MSS Ch 11: Musculoskeletal Disorders Practice Questions

Question 1

The nurse is caring for an elderly client diagnosed with a herniated nucleus pulposus of L4-5. Which scientific rationale explains the incidence of a ruptured disk in the elderly?

1. The client did not use good body mechanics when lifting an object.
2. There is an increased blood supply to the back as the body ages.
3. Older clients develop atherosclerotic joint disease as a result of fat deposits.
4. Clients develop intervertebral disk degeneration as they age.

Answer 1

1. Back pain occurs in 80% to 90% of the population at different times in their lives. Although not using good body mechanics when lifting an object may be a reason for younger clients to develop a herniated disk, it is not the reason most elderly people develop back pain.
2. There is a decreased blood supply as the body ages.
3. Older clients develop degenerative joint disease. Fat does not deposit itself in the nucleus pulposus.
4. Less blood supply, degeneration of the disk, and arthritis are reasons elderly people develop back problems.

Question 2

The 34-year-old male client presents to the outpatient clinic complaining of numbness and pain radiating down the left leg. Which further data should the nurse assess?

1. Posture and gait.
2. Bending and stooping.
3. Leg lifts and arm swing.
4. Waist twists and neck mobility.

Answer 2

1. Posture and gait will be affected if the client is experiencing sciatica (pain radiating down a leg resulting from pressure on the sciatic nerve).
2. The client with pain and numbness is not able to bend or stoop and should not be asked to do so.
3. Leg lifts will not give the nurse the needed information and could cause this client pain; also, the lower extremity, not the upper extremity, is being assessed.
4. Waist twists will not assess the mobility of the lower extremity, and neck mobility is assessed if a cervical neck problem is suspected.

Question 3

The occupational health nurse is preparing an in-service for a group of workers in a warehouse. Which information should be included to help prevent on-the-job injuries?

1. Increase sodium and potassium in the diet during the winter months.
2. Use the large thigh muscles when lifting and hold the weight near the body.
3. Use soft-cushioned chairs when performing desk duties.
4. Have the employee arrange for assistance with household chores.

Answer 3

1. Increased calcium, not potassium or sodium, is helpful in preventing orthopedic injuries. Increasing sodium intake could prevent water loss in a non–air-conditioned warehouse in the summer months, not the winter months.
2. These are instructions to prevent back in- juries as a result of poor body mechanics.
3. Soft-cushioned chairs are not ergonomically designed. Soft-cushioned chairs promote poor body posture.
4. This might help the client prevent back injuries at home, but it does not prevent job-related injuries.

Question 4

The occupational health nurse is planning health promotion activities for a group of factory workers. Which activity is an example of primary prevention for clients at risk for low back pain?

1. Teach back exercises to workers after returning from an injury.
2. Place signs in the work area about how to perform first aid.
3. Start a weight-reduction group to meet at lunchtime.
4. Administer a nonnarcotic analgesic to a client complaining of back pain.

Answer 4

1. Teaching back exercises to a client who has already experienced a problem is tertiary care.
2. Placing signs with instructions about how to render first aid is a secondary intervention, not primary prevention.
3. Excess weight increases the workload on the vertebrae. Weight-loss activities help to prevent back injury.
4. Administering a nonnarcotic analgesic to a client with back pain is an example of secondary or tertiary care, depending on whether the client has a one-time problem or a chronic problem with back pain.

Question 5

The client with a cervical neck injury as a result of a motor-vehicle accident is complaining of unrelieved pain after administration of a narcotic analgesic. Which alternative method of pain control is an independent nursing action?

1. Medicate the client with a muscle relaxant.
2. Heat alternating with ice applied by a physical therapist.
3. Watch television or listen to music.
4. Discuss surgical options with the health-care provider.

Answer 5

1. This is an example of collaborative care.
2. This is an example of collaborative care.
3. This is distraction and is an alternative method often recommended for the promotion of client comfort.
4. Surgery is collaborative care.

Question 6

The client diagnosed with cervical disk degeneration has undergone a laminectomy. Which interventions should the nurse implement?

1. Position the client prone with the knees slightly elevated.
2. Assess the client for difficulty speaking or breathing.
3. Measure the drainage in the Jackson Pratt bulb every day.
4. Encourage the client to postpone the use of narcotic medications.

Answer 6

1. “Prone” means on the abdomen. On the abdomen with the knees flexed is an uncomfortable position, placing the spine in an unnatural position.
2. The surgical position of the wound places the client at risk for edema of tissues in the neck. Difficulty speaking or breathing should alert the nurse to a potentially life-threatening problem.
3. The drainage from a JP drain should be emptied and monitored every shift.
4. The client should be kept as comfortable as possible.

Question 7

The client is 12-hours post–lumbar laminectomy. Which nursing interventions should be implemented?

1. Assess ability to void and log roll the client every two (2) hours.
2. Medicate with IV steroids and keep the bed in a Trendelenburg position.
3. Place sandbags on each side of the head and give cathartic medications.
4. Administer IV anticoagulants and place on O2 at eight (8) L/min.

Answer 7

1. The lumbar nerves innervate the lower abdomen. The bladder is in the lower abdomen. The client will be required to lie flat, and this is a difficult position for many clients, especially males, to be in to void. Clients are log rolled every 2 hours.
2. The client should be receiving IV pain medication, not steroids. A Trendelenburg position is head down.
3. Sandbags keep the neck still, but the surgical area is in the lumbar region, so there is no reason the client cannot turn the head; also, cathartic medications are harsh laxatives.
4. The client will be receiving subcutaneous anticoagulant medications to prevent deep vein thrombosis, but IV anticoagulant therapy is not warranted. Eight (8) L/min of oxygen is high-flow oxygen and is used for a client in respiratory distress who does not have carbon dioxide narcosis.

Question 8

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

Answer 8

1. Clients two (2) days postoperative laminectomy should be eating a regular diet.
2. The client who has undergone a lumbar laminectomy is log rolled. It requires four (4) people or more to log roll a client.
3. The legs of any client diagnosed with back pain can give out and collapse at any time, but a large client diagnosed with back pain is at increased risk of injuring the UAP as well as the client. The nurse should intervene before the client or UAP becomes injured.
4. This action helps ensures safety for the client.

Question 9

The nurse is caring for clients on an orthopedic floor. Which client should be assessed first?

1. The client diagnosed with back pain who is complaining of a “4” on a 1-to-10 scale.
2. The client who has undergone a myelogram who is complaining of a slight headache.
3. The client two (2) days post–disk fusion who has T 100.4, P 96, R 24, and BP 138/78.
4. The client diagnosed with back pain who is being discharged and whose ride is here.

Answer 9

1. Mild back pain is expected with this client.
2. Lumbar myelograms require access into the spinal column. A small amount of cerebrospinal fluid may be lost, causing a mild headache. The client should stay flat in bed to prevent this from occurring.
3. This client is postoperative and now has a fever. This client should be assessed and the health-care provider should be notified.
4. A discharged client does not have priority over a surgical infection.

Question 10

The nurse is administering 0730 medications to clients on a medical orthopedic unit. Which medication should be administered first?

1. The daily cardiac glycoside to a client diagnosed with back pain and heart failure.
2. The routine insulin to a client diagnosed with neck strain and type 1 diabetes.
3. The oral proton pump inhibitor to a client scheduled for a laminectomy this a.m.
4. The fourth dose of IV antibiotic for a client diagnosed with a surgical infection.

Answer 10

1. This could be administered after breakfast if necessary. There is nothing in the action of the medication requiring before-breakfast medication administration.
2. Clients with type 1 diabetes are insulin dependent. This medication should be administered before the client eats.
3. This medication should be held until after surgery.
4. The client has already received three (3) doses of IV antibiotic. This medication could be given after the insulin.

Question 11

The nurse writes the problem of “pain” for a client diagnosed with lumbar strain. Which nursing interventions should be included in the plan of care? Select all that apply.

1. Assess pain on a 1-to-10 scale.
2. Administer pain medication PRN.
3. Provide a regular bedpan for elimination.
4. Assess surgical dressing every four (4) hours.
5. Perform a position change by the log roll method every two (2) hours.

Answer 11

1. An objective method of quantifying the client’s pain should be used.
2. Once the nurse has determined the client is stable and not experiencing complications, the nurse can medicate the client.
3. A regular bedpan is high and could cause pain for a client diagnosed with back pain. The client should be given a fracture pan.
4. There is no surgical dressing.
5. The client has not been to surgery, so log rolling is not necessary.

Question 12

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

Answer 12

1. The nurse should not continue working, and this is self-diagnosing and treating.
2. The nurse may go to the emergency department, but this is not the first action.
3. The first action is to notify the charge nurse so a replacement can be arranged to take over care of the clients. The nurse should notify the nurse manager or house supervisor. An occurrence report should be completed documenting the situation. This provides the nurse with the required documentation to begin a worker’s compensation case for payment of medical bills.
4. The nurse has the right to see a private health-care provider in most states, but this is not the first action.

Question 13

The occupational health nurse is teaching a class on the risk factors for developing osteoarthritis (OA). Which is a modifiable risk factor for developing OA?

1. Being overweight.
2. Increasing age.
3. Previous joint damage.
4. Genetic susceptibility.

Answer 13

1. Obesity is a well-recognized risk factor for the development of OA and it is modifiable because the client can lose weight.
2. Increasing age is a risk factor, but there is nothing the client can do about getting older, except to die.
3. Previous joint damage is a risk factor, but it is not modifiable, which means the client cannot do anything to change it.
4. Genetic susceptibility is a result of family genes, which the client cannot change; it is a nonmodifiable risk factor.

Question 14

The client is diagnosed with osteoarthritis. Which sign/symptom should the nurse expect the client to exhibit?

1. Severe bone deformity.
2. Joint stiffness.
3. Waddling gait.
4. Swan-neck fingers.

Answer 14

1. Severe bone deformity is seen in clients diagnosed with rheumatoid arthritis.
2. Pain, stiffness, and functional impairment are the primary clinical manifestations of OA. Stiffness of the joints is commonly experienced after resting but usually lasts less than 30 minutes and decreases with movement.
3. A waddling gait is usually seen in women in their third trimester of pregnancy or in older children with congenital hip dysplasia.
4. Swan-neck fingers are seen in clients with rheumatoid arthritis.

Question 15

The client diagnosed with OA is a resident in a long-term care facility. The resident is refusing to bathe because she is hurting. Which instruction should the nurse give the unlicensed assistive personnel (UAP)?

1. Allow the client to stay in bed until the pain becomes bearable.
2. Tell the UAP to give the client a bed bath this morning.
3. Try to encourage the client to get up and go to the shower.
4. Notify the family the client is refusing to be bathed.

Answer 15

1. Clients with OA should be encouraged to move, which will decrease the pain.
2. A bed bath does not require as much movement from the client as getting up and walking to the shower.
3. Pain will decrease with movement, and warm or hot water will help decrease the pain. The worst thing the client can do is not move.
4. Notifying the family will not address the client’s pain, and the client has a right to refuse a bath, but the nursing staff must explain why moving and bathing will help decrease the pain.

Question 16

The client has been diagnosed with OA for the last seven (7) years and has tried multiple medical treatments and alternative treatments but still has significant joint pain. Which psychosocial client problem should the nurse identify?

1. Severe pain.
2. Body image disturbance.
3. Knowledge deficit.
4. Depression.

Answer 16

1. Pain is a physiological problem, not a psychosocial problem.
2. A client with OA does not have bone deformities; therefore, body image disturbance is not appropriate.
3. After seven (7) years of OA and multiple treatment modalities, knowledge deficit is not appropriate for this client.
4. The client experiencing chronic pain often experiences depression and hopelessness.

Question 17

The client diagnosed with OA is prescribed a nonsteroidal anti-inflammatory drug (NSAID). Which instruction should the nurse teach the client?

1. Take the medication on an empty stomach.
2. Make sure to taper the medication when discontinuing.
3. Apply the medication topically over the affected joints. 4. Notify the health-care provider if vomiting blood.

Answer 17

1. This medication should be taken with food to prevent gastrointestinal distress. Glucocorticoids, not NSAIDs, must be tapered when discontinuing.
2. Topical analgesics are applied to the
3. skin; NSAIDs are oral or intravenous medications.
4. NSAIDs are well known for causing gastric upset and increasing the risk for peptic ulcer disease, which could cause the client to vomit blood.

Question 18

Which client goal is most appropriate for a client diagnosed with OA?

1. Perform passive range-of-motion exercises.
2. Maintain optimal functional ability.
3. Client will walk three (3) miles every day.
4. Client will join a health club.

Answer 18

1. This is an intervention, not a goal, and “passive” means the nurse performs the range of motion, which should not be encouraged.
2. The two main goals of treatment for OA are pain management and optimizing functional ability of the joints to ensure movement of the joints.
3. Most clients with OA are elderly, are overweight, and have a sedentary lifestyle, so walking three (3) miles every day is not a realistic or safe goal.
4. Joining a health club is an intervention, and the fact the client joins the health club doesn’t mean the client will exercise.

Question 19

To which member of the health-care team should the nurse refer the client diagnosed with OA who is complaining of not being able to get in and out of the bathtub?

1. Physiatrist.
2. Social worker.
3. Physical therapist.
4. Counselor.

Answer 19

1. A physiatrist is a physician who specializes in physical medicine and rehabilitation, but the nurse should not refer the client to this person just because the client is having difficulty with transfers.
2. The social worker does not address this type of physical problem. Social workers address issues concerning finances, placement, and acquiring assistive devices.
3. The physical therapist is able to help the client with transferring, ambulation, and other lower extremity difficulties.
4. A counselor is not able to help the client learn how to get in and out of the bathtub.

Question 20

The nurse is discussing the importance of an exercise program for pain control to a client diagnosed with OA. Which intervention should the nurse include in the teaching?

1. Wear supportive tennis shoes with white socks when walking.
2. Carry a complex carbohydrate while exercising.
3. Alternate walking briskly and jogging when exercising. 4. Walk at least 30 minutes three (3) times a week.

Answer 20

1. Safety should always be discussed when teaching about exercises. Supportive shoes will prevent shin splints. Colored socks have dye and may cause athlete’s foot, which is why white socks are recommended.
2. Clients with diabetes mellitus should carry complex carbohydrates with them. Osreoarthritis occurs most often in weight- bearing joints. Exercise is encouraged, but jogging increases stress on these joints.
3. For exercising to help pain control, the client must walk daily, not three (3) times a week. Walking at least 30 minutes three (3) times a week is appropriate for
4. weight loss.

Question 21

The HCP prescribes glucosamine and chondroitin for a client diagnosed with OA. What is the scientific rationale for prescribing this medication?

1. It will help decrease the inflammation in the joints.
2. It improves tissue function and retards breakdown of cartilage.
3. It is a potent medication which decreases the client’s joint pain.
4. It increases the production of synovial fluid in the joint.

Answer 21

1. NSAIDs or glucocorticoids help decrease inflammation of the joints.
2. This is the rationale for administering these medications.
3. Narcotic and nonnarcotic analgesics help decrease the client’s pain.
4. There is no medication at this time to help increase synovial fluid production, but sur- gery can increase the viscosupplementation in the joint.

Question 22

The nurse is admitting the client with OA to the medical floor. Which statement by the client indicates an alternative form of treatment for OA?

1. “I take medication every two (2) hours for my pain.”
2. “I use a heating pad when I go to bed at night.”
3. “I wear a copper bracelet to help with my OA.”
4. “I always wear my ankle splints when I sleep.”

Answer 22

1. Medication is a standard therapy and is not considered an alternative therapy.
2. A heating pad is an accepted medical recommendation for the treatment of pain for clients with OA.
3. Alternative forms of treatment have not been proved efficacious in the treatment of a disease. The nurse should be nonjudgmental and open to discussions about alternative treatment, unless it interferes with the medical regimen.
4. Conservative treatment measures for OA include splints and braces to support inflamed joints.

Question 23

The client is complaining of joint stiffness, especially in the morning. Which diagnostic tests should the nurse expect the health-care provider to order to R/O osteoarthritis?

1. Full-body magnetic resonance imaging scan.
2. Serum studies for synovial fluid amount.
3. X-ray of the affected joints.
4. Serum erythrocyte sedimentation rate (ESR).

Answer 23

1. MRIs are not routinely ordered for diagnosing OA.
2. There is no serum laboratory test to measure synovial fluid in the joints.
3. X-rays reveal loss of joint cartilage, which appears as a narrowing of the joint space in clients diagnosed with OA.
4. An ESR is a diagnostic laboratory test for rheumatoid arthritis, not osteoarthritis.

Question 24

The nurse is caring for the following clients. After receiving the shift report, which client should the nurse assess first?

1. The client with a total knee replacement who is complaining of a cold foot.
2. The client diagnosed with osteoarthritis who is complaining of stiff joints.
3. The client who needs to receive a scheduled intravenous antibiotic.
4. The client diagnosed with back pain who is scheduled for a lumbar myelogram.

Answer 24

1. A cold foot in a client who has had surgery may indicate a neurovascular compromise and must be assessed first.
2. A client with osteoarthritis is expected to have stiff joints.
3. A routine medication is not priority over a potential complication of surgery.
4. A routine diagnostic procedure does not have priority over a potential complication of surgery.

Question 25

The nurse is discussing osteoporosis with a group of women. Which factor will the nurse identify as a nonmodifiable risk factor?

1. Calcium deficiency.
2. Tobacco use.
3. Female gender.
4. High alcohol intake.

Answer 25

1. Calcium deficiency is a modifiable risk factor, which means the client can do something about this factor—namely, increase the intake of calcium—to help prevent the development of osteoporosis.
2. Smoking is a modifiable risk factor because the client can quit smoking.
3. A nonmodifiable risk factor is a factor the client cannot do anything to alter or change. Approximately 50% of all women will experience an osteo- porosis-related fracture in their lifetime.
4. The client can quit drinking alcohol; therefore, this is a modifiable risk factor.

Question 26

The client diagnosed with osteoporosis asks the nurse, “Why does smoking cigarettes cause my bones to be brittle?” Which response by the nurse is most appropriate?

1. “Smoking causes nutritional deficiencies which contribute to osteoporosis.”
2. “Tobacco causes an increase in blood supply to the bones, causing osteoporosis.”
3. “Smoking low-tar cigarettes will not cause your bones to become brittle.”
4. “Nicotine impairs the absorption of calcium, causing decreased bone strength.”

Answer 26

1. This is the rationale for heavy alcohol use leading to the development of osteoporosis.
2. Smoking decreases, not increases, blood supply to the bone.
3. Cigarette smoking has long been identified as a risk factor for osteoporosis, and it doesn’t matter if the cigarettes are low tar.
4. Nicotine slows the production of osteoblasts and impairs the absorption of calcium, contributing to decreased bone density.

Question 27

Which signs/symptoms indicate to the nurse the client has developed osteoporosis?

1. The client has lost one (1) inch in height.
2. The client has lost 12 pounds in the last year.
3. The client’s hands are painful to the touch.
4. The client’s serum uric acid level is elevated.

Answer 27

1. The loss of height occurs as vertebral bodies collapse.
2. Weight loss is not a sign of osteoporosis.
3. This may indicate rheumatoid arthritis but not osteoporosis.
4. This is a sign of gout.

Question 28

The client is being evaluated for osteoporosis. Which diagnostic test is the most accurate when diagnosing osteoporosis?

1. X-ray of the femur.
2. Serum alkaline phosphatase.
3. Dual-energy x-ray absorptiometry (DEXA).
4. Serum bone Gla-protein test.

Answer 28

1. Osteoporotic changes do not occur in the bone until more than 30% of the bone mass has been lost.
2. This serum blood study may be elevated after a fracture, but it does not help diagnose osteoporosis.
3. This test measures bone density in the lumbar spine or hip and is considered to be highly accurate.
4. This test is most useful to evaluate the effects of treatment, rather than as an indicator of the severity of bone disease.

Question 29

Which foods should the nurse recommend to a client when discussing sources of dietary calcium?

1. Yogurt and dark-green, leafy vegetables.
2. Oranges and citrus fruits.
3. Bananas and dried apricots.
4. Wheat bread and bran.

Answer 29

1. The best dietary sources of calcium are milk and other dairy products. Other sources include oysters; canned sardines or salmon; beans; cauliflower; and dark-green, leafy vegetables.
2. These foods are high in vitamin C.
3. These foods are high in potassium.
4. These foods are recommended for a high-fiber diet.

Question 30

Which intervention is an example of a secondary nursing intervention when discussing osteoporosis?

1. Obtain a bone density evaluation test.
2. Perform non–weight-bearing exercises regularly.
3. Increase the intake of dietary calcium.
4. Refer clients to a smoking cessation program.

Answer 30

1. This is an example of a secondary nursing intervention, which includes screening for early detection.
2. The client should perform weight-bearing exercises, which promote osteoblast activity helping to maintain bone strength and integrity. This is a primary nursing intervention.
3. Increasing dietary calcium may be a primary intervention to help prevent osteoporosis or a tertiary intervention, which helps treat osteoporosis.
4. Smoking cessation is a primary intervention, which will help prevent the development of osteoporosis.

Question 31

The female client diagnosed with osteoporosis tells the nurse she is going to perform swim aerobics for 30 minutes every day. Which response is most appropriate by the nurse?

1. Praise the client for committing to do this activity.
2. Explain to the client walking 30 minutes a day is a better activity.
3. Encourage the client to swim every other day instead of daily.
4. Discuss with the client how sedentary activities help prevent osteoporosis.

Answer 31

1. Swimming is not as beneficial as walking in maintaining bone density because of the lack of weight-bearing activity.
2. Weight-bearing activity, such as walking, is beneficial in preventing or slowing bone loss. The mechanical force of weight-bearing exercises promotes bone growth.
3. Swimming is not as beneficial in maintaining bone density because of the lack of weight-bearing activity.
4. A sedentary lifestyle is a risk factor for the development of osteoporosis.

Question 32

The client newly diagnosed with osteoporosis is prescribed calcitonin by nasal spray. Which assessment data indicate to the nurse an adverse effect of the medication?

1. The client complains of nausea and vomiting.
2. The client is drinking two (2) glasses of milk a day.
3. The client has a runny nose and nasal itching.
4. The client has had numerous episodes of nosebleeds.

Answer 32

1. Nausea and vomiting may occur during initial stages of therapy, but they will disappear as treatment continues.
2. The client should be sure to consume adequate amounts of calcium and vitamin D while taking calcitonin.
3. Rhinitis (runny nose) is the most common side effect with calcitonin nasal spray along with itching, sores, and other nasal symptoms.
4. Nosebleeds are adverse effects and should be reported to the client’s HCP.

Question 33

The nurse is teaching a class to pregnant teenagers. Which information is most important when discussing ways to prevent osteoporosis?

1. Take at least 1,200 mg of calcium supplements a day.
2. Eat foods low in calcium and high in phosphorus.
3. Osteoporosis does not occur until around age 50 years.
4. Remain as active as possible until the baby is born.

Answer 33

1. The National Institutes of Health (NIH) recommends a daily calcium intake of 1,200 to 1,500 mg/day for adolescents, young adults, and pregnant and lactating women.
2. The pregnant teenager should eat foods high in calcium.
3. Osteoporosis may not occur before age 50 years, but taking calcium throughout the life span will help prevent it. Remem- ber, teenagers tend to focus on the pres- ent, not the future, so the most important intervention to teach them is to take calcium supplements.
4. Activity will not help prevent osteoporosis in the teenager; the teenager must take calcium supplements.

Question 34

The 84-year-old client is a resident in a long-term care facility. Which intervention should be implemented to help prevent complications secondary to osteoporosis?

1. Keep the bed in the high position.
2. Perform passive range-of-motion exercises.
3. Turn the client every two (2) hours.
4. Provide nighttime lights in the room.

Answer 34

1. The bed should be kept in the low position. Preventing falls is a priority for a client diagnosed with osteoporosis.
2. Range-of-motion (ROM) exercises will help prevent deep vein thrombosis or contractures, but they do not help prevent osteoporosis.
3. Turning the client will help prevent pressure ulcers, but does not help prevent osteoporosis.
4. Nighttime lights will help prevent the client from falling; fractures are the number-one complication of osteoporosis.

Question 35

The client is taking calcium carbonate (Tums) to help prevent further development of osteoporosis. Which teaching should the nurse implement?

1. Encourage the client to take Tums with at least eight (8) ounces of water.
2. Teach the client to take Tums with the breakfast meal only.
3. Instruct the client to take Tums 30 to 60 minutes before a meal.
4. Discuss the need to get a monthly serum calcium level.

Answer 35

1. There is no reason to take Tums with eight (8) ounces of water. Tums are usually chewed.
2. Tums should not be taken with meals.
3. Free hydrochloric acid is needed for calcium absorption; therefore, Tums should be taken on an empty stomach.
4. To determine the effectiveness of calcium supplements, the client must have a bone density test, not a serum calcium level measurement.

Question 36

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

Answer 36

Six (6) tablets.

1,000 mg is equal to one (1) gram. Therefore, three (3) grams is equal to 3,000 mg. If one (1) tablet is 500 mg, the client will need six (6) tablets to get the total amount of calcium needed daily: 3,000 ÷ 500 = 6

Question 37

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

Answer 37

1. This position will decrease lung expansion.
2. The prone position will help stretch the hamstring muscles, which will help prevent flexion contractures leading to problems when fitting the client for a prosthesis.
3. Lying on the back will not help decrease actual or phantom pain.
4. This will help take pressure off the client’s buttocks area, but it is not why it is recommended for a client with a lower extremity amputation.

Question 38

The recovery room nurse is caring for a client who has just had a left BKA. Which intervention should the nurse implement?

1. Assess the client’s surgical dressing every two (2) hours.
2. Do not allow the client to see the residual limb.
3. Keep a large tourniquet at the client’s bedside.
4. Perform passive range-of-motion exercises to the right leg.

Answer 38

1. The client is in the recovery room, and the dressing must be assessed more frequently than every two (2) hours.
2. The client must come to terms with the amputation; therefore, the nurse should encourage the client to look at the residual limb.
3. The large tourniquet can be used if the residual limb begins to hemorrhage either internally or externally.
4. The nurse should encourage active, not passive, range-of-motion exercises.

Question 39

The 62-year-old client diagnosed with type 2 diabetes who has a gangrenous right toe is being admitted for a below-the-knee amputation. Which nursing intervention should the nurse implement?

1. Assess the client’s nutritional status.
2. Refer the client to an occupational therapist.
3. Determine if the client is allergic to IVP dye.
4. Start a 22-gauge Angiocath in the right arm.

Answer 39

1. For wound healing, a balanced diet with adequate protein and vitamins is essential, along with meals appropriate for type 2 diabetes.
2. An occupational therapist addresses activities of daily living and usually addresses upper extremity amputations.
3. A referral to a physical therapist is most appropriate to address ambulating and transfer concerns.
4. There is no type of intravenous dye used in this surgical procedure, so this answer is not appropriate.
5. An 18-gauge catheter should be started because the client is going to surgery; the client may need a blood transfusion, which should be administered through an 18-gauge catheter.

Question 40

The male nurse is helping his friend cut wood with an electric saw. His friend cuts two fingers of his left hand off with the saw. Which action should the nurse implement first?

1. Wrap the left hand with towels and apply pressure.
2. Instruct the friend to hold his hand above his head.
3. Apply pressure to the radial artery of the left hand.
4. Go into the friend’s house and call 911.

Answer 40

1. Wrapping the hand with towels is appropriate, but it is not the first intervention.
2. Holding the arm above the head will help decrease the bleeding, but it is not the first intervention.
3. Applying direct pressure to the artery above the amputated parts will help decrease the bleeding immediately and is the first intervention the nurse should implement. Then the nurse should instruct the client to hold the hand above the head, apply towels, and call 911.
4. Calling 911 should be done, but it is not the first intervention.

Question 41

A person’s right thumb was accidentally severed with an axe. The amputated right thumb was recovered. Which action by the nurse preserves the thumb so it could possibly be reattached in surgery?

1. Place the right thumb directly on some ice.
2. Put the right thumb in a glass of warm water.
3. Wrap the thumb in a clean piece of material.
4. Secure the thumb in a plastic bag and place on ice.

Answer 41

1. Placing the amputated part directly on ice will cause vasoconstriction and necrosis of viable tissue.
2. Warm water will cause the amputated part to disintegrate and lose viable tissue.
3. Wrapping the amputated part in a piece of material will not help preserve the thumb so it can be reconnected.
4. Placing the thumb in a plastic bag will protect it and then placing the plastic bag on ice will help preserve the thumb so it may be reconnected in surgery. Do not place the amputated part directly on ice because this will cause necrosis of viable tissue.

Question 42

The Jewish client with peripheral vascular disease is scheduled for a left AKA. Which question is most important for the operating room nurse to ask the client?

1. “Have you made any special arrangements for your amputated limb?”
2. “What types of food would you like to eat while you’re in the hospital?”
3. “Would you like a rabbi to visit you while you are in the recovery room?”
4. “Will you start checking your other foot at least once a day for cuts?”

Answer 42

1. The Jewish faith believes all body parts must be buried together. Therefore, many synagogues will keep amputated limbs until death occurs.
2. Specific foods are important, but not while the client is in the operating room.
3. Spiritual issues are important for the nurse to discuss with the client, but the operat- ing room should be concerned with disposition of the amputated limb.
4. Addressing teaching issues is important, but the most important concern is disposition of the amputated limb.

Question 43

The client is three (3) hours postoperative left AKA. The client tells the nurse, “My left foot is killing me. Please do something.” Which intervention should the nurse implement?

1. Explain to the client his left leg has been amputated.
2. Medicate the client with a narcotic analgesic immediately.
3. Instruct the client on how to perform biofeedback exercises.
4. Place the client’s residual limb in the dependent position.

Answer 43

1. The client is three (3) hours postoperative and needs medical intervention.
2. Phantom pain is caused by severing the peripheral nerves. The pain is real to the client, and the nurse needs to medicate the client immediately.
3. Biofeedback exercises will not help address the client’s postoperative surgical pain.
4. Placing the residual limb below the heart (dependent) will not help address the client’s pain and could actually increase the pain.

Question 44

The nurse is caring for a client with a right below-the-knee amputation. There is a large amount of bright red blood on the client’s residual limb dressing. Which intervention should the nurse implement first?

1. Notify the client’s surgeon immediately.
2. Assess the client’s blood pressure and pulse.
3. Reinforce the dressing with additional dressing.
4. Check the client’s last hemoglobin and hematocrit level.

Answer 44

1. If the client is hemorrhaging, the surgeon needs to be notified, but hemorrhaging has not been determined.
2. Determining if the client is hemorrhaging is the first intervention. The nurse should check for signs of hypovolemic shock: decreased BP and increased pulse.
3. Reinforcing the dressing helps decrease bleeding, but the nurse must assess first.
4. Checking the client’s laboratory results is an appropriate intervention, but it is not the first intervention.

Question 45

The nurse is caring for clients on a surgical unit. Which nursing task is most appropriate for the nurse to delegate to an unlicensed assistive personnel (UAP)?

1. Help the client with a 2-day postop amputation put on the prosthesis.
2. Request the UAP double-check a unit of blood to be hung.
3. Change the surgical dressing on the client with a Syme’s amputation.
4. Ask the UAP to take the client to the physical therapy department.

Answer 45

1. A client who is only two (2) days postoperative amputation is not putting on a prosthesis.
2. Two (2) registered nurses must double-check a unit of blood prior to infusing the blood.
3. The surgical dressing is changed by the surgeon or the nurse; Syme’s amputation is above the ankle, just removing the foot.
4. The unlicensed assistive personnel (UAP) could take a client to another department in the hospital.

Question 46

The client with a right AKA is being taught how to toughen the residual limb. Which intervention should the nurse implement?

1. Instruct the client to push the residual limb against a pillow.
2. Demonstrate how to apply an elastic bandage around the residual limb.
3. Encourage the client to apply vitamin B12 to the surgical incision.
4. Teach the client to elevate the residual limb at least three (3) times a day.

Answer 46

1. Applying pressure to the end of the residual limb will help toughen the limb. Gradually pushing the residual limb against harder and harder surfaces is done in preparation for prosthesis training.
2. An Ace bandage applied distal to proximal will help decrease edema and help shape the residual limb into a conical shape.
3. Vitamin E oil will help decrease the angriness of the scar, but it will not help with residual limb toughening.
4. Elevating the residual limb will help decrease edema, but it will also cause a contracture if the residual limb is elevated after the first 24 hours.

Question 47

The 27-year-old client has a right above-the-elbow amputation secondary to a boating accident. Which statement to the rehabilitation nurse indicates the client has accepted the amputation?

1. “I am going to sue the guy who hit my boat.”
2. “The therapist is going to help me get retrained for another job.”
3. “I decided not to get a prosthesis. I don’t think I need it.”
4. “My wife is so worried about me and I wish she weren’t.”

Answer 47

1. This statement does not indicate acceptance; the client is still in the anger stage of grieving.
2. Looking toward the future and problem-solving indicate the client is accepting the loss.
3. At this young age, a client with an upper extremity prosthesis needs to be thinking about obtaining employment and living a full life. Getting a prosthesis is important to pursue this goal.
4. This statement does not indicate acceptance; his wife will worry about the client’s life, which has been changed dramatically.

Question 48

The 32-year-old male client with a traumatic left AKA is being discharged from the rehabilitation department. Which discharge instructions should be included in the teaching? Select all that apply.

1. Report any pain not relieved with analgesics.
2. Eat a well-balanced diet and increase protein intake.
3. Be sure to attend all outpatient rehabilitation appointments.
4. Encourage the client to attend a support group for amputations. 5. Stay at home as much as possible for the first couple of months.

Answer 48

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

Question 49

The client is taken to the emergency department with an injury to the left arm. Which intervention should the nurse implement first?

1. Assess the nailbeds for capillary refill time.
2. Remove the client’s clothing from the arm.
3. Call radiology for a STAT x-ray of the extremity.
4. Prepare the client for the application of a cast.

Answer 49

1. The nurse should assess the nailbeds for the capillary refill time. A prolonged time (greater than three [3] seconds) indicates impaired circulation to the extremity.
2. Clothing may need to be removed but not before assessment.
3. An x-ray will be done, but is not the highest priority action.
4. A cast may or may not be applied, depending on the type and location of the fracture.

Question 50

The nurse is preparing the plan of care for the client with a closed fracture of the right arm. Which problem is most appropriate for the nurse to identify?

1. Risk for ineffective coping related to the inability to perform ADLs.
2. Risk for compartment syndrome–related injured muscle tissue.
3. Risk for infection related to exposed bone and tissue.
4. Risk for complications related to compromised neurovascular status.

Answer 50

1. The client may experience difficulty coping depending on how much mobility the client has after medical treatment, but it is not the most appropriate nursing diagnosis at this time.
2. Compartment syndrome (edema within a muscle compartment) may occur, but there are multiple complications the nurse should be assessing for, so this is not the most appropriate nursing intervention.
3. The client has a closed fracture, so there is no exposed bone or tissue.
4. Assessing and preventing complications related to the neurovascular compromise is the most appropriate intervention because, if there are no complications, a closed fracture should heal without problems.

Question 51

Which interventions should the nurse implement for the client diagnosed with an open fracture of the left ankle? Select all that apply.

1. Apply an immobilizer snugly to prevent edema.
2. Apply an ice pack for 10 minutes and remove for 20 minutes.
3. Place the extremity in the dependent position to allow drainage.
4. Obtain an x-ray of the ankle after applying the immobilizer.
5. Administer tetanus toxoid, 0.5 mL intramuscularly, in the deltoid.

Answer 51

1. An immobilizer should not be applied snugly. There should be enough room to allow for edema and adequate perfusion of the tissues.
2. Ice packs should be applied 10 minutes on and 20 minutes off. This allows for vasoconstriction and decreases edema. Ice is a nonpharmacological pain management technique.
3. An injured extremity should be elevated above the level of the heart to decrease edema and pain.
4. An x-ray should be done before the immobilizer is in place, not after.
5. Anytime trauma occurs, tetanus should be considered. In an open fracture, this is an appropriate treatment.

Question 52

The nurse is caring for a client with a fractured left tibia and fibula. Which data should the nurse report to the health-care provider immediately?

1. Localized edema and discoloration occurring hours after the injury.
2. Generalized weakness and increasing sensitivity to touch.
3. Dorsalis pedal pulse cannot be located with a Doppler and increasing pain.
4. Pain relieved after taking four (4) mg hydromorphone, a narcotic analgesic.

Answer 52

1. Localized edema and discoloration hours after the injury are normal occurrences after a fracture.
2. Generalized weakness and increasing tenderness are common and not life threatening.
3. If the nurse cannot hear the pedal pulse with a Doppler and the client’s pain is increasing, the nurse should notify the health-care provider. These are signs of neurovascular compromise.
4. Pain management is a desired outcome demonstrated by pain relieved after medication administration.

Question 53

The unlicensed assistive personnel (UAP) reports a client with a fractured femur has “globs” floating in the urinal. What intervention should the nurse implement first?

1. Assess the client for dyspnea and altered mental status.
2. Obtain an arterial blood gas and order a portable chest x-ray.
3. Call the HCP for a ventilation/perfusion scan.
4. Instruct the UAP keep the client on strict bedrest.

Answer 53

1. The nurse should assess the client for signs of hypoxia from a fat embolism, which is what the nurse should anticipate from “globs” in the urine.
2. Arterial blood gases and portable chest x-ray will be done, but they will not be done first.
3. A ventilation/perfusion scan not the highest priority for the client. Assessment for complications is priority.
4. The UAP should keep the client on strict bedrest, but the nurse’s first intervention is to assess the client. The client is unstable and the nurse should assess the client first, then maintain strict bedrest.

Question 54

The nurse is caring for an 80-year-old client admitted with a fractured right femoral neck who is oriented × 1. Which intervention should the nurse implement first?

1. Check for a positive Homans’ sign.
2. Encourage the client to take deep breaths and cough.
3. Determine the client’s normal orientation status.
4. Monitor the client’s Buck’s traction.

Answer 54

1. There is controversy over assessing for a positive Homans’ sign, but it is not the first intervention for a client who is oriented to person only.
2. Encouraging the client to take deep breaths and cough aids in the exchange of gases. Mental changes are early signs of hypoxia in the elderly client, but the nurse must first determine if mental changes have occurred.
3. The nurse is not aware of the client’s usual mental status so, before taking any further action, the nurse should determine what is normal or usual for this client.
4. Checking the client’s Buck’s traction will not address the problem of confusion. This will not address taking care of the orientation of the client.

Question 55

The client admitted with a diagnosis of a fractured hip who is in Buck’s traction is complaining of severe pain. Which intervention should the nurse implement?

1. Adjust the patient-controlled analgesia (PCA) machine for a lower dose.
2. Ensure the weights of the Buck’s traction are off the floor and hang freely.
3. Raise the head of the bed to 45 degrees and the foot to 15 degrees.
4. Turn the client on the affected leg using pillows to support the other leg.

Answer 55

1. The health-care provider orders the dosage on a PCA. Unless a range of dosages or a new order is obtained, a lower dose will not help pain.
2. Weights from traction should be off the floor and hanging freely. Buck’s traction is used to reduce muscle spasms preoperatively in clients who have fractured hips.
3. Raising the head of the bed or the foot will alter the traction.
4. Turning the client to the affected side could increase pain rather than relieve it.

Question 56

The nurse is providing discharge teaching to the 12-year-old with a fractured humerus and the parents. Which information should the nurse include regarding cast care?

1. Keep the fractured arm at heart level.
2. Use a wire hanger to scratch inside the cast.
3. Apply an ice pack to any itching area.
4. Explain foul smells are expected occurrences.

Answer 56

1. The arm should be elevated above the heart, not at heart level.
2. The nurse should instruct the child to not insert anything under the cast because it could cause a break in the skin leading to an infection.
3. Applying ice packs to the cast will relieve itching, and nothing should be placed down a cast to scratch. Skin becomes fragile inside the cast and is torn easily. Alteration in the skin’s integrity can become infected.
4. Smells indicate infection and should be reported to the HCP.

Question 57

Which statement by the client diagnosed with a fractured ulna indicates to the nurse the client needs further teaching?

1. “I need to eat a high-protein diet to ensure healing.”
2. “I need to wiggle my fingers every hour to increase circulation.”
3. “I need to take my pain medication before my pain is too bad.”
4. “I need to keep this immobilizer on when lying down only.”

Answer 57

1. Protein is necessary for healing.
2. By wiggling the fingers of the affected arm, the client can improve the circulation.
3. Pain medication should be taken prior to perception of severe pain. Pain relief will require more medication if allowed to become severe.
4. The immobilizer should be kept on at all times. This indicates the client does not understand the teaching and needs the nurse to provide more instruction.

Question 58

The nurse is preparing the care plan for a client with a fractured lower extremity. Which outcome is most appropriate for the client?

1. The client will maintain function of the leg.
2. The client will ambulate with assistance.
3. The client will be turned every two (2) hours.
4. The client will have no infection.

Answer 58

1. The expected outcome for a client with a fracture is maintaining the function of the extremity.
2. Ambulation with assistance is not the best goal.
3. This is a nursing intervention, not a client goal.
4. Infection is not the highest priority problem for a client with a fracture.

Question 59

The nurse is caring for a client diagnosed with a fracture of the right distal humerus. Which data indicate a complication? Select all that apply.

1. Numbness and mottled cyanosis.
2. Paresthesia and paralysis.
3. Proximal pulses and point tenderness.
4. Coldness of the extremity and crepitus.
5. Palpable radial pulse and functional movement.

Answer 59

1. The nurse should assess for numbness and mottled cyanosis, which might indicate nerve damage.
2. The presence of paresthesia and paralysis indicates impaired circulation.
3. Pulses should be assessed but not proximal to the fracture. Pulses distal to the fracture should be assessed. Point tenderness should be expected.
4. Coldness indicates decreased blood supply. Crepitus indicates air in subcutaneous tissue and is not expected.
5. Palpable radial pulses and functional movement do not indicate a complication has occurred.

Question 60

An 88-year-old client is admitted to the orthopedic floor with the diagnosis of fractured pelvis. Which intervention should the nurse implement first?

1. Insert an indwelling catheter.
2. Administer a Fleet’s enema.
3. Assess abdomen for bowel sounds.
4. Apply Buck’s traction.

Answer 60

1. Inserting an indwelling catheter is a good intervention, but it is not the first intervention. A tear or injury to the bladder should be suspected.
2. Administering a Fleet’s enema should not be implemented until internal bleeding has been ruled out.
3. Assessing the bowel sounds should be the first intervention to determine if an ileus has occurred. This is a common complication of a fractured pelvis.
4. Buck’s traction is not used to treat a fractured pelvis. It is used to treat a fractured hip.

Question 61

The nurse is preparing the preoperative client for a total hip replacement (THR). Which intervention should the nursing implement postoperatively?

1. Keep an abduction pillow in place between the legs at all times.
2. Cough and deep breathe at least every four (4) to five (5) hours.
3. Turn to both sides every two (2) hours to prevent pressure ulcers.
4. Sit in a high-seated chair for a flexion of less than 90 degrees.

Answer 61

1. The abduction pillow should be kept between the legs while in bed to maintain a neutral position and prevent internal rotation.
2. The client should deep breathe and cough at least every two (2) hours to prevent atelectasis and pneumonia.
3. The client will need to turn every two (2) hours but should not turn to the affected side.
4. Using a high-seated toilet and chair will help prevent dislocation by limiting the flexion to less than 90 degrees.

Question 62

The client one (1) day postoperative total hip replacement complains of hearing a “popping sound” when turning. Which assessment data should the nurse report immediately to the surgeon?

1. Dark red–purple discoloration.
2. Equal length of lower extremities.
3. Groin pain in the affected leg.
4. Edema at the incision site.

Answer 62

1. Bruising is common after a total hip replacement.
2. When a dislocation occurs, the affected extremity will be shorter.
3. Groin pain or increasing discomfort in the affected leg and the “popping sound” indicate the leg has dislocated, which should be reported immediately to the HCP for a possible closed reduction.
4. Edema at the incision site is common, but an increase in edema or redness should be reported.

Question 63

The nurse is discharging a client who had a total hip replacement. Which statement indicates further teaching is needed?

1. “I should not cross my legs because my hip may come out of the socket.”
2. “I will call my HCP if I have a sudden increase in pain.”
3. “I will sit on a chair with arms and a firm seat.”
4. “After three (3) weeks, I don’t have to worry about infection.”

Answer 63

1. Clients should not cross their legs because the position increases the risk for dislocation.
2. If the client experiences a sudden increase in pain, redness, edema, or stiffness in the joint or surrounding area, the client should notify the HCP.
3. Clients should sleep on firm mattresses and sit on chairs with firm seats and high arms. These will decrease the risk of dislocating the hip joint.
4. Infections are possible months after surgery. Clients should monitor temperatures and report any signs of infection.

Question 64

The nurse finds small, fluid-filled lesions on the margins of the client’s surgical dressing. Which statement is the most appropriate scientific rationale for this occurrence?

1. These were caused by the cautery unit in the operating room.
2. These are papular wheals from herpes zoster.
3. These are blisters from the tape used to anchor the dressing.
4. These macular lesions are from a latex allergy.

Answer 64

1. These are not burns from the cautery unit. Such burns are located in or near the incision site and are usually black.
2. Herpes simplex lesions occur in a linear pattern along a dermatome.
3. Fluid-filled blisters are from a reaction to the tape and usually occur along the margins of the dressing where the tape was applied.
4. Skin reactions to latex are local irritations or generalized dermatitis, not blisters.

Question 65

Which interventions should be included in the discharge teaching for a client who had a total hip replacement? Select all that apply.

1. Discuss the client’s weight-bearing limits.
2. Request the client demonstrate use of assistive devices.
3. Explain the importance of increasing activity gradually.
4. Instruct the client not to take medication prior to ambulating. 5. Tell the client to ambulate with open-toed house shoes.

Answer 65

1. Clients need to understand the amount of weight bearing to prevent injury.
2. Teaching the safe use of assistive devices is necessary prior to discharge.
3. Increases in activity should occur slowly to prevent complications.
4. Using medication therapy, including analgesics, anti-inflammatory agents, or muscle relaxants, should be taught so the client is comfortable while ambulating.
5. The client should ambulate with well-fitted, supported, closed-toed shoes such as a tennis shoe or walking shoe.

Question 66

The nurse is caring for the client who has had a total hip replacement. Which data indicate the surgical treatment is effective?

1. The client states the pain is at a “3” on a 1-to-10 scale.
2. The client has a limited ability to ambulate.
3. The client’s left leg is shorter than the right leg.
4. The client ambulates to the bathroom.

Answer 66

1. Minimal pain is expected in a postoperative client but it does indicate surgical treatment is effective.
2. The client should be able to ambulate with almost full mobility.
3. A shorter leg indicates a dislocation of the hip.
4. The hip should have functional motion and client should be able to ambulate to the bathroom. This indicates surgical treatment has been effective.

Question 67

The nurse is caring for a client six (6) hours postoperative right total knee replacement. Which data should the nurse report to the surgeon?

1. A total of 100 mL of red drainage in the autotransfusion drainage system.
2. Pain relief after using the patient-controlled analgesia (PCA) pump.
3. Cool toes, distal pulses palpable, and pale nailbeds bilaterally.
4. Urinary output of 60 mL of clear yellow urine in three (3) hours.

Answer 67

1. Drainage in the first 24 hours can be expected to be 200 to 400 mL. When using an autotransfusion drainage system, the client’s blood will be filtered and returned to the client.
2. Pain relief with the PCA does not require notifying the surgeon.
3. Bilateral coolness of toes is not concerning since both feet are cool. Circulation is not restricted if pulses are present. Seeing pale pink nailbeds indicates blood loss during surgery.
4. The urinary output is not adequate; therefore, the surgeon needs to be notified. This is only 20 mL/hr. The minimum should be 30 mL/hr.

Question 68

The client who had a total knee replacement is being discharged home. To which multidisciplinary team member should the nurse refer the client?

1. The occupational therapist.
2. The physiatrist.
3. The recreational therapist.
4. The home health nurse.

Answer 68

1. The occupational therapist addresses upper extremity activities of daily living, swallowing issues, and cognition. This is not an appropriate referral.
2. The physiatrist is a physician specializing in rehabilitation medicine who practices in a rehabilitation setting.
3. The recreational therapist is used in psychiatric settings, rehabilitation hospitals, and long-term care facilities. The discipline is not seen in the home.
4. The home health care nurse will be able to assess the client in the home and make further referrals if necessary.

Question 69

The nurse is caring for a client with a right total knee repair. Which intervention should the nurse implement?

1. Monitor the continuous passive motion machine.
2. Apply thigh-high TED hose bilaterally.
3. Place the abductor pillow between the legs.
4. Encourage the family to perform ADLs for the client.

Answer 69

1. The CPM machine is used to ensure the client has adequate range of motion in the knee postoperatively.
2. The TED hose are only applied to the unaffected leg, not the leg with the incision.
3. Adductor pillows are used in clients with total hip replacements to maintain function hip alignment.
4. The client should perform as many ADLs as possible. The client should maintain independence as much as possible.

Question 70

The nurse is caring for the client who had a right shoulder replacement. Which data warrant immediate intervention?

1. The client’s hemoglobin is 8.1 g/dL.
2. The client’s white blood cell count is 9,000/mm3.
3. The client’s creatinine level is 0.8 mg/dL.
4. The client’s potassium level is 4.2 mEq/L.

Answer 70

1. The client’s hemoglobin is near 8 g/dL, which indicates the client requires a blood transfusion. This information warrants intervention by the nurse.
2. This white blood cell count is within normal limits, so it does not warrant immediate intervention.
3. The creatinine level is within normal limits and does not warrant intervention.
4. The potassium level is within normal limits and does not require intervention by the nurse.

Question 71

The nurse is assessing the client who is postoperative total knee replacement. Which assessment data warrant immediate intervention?

1. T 99 ̊F, HR 80, RR 20, and BP 128/76.
2. Pain in the unaffected leg during dorsiflexion of the ankle.
3. Bowel sounds heard intermittently in four quadrants.
4. Diffuse, crampy abdominal pain.

Answer 71

1. These vital signs are within normal limits.
2. Pain with dorsiflexion of the ankle indicates deep vein thrombosis. This can be from immobility or surgery; therefore, pain should be assessed in both legs.
3. Bowel sounds are normally intermittent.
4. This type of pain should make the nurse suspect the client has flatus, which is not a life-threatening complication and does not warrant immediate intervention.

Question 72

The nurse is working on an orthopedic floor. Which client should the nurse assess first after the change-of-shift report?

1. The 84-year-old female with a fractured right femoral neck in Buck’s traction.
2. The 64-year-old female with a left total knee replacement who has confusion.
3. The 88-year-old male post–right total hip replacement with an abduction pillow.
4. The 50-year-old postop client with a continuous passive motion (CPM) device.

Answer 72

1. This is a normal treatment of a fractured femoral neck.
2. This is an abnormal occurrence from this information. This client should be seen first because confusion is a symptom of hypoxia.
3. This is a common treatment of a total hip replacement.
4. This is a treatment used for total knee replacement.