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Med-Surg Chap. 42 - 39 -40, 41
Terms in this set (160)
A nurse admits a patient who has a fracture of the nose that has resulted in a skin tear and involvement
of the mucous membranes of the nasal passages. The orthopedic nurse is aware that this description
likely indicates which type of fracture?
A compound fracture involves damage to the skin or mucous membranes and is also called an open fracture. A compression fracture involves compression of bone and is seen in vertebral fractures. An impacted fracture occurs when a bone fragment is driven into another bone fragment. A transverse fracture occurs straight across the bone shaft.
A patient has sustained a long bone fracture and the nurse is preparing the patients care plan. Which of
the following should the nurse include in the care plan?
A) Administer vitamin D and calcium supplements as ordered.
B) Monitor temperature and pulses of the affected extremity.
C) Perform passive range of motion exercises as tolerated.
D) Administer corticosteroids as ordered.
The nurse should include monitoring for sufficient blood supply by assessing the color, temperature, and
pulses of the affected extremity. Weight-bearing exercises are encouraged, but passive ROM exercises
have the potential to cause pain and inhibit healing. Corticosteroids, vitamin D, and calcium are not
A nurses assessment of a patients knee reveals edema, tenderness, muscle spasms, and ecchymosis. The patient states that 2 days ago he ran 10 miles and now it really hurts to stand up. The nurse should plan care based on the belief that the patient has experienced what?
A) A first-degree strain
B) A second-degree strain
C) A first-degree sprain
D) A second-degree sprain
A second-degree strain involves tearing of muscle fibers and is manifested by notable loss of load- bearing strength with accompanying edema, tenderness, muscle spasm, and ecchymosis. A first-degree strain reflects tearing of a few muscle fibers and is accompanied by minor edema, tenderness, and mild
muscle spasm, without noticeable loss of function. However, this patient states a loss of function. A
sprain normally involves twisting, which is inconsistent with the patients overuse injury.
A nurse is preparing to discharge a patient from the emergency department after receiving treatment for
an ankle sprain. While providing discharge education, the nurse should encourage which of the
A) Apply heat for the first 24 to 48 hours after the injury.
B) Maintain the ankle in a dependent position.
C) Exercise hourly by performing rotation exercises of the ankle.
D) Keep an elastic compression bandage on the ankle.
Feedback: Treatment of a sprain consists of resting and elevating the affected part, applying cold, and using a compression bandage. After the acute inflammatory stage (usually 24 to 48 hours after injury), heat may be applied intermittently. Rotation exercises would likely be painful.
A nurse is writing a care plan for a patient admitted to the emergency department (ED) with an open
fracture. The nurse will assign priority to what nursing diagnosis for a patient with an open fracture of
A) Risk for Infection
B) Risk for Ineffective Role Performance
C) Risk for Perioperative Positioning Injury
D) Risk for Powerlessness
The patient has a significant risk for osteomyelitis and tetanus due to the fact that the fracture is open. Powerlessness and ineffective role performance are psychosocial diagnoses that may or may not apply, and which would be superseded by immediate physiologic threats such as infection. Surgical positioning
injury is not plausible, since surgery is not likely indicated.
A nurse is caring for a patient who has suffered a hip fracture and who will require an extended hospital
stay. The nurse should ensure that the patient does which of the following in order to prevent common
complications associated with a hip fracture?
A) Avoid requesting analgesia unless pain becomes unbearable.
B) Use supplementary oxygen when transferring or mobilizing.
C) Increase fluid intake and perform prescribed foot exercises.
D) Remain on bed rest for 14 days or until instructed by the orthopedic surgeon.
Deep vein thrombosis (DVT) is among the most common complications related to a hip fracture. To
prevent DVT, the nurse encourages intake of fluids and ankle and foot exercises. The patient should not
be told to endure pain; a proactive approach to pain control should be adopted. While respiratory
complications commonly include atelectasis and pneumonia, the use of deep-breathing exercises, changes in position at least every 2 hours, and the use of incentive spirometry help prevent the
respiratory complications more than using supplementary oxygen. Bed rest may be indicated in the short term, but is not normally required for 14 days.
A nurse is caring for a patient who has suffered an unstable thoracolumbar fracture. Which of the
following is the priority during nursing care?
A) Preventing infection
B) Maintaining spinal alignment
C) Maximizing function
D) Preventing increased intracranial pressure
Patients with an unstable fracture must have their spine in alignment at all times in order to prevent
neurologic damage. This is a greater threat, and higher priority, than promoting function and preventing
infection, even though these are both valid considerations. Increased ICP is not a high risk.
The patient scheduled for a Syme amputation is concerned about the ability to eventually stand on the
amputated extremity. How should the nurse best respond to the patients concern?
A) You will eventually be able to withstand full weight-bearing after the amputation.
B) You will have minimal weight-bearing on this extremity but youll be taught how to use an assistive
C) You likely will not be able to use this extremity but you will receive teaching on use of a
D) You will be fitted for a prosthesis which may or may not allow you to walk.
Syme amputation (modified ankle disarticulation amputation) is performed most frequently for extensive
foot trauma and produces a painless, durable extremity end that can withstand full weight-bearing. Therefore, each of the other teaching statements is incorrect.
A patient with a simple arm fracture is receiving discharge education from the nurse. What would the
nurse instruct the patient to do?
A) Elevate the affected extremity to shoulder level when at rest.
B) Engage in exercises that strengthen the unaffected muscles.
C) Apply topical anesthetics to accessible skin surfaces as needed.
D) Avoid using analgesics so that further damage is not masked.
The nurse will encourage the patient to engage in exercises that strengthen the unaffected muscles. Comfort measures may include appropriate use of analgesics and elevation of the affected extremity to the heart level. Topical anesthetics are not typically used
Six weeks after an above-the-knee amputation (AKA), a patient returns to the outpatient office for a
routine postoperative checkup. During the nurses assessment, the patient reports symptoms of phantom
pain. What should the nurse tell the patient to do to reduce the discomfort of the phantom pain?
A) Apply intermittent hot compresses to the area of the amputation.
B) Avoid activity until the pain subsides.
C) Take opioid analgesics as ordered.
D) Elevate the level of the amputation site.
Opioid analgesics may be effective in relieving phantom pain. Heat, immobility, and elevation are not
noted to relieve this form of pain.
A nurse is caring for a patient who had a right below-the-knee amputation (BKA). The nurse recognizes
the importance of implementing measures that focus on preventing flexion contracture of the hip and
maintaining proper positioning. Which of the following measures will best achieve these goals?
A) Encouraging the patient to turn from side to side and to assume a prone position
B) Initiating ROM exercises of the hip and knee 10 to 12 weeks after the amputation
C) Minimizing movement of the flexor muscles of the hip
D) Encouraging the patient to sit in a chair for at least 8 hours a day
The nurse encourages the patient to turn from side to side and to assume a prone position, if possible, to
stretch the flexor muscles and to prevent flexion contracture of the hip. Postoperative ROM exercises are
started early, because contracture deformities develop rapidly. ROM exercises include hip and knee
exercises for patients with BKAs. The nurse also discourages sitting for prolonged periods of time.
A nurse is preparing to discharge an emergency department patient who has been fitted with a sling to
support her arm after a clavicle fracture. What should the nurse instruct the patient to do?
A) Elevate the arm above the shoulder 3 to 4 times daily.
B) Avoid moving the elbow, wrist, and fingers until bone remodeling is complete.
C) Engage in active range of motion using the affected arm.
D) Use the arm for light activities within the range of motion.
A patient with a clavicle fracture may use a sling to support the arm and relieve the pain. The patient
may be permitted to use the arm for light activities within the range of comfort. The patient should not
elevate the arm above the shoulder level until the ends of the bones have united, but the nurse should
encourage the patient to exercise the elbow, wrist, and fingers.
The orthopedic nurse should assess for signs and symptoms of Volkmanns contracture if a patient has
fractured which of the following bones?
C) Radial head
The most serious complication of a supracondylar fracture of the humerus is Volkmanns ischemic
contracture, which results from antecubital swelling or damage to the brachial artery. This complication
is specific to humeral fractures.
An emergency department nurse is assessing a 17-year-old soccer player who presented with a knee
injury. The patients description of the injury indicates that his knee was struck medially while his foot
was on the ground. The nurse knows that the patient likely has experienced what injury?
A) Lateral collateral ligament injury
B) Medial collateral ligament injury
C) Anterior cruciate ligament injury
D) Posterior cruciate ligament injury
When the knee is struck medially, damage may occur to the lateral collateral ligament. If the knee is
struck laterally, damage may occur to the medial collateral ligament. The ACL and PCL are not typically
injured in this way.
A school nurse is assessing a student who was kicked in the shin during a soccer game. The area of the
injury has become swollen and discolored. The triage nurse recognizes that the patient has likely
A contusion is a soft-tissue injury that results in bleeding into soft tissues, creating a hematoma and
ecchymosis. A sprain is an injury to ligaments caused by wrenching or twisting. A strain is a muscle pull
from overuse, overstretching, or excessive stress. A dislocation is a condition in which the articular
surfaces of the bones forming a joint are no longer in anatomic contact. Because the injury is not at the
site of a joint, the patient has not experienced a sprain, strain, or dislocation.
Radiographs of a boys upper arm show that the humerus appears to be fractured on one side and slightly
bent on the other. This diagnostic result suggests what type of fracture?
Greenstick fractures are an incomplete fracture that results in the bone being broken on one side, while
the other side is bent. This is not characteristic of an impacted, compound, or compression fracture.
A nurse is performing a shift assessment on an elderly patient who is recovering after surgery for a hip
fracture. The nurse notes that the patient is complaining of chest pain, has an increased heart rate, and
increased respiratory rate. The nurse further notes that the patient is febrile and hypoxic, coughing, and
producing large amounts of thick, white sputum. The nurse recognizes that this is a medical emergency
and calls for assistance, recognizing that this patient is likely demonstrating symptoms of what
A) Avascular necrosis of bone
B) Compartment syndrome
C) Fat embolism syndrome
D) Complex regional pain syndrome
Fat embolism syndrome occurs most frequently in young adults and elderly patients who experience
fractures of the proximal femur (i.e., hip fracture). Presenting features of fat embolism syndrome include
hypoxia, tachypnea, tachycardia, and pyrexia. The respiratory distress response includes tachypnea, dyspnea, wheezes, precordial chest pain, cough, large amounts of thick, white sputum, and tachycardia. Avascular necrosis (AVN) occurs when the bone loses its blood supply and dies. This does not cause
coughing. Complex regional pain syndrome does not have cardiopulmonary involvement.
A young patient is being treated for a femoral fracture suffered in a snowboarding accident. The nurses
most recent assessment reveals that the patient is uncharacteristically confused. What diagnostic test
should be performed on this patient?
A) Electrolyte assessment
C) Arterial blood gases
D) Abdominal ultrasound
Subtle personality changes, restlessness, irritability, or confusion in a patient who has sustained a fracture are indications for immediate arterial blood gas studies due to the possibility of fat embolism syndrome. This assessment finding does not indicate an immediate need for electrolyte levels, an ECG, or abdominal ultrasound.
Which of the following is the most appropriate nursing intervention to facilitate healing in a patient who
has suffered a hip fracture?
A) Administer analgesics as required.
B) Place a pillow between the patients legs when turning.
C) Maintain prone positioning at all times.
D) Encourage internal and external rotation of the affected leg.
Placing a pillow between the patients legs when turning prevents adduction and supports the patients
legs. Administering analgesics addresses pain but does not directly protect bone remodeling and
promote healing. Rotation of the affected leg can cause dislocation and must be avoided. Prone
positioning does not need to be maintained at all times.
A nurse is planning the care of an older adult patient who will soon be discharged home after treatment
for a fractured hip. In an effort to prevent future fractures, the nurse should encourage which of the
following? Select all that apply.
A) Regular bone density testing
B) A high-calcium diet
C) Use of falls prevention precautions
D) Use of corticosteroids as ordered
E) Weight-bearing exercise
A, B, C, E
Health promotion measures after an older adults hip fracture include weight-bearing exercise, promotion of a healthy diet, falls prevention, and bone density testing. Corticosteroids have the potential to reduce bone density and increase the risk for fractures.
A patient is brought to the emergency department by ambulance after stepping in a hole and falling. While assessing him the nurse notes that his right leg is shorter than his left leg; his right hip is
noticeably deformed and he is in acute pain. Imaging does not reveal a fracture. Which of the following
is the most plausible explanation for this patients signs and symptoms?
A) Subluxated right hip
B) Right hip contusion
C) Hip strain
D) Traumatic hip dislocation
Signs and symptoms of a traumatic dislocation include acute pain, change in positioning of the joint, shortening of the extremity, deformity, and decreased mobility. A subluxation would cause moderate
deformity, or possibly no deformity. A contusion or strain would not cause obvious deformities.
An emergency department patient is diagnosed with a hip dislocation. The patients family is relieved
that the patient has not suffered a hip fracture, but the nurse explains that this is still considered to be a
medical emergency. What is the rationale for the nurses statement?
A) The longer the joint is displaced, the more difficult it is to get it back in place.
B) The patients pain will increase until the joint is realigned.
C) Dislocation can become permanent if the process of bone remodeling begins.
D) Avascular necrosis may develop at the site of the dislocation if it is not promptly resolved
If a dislocation or subluxation is not reduced immediately, avascular necrosis (AVN) may develop. Bone remodeling does not take place because a fracture has not occurred. Realignment does not become more difficult with time and pain would subside with time, not become worse.
The surgical nurse is admitting a patient from postanesthetic recovery following the patients below-the- knee amputation. The nurse recognizes the patients high risk for postoperative hemorrhage and should keep which of the following at the bedside?
A) A tourniquet
B) A syringe preloaded with vitamin K
C) A unit of packed red blood cells, placed on ice
D) A dose of protamine sulfate
Immediate postoperative bleeding may develop slowly or may take the form of massive hemorrhage
resulting from a loosened suture. A large tourniquet should be in plain sight at the patients bedside so
that, if severe bleeding occurs, it can be applied to the residual limb to control the hemorrhage. PRBCs
cannot be kept at the bedside. Vitamin K and protamine sulfate are antidotes to warfarin and heparin, but
are not administered to treat active postsurgical bleeding.
An elite high school football player has been diagnosed with a shoulder dislocation. The patient has been
treated and is eager to resume his role on his team, stating that he is not experiencing pain. What should
the nurse emphasize during health education?
A) The need to take analgesia regardless of the short-term absence of pain
B) The importance of adhering to the prescribed treatment and rehabilitation regimen
C) The fact that he has a permanently increased risk of future shoulder dislocations
D) The importance of monitoring for intracapsular bleeding once he resumes playing
Patients who have experienced sports-related injuries are often highly motivated to return to their
previous level of activity. Adherence to restriction of activities and gradual resumption of activities
needs to be reinforced. Appropriate analgesia use must be encouraged, but analgesia does not
necessarily have to be taken in the absence of pain. If healing is complete, the patient does not likely
have a greatly increased risk of reinjury. Dislocations rarely cause bleeding after the healing process.
. A patient has presented to the emergency department with an injury to the wrist. The patient is
diagnosed with a third-degree strain. Why would the physician order an x-ray of the wrist?
A) Nerve damage is associated with third-degree strains.
B) Compartment syndrome is associated with third-degree strains.
C) Avulsion fractures are associated with third-degree strains.
D) Greenstick fractures are associated with third-degree strains
An x-ray should be obtained to rule out bone injury, because an avulsion fracture (in which a bone
fragment is pulled away from the bone by a tendon) may be associated with a third-degree strain. Nerve
damage, compartment syndrome, and greenstick fractures are not associated with third-degree strains.
A 20 year-old is brought in by ambulance to the emergency department after being involved in a
motorcycle accident. The patient has an open fracture of his tibia. The wound is highly contaminated and
there is extensive soft-tissue damage. How would this patients fracture likely be graded?
A) Grade I
B) Grade II
C) Grade III
Open fractures are graded according to the following criteria. Grade I is a clean wound less than 1 cm
long. Grade II is a larger wound without extensive soft-tissue damage. Grade III is highly contaminated, has extensive soft-tissue damage, and is the most severe. There is no grade IV fracture.
A 25-year-old man is involved in a motorcycle accident and injures his arm. The physician diagnoses the
man with an intra-articular fracture and splints the injury. The nurse implements the teaching plan
developed for this patient. What sequela of intra-articular fractures should the nurse describe regarding
A) Post-traumatic arthritis
B) Fat embolism syndrome (FES)
D) Compartment syndrome
Intra-articular fractures often lead to post-traumatic arthritis. Research does not indicate a correlation
between intra-articular fractures and FES, osteomyelitis, or compartment syndrome.
A nurse is planning the care of a patient with osteomyelitis that resulted from a diabetic foot ulcer. The
patient requires a transmetatarsal amputation. When planning the patients postoperative care, which of
the following nursing diagnoses should the nurse most likely include in the plan of care?
A) Ineffective Thermoregulation
B) Risk-Prone Health Behavior
C) Disturbed Body Image
D) Deficient Diversion Activity
Amputations present a serious threat to any patients body image. None of the other listed diagnoses is
specifically associated with amputation.
A patient is admitted to the orthopedic unit with a fractured femur after a motorcycle accident. The
patient has been placed in traction until his femur can be rodded in surgery. For what early
complications should the nurse monitor this patient? Select all that apply.
A) Systemic infection
B) Complex regional pain syndrome
C) Deep vein thrombosis
D) Compartment syndrome
E) Fat embolism
C, D, E
Early complications include shock, fat embolism, compartment syndrome, and venous thromboemboli
(deep vein thrombosis [DVT], pulmonary embolism [PE]). Infection and CRPS are later complications
A patient has come to the orthopedic clinic for a follow-up appointment 6 weeks after fracturing his
ankle. Diagnostic imaging reveals that bone union is not taking place. What factor may have contributed
to this complication?
A) Inadequate vitamin D intake
B) Bleeding at the injury site
C) Inadequate immobilization
D) Venous thromboembolism (VTE)
Inadequate fracture immobilization can delay or prevent union. A short-term vitamin D deficiency
would not likely prevent bone union. VTE is a serious complication but would not be a cause of
nonunion. Similarly, bleeding would not likely delay union.
An older adult patient has fallen in her home and is brought to the emergency department by ambulance
with a suspected fractured hip. X-rays confirm a fracture of the left femoral neck. When planning
assessments during the patients presurgical care, the nurse should be aware of the patients heightened
risk of what complication?
B) Avascular necrosis
C) Phantom pain
Fractures of the neck of the femur may damage the vascular system that supplies blood to the head and
the neck of the femur, and the bone may become ischemic. For this reason, AVN is common in patients
with femoral neck fractures. Infections are not immediate complications and phantom pain applies to patients with amputations, not hip fractures.
A patient is being treated for a fractured hip and the nurse is aware of the need to implement
interventions to prevent muscle wasting and other complications of immobility. What intervention best
addresses the patients need for exercise?
A) Performing gentle leg lifts with both legs
B) Performing massage to stimulate circulation
C) Encouraging frequent use of the overbed trapeze
D) Encouraging the patient to log roll side to side once per hour
Feedback: The patient is encouraged to exercise as much as possible by means of the overbed trapeze. This device helps strengthen the arms and shoulders in preparation for protected ambulation. Independent logrolling may result in injury due to the location of the fracture. Leg lifts would be contraindicated for the same reason. Massage by the nurse is not a substitute for exercise.
A patient who has had an amputation is being cared for by a multidisciplinary rehabilitation team. What
is the primary goal of this multidisciplinary team?
A) Maximize the efficiency of care
B) Ensure that the patients health care is holistic
C) Facilitate the patients adjustment to a new body image
D) Promote the patients highest possible level of function
The multidisciplinary rehabilitation team helps the patient achieve the highest possible level of function
and participation in life activities. The team is not primarily motivated by efficiency, the need for
holistic care, or the need to foster the patients body image, despite the fact that each of these are valid
A rehabilitation nurse is working with a patient who has had a below-the-knee amputation. The nurse
knows the importance of the patients active participation in self-care. In order to determine the patients
ability to be an active participant in self-care, the nurse should prioritize assessment of what variable?
A) The patients attitude
B) The patients learning style
C) The patients nutritional status
D) The patients presurgical level of function
Amputation of an extremity affects the patients ability to provide adequate self-care. The patient is
encouraged to be an active participant in self-care. The patient and the nurse need to maintain positive
attitudes and to minimize fatigue and frustration during the learning process. Balanced nutrition and the
patients learning style are important variables in the rehabilitation process but the patients attitude is
among the most salient variables. The patients presurgical level of function may or may not affect
participation in rehabilitation.
The nurse is providing care for a patient who has had a below-the-knee amputation. The nurse enters the
patients room and finds him resting in bed with his residual limb supported on pillow. What is the nurses
most appropriate action?
A) Inform the surgeon of this finding.
B) Explain the risks of flexion contracture to the patient.
C) Transfer the patient to a sitting position.
D) Encourage the patient to perform active ROM exercises with the residual limb.
The residual limb should not be placed on a pillow, because a flexion contracture of the hip may result. There is no acute need to contact the patients surgeon. Encouraging exercise or transferring the patient
does not address the risk of flexion contracture.
A patient has returned to the postsurgical unit from the PACU after an above-the-knee amputation of the right leg. Results of the nurses initial postsurgical assessment were unremarkable but the patient has called out. The nurse enters the room and observes copious quantities of blood at the surgical site. What should be the nurses initial action?
A) Apply a tourniquet.
B) Elevate the residual limb.
C) Apply sterile gauze.
D) Call the surgeon.
The nurse should apply a tourniquet in the event of postsurgical hemorrhage. Elevating the limb and
applying sterile gauze are likely insufficient to stop the hemorrhage. The nurse should attempt to control
the immediate bleeding before contacting the surgeon.
A nurse in a busy emergency department provides care for many patients who present with contusions, strains, or sprains. Treatment modalities that are common to all of these musculoskeletal injuries include
which of the following? Select all that apply.
B) Applying ice
C) Compression dressings
D) Resting the affected extremity
F) Elevating the injured limb
B, C, D, F
Treatment of contusions, strains, and sprains consists of resting and elevating the affected part, applying
cold, and using a compression bandage. Massage and corticosteroids are not used to treat these injuries.
A patient who has undergone a lower limb amputation is preparing to be discharged home. What
outcome is necessary prior to discharge?
A) Patient can demonstrate safe use of assistive devices.
B) Patient has a healed, nontender, nonadherent scar.
C) Patient can perform activities of daily living independently.
D) Patientis free of pain.
A patient should be able to use assistive devices appropriately and safely prior to discharge. Scar
formation will not be complete at the time of hospital discharge. It is anticipated that the patient will
require some assistance with ADLs postdischarge. Pain should be well managed, but may or may not be
An older adult patient experienced a fall and required treatment for a fractured hip on the orthopedic
unit. Which of the following are contributory factors to the incidence of falls and fractured hips among
the older adult population? Select all that apply.
A) Loss of visual acuity
B) Adverse medication effects
C) Slowed reflexes
D) Hearing loss
E) Muscle weakness
A, B, C, E
Older adults are generally vulnerable to falls and have a high incidence of hip fracture. Weak quadriceps
muscles, medication effects, vision loss, and slowed reflexes are among the factors that contribute to the
incidence of falls. Decreased hearing is not noted to contribute to the incidence of falls.
A patient was fitted with an arm cast after fracturing her humerus. Twelve hours after the application of
the cast, the patient tells the nurse that her arm hurts. Analgesics do not relieve the pain. What would be
the most appropriate nursing action?
A) Prepare the patient for opening or bivalving of the cast.
B) Obtain an order for a different analgesic.
C) Encourage the patient to wiggle and move the fingers.
D) Petal the edges of the patients cast.
Acute compartment syndrome involves a sudden and severe decrease in blood flow to the tissues distal
to an area of injury that results in ischemic necrosis if prompt, decisive intervention does not occur. Removing or bivalving the cast is necessary to relieve pressure. Ordering different analgesics does not
address the underlying problem. Encouraging the patient to move the fingers or perform range-of-motion
exercises will not treat or prevent compartment syndrome. Petaling the edges of a cast with tape prevents
abrasions and skin breakdown, not compartment syndrome.
A nurse on the orthopedic unit is assessing a patients peroneal nerve. The nurse will perform this assessment by doing which of the following actions?
A) Pricking the skin between the great and second toe
B) Stroking the skin on the sole of the patients foot
C) Pinching the skin between the thumb and index finger
D) Stroking the distal fat pad of the small finger
A public health nurse is organizing a campaign that will address the leading cause of musculoskeletalrelated disability in the United States. The nurse should focus on what health problem?
C) Hip fractures
D) Lower back pain
A nurse is providing care for a patient whose pattern of laboratory testing reveals longstanding hypocalcemia. What other laboratory result is most consistent with this finding?
A) An elevated parathyroid hormone level
B) An increased calcitonin level
C) An elevated potassium level
D) A decreased vitamin D level
A nurse is caring for a patient whose cancer metastasis has resulted in bone pain. Which of the following are typical characteristics of bone pain?
A) A dull, deep ache that is boring in nature
B) Soreness or aching that may include cramping
C) Sharp, piercing pain that is relieved by immobilization
D) Spastic or sharp pain that radiates
A nurse is assessing a patient who is experiencing peripheral neurovascular dysfunction. What assessment findings are most consistent with this diagnosis?
A) Hot skin with a capillary refill of 1 to 2 seconds
B) Absence of feeling, capillary refill of 4 to 5 seconds, and cool skin
C) Pain, diaphoresis, and erythema
D) Jaundiced skin, weakness, and capillary refill of 3 seconds
An older adult patient has symptoms of osteoporosis and is being assessed during her annual physical examination. The assessment shows that the patient will require further testing related to a possible exacerbation of her osteoporosis. The nurse should anticipate what diagnostic test?
A) Bone densitometry
B) Hip bone radiography
C) Computed tomography (CT)
D) Magnetic resonance imaging (MRI)
A patient injured in a motor vehicle accident has sustained a fracture to the diaphysis of the right femur. Of what is the diaphysis of the femur mainly constructed?
C) Cortical bone
D) Cancellous bone
An older adult patient has come to the clinic for a regular check-up. The nurses initial inspection reveals an increased thoracic curvature of the patients spine. The nurse should document the presence of which of the following?
When assessing a patients peripheral nerve function, the nurse uses an instrument to prick the fat pad at the top of the patients small finger. This action will assess which of the following nerves?
The results of a nurses musculoskeletal examination show an increase in the lumbar curvature of the spine. The nurse should recognize the presence of what health problem?
The human body is designed to protect its vital parts. A fracture of what type of bone may interfere with the protection of vital organs? A) Long bones
B) Short bones
C) Flat bones
D) Irregular bones
A patient has just had an arthroscopy performed to assess a knee injury. What nursing intervention should the nurse implement following this procedure?
A) Wrap the joint in a compression dressing.
B) Perform passive range of motion exercises.
C) Maintain the knee in flexion for up to 30 minutes.
D) Apply heat to the knee.
While assessing a patient, the patient tells the nurse that she is experiencing rhythmic muscle contractions when the nurse performs passive extension of her wrist. What is this pattern of muscle contraction referred to as?
A nurse is caring for an older adult who has been diagnosed with geriatric failure to thrive. This patients prolonged immobility creates a risk for what complication?
A) Muscle clonus
B) Muscle atrophy
C) Rheumatoid arthritis
D) Muscle fasciculations
A nurse is caring for a patient who has been scheduled for a bone scan. What should the nurse teach the patient about this diagnostic test?
A) The test is brief and requires that you drink a calcium solution 2 hours before the test.
B) You will not be allowed fluid for 2 hours before and 3 hours after the test.
C) Youll be encouraged to drink water after the administration of the radioisotope injection.
D) This is a common test that can be safely performed on anyone.
A nurse is assessing a child who has a diagnosis of muscular dystrophy. Assessment reveals that the childs muscles have greater-than-normal tone. The nurse should document the presence of which of the following?
The nurses comprehensive assessment of an older adult involves the assessment of the patients gait. How should the nurse best perform this assessment?
A) Instruct the patient to walk heel-to-toe for 15 to 20 steps.
B) Instruct the patient to walk in a straight line while not looking at the floor.
C) Instruct the patient to walk away from the nurse for a short distance and then toward the nurse.
D) Instruct the patient to balance on one foot for as long as possible and then walk in a circle around the room.
A clinic nurse is caring for a patient with a history of osteoporosis. Which of the following diagnostic tests best allows the care team to assess the patients risk of fracture?
B) Bone scan
C) Bone densitometry
A nurse is performing a musculoskeletal assessment of a patient with arthritis. During passive range-of- motion exercises, the nurse hears an audible grating sound. The nurse should document the presence of which of the following?
A patients fracture is healing and callus is being deposited in the bone matrix. This process characterizes what phase of the bone healing process?
A) The reparative phase
B) The reactive phase
C) The remodeling phase
D) The revascularization phase
A child is growing at a rate appropriate for his age. What cells are responsible for the secretion of bone matrix that eventually results in bone growth?
A nurse is caring for a patient who has an MRI scheduled. What is the priority safety action prior to this diagnostic procedure?
A) Assessing the patient for signs and symptoms of active infection
B) Ensuring that the patient can remain immobile for up to 3 hours
C) Assessing the patient for a history of nut allergies
D) Ensuring that there are no metal objects on or in the patient
A nurse is taking a health history on a patient with musculoskeletal dysfunction. What is the primary focus of this phase of the nurses assessment?
A) Evaluating the effects of the musculoskeletal disorder on the patients function
B) Evaluating the patients adherence to the existing treatment regimen
C) Evaluating the presence of genetic risk factors for further musculoskeletal disorders
D) Evaluating the patients active and passive range of motion
A patient is scheduled for a bone scan to rule out osteosarcoma of the pelvic bones. What would be most important for the nurse to assess before the patients scan?
A) That the patient completed the bowel cleansing regimen
B) That the patient emptied the bladder
C) That the patient is not allergic to penicillins
D) That the patient has fasted for at least 8 hours
A nurse is explaining a patients decreasing bone density in terms of the balance between bone resorption and formation. What dietary nutrients and hormones play a role in the resorption and formation of adult bones? Select all that apply.
A) Thyroid hormone
B) Growth hormone
D) Vitamin B12
E) Luteinizing hormone
A, B, C
Diagnostic tests show that a patients bone density has decreased over the past several years. The patient asks the nurse what factors contribute to bone density decreasing. What would be the nurses best response?
A) For many people, lack of nutrition can cause a loss of bone density.
B) Progressive loss of bone density is mostly related to your genes.
C) Stress is known to have many unhealthy effects, including reduced bone density.
D) Bone density decreases with age, but scientists are not exactly sure why this is the case.
A bone biopsy has just been completed on a patient with suspected bone metastases. What assessment should the nurse prioritize in the immediate recovery period?
A) Assessment for dehiscence at the biopsy site
B) Assessment for pain
C) Assessment for hematoma formation
D) Assessment for infection
A nurse is taking a health history on a new patient who has been experiencing unexplained paresthesia. What question should guide the nurses assessment of the patients altered sensations?
A) How does the strength in the affected extremity compare to the strength in the unaffected extremity?
B) Does the color in the affected
extremity match the color in the unaffected extremity?
C) How does the feeling in the affected extremity compare with the feeling in the unaffected extremity?
D) Does the patient have a family history of paresthesia or other forms of altered sensation?
The nurse is assessing a patient for dietary factors that may influence her risk for osteoporosis. The nurse should question the patient about her intake of what nutrients? Select all that apply.
B) Simple carbohydrates
E) Soluble fiber
The nurse is performing an assessment of a patients musculoskeletal system and is appraising the patients bone integrity. What action should the nurse perform during this phase of assessment?
A) Compare parts of the body symmetrically.
B) Assess extremities when in motion rather than at rest.
C) Percuss as many joints as are accessible.
D) Administer analgesia 30 to 60 minutes before assessment.
A nurse is performing a nursing assessment of a patient suspected of having a musculoskeletal disorder. What is the primary focus of the nursing assessment with a patient who has a musculoskeletal disorder?
A) Range of motion
B) Activities of daily living
A nurses assessment of a teenage girl reveals that her shoulders are not level and that she has one prominent scapula that is accentuated by bending forward. The nurse should expect to read about what health problem in the patients electronic health record?
D) Muscular dystrophy
A patient is receiving ongoing nursing care for the treatment of Parkinsons disease. When assessing this patients gait, what finding is most closely associated with this health problem?
A) Spastic hemiparesis gait
B) Shuffling gait
C) Rapid gait
D) Steppage gait
A nurse is caring for a patient who has just had an arthroscopy as an outpatient and is getting ready to go home. The nurse should teach the patient to monitor closely for what postprocedure complication?
D) Synovial fluid leakage
A patient is undergoing diagnostic testing for suspected Pagets disease. What assessment finding is most consistent with this diagnosis?
A) Altered serum magnesium levels
B) Altered serum calcium levels
C) Altered serum potassium levels
D) Altered serum sodium levels
A nurse is caring for a patient with a diagnosis of cancer that has metastasized. What laboratory value would the nurse expect to be elevated in this patient?
C) Alkaline phosphatase
A patient has had a cast placed for the treatment of a humeral fracture. The nurses most recent assessment shows signs and symptoms of compartment syndrome. What is the nurses most appropriate action?
A) Arrange for a STAT assessment of the patients serum calcium levels.
B) Perform active range of motion exercises.
C) Assess the patients joint function symmetrically.
D) Contact the primary care provider immediately.
A patient has been experiencing an unexplained decline in knee function and has consequently been scheduled for arthrography. The nurse should teach the patient about what process?
A) Injection of a contrast agent into the knee joint prior to ROM exercises
B) Aspiration of synovial fluid for serologic testing
C) Injection of corticosteroids into the patients knee joint to facilitate ROM
D) Replacement of the patients synovial fluid with a synthetic substitute
The nurses musculoskeletal assessment of a patient reveals involuntary twitching of muscle groups. How would the nurse document this observation in the patients chart?
A patient has been experiencing progressive increases in knee pain and diagnostic imaging reveals a worsening effusion in the synovial capsule. The nurse should anticipate which of the following?
B) Knee biopsy
A nurse is caring for a patient who has had a plaster arm cast applied. Immediately postapplication, the nurse should provide what teaching to the patient?
A) The cast will feel cool to touch for the first 30 minutes.
B) The cast should be wrapped snuggly with a towel until the patient gets home.
C) The cast should be supported on a board while drying.
D) The cast will only have full strength when dry
A patient broke his arm in a sports accident and required the application of a cast. Shortly following application, the patient complained of an inability to straighten his fingers and was subsequently diagnosed with Volkmann contracture. What pathophysiologic process caused this complication?
A) Obstructed arterial blood flow to the forearm and hand
B) Simultaneous pressure on the ulnar and radial nerves
C) Irritation of Merkel cells in the patients skin surfaces
D) Uncontrolled muscle spasms in the patients forearm
A patient is admitted to the unit in traction for a fractured proximal femur and requires traction prior to surgery. What is the most appropriate type of traction to apply to a fractured proximal femur?
A) Russells traction
B) Dunlops traction
C) Bucks extension traction
D) Cervical head halter
A nurse is caring for a patient who is in skeletal traction. To prevent the complication of skin breakdown in a patient with skeletal traction, what action should be included in the plan of care?
A) Apply occlusive dressings to the pin sites.
B) Encourage the patient to push up with the elbows when repositioning.
C) Encourage the patient to perform isometric exercises once a shift.
D) Assess the pin insertion site every 8 hours
A nurse is caring for a patient who is postoperative day 1 right hip replacement. How should the nurse position the patient?
A) Keep the patients hips in abduction at all times.
B) Keep hips flexed at no less than 90 degrees.
C) Elevate the head of the bed to high Fowlers.
D) Seat the patient in a low chair as soon as possible.
While assessing a patient who has had knee replacement surgery, the nurse notes that the patient has developed a hematoma at the surgical site. The affected leg has a decreased pedal pulse. What would be the priority nursing diagnosis for this patient?
A) Risk for Infection
B) Risk for Peripheral Neurovascular Dysfunction
C) Unilateral Neglect
D) Disturbed Kinesthetic Sensory Perception
A patient was brought to the emergency department after a fall. The patient is taken to the operating room to receive a right hip prosthesis. In the immediate postoperative period, what health education should the nurse emphasize?
A) Make sure you dont bring your knees close together.
B) Try to lie as still as possible for the first few days.
C) Try to avoid bending your knees until next week.
D) Keep your legs higher than your chest whenever you can.
A patient with a fractured femur is in balanced suspension traction. The patient needs to be repositioned toward the head of the bed. During repositioning, what should the nurse do?
A) Place slight additional tension on the traction cords.
B) Release the weights and replace them immediately after positioning.
C) Reposition the bed instead of repositioning the patient.
D) Maintain consistent traction tension while repositioning.
A patient with a total hip replacement is progressing well and expects to be discharged tomorrow. On returning to bed after ambulating, he complains of a new onset of pain at the surgical site. What is the nurses best action?
A) Administer pain medication as ordered.
B) Assess the surgical site and the affected extremity.
C) Reassure the patient that pain is a direct result of increased activity.
D) Assess the patient for signs and symptoms of systemic infection.
A nurse is caring for a patient who has a leg cast. The nurse observes that the patient uses a pencil to scratch the skin under the edge of the cast. How should the nurse respond to this observation?
A) Allow the patient to continue to scratch inside the cast with a pencil but encourage him to be cautious.
B) Give the patient a sterile tongue depressor to use for scratching instead of the pencil.
C) Encourage the patient to avoid scratching, and obtain an order for an antihistamine if severe itching persists.
D) Obtain an order for a sedative, such as lorazepam (Ativan), to prevent the patient from scratching.
The nurse is caring for a patient who underwent a total hip replacement yesterday. What should the nurse do to prevent dislocation of the new prosthesis?
A) Keep the affected leg in a position of adduction.
B) Have the patient reposition himself independently.
C) Protect the affected leg from internal rotation.
D) Keep the hip flexed by placing pillows under the patients knee.
A patient is complaining of pain in her casted leg. The nurse has administered analgesics and elevated the limb. Thirty minutes after administering the analgesics, the patient states the pain is unrelieved. The nurse should identify the warning signs of what complication?
A) Subcutaneous emphysema
B) Skin breakdown
C) Compartment syndrome
D) Disuse syndrome
The nurse educator on an orthopedic trauma unit is reviewing the safe and effective use of traction with some recent nursing graduates. What principle should the educator promote?
A) Knots in the rope should not be resting against pulleys.
B) Weights should rest against the bed rails.
C) The end of the limb in traction should be braced by the footboard of the bed.
D) Skeletal traction may be removed for brief periods to facilitate the patients independence.
The orthopedic surgeon has prescribed balanced skeletal traction for a patient. What advantage is conferred by balanced traction?
A) Balanced traction can be applied at night and removed during the day.
B) Balanced traction allows for greater patient movement and independence than other forms of traction.
C) Balanced traction is portable and may accompany the patients movements.
D) Balanced traction facilitates bone remodeling in as little as 4 days.
The nursing care plan for a patient in traction specifies regular assessments for venous thromboembolism (VTE). When assessing a patients lower limbs, what sign or symptom is suggestive of deep vein thrombosis (DVT)?
A) Increased warmth of the calf
B) Decreased circumference of the calf
C) Loss of sensation to the calf
D) Pale-appearing calf
A nurse is providing discharge education to a patient who is going home with a cast on his leg. What teaching point should the nurse emphasize in the teaching session?
A) Using crutches efficiently
B) Exercising joints above and below the cast, as ordered
C) Removing the cast correctly at the end of the treatment period
D) Reporting signs of impaired circulation
A patient with a right tibial fracture is being discharged home after having a cast applied. What instruction should the nurse provide in relationship to the patients cast care?
A) Cover the cast with a blanket until the cast dries.
B) Keep your right leg elevated above heart level.
C) Use a clean object to scratch itches inside the cast.
D) A foul smell from the cast is normal after the first few days.
An elderly patients hip joint is immobilized prior to surgery to correct a femoral head fracture. What is the nurses priority assessment?
A) The presence of leg shortening
B) The patients complaints of pain
C) Signs of neurovascular compromise
D) The presence of internal or external rotation
A nurse is caring for a patient who has had a total hip replacement. The nurse is reviewing health education prior to discharge. Which of the patients statements would indicate to the nurse that the patient requires further teaching?
A) Ill need to keep several pillows between my legs at night.
B) I need to remember not to cross my legs. Its such a habit.
C) The occupational therapist is showing me how to use a sock puller to help me get dressed.
D) I will need my husband to assist me in getting off the low toilet seat at home.
A nurse is admitting a patient to the unit who presented with a lower extremity fracture. What signs and symptoms would suggest to the nurse that the patient may have aperoneal nerve injury?
A) Numbness and burning of the foot
B) Pallor to the dorsal surface of the foot
C) Visible cyanosis in the toes
D) Inadequate capillary refill to the toes
A patient has suffered a muscle strain and is complaining of pain that she rates at 6 on a 10-point scale. The nurse should recommend what action?
A) Taking an opioid analgesic as ordered
B) Applying a cold pack to the injured site
C) Performing passive ROM exercises
D) Applying a heating pad to the affected muscle
A patient has had a brace prescribed to facilitate recovery from a knee injury. What are the potential therapeutic benefits of a brace? Select all that apply.
A) Preventing additional injury
B) Immobilizing prior to surgery
C) Providing support
D) Controlling movement
E) Promoting bone remodeling
A, C, D
A nurse is assessing the neurovascular status of a patient who has had a leg cast recently applied. The nurse is unable to palpate the patients dorsalis pedis or posterior tibial pulse and the patients foot is pale. What is the nurses most appropriate action?
A) Warm the patients foot and determine whether circulation improves.
B) Reposition the patient with the affected foot dependent.
C) Reassess the patients neurovascular status in 15 minutes.
D) Promptly inform the primary care provider.
A physician writes an order to discontinue skeletal traction on an orthopedic patient. The nurse should anticipate what subsequent intervention?
A) Application of a walking boot
B) Application of a cast
C) Education on how to use crutches
D) Passive range of motion exercises
A patient has just begun been receiving skeletal traction and the nurse is aware that muscles in the patients affected limb are spastic. How does this change in muscle tone affect the patients traction prescription?
A) Traction must temporarily be aligned in a slightly different direction.
B) Extra weight is needed initially to keep the limb in proper alignment.
C) A lighter weight should be initially used.
D) Weight will temporarily alternate between heavier and lighter weights.
A nurse is planning the care of a patient who will require a prolonged course of skeletal traction. When planning this patients care, the nurse should prioritize interventions related to which of the following risk nursing diagnoses?
A) Risk for Impaired Skin Integrity
B) Risk for Falls
C) Risk for Imbalanced Fluid Volume
D) Risk for Aspiration
A nurse is caring for a patient receiving skeletal traction. Due to the patients severe limits on mobility, the nurse has identified a risk for atelectasis or pneumonia. What intervention should the nurse provide in order to prevent these complications?
A) Perform chest physiotherapy once per shift and as needed.
B) Teach the patient to perform deep breathing and coughing exercises.
C) Administer prophylactic antibiotics as ordered.
D) Administer nebulized bronchodilators and corticosteroids as ordered.
The nurse has identified the diagnosis of Risk for Impaired Tissue Perfusion Related to Deep Vein Thrombosis in the care of a patient receiving skeletal traction. What nursing intervention best addresses this risk?
A) Encourage independence with ADLs whenever possible.
B) Monitor the patients nutritional status closely.
C) Teach the patient to perform ankle and foot exercises within the limitations of traction.
D) Administer clopidogrel (Plavix) as ordered.
A patient is scheduled for a total hip replacement and the surgeon has explained the risks of blood loss associated with orthopedic surgery. The risk of blood loss is the indication for which of the following actions?
A) Use of a cardiopulmonary bypass machine
B) Postoperative blood salvage
C) Prophylactic blood transfusion
D) Autologous blood donation
The nurse is helping to set up Bucks traction on an orthopedic patient. How often should the nurse assess circulation to the affected leg?
A) Within 30 minutes, then every 1 to 2 hours
B) Within 30 minutes, then every 4 hour
C) Within 30 minutes, then every 8 hours
D) Within 30 minutes, then every shift
A nurse is assessing a patient who is receiving traction. The nurses assessment confirms that the patient is able to perform plantar flexion. What conclusion can the nurse draw from this finding?
A) The leg that was assessed is free from DVT.
B) The patients tibial nerve is functional.
C) Circulation to the distal extremity is adequate.
D) The patient does not have peripheral neurovascular dysfunction
A nurse is caring for a patient in skeletal traction. In order to prevent bony fragments from moving against one another, the nurse should caution the patient against which of the following actions?
A) Shifting ones weight in bed
B) Bearing down while having a bowel movement
C) Turning from side to side
D) Coughing without splinting
A nurse is caring for an older adult patient who is preparing for discharge following recovery from a total hip replacement. Which of the following outcomes must be met prior to discharge?
A) Patient is able to perform ADLs independently.
B) Patient is able to perform transfers safely.
C) Patient is able to weight-bear equally on both legs.
D) Patient is able to demonstrate full ROM of the affected hip.
A nurse is caring for a patient who is recovering in the hospital following orthopedic surgery. The nurse is performing frequent assessments for signs and symptoms of infection in the knowledge that the patient faces a high risk of what infectious complication?
B) Septic arthritis
A patient is being prepared for a total hip arthroplasty, and the nurse is providing relevant education. The patient is concerned about being on bed rest for several days after the surgery. The nurse should explain what expectation for activity following hip replacement?
A) Actually, patients are only on bed rest for 2 to 3 days before they begin walking with assistance.
B) The physical therapist will likely help you get up using a walker the day after your surgery.
C) Our goal will actually be to have you walking normally within 5 days of your surgery.
D) For the first two weeks after the surgery, you can use a wheelchair to meet your mobility needs.
A patient has recently been admitted to the orthopedic unit following total hip arthroplasty. The patient has a closed suction device in place and the nurse has determined that there were 320 mL of output in the first 24 hours. How should the nurse best respond to this assessment finding?
A) Inform the primary care provider promptly.
B) Document this as an expected assessment finding.
C) Limit the patients fluid intake to 2 liters for the next 24 hours.
D) Administer a loop diuretic as ordered.
A nurse is reviewing a patients activities of daily living prior to discharge from total hip replacement. The nurse should identify what activity as posing a potential risk for hip dislocation?
A) Straining during a bowel movement
B) Bending down to put on socks
C) Lifting items above shoulder level
D) Transferring from a sitting to standing position
A 91-year-old patient is slated for orthopedic surgery and the nurse is integrated gerontologic considerations into the patients plan of care. What intervention is most justified in the care of this patient?
A) Administration of prophylactic antibiotics
B) Total parenteral nutrition (TPN)
C) Use of a pressure-relieving mattress
D) Use of a Foley catheter until discharge
A nurse is emptying an orthopedic surgery patients closed suction drainage at the end of a shift. The nurse notes that the volume is within expected parameters but that the drainage has a foul odor. What is the nurses best action?
A) Aspirate a small amount of drainage for culturing.
B) Advance the drain 1 to 1.5 cm.
C) Irrigate the drain with normal saline.
D) Inform the surgeon of this finding.
A nurse is planning the care of a patient who has undergone orthopedic surgery. What main goal should guide the nurses choice of interventions?
A) Improving the patients level of function
B) Helping the patient come to terms with limitations
C) Administering medications safely
D) Improving the patients adherence to treatment
A nurse is caring for an adult patient diagnosed with a back strain. What health education should the nurse provide to this patient?
A) Avoid lifting more than one-third of body weight without assistance.
B) Focus on using back muscles efficiently when lifting heavy objects.
C) Lift objects while holding the object a safe distance from the body.
D) Tighten the abdominal muscles and lock the knees when lifting of an object.
A nurse is discussing conservative management of tendonitis with a patient. Which of the following may be an effective approach to managing tendonitis?
A) Weight reduction
B) Use of oral opioid analgesics
C) Intermittent application of ice and heat
D) Passive range of motion exercises
A patient presents at a clinic complaining of pain in his heel so bad that it inhibits his ability to walk. The patient is subsequently diagnosed with plantar fasciitis. This patients plan of care should include what intervention?
A) Wrapping the affected area in lambs wool or gauze to relieve pressure
B) Gently stretching the foot and the Achilles tendon C) Wearing open-toed shoes at all times
D) Applying topical analgesic ointment to plantar surface each morning
A nurse is providing an educational class to a group of older adults at a community senior center. In an effort to prevent osteoporosis, the nurse should encourage participants to ensure that they consume the recommended adequate intake of what nutrients? Select all that apply.
A) Vitamin B12
E) Vitamin D
A nurse is providing a class on osteoporosis at the local seniors center. Which of the following
statements related to osteoporosis is most accurate?
A) Osteoporosis is categorized as a disease of the elderly.
B) A nonmodifiable risk factor for osteoporosis is a persons level of activity.
C) Secondary osteoporosis occurs in women after menopause.
D) Slow discontinuation of corticosteroid therapy can halt the progression of the osteoporosis.
A nurse is teaching a patient with osteomalacia about the role of diet. What would be the best choice for breakfast for a patient with osteomalacia?
A) Cereal with milk, a scrambled egg, and grapefruit
B) Poached eggs with sausage and toast
C) Waffles with fresh strawberries and powdered sugar
D) A bagel topped with butter and jam with a side dish of grapes
A nurse is caring for a patient with Pagets disease and is reviewing the patients most recent laboratory values. Which of the following values is most characteristic of Pagets disease?
A) An elevated level of parathyroid hormone and low calcitonin levels
B) A low serum alkaline phosphatase level and a low serum calcium level
C) An elevated serum alkaline phosphatase level and a normal serum calcium level
D) An elevated calcitonin level and low levels of parathyroid hormone
Which of the following patients should the nurse recognize as being at the highest risk for the development of osteomyelitis?
A) A middle-age adult who takes ibuprofen daily for rheumatoid arthritis
B) An elderly patient with an infected pressure ulcer in the sacral area
C) A 17-year-old football player who had orthopedic surgery 6 weeks prior
D) An infant diagnosed with jaundice
A nurse is caring for a patient with a bone tumor. The nurse is providing education to help the patient reduce the risk for pathologic fractures. What should the nurse teach the patient?
A) Strive to achieve maximum weight-bearing capabilities.
B) Gradually strengthen the affected muscles through weight training.
C) Support the affected extremity with external supports such as splints.
D) Limit reliance on assistive devices in order to build strength.
A patient presents at a clinic complaining of back pain that goes all the way down the back of the leg to the foot. The nurse should document the presence of what type of pain?
A patient tells the nurse that he has pain and numbness to his thumb, first finger, and second finger of the right hand. The nurse discovers that the patient is employed as an auto mechanic, and that the pain is increased while working. This may indicate that the patient could possibly have what health problem?
A) Carpel tunnel syndrome
C) Impingement syndrome
D) Dupuytrens contracture
A nurse is assessing a patient who reports a throbbing, burning sensation in the right foot. The patient states that the pain is worst during the day but notes that the pain is relieved with rest. The nurse should recognize the signs and symptoms of what health problem?
A) Mortons neuroma
C) Hallux valgus
A nurse is reviewing the pathophysiology that may underlie a patients decreased bone density. What hormone should the nurse identify as inhibiting bone resorption and promoting bone formation?
B) Parathyroid hormone (PTH)
A patient is undergoing diagnostic testing for osteomalacia. Which of the following laboratory results is most suggestive of this diagnosis?
A) High chloride, calcium, and magnesium
B) High parathyroid and calcitonin levels
C) Low serum calcium and magnesium levels
D) Low serum calcium and low phosphorus level
An 80-year-old man in a long-term care facility has a chronic leg ulcer and states that the area has become increasingly painful in recent days. The nurse notes that the site is now swollen and warm to the touch. The patient should undergo diagnostic testing for what health problem?
D) Septic arthritis
A patient has returned to the unit after undergoing limb-sparing surgery to remove a metastatic bone tumor. The nurse providing postoperative care in the days following surgery assesses for what complication from surgery?
A) Deficient fluid volume
B) Delayed wound healing
D) Pathologic fractures
A nurse is caring for a patient who is 12 hours postoperative following foot surgery. The nurse assesses the presence of edema in the foot. What nursing measure will the nurse implement to control the edema?
A) Elevate the foot on several pillows.
B) Apply warm compresses intermittently to the surgical area.
C) Administer a loop diuretic as ordered.
D) Increase circulation through frequent ambulation.
A patient with diabetes is attending a class on the prevention of associated diseases. What action should the patient perform to reduce the risk of osteomyelitis?
A) Increase calcium and vitamin intake.
B) Perform meticulous foot care.
C) Exercise 3 to 4 times weekly for at least 30 minutes.
D) Take corticosteroids as ordered.
A nurse is planning the care of an older adult patient with osteomalacia. What action should the nurse recommend in order to promote vitamin D synthesis?
A) Ensuring adequate exposure to sunlight
B) Eating a low-purine diet
C) Performing cardiovascular exercise while avoiding weight-bearing exercises
D) Taking thyroid supplements as ordered
A patient presents to a clinic complaining of a leg ulcer that isnt healing; subsequent diagnostic testing suggests osteomyelitis. The nurse is aware that the most common pathogen to cause osteomyelitis is what?
A) Staphylococcus aureus
D) Escherichia coli
A nurse is providing care for a patient who has a recent diagnosis of Pagets disease. When planning this patients nursing care, interventions should address what nursing diagnoses? Select all that apply.
A) Impaired Physical Mobility
B) Acute Pain
C) Disturbed Auditory Sensory Perception
D) Risk for Injury
E) Risk for Unstable Blood Glucose
A, B, C, D
A nurse is caring for a patient who is being assessed following complaints of severe and persistent low back pain. The patient is scheduled for diagnostic testing in the morning. Which of the following are appropriate diagnostic tests for assessing low back pain? that apply.
A) Computed tomography (CT)
C) Magnetic resonance imaging (MRI)
D) Ultrasound E) X-ray
A, C, D, E
A nurse is reviewing the care of a patient who has a long history of lower back pain that has not responded to conservative treatment measures. The nurse should anticipate the administration of what drug?
A nurse is collaborating with the physical therapist to plan the care of a patient with osteomyelitis. What principle should guide the management of activity and mobility in this patient?
A) Stress on the weakened bone must be avoided.
B) Increased heart rate enhances perfusion and bone healing.
C) Bed rest results in improved outcomes in patients with osteomyelitis.
D) Maintenance of baseline ADLs is the primary goal during osteomyelitis treatment.
A 32-year-old patient comes to the clinic complaining of shoulder tenderness, pain, and limited movement. Upon assessment the nurse finds edema. An MRI shows hemorrhage of the rotator cuff tendons and the patient is diagnosed with impingement syndrome. What action should the nurse recommend in order to promote healing?
A) Support the affected arm on pillows at night.
B) Take prescribed corticosteroids as ordered.
C) Put the shoulder through its full range of motion 3 times daily.
D) Keep the affected arm in a sling for 2 to 4 weeks.
A patient presents at the clinic with complaints of morning numbness, cramping, and stiffness in his fourth and fifth fingers. What disease process should the nurse suspect?
B) A ganglion
C) Carpal tunnel syndrome
D) Dupuytrens disease
A patients electronic health record notes that the patient has hallux valgus. What signs and symptoms would the nurse expect this patient to manifest?
A) Deviation of a great toe laterally
B) Abnormal flexion of the great toe
C) An exaggerated arch of the foot
D) Fusion of the toe joints
An older adult womans current medication regimen includes alendronate (Fosamax). What outcome would indicate successful therapy?
A) Increased bone mass
B) Resolution of infection
C) Relief of bone pain
D) Absence of tumor spread
A nurse is caring for a patient who is being treated in the hospital for a spontaneous vertebral fracture related to osteoporosis. The nurse should address the nursing diagnosis of Acute Pain Related to Fracture by implementing what intervention?
A) Maintenance of high Fowlers positioning whenever possible
B) Intermittent application of heat to the patients back
C) Use of a pressure-reducing mattress
D) Passive range of motion exercises
A patient has been admitted to the hospital with a spontaneous vertebral fracture related to osteoporosis. Which of the following nursing diagnoses must be addressed in the plan of care?
A) Risk for Aspiration Related to Vertebral Fracture
B) Constipation Related to Vertebral Fracture
C) Impaired Swallowing Related to Vertebral Fracture
D) Decreased Cardiac Output Related to Vertebral Fracture
A nursing educator is reviewing the risk factors for osteoporosis with a group of recent graduates. What risk factor of the following should the educator describe?
A) Recurrent infections and prolonged use of NSAIDs
B) High alcohol intake and low body mass index
C) Small frame, female gender, and Caucasian ethnicity
D) Male gender, diabetes, and high protein intake
A nurse is providing care for a patient who has osteomalacia. What major goal will guide the choice of medical and nursing interventions?
A) Maintenance of skin integrity
B) Prevention of bone metastasis
C) Maintenance of adequate levels of activated vitamin D
D) Maintenance of adequate parathyroid hormone function
A patient has been admitted to the medical unit for the treatment of Pagets disease. When reviewing the medication administration record, the nurse should anticipate what medications? Select all that apply.
C) Alkaline phosphatase
D) Calcium gluconate
The health care team is caring for a patient with osteomalacia. It has been determined that the osteomalacia is caused by malabsorption. What is the usual treatment for osteomalacia caused by malabsorption?
A) Supplemental calcium and increased doses of vitamin D
B) Exogenous parathyroid hormone and multivitamins
C) Colony-stimulating factors and calcitonin
D) Supplemental potassium and pancreatic enzymes
A patient with diabetes has been diagnosed with osteomyelitis. The nurse notes that the patients right foot is pale and mottled, cool to touch, with a capillary refill of greater than 3 seconds. The nurse should suspect what type of osteomyelitis?
A) Hematogenous osteomyelitis
B) Osteomyelitis with vascular insufficiency
C) Contiguous-focus osteomyelitis
D) Osteomyelitis with muscular deterioratio
An orthopedic nurse is caring for a patient who is postoperative day one following foot surgery. What nursing intervention should be included in the patients subsequent care?
A) Dressing changes should not be performed unless there are clear signs of infection.
B) The surgical site can be soaked in warm bath water for up to 5 minutes.
C) The surgical site should be cleansed with hydrogen peroxide once daily.
D) The foot should be elevated in order to prevent edema.
A nurse is providing discharge teaching for a patient who underwent foot surgery. The nurse is collaborating with the occupational therapist and discussing the use of assistive devices. On what variables does the choice of assistive devices primarily depend?
A) Patients general condition, balance, and weight-bearing prescription
B) Patients general condition, strength, and gender
C) Patients motivation, age, and weight-bearing prescription
D) Patients occupation, motivation, and age
A patient has come to the clinic for a routine annual physical. The nurse practitioner notes a palpable, painless projection of bone at the patients shoulder. The projection appears to be at the distal end of the humerus. The nurse should suspect the presence of which of the following?
D) Pagets disease
An elderly female with osteoporosis has been hospitalized. Prior to discharge, when teaching the patient, the nurse should include information about which major complication of osteoporosis?
A) Bone fracture
B) Loss of estrogen
C) Negative calcium balance
D) Dowagers hump
An older adult patient sought care for the treatment of a swollen, painful knee joint. Diagnostic imaging
and culturing of synovial fluid resulted in a diagnosis of septic arthritis. The nurse should prioritize
which of the following aspects of care?
A) Administration of oral and IV corticosteroids as ordered
B) Prevention of falls and pathologic fractures
C) Maintenance of adequate serum levels of vitamin D
D) Intravenous administration of antibiotics
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