathroom is information that the nurse should include when educating a? client, for this will keep the client safe at home. The nurse should educate the client on the importance of using assistive devices to minimize joint stress. The nurse should instruct the client to avoid repetitive movement and to avoid heavy? lifting, for these actions will increase pain and joint degeneration and will not improve physical mobility.
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The nurse is providing education to a client who is scheduled for an osteotomy. Which information should the nurse include about this? procedure? The joint will be reconstructed. Excess debris will be flushed out. Realignment of the joint will occur. The procedure will stop osteoarthritis from progressing.
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Realignment of the joint will occur Rationale An osteotomy is performed to realign the joint or to shift the joint load toward areas of less cartilage damage.An osteotomy will not stop the process of osteoarthritis.Joint? arthroplasty, not an? osteotomy, is a procedure that reconstructs the? joint.Arthroscopy, not an? osteotomy, is a procedure used to debride the joint by smoothing rough cartilage and flushing out excess debris.
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The nurse is planning care for a client with osteoarthritis. Which potential problem is priority for the nurse to? address? ?(Select all that? apply.) Impaired skin integrity Fluid volume deficit Chronic pain Impaired cardiac output Impaired physical mobility
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Chronic pain fluid volume deficit Impaired physical mobility Rationale Chronic pain and impaired physical mobility are priority potential problems for the nurse to address when planning care for a client diagnosed with osteoarthritis. Skin? integrity, fluid volume? deficit, and cardiac output are not potential problems for the nurse to address when planning care for a client diagnosed with osteoarthritis.
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The nurse is providing education at a community health fair about osteoarthritis. Which are the general clinical manifestations associated with osteoarthritis that the nurse should include when providing this? education? ?(Select all that? apply.) Crepitus with movement of joint Abrupt onset Joint pain with activity Mild fever Pain and stiffness at night
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Crepitus with movement of joint Joint pain with activity Pain and stiffness at night Rationale Joint pain with? activity, grating or crepitus noted with? movement, and pain and stiffness with prolonged inactivity are general manifestations of osteoarthritis. Mild fever is associated with rheumatoid? arthritis, not osteoarthritis. General manifestations of osteoarthritis include a gradual? onset, not an abrupt onset.
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A client with possible osteoarthritis is scheduled for a synovial fluid analysis. The nurse should explain to the client that this diagnostic test is being completed for what? reason? To evaluate for increased density of subchondral bone To identify irregular joint space narrowing To rule out inflammatory arthritis and gout To determine the extent of joint damage
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To rule out inflammatory arthritis and gout Rationale Joint fluid analysis is used to detect? inflammation, bacteria, and uric acid crystals in order to rule out inflammatory arthritis and gout. This test will not provide information on the extent of the joint damaged. This test cannot identify the amount of joint space that has narrowed. This test cannot evaluate bone density.
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Which diagnostic test will best determine the cause of joint damage with? osteoarthritis? MRI of joint Joint? x-ray Synovial fluid analysis Electromyogram? (EMG)
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Synovial fluid analysis rationale Analyzing the synovial fluid of the involved joint helps to determine the cause of joint? damage, which may include inflammatory arthritis and gout. This distinction will determine the factors of treatment. An EMG analyzes the strength of muscle contraction. It does not provide any information about joint mobility. An MRI of the affected joint determines the extent of joint damage but does not differentiate causes of the damage. An? x-ray of the joint determines the presence of osteoarthritis and the potential presence of joint complications.
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Which surgical treatment can be used to realign a joint that is affected by? osteoarthritis? Osteotomy Arthroscopy Joint biopsy Joint arthroplasty
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Osteotomy Rationale An osteotomy is an incision into or through the bone that can realign or shift the joint load into a better aligned point or toward a less damaged part of the joint. A joint arthroplasty reconstructs or replaces the affected joint when it is severely damaged and pain seriously alters lifestyle. An arthroscopy is used to debride the rough and irregular damaged cartilage. Although fluid may be aspirated from a joint for? analysis, joint cartilage is not biopsied to realign a joint affected by osteoarthritis.
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Which health promotion activities support a healthy lifestyle for clients with? osteoarthritis? ?(Select all that? apply.) Use assistive devices as needed Increase dietary intake of calcium Maintain a normal weight Use soft chairs and recliners for rest Limit participation in ROM exercises
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Use assistive devices as needed Maintain a normal weight Rational Maintaining a normal weight places less strain on the joints than carrying additional weight. Assistive devices such as grab? bars, a shower? chair, or? long-handled grippers help the client to maintain an independent lifestyle in safety. ROM exercises assist the client to maintain maximal use of joint mobility and are an important component in the exercise plan. Although calcium intake is essential to prevent? osteoporosis, especially in older? adults, increasing calcium in the daily intake does not have a positive effect on osteoarthritis. Chairs and mattresses should provide support and help to maintain normal body alignment. Soft chairs and recliners do not provide such support.
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Which interventions support effective management of chronic pain that is experienced by a client with? osteoarthritis? ?(Select all that? apply.) Limiting isometric exercises to reduce strain on the joints Encouraging resting painful joints Applying cool compresses to painful joints to reduce inflammation Teaching proper posture and good body mechanics for activities of mobility Using firm support in chairs and mattresses to properly align the body
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Using firm support in chairs and mattresses to properly align the body Encouraging resting painful joints Teaching proper posture and good body mechanics for activities of mobility Rationale Chronic pain is frequently associated with osteoarthritis. When joints are? painful, they should be rested. The rest should be balanced with periods of? activity, which will reduce joint stiffness. Using proper posture and good body mechanics places the body in proper alignment and offers the joints a neutral platform to perform ROM activities. Firm chairs and mattresses assist the body in proper alignment. Heat should be applied to painful? joints, which will increase joint mobility. Cool compresses may increase joint pain and will limit joint mobility. Isometric exercises strengthen muscle? groups, which is important to provide additional strength in movement. Strong muscles will reduce strain on joints. OK
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Mrs. Kingsley is a? 64-year-old African American woman who has returned to the healthcare? provider's office for? follow-up of the osteoarthritic condition of her knees. Although both knees are? affected, today her left knee is more swollen than the right knee. During your? assessment, Mrs. Kingsley asks? you, "If I am losing the cartilage in my? knees, why do my knees look? larger?" What would be an appropriate? response? Although the cartilage is? destroyed, you may be building up more bone in the knee. Since your condition has? progressed, your knees have developed contractures and this increases the size of the knees. As your joint cartilage? reduces, with? exercise, muscle mass? increases, which makes the knees look larger. With? osteoarthritis, sometimes inflammation increases the size of your knees or fluid? build-up occurs.
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With? osteoarthritis, sometimes inflammation increases the size of your knees or fluid? build-up occurs. Rationale Inflammation causes swelling of the knee? joint, which makes the joint appear larger. Joint effusion or fluid? build-up may also occur. An increase in bone or muscle tissue does not occur in osteoarthritis. Flexion contractures may develop with osteoarthritis of the knee? joint, but this will not result in an increase in the size of the joint.
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Mrs. Gladek is a? 70-year-old White woman who has experienced progressive symptoms of osteoarthritis over the past 5 years. In addition to taking prescribed analgesics and? anti-inflammatory medications, she is discussing interventions that she implemented into her daily lifestyle to manage her disease condition. Which activity would you suggest to Mrs. Gladek to provide additional exercise opportunities for? her? Interval training to jog a 5K Doubles tennis for older adults Water aerobic activities Meditation
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Water aerobic activities Rationale Water aerobic exercises provide cardiopulmonary exercise and strengthen core muscle groups while cushioning joint impact. This is an appropriate intervention for the nurse to recommend to the client. Tennis increases impact in the feet and ankle and knee joints and would not be appropriate for this client. Interval training may be acceptable to walk a? 5K, but jogging will place impact on the ankle and knee joints. Meditation is helpful to focus mental and spiritual energy but does not involve activity of the knee joints.
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The nurse is providing home care teaching to a client diagnosed with osteoarthritis. Which statement is appropriate for the nurse to include in the teaching session for this? client? ?"Water exercises should not be tried because water buoyancy increases force on the? joints." ?"Stretching all muscle groups for 30 minutes each day has been recommended by the healthcare? provider." ?"When you begin your strengthening? exercises, it is appropriate to start with a large weight and work your way? down." ?"Balance and agility exercises can help maintain daily living skills and have been recommended by your healthcare? provider."
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"Balance and agility exercises can help maintain daily living skills and have been recommended by your healthcare? provider." Rationale Balance and agility exercises are recommended for clients with osteoarthritis because they help to maintain daily living skills. When beginning strengthening? exercises, clients should start with a low weight and work their way up. Water exercise is beneficial because the buoyancy of the water decreases the force on the joints. The client should stretch all muscle groups for 10 minutes each day. Overstretching is contraindicated.
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A client diagnosed with osteoarthritis of the hands presents with bony lumps on the end joints of her digits. How will the nurse document this finding in the medical? record? Lymph node swelling Heberden nodes Osteoblasts Bouchard nodes
answer
Heberden nodes Rationale Heberden nodes are bony lumps occurring at the end joint of the digits in a client with OA. Bouchard nodes occur in the middle joint of the digits. Osteoblasts are cells that form new bone. Lymph node swelling does not occur in the hands.
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The nurse is providing education to a community group about developing osteoarthritis. What? joints, commonly? affected, will the nurse include in the educational? session? ?Neck, shoulders, and ankles ?Hands, knees, and hips ?Knees, feet, and spine ?Ankles, feet, and spine
answer
Hands, knees, and hips Rationale Hands, knees and hips are the most commonly affected joints of OA.? Feet, spine,? neck, shoulders, and ankles are not the most common locations.
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The nurse is planning care for a client with osteoarthritis of the hips. Which intervention will assist in addressing the potential problem of physical? mobility? Recommend a local support group for the client and spouse. Encourage the client to avoid all physical activity. Educate the client about proper skin care. Teach active and passive range of motion exercises.
answer
Teach active and passive ROM exercises Rationale Teaching active and passive range of motion exercises will assist in addressing the potential problem of physical mobility with a client with osteoarthritis. Encouraging the client to avoid all physical activity does not address the potential problem of physical mobility for a client with osteoarthritis. The client should be encouraged to exercise to develop supportive muscles and tendons. Recommending a local support group for the client and spouse and educating the client about proper skin care do not address the potential problem of physical mobility for a client with osteoarthritis.
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A client complains of knee pain during an appointment at a medical clinic. After reviewing the client?'s medical? record, the nurse notes the client has been taking? over-the-counter NSAIDs, with no pain relief. The nurse can anticipate the healthcare provider writing a prescription for what medication at ?discharge? Acetaminophen? (Tylenol) Celecoxib? (Celebrex) Morphine sulfate Naproxen? (Aleve)
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Celecoxib (Celebrex) Rationale Celecoxib? (Celebrex) is a prescription? NSAID, COX-2 inhibitor that relieves pain associated with osteoarthritis. Naproxen? (Aleve) does relieve pain and stiffness associated with? osteoarthritis; however, it is an OTC? NSAID, which has not provided relief for the client. Acetaminophen is a? first-line therapy for? pain; however, it is OTC and not providing client relief. Morphine sulfate is used for clients experiencing moderate to severe? pain, but should not be used before trying celecoxib.
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A client experiencing severe pain that cannot be managed through pain medications or nonpharmacologic therapy may need surgical intervention. Which surgical treatments will the nurse include in the teaching session with other members of the healthcare? team? ?(Select all that? apply.) Cortisone therapy Joint fusion Serum hyaluronic acid Arthroplasty Osteotomy
answer
Arthroplasty Osteotomy Joint Fusion Rational Arthroplasty, osteotomy, and joint fusion are all surgical interventions indicated for a client with osteoarthritis. Serum hyaluronic acid is a diagnostic blood test for knee osteoarthritis and is not a surgical treatment. Cortisone therapy is not a surgical? treatment; it is injected into the inflamed joint.
