NCLEX 10000 Musculoskeletal

A nurse is teaching a client who was recently diagnosed with carpal tunnel syndrome. Which statement should the nurse include?

Ergonomic changes, such as adjusting keyboard height, can help clients with carpal tunnel syndrome avoid hyperextension of the wrist. This condition is associated with repetitive tasks such as clerical work, not sports. The condition may be managed with m

A nurse notes that a client has kyphosis and generalized muscle atrophy. Which problem is a priority when the nurse develops a nursing plan of care?

ineffective coughing and deep breathing
Explanation:
In kyphosis, the thoracic spine bends forward with convexity of the curve in a posterior direction, making effective coughing and deep breathing difficult. Although the client may develop other problems

Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used in the treatment of musculoskeletal conditions. It is important for the nurse to remind the client to:

take NSAIDs with food.
Explanation:
NSAIDs irritate the gastric mucosa and should be taken with food. NSAIDs are usually taken once or twice daily. Joint exercise is not related to the drug administration. Antacids may interfere with the absorption of NSA

A client has bursitis in the subacromial bursa. A nurse determines that the client understands teaching when the client says:

I will apply moist heat to my shoulder for 20 minutes three times each day."
Explanation:
Moist heat is a nonpharmacologic pain management strategy that may alleviate pain and reduce the dose of analgesic, if required. Heat dilates blood vessels and decr

Which nursing diagnosis is most appropriate for an elderly client with osteoarthritis?

Risk for injury related to altered mobility
Explanation:
Typically, a client with osteoarthritis has stiffness in large, weight-bearing joints, such as the hips. This joint stiffness alters functional ability and range of movement, placing the client at r

A nurse is assigned a client with an acute exacerbation of rheumatoid arthritis (RA). Which medical facts about RA are essential in developing a plan of care? Select all that apply.

� The client experiences stiff, swollen joints bilaterally.
� Erythrocyte sedimentation rate (ESR) is elevated, and x-rays show erosions and decalcification of involved joints.
� Inflamed cartilage triggers complement activation, which stimulates the rele

The nurse is caring for a client admitted for pneumonia with a history of hypertension and heart failure. The client has reported at least one fall in the last 3 months. The client may ambulate with assistance, has a saline lock in place, and has demonstr

60, high risk
Explanation:
Several factors designate this client as a high fall risk based on the Morse Fall Scale: history of falling (25), secondary diagnosis (15), plus IV access (20). The client's total score is 60. There is also concern that the clie

Which condition should the nurse assess when completing the history and physical examination of a client diagnosed with osteoarthritis?

local joint pain
Osteoarthritis is a degenerative joint disease with local manifestations such as local joint pain. Rheumatoid arthritis has systemic manifestation such as anemia and osteoporosis. Weight loss occurs in rheumatoid arthritis, whereas most c

A client undergoes an arthroscopy at the outpatient clinic. After the procedure, the nurse provides discharge teaching. Which response by the client indicates the need for further teaching?

I should use my heating pad this evening to reduce some of the pain in my knee."
Explanation:
The client requires additional teaching if he states that he'll use a heating pad to reduce pain the evening of the procedure. The client shouldn't use heat at

The nurse has instructed the client about the correct positioning of the leg and hip following hip replacement surgery. Which statement indicates that the client has understood these instructions?

I should avoid bending over to tie my shoes."
Explanation:
Acute flexion and adduction of the hip should be avoided after hip replacement surgery and the client should not bend over to tie the shoes. Slip on shoes that can be positioned with a long handl

The client with an above-the-knee amputation is to be fitted with a functioning prosthesis. The nurse has been teaching the client how to care for the residual limb. Which behavior would demonstrate that the client has an understanding of proper residual

washes and dries the residual limb daily.
Washing and thoroughly drying the residual limb daily are important hygiene measures to prevent infection.
Nothing should be applied to the residual limb after it is cleansed. Powder may cause excessive drying and

When caring for a client with acute osteomyelitis in the right tibia, which measure is most appropriate to implement when repositioning the client's leg?

Support the leg above and below the affected area when positioning.
Explanation:
Acute osteomyelitis can be very painful. Therefore, the extremity must be handled carefully and moved slowly. The most appropriate action when moving an extremity with acute

After a total hip replacement, the client tells the nurse that the pain in the operative hip has increased. Assessing the hip and leg, the nurse notes that the leg is internally rotated and shorter than the other leg and that the client has difficulty mov

has experienced a dislocation of the hip prosthesis.
Explanation:
Classic signs of dislocation of the hip prosthesis include increasing pain, abnormal rotation, shortened leg, difficulty or inability moving the leg, and misalignment of the leg. The nurse

A client is to have a below-the-knee amputation. Prior to surgery, the circulating nurse in the operating room should:

initiate a time-out.
Explanation:
The Universal Protocol is used to prevent wrong site, wrong procedure, and wrong person surgery. Actions included in the protocol are as follows: conduct a preprocedure verification process, mark the procedure site, and p

The nurse is planning an educational program about the prevention of osteoporosis for a group of women. Which preventive measures would be appropriate for the nurse to include in the teaching plan?

encouraging weight-bearing exercise on a regular basis
Explanation:
Exercise, especially weight-bearing exercise such as walking or jogging, is recommended on a regular basis to maintain high-density bone mass.
Diet should be high in calcium and vitamin D

A client is admitted with acute osteomyelitis that developed after an open fracture of the right femur. When planning this client's care, the nurse should anticipate which measure?

Administering large doses of I.V. antibiotics as ordered
Explanation:
Treatment of acute osteomyelitis includes large doses of I.V. antibiotics (after blood cultures identify the infecting organism). Surgical drainage may be indicated, and the affected bo

I don't know if I'll be able to get off that low toilet seat at home by myself."
Explanation:
The client requires additonal teaching if he is concerned about using a low toilet seat. To prevent hip dislocation after a total hip replacement, the client mu

A client undergoes a total hip replacement. Which statement made by the client indicates to the nurse that the client requires further teaching?

A client has a herniated disk in the region of the third and fourth lumbar vertebrae. Which nursing assessment finding most supports this diagnosis?

Severe lower back pain
Explanation:
The most common finding in a client with a herniated lumbar disk is severe lower back pain, which radiates to the buttocks, legs, and feet � usually unilaterally. A herniated disk also may cause sensory and motor loss (

Passive range-of-motion (ROM) exercises for the legs and assisted ROM exercises for the arms are part of the care regimen for a client with a spinal cord injury. Which observation by the nurse would indicate a successful outcome of this treatment?

free, easy movement of the joints
Explanation:
ROM exercises help preserve joint motion and stimulate circulation. Contractures develop rapidly in clients with spinal cord injuries, and the absence of this complication indicates treatment success.
Range o

The initial postoperative assessment is completed on a client who had an arthroscopy of the knee. Which information is not necessary to obtain every 15 minutes during the first postoperative hour?

urine output
Explanation:
The urine output does not have to be checked every 15 minutes for a client who has had an arthroscopy because this client probably does not have a catheter in place. If the client voids, the output would be recorded. Assessments

A client had a cast applied to the left femur to stabilize a fracture. To promote early rehabilitation, the nurse should first:

teach the client how to do isometric exercise of the quadriceps.
Explanation:
The nurse should teach the client how to do isometric exercise, contraction of the quadriceps muscle without movement of joint, to maintain muscle strength. Physical therapy may

A nurse suspects that a client with a recent fracture has compartment syndrome. Assessment findings may include:

inability to perform active movement and pain with passive movement.
Explanation:
With compartment syndrome, the client can't perform active movement, and pain occurs with passive movement.

Which goal is the priority for a client with a fractured femur who is in traction at this time?

Prevent effects of immobility while in traction.
Explanation:
The priority for this client is to prevent the effects of prolonged immobility, such as preventing skin breakdown and encouraging the client to take deep breaths, and use active range-of-motion

A diet plan is developed for a client with gouty arthritis. The nurse should advise the client to limit his intake of:

organ meats
Gouty arthritis is a disorder of purine metabolism. High-purine foods include organ meats, anchovies, sardines, shellfish, and meat extracts. Citrus fruits, green vegetables, and fresh fish are appropriate foods for a client with gouty arthrit

The nurse is evaluating the outcome of therapy for a client with osteoarthritis. Which outcome indicates the goals of therapy have been met?

joint range of motion improved
Explanation:
One outcome criterion for the client with osteoarthritis is improved joint mobility.
It is probably not possible to arrest the disease.
Gold compound is administered to clients with rheumatoid arthritis, not ost

The client with rheumatoid arthritis has been taking large doses of aspirin to relieve joint pain. The nurse should assess the client for:

tinnitus.
Explanation:
Tinnitus (ringing in the ears) is a common symptom of aspirin toxicity.
Dysuria, chest pain, and drowsiness are not associated with aspirin toxicity.

After the nurse teaches a client about wearing a back brace after a spinal fusion, which statement indicates effective teaching?

I should wear a thin cotton undershirt under the brace."
The client should wear a thin cotton undershirt under the brace to prevent the brace from abrading directly against the skin. The cotton material also aids in absorbing any moisture, such as perspi

A nurse is caring for a client who underwent a total hip replacement. What should the nurse and other caregivers do to prevent dislocation of the new prosthesis?

Prevent internal rotation of the affected leg.
Explanation:
The nurse and other caregivers should prevent internal rotation of the affected leg. However, external rotation and abduction of the hip will help prevent dislocation of a new hip joint. Postoper

A client is admitted to the orthopedic unit in balanced skeletal traction using a Thomas splint and Pearson attachment. The primary purpose of traction is to:

realign fracture fragments.
t
Explanation:
Traction promotes realignment of the bone fragments. This will facilitate subsequent internal fixation. Traction immobilizes the fracture site and may increase the client's comfort. Mobilization could result in f

To prevent back injury, the nurse should instruct the client to:

avoid prolonged sitting and standing.
Explanation:
Prolonged sitting and standing should be avoided because they strain the lower back.
Pushing objects rather than pulling them will help decrease back strain.
Clients should select a semi-firm to firm matt

A client has sustained a right tibial fracture and has just had a cast applied. Which instruction should the nurse provide in his cast care?

Keep your right leg elevated above heart level."
Explanation:
The nurse should instruct the client to elevate the leg to promote venous return and prevent edema. The cast shouldn't be covered while drying. Covering the cast will cause heat buildup and pr

A client with osteoarthritis tells the nurse she is concerned that the disease will prevent her from doing her chores. Which suggestion should the nurse offer?

Pace yourself and rest frequently, especially after activities."
Explanation:
A client with osteoarthritis must adapt to this chronic and disabling disease, which causes deterioration of the joint cartilage. The most common symptom of the disease is deep

A client is scheduled for a laminectomy to repair a herniated intervertebral disk. When developing the postoperative care plan, the nurse should include which action?

Turning the client from side to side, using the logroll technique
Explanation:
To avoid twisting the spine or hips when turning a client onto the side, the nurse should use the logroll technique. (Twisting after a laminectomy could injure the spine.) Afte

The client sustained an open fracture of the femur from an automobile accident. The nurse should assess the client for which type of shock?

hypovolemic
Explanation:
A fractured femur, especially an open fracture, can cause much soft tissue damage and lead to significant blood loss. Hypovolemic shock can develop. Cardiogenic shock occurs when cardiac output is decreased as a result of ineffect

A client has been diagnosed with osteoporosis after a bone density test and is asking what has caused it. Discussion of risk factors would include which of the following?

Heavy smoking, sedentary lifestyle, and high intake of carbonated drinks
Explanation:
Osteoporosis has been linked to heavy smoking. A sedentary lifestyle results in more osteoclastic or breakdown activity rather than bone building or osteoblastic activit

The client returns from surgery for a below-the-knee amputation with the residual limb covered with dressings and a woven elastic bandage. At first, the bandage was dry. Now, 30 minutes later, the nurse notices a small amount of bloody drainage. The nurse

mark the area of drainage.
The nurse should mark the bloody drainage and observe it again in 10 minutes to assess if the bleeding is continuing.
There is no need to notify the health care provider immediately because some oozing and bloody drainage are ex

The nurse is caring for an older adult male who had open reduction internal fixation (ORIF) of the right hip 24 hours ago. The client is now experiencing shortness of breath and reports having "tightness in my chest." The nurse reviews the recent lab resu

troponin: 1.4 mcg/L (1.4 ?g/L)
Explanation:
Troponin is a cardiac biomarker and is normally almost undetectable in the blood. A level of 1.4 means there has likely been some damage to the heart muscle. Though serum glucose (normal 60 to 100 mg/dL [3.3 to

A client is brought to the emergency department after injuring his right arm in a bicycle accident. The orthopedic surgeon tells the nurse that the client has a greenstick fracture of the arm. What does this mean?

One side of the bone is broken and the other side is bent.
Explanation:
In a greenstick fracture, one side of the bone is broken and the other side is bent. A greenstick fracture also may refer to an incomplete fracture in which the fracture line extends

A nurse is caring for a client who had hip pinning surgery 6 hours ago to treat intertrochanteric fracture of the right hip. What assessment finding requires further investigation by the nurse?

Client is anxious and confused
Explanation:
The client is anxious and confused is the appropriate answer. Postoperative complications of hip fractures include hemorrhage, pulmonary emboli, and fat emboli. Anxiety and confusion may be indicative of hypoxia

A client with osteoarthritis asks for information concerning activity and exercise. When assisting the client, which concept should be included?

Exercising at least 1 hour after awakening allows the client to participate in exercise after some of the morning-related stiffness has subsided.
Explanation:
A client with osteoarthritis has increased stiffness in the morning upon awakening. Exercise sho

To protect a client's skin under a back brace, the nurse should:

have the client wear a thin cotton shirt under the back brace.
Explanation:
Having the client wear a thin cotton shirt that is close fitting to avoid having extra folds that could cause pressure under a back brace helps to protect the skin and to keep the

The nurse is evaluating the pin insertion site of a client's skeletal traction. Which finding indicates a complication?

pin moves slightly at insertion site
Explanation:
Skeletal pins should not be loose and able to move. Any pin loosening should be reported immediately. Slight serous drainage is normal and may crust around the insertion site or be present on the dressing.

What are important nursing priorities on the first postoperative day for a client who has had an open reduction and internal fixation (ORIF) after a right hip fracture?

Assessing the neurovascular status in the right leg, providing pain control, encouraging position changes, and early ambulation
Explanation:
Assessing the neurovascular status, including circulation and innervation, is very important postoperatively. Cont

A client who had a total hip replacement 4 days ago is worried about dislocation of the prosthesis. The nurse should respond by saying:

Activities that tend to cause adduction of the hip tend to cause dislocation, so try to avoid them."
Explanation:
Dislocation precautions include: avoid extremes of internal rotation, adduction, and 90-degree flexion of affected hip for at least 4 to 6 w

A client is 4 days postoperative from a tibia fracture and has a long leg cast. The nurse is conducting initial teaching for walking with crutches. What is the most important activity for the nurse to encourage the client to do prior to discharge from the

Conduct exercises in bed to strengthen the upper extremities, as this will assist the client in crutch use.
Explanation:
When walking with crutches, the client engages the triceps, trapezius, and latissimus muscles. A client who has been immobilized may n

The client in balanced suspension traction is transported to surgery for closed reduction and internal fixation of a fractured femur. What should the nurse do when transporting the client to the operating room?

Send the client on the bed with extra help to stabilize the traction.
Explanation:
The nurse should send the client to the operating room on the bed with extra help to keep the traction from moving to maintain the femur in the proper alignment before surg

A client was diagnosed with chronic gouty arthritis 2 years ago. He has been taking sulfinpyrazone, 200 mg P.O. b.i.d. as maintenance therapy. How soon after administration of this drug does onset of action occur?

30 minutes
Explanation:
Sulfinpyrazone has a rapid onset of action, within 30 minutes after oral administration. It reaches its peak concentration within 1 to 2 hours and has a duration of action of 4 to 6 hours

After a laminectomy, the client states, "The doctor said that I can do anything I want to." Which activity that the client intends to do indicates the need for further teaching?

sweeping the front porch
Explanation:
Sweeping causes a twisting motion, which should be avoided because twisting can cause undue stress on the recently ruptured disc site, muscle spasms, and a potential recurrent disc rupture. Although the client should

Which activities should the nurse teach the client to do to strengthen the hand muscles in preparation for using crutches?

squeezing a rubber ball
Explanation:
A client being prepared for crutch walking should be taught to support weight with the hands when crutch walking. Supporting weight in the axillae is contraindicated owing to the risk of possible nerve damage and circu

A female client is at risk for developing osteoporosis. Which action will reduce the client's risk?

Initiating weight-bearing exercise routines
Explanation:
Performing weight-bearing exercise increases bone health. A sedentary lifestyle increases the risk of developing osteoporosis. Estrogen is needed to promote calcium absorption. The recommended daily

A client has a left tibial fracture that required casting. Approximately 5 hours later, the client has increasing pain distal to the fracture despite the morphine injection administered 30 minutes previously. Which area should be the nurse's next assessme

distal pulse
Explanation:
The nurse should assess the client's ability to move the toes and for the presence of distal pulses, including a neurovascular assessment of the area below the cast. Increasing pain unrelieved by usual analgesics and occurring 4

Which cells are involved in bone resorption?

Osteoclasts
Explanation:
Osteoclasts carry out bone resorption by removing unwanted bone while new bone is forming in other areas. Chondrocytes are responsible for forming new cartilage. Osteoblasts are bone-forming cells that secrete collagen and other s

A male client underwent a lumbar spinal fusion yesterday. Which nursing assessment should alert the nurse to the development of a possible complication?

clear yellowish fluid on the dressing
Explanation:
Clear yellowish fluid on the dressing may be cerebrospinal fluid (CSF). This fluid must be tested for glucose to determine whether it is CSF. If so, the client is at great risk for an infection of the cen

To prevent external rotation of the client's hips while lying on the back, it would be best for the nurse to place:

trochanter rolls alongside the legs from ilium to midthigh.
Explanation:
Trochanter rolls placed alongside the client's legs from the ilium to midthigh are recommended to prevent external rotation of the hips.
Pillows can be used only as a temporary measu

A client has a C7 spinal cord injury. Which would be the most important nursing intervention during the acute stage of the injury?

Maintain a patent airway.
Explanation:
Initial care is focused on establishing and maintaining a patent airway and supporting ventilation. Innervation to the intercostal muscles is affected; if spinal edema extends to the C4 level, paralysis of the diaphr

When developing a care plan for a client newly diagnosed with scleroderma, which nursing diagnosis has the highest priority?

Impaired skin integrity
Explanation:
Impaired skin integrity is a concern for the client with scleroderma in its earlier stages. Meticulous skin care is required to prevent complications. Although Risk for constipation may also be appropriate, this nursin

A nurse is teaching a client with a long leg cast how to use crutches properly while descending a staircase. The nurse should tell the client to transfer body weight to the unaffected leg, and then:

advance both crutches.
Explanation:
The nurse should instruct the client to advance both crutches to the step below, then transfer his body weight to the crutches as he brings the affected leg to the step. The client should then bring the unaffected leg d

During a routine physical examination on a 75-year-old female client, a nurse notes that the client is 5 feet, 3/8 inches (1.6 m) tall. The client states, "How is that possible? I was always 5 feet and 1/2 inches (1.7 m) tall." Which statement is the best

After menopause, the body's bone density declines, resulting in a gradual loss of height."
Explanation:
The nurse should tell the client that after menopause, the loss of estrogen leads to a loss in bone density, resulting in a loss of height. This clien

A client suspected of having systemic lupus erythematosus (SLE) is being scheduled for testing. She asks which of the tests ordered will determine if she is positive for the disorder. Which statement by the nurse is most accurate?

The diagnosis won't be based on the findings of a single test but by combining all data found."
Explanation:
There is no single test available to diagnose SLE. Therefore, the nurse should inform the client that diagnosis is based on combining the finding

A 63-year-old woman has been taking prednisone (Deltasone) daily for several years after a kidney transplant to prevent organ rejection. What is most important for the nurse to assess?

Back or neck pain
Osteoporosis with resultant fractures is a frequent and serious complication of systemic corticosteroid therapy. The ribs and vertebrae are affected the most, and patients should be observed for signs of compression fractures (back and n

The home care nurse visits an 84-year-old woman with pneumonia after her discharge from the hospital. Which assessment finding would the nurse expect because of age-related changes in the musculoskeletal system?

Muscle strength is scale grade 3/5
Decreased muscle strength is an age-related change of the musculoskeletal system caused by decreased number and size of the muscle cells. The other assessment findings indicate musculoskeletal abnormalities. A positive s

The nurse admits a 55-year-old female with multiple sclerosis to a long-term care facility. Which finding is of most immediate concern to the nurse?

ataxic gait
An ataxic gait is a staggering, uncoordinated gait. Fall risk is the highest in individuals with gait instability or visual or cognitive impairments. The other signs and symptoms (e.g., fatigue, urinary retention, radicular pain) may also occu

A 57-year-old postmenopausal woman is scheduled for dual-energy x-ray absorptiometry (DXA). Which statement, if made by the patient to the nurse, indicates understanding of the procedure?

This procedure will not cause any pain or discomfort
Dual-energy x-ray absorptiometry (DXA) is painless and measures the bone mass of spine, femur, forearm, and total body with minimal radiation exposure. A quantitative ultrasound (QUS) evaluates density,

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?

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

A 54-year-old patient is about to have a bone scan. In teaching the patient about this procedure, the nurse should include what information?

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 ar

Musculoskeletal assessment is an important component of care for patients on what type of long-term therapy?

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

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?

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.

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?

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 l

In reviewing bone remodeling, what should the nurse know about the involvement of bone cells?

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 b

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)?

hinge joint of the knee; Ball and socket joint of the shoulder or hip
The diarthrodial joints include the hinge joint of the knee and elbow, the ball and socket joint of the shoulder and hip, the pivot joint of the radioulnar joint, and the condyloid, sad

An 82-year-old patient is frustrated by her flabby belly and rigid hips. What should the nurse tell the patient about these frustrations?

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;

A 50-year-old patient is reporting a sore shoulder after raking the yard. The nurse should suspect which problem?

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 inflammatio

A 19-year-old male patient has a plaster cast applied to the right upper extremity for a Colles' fracture after a skateboarding accident. Which action, if taken by the nurse, is the most appropriate?

Elevate the right arm on two pillows for 24 hours.Elevate the right arm on two pillows for 24 hours.
The cast should be supported on pillows during the drying period to prevent denting and flattening of the cast. The casted extremity should be elevated at

The home care nurse visits a 74-year-old man diagnosed with Parkinson's disease who fell while walking this morning. What observation is of most concern to the nurse?

Left leg externally rotated and shorter than the right leg
Clinical manifestations of a hip fracture include external rotation, muscle spasm, shortening of the affected extremity, and severe pain and tenderness in the region of the fracture site. Expected

A 28-year-old woman with a fracture of the proximal left tibia in a long leg cast complains of severe pain and a prickling sensation in the left foot. The toes on the left foot are pale and cool. Which action should the nurse take?

Notify the health care provider immediately.
Clinical manifestations of compartment syndrome include (1) paresthesia, (2) pain distal to the injury that is not relieved by opioid analgesics and pain on passive stretch of muscle traveling through the compa

A 42-year-old man has a recent amputation of the left leg below the knee as a result of a heavy farm machinery accident. Which intervention should the nurse include in the plan of care for this patient?

Lay prone with hip extended for 30 minutes four times per day.
To prevent hip flexion contractures, patients should lie on their abdomen for 30 minutes three or four times each day and position the hip in extension while prone. Patients should avoid sitti

A nurse performs discharge teaching for a 58-year-old woman after a left hip arthroplasty (posterior approach). Which statement, if made by the patient to the nurse, indicates teaching is successful?

Leg-raising exercises are necessary for several months."
Exercises designed to restore strength and muscle tone will be done for months after surgery. The exercises include leg raises in supine and prone positions. Driving a car is not allowed for 4 to 6

A 30-year-old client hospitalized with a fractured femur, which is being treated with skeletal traction, has not had a bowel movement for 2 days. The nurse should:

increase the client's fluid intake to 3,000 mL/day.
Explanation:
Increasing the client's fluid intake to 3,000 mL/day, unless contraindicated, is the most appropriate action. Typically, clients who are immobilized by skeletal traction are given stool soft

A client with end-stage dementia is admitted to the orthopedic unit after undergoing internal fixation of the right hip. How should the nurse manage the client's postoperative pain?

Administer analgesics around the clock.
Explanation:
Because assessing pain medication needs in a client with end-stage dementia is difficult, analgesics should be administered around the clock. Clients at this stage of dementia typically can't request or

A client with arterial insufficiency undergoes below-knee amputation of the right leg. Which action should the nurse include in the postoperative care plan?

Elevating the stump for the first 24 hours
Explanation:
Stump elevation for the first 24 hours after surgery helps reduce edema and pain by increasing venous return and decreasing venous pooling at the distal portion of the extremity. Bed rest isn't indic

A client who has skeletal traction to stabilize a fractured femur has not had a bowel movement for 2 days. The nurse should:

increase the client's fluid intake to 3,000 mL/day.
Explanation:
The most appropriate nursing action is to first increase the client's fluid intake to 3,000 mL/day to soften stool.
A stool softener would be prescribed before resorting to an enema. Oil ret

A client diagnosed with arthritis doesn't want to take medications. Physical therapy and occupational therapy have been consulted for nonpharmacologic measures to control pain. What might physical and occupational therapy include in the care plan to help

An exercise routine that includes range-of-motion (ROM) exercises
Explanation:
Physical and occupational therapy will most likely develop an exercise routine that includes ROM exercises to control the client's pain. Acupuncture may help relieve the client

A client's left leg is in skeletal traction with a Thomas leg splint and Pearson attachment. Which intervention should the nurse include in this client's care plan?

Teach the client how to prevent problems caused by immobility.
Explanation:
By teaching the client about prevention measures, the nurse can help prevent problems caused by immobility, such as hypostatic pneumonia, muscle contracture, and atrophy. The nurs

During a routine physical examination on a 75-year-old female client, a nurse notes that the client is 5 feet, 3/8 inches (1.6 m) tall. The client states, "How is that possible? I was always 5 feet and 1/2 inches (1.7 m) tall." Which statement is the best

After menopause, the body's bone density declines, resulting in a gradual loss of height."
Explanation:
The nurse should tell the client that after menopause, the loss of estrogen leads to a loss in bone density, resulting in a loss of height. This clien

The nurse is caring for a client on a second course of antibiotics to eliminate osteomyelitis. It is most essential for the nurse to instruct on which aspect of daily care?

A diet high in protein and nutrients
Explanation:
It is essential for the nurse to instruct on a diet that is high in protein and nutrients to increase healing and strengthen the immune system. This, in addition to the second course of antibiotics, may be

The nurse is caring for a client on a second course of antibiotics to eliminate osteomyelitis. It is most essential for the nurse to instruct on which aspect of daily care?

A diet high in protein and nutrients
Explanation:
It is essential for the nurse to instruct on a diet that is high in protein and nutrients to increase healing and strengthen the immune system. This, in addition to the second course of antibiotics, may be

A diet plan is developed for a client with gouty arthritis. The nurse should advise the client to limit his intake of:

organ meats.
Explanation:
Gouty arthritis is a disorder of purine metabolism. High-purine foods include organ meats, anchovies, sardines, shellfish, and meat extracts. Citrus fruits, green vegetables, and fresh fish are appropriate foods for a client with

The nurse is planning care for a group of clients who have had total hip replacement. Of the clients listed below, which is at highest risk for infection and should be assessed first?

a 74-year-old who has periodontal disease with periodontitis
Explanation:
Infection is a serious complication of total hip replacement and may necessitate removal of the implant. Clients who are obese, poorly nourished, or elderly, and those who have poor

The nurse teaches the client to perform isometric exercises to strengthen the leg muscles after arthroplasty. Isometric exercises are particularly effective for clients with rheumatoid arthritis because they:

strengthen the muscles while keeping the joints stationary.
Explanation:
An exercise program is recommended to strengthen muscles after arthroplasty. Isometric (or muscle-setting) exercises strengthen muscles but keep the joint stationary during the heali

A client with osteoarthritis tells the nurse she is concerned that the disease will prevent her from doing her chores. Which suggestion should the nurse offer?

Pace yourself and rest frequently, especially after activities."
Explanation:
A client with osteoarthritis must adapt to this chronic and disabling disease, which causes deterioration of the joint cartilage. The most common symptom of the disease is deep

The nurse should instruct a family living in a rural area where the drinking water is not fluoridated to use which dietary means of obtaining a significant amount of fluoride?

tea
Explanation:
Most foods�including yogurt, citrus juices, and natural cheeses�contain limited amounts of fluoride. However, tea contains a significant amount of fluoride and would be the most appropriate suggestion.

A client is being discharged following an open reduction and internal fixation of the left ankle, and is to wear a non-weight-bearing cast for 2 weeks. What should the nurse teach the client to do when using crutches?

Maintain two to three finger widths between the axillary fold and underarm piece grip.
Explanation:
The nurse instructs the client to maintain two finger widths between the axillary fold and the underarm piece grip of the crutches to prevent pressure on t

A client seeks care for lower back pain of 2 weeks' duration. Which assessment finding suggests a herniated intervertebral disk?

Pain radiating down the posterior thigh
Explanation:
A herniated intervertebral disk may compress the spinal nerve roots, causing sciatic nerve inflammation that results in pain radiating down the leg. Slight knee flexion should relieve, not precipitate,

A client undergoes a total hip replacement. Which statement made by the client indicates to the nurse that the client requires further teaching?

I don't know if I'll be able to get off that low toilet seat at home by myself."
Explanation:
The client requires additonal teaching if he is concerned about using a low toilet seat. To prevent hip dislocation after a total hip replacement, the client mu

A 14-year-old has just had a plaster cast placed on his lower left leg. To provide safe cast care, the nurse should:

use only the palms of the hand when handling the cast.
Explanation:
The wet plaster cast should be handled using only the palms of the hands to prevent indentations of the cast surface. Petaling a cast should be done only when the edges of the cast are ro

Two days after being placed in a cast for a fractured femur, the client suddenly has chest pain and dyspnea. The client is confused and has an elevated temperature. The nurse should assess the client for:

fat embolism syndrome.
Explanation:
Clients with fractures of the long bones such as the femur are particularly susceptible to fat embolism syndrome (FES). Signs and symptoms include chest pain, dyspnea, tachycardia, and cyanosis. Changes in mental status

Following a client's total hip replacement, what should the nurse do? Select all that apply.

� Encourage the client to use the overhead trapeze to assist with position changes.
� Use a fracture bedpan when needed by the client.
� When the client is in bed, prevent thromboembolism by encouraging the client to do toe-pointing exercises.
Explanation