An older client has bilateral osteoarthritis in his hips. What would be important for the nurse to teach this client regarding protection of his joints?

An older client has bilateral osteoarthritis in his hips. What would be important for the nurse to teach this client regarding protection of his joints?

1. Use a cane or walker for ambulation.
2. Sit in straight back chairs that you can get out of easily.
3. Use a wheel chair when you are tired.
4. Exercise regularly and control weight.


Answer: 4

Regular exercise increases and strengthens joint mobility, in addition to muscles supporting the joints. It also increases cartilage formation for continued joint mobility. Weight reduction, if appropriate, is critical to decreasing stress on weight-bearing joints. Sitting in a straight back chair does facilitate movement but does not protect the joints. Using devices assists in ambulation and promotes independence but does not offer joint protection as well as exercise and weight loss.

Which dietary recommendations would the nurse encourage for a client who has just been diagnosed with gout?

Which dietary recommendations would the nurse encourage for a client who has just been diagnosed with gout?

1. Increase protein
2. Increase intake fluids to 3000 ml daily
3. Avoid foods containing chocolate
4. Avoid eating cranberries and prunes


Answer: 2

The client should increase the intake of fluids to promote excretion of uric acid. Some physicians prescribe a low-purine diet to decrease formation of uric acid crystals. Chocolate, cranberries, and prunes do not have any effect on the gout. (Ignatavicius, Workman, 7 ed., p. 350.)

A client with osteoarthritis in the left knee has had a total knee replacement. What is important to include in the postoperative nursing care plan?

A client with osteoarthritis in the left knee has had a total knee replacement. What is important to include in the postoperative nursing care plan?

1. Use constant passive motion (CPM) to promote joint flexibility.
2. Wrap the knee in a loose fitting absorbent bandage to promote flexibility.
3. Maintain bed rest for 2 days to maintain extension and immobilization of leg.
4. Insert a urinary retention catheter since client is on total bed rest for 2 days.


Answer: 1

Constant passive motion is utilized early to maintain joint flexibility. A compression dressing is used immediately after surgery. The client is ambulated as early as possible. A urinary retention catheter is not used with bed rest unless it is absolutely necessary and the client cannot void on his own. (Ignatavicius, Workman, 7 ed., pp. 329-330.)

The nurse understands that which characteristic of rheumatoid arthritis distinguishes it from both osteoarthritis and gouty arthritis?

The nurse understands that which characteristic of rheumatoid arthritis distinguishes it from both osteoarthritis and gouty arthritis?

1. Impact is on weight-bearing joints
2. Symmetric involvement of joints
3. Uric acid serum levels are elevated
4. Range-of-motion crepitus


Answer: 2

Rheumatoid arthritis is bilateral and symmetric. Osteoarthritis and gouty arthritis are unilateral. Crepitus is associated with osteoarthritis. Elevated serum uric acid levels occur in gouty arthritis, and an impact on weight-bearing joints is observed with osteoarthritis. (Lewis, et al, 8 ed., p. 1651.)

A client has a problem with severe painful osteoarthritis. A regimen of heat, massage, and exercise has been ordered. What is the desired response to this treatment?

A client has a problem with severe painful osteoarthritis. A regimen of heat, massage, and exercise has been ordered. What is the desired response to this treatment?

1. Help maintain joint flexibility and relieve pain and stiffness.
2. Restore range of motion previously lost.
3. Prevent the inflammatory process.
4. Assist the client to effectively cope with pain.


Answer: 1

The nurse is screening an older woman for the early signs of osteoporosis. What assessment findings would be strongly suggestive of the presence of osteoporosis?

The nurse is screening an older woman for the early signs of osteoporosis. What assessment findings would be strongly suggestive of the presence of osteoporosis?

1. Increased pain in lower back when walking
2. A limp when walking because one leg is shorter
3. Waddling gait, frequently requiring assistive devices
4. Decrease of 3 inches in height


Answer: 4

The classic initial observations that indicate osteoporosis is the loss of height along with the spinal deformity of kyphosis or "dowager's hump." The back pain is generally continuous and does not just occur with walking. Both legs are the same length, and the gait is not particularly affected in the early stages.

Which of the following put a woman at increased risk for development of osteoporosis?

Which of the following put a woman at increased risk for development of osteoporosis? 

1. Hormone replacement therapy
2. Menopausal age
3. Prolonged steriod intake
4. Fractured hip
5. Hyperthyroid disease
6. Compromised pulmonary function


Answers: 2, 3, 5

Menopausal or post menopausal women, prolonged steroid intake, and hyperthyroid disease have been associated with the development of osteoporosis. Hormone replacement actually decreases the risk factor, but use of it must be considered with other associated risks. Presence of a fracture may indicate that osteoporosis is present but is not considered a risk factor. Compromised pulmonary function may occur as a result of the kyphosis but is not considered a risk factor.

The nurse is preparing health teaching for adult women regarding the prevention of osteoporosis. What would be important to include in the teaching plan?

The nurse is preparing health teaching for adult women regarding the prevention of osteoporosis. What would be important to include in the teaching plan?

1. Daily walking for 15 to minutes
2. Supplemental calcium intake
3. Reduction of caffeine intake
4. Increased intake of water
5. Avoidance of sunlight because of photosensitivity
6. Increase intake of fresh fruit and vegetables


Answers: 1, 2, 3, 6

Daily walking, supplemental calcium, and reduction of caffeine intake are the most common preventive measures in women at increased risk for osteoporosis. Some sunlight is encouraged to facilitate utilization of vitamin D and the absorption of the calcium intake. Increased water intake is healthy, but not specific for osteoporosis. Fruits and vegetables are important to a healthy diet and should be encouraged.

A child has an injured wrist and will not allow the nurse to exam the injured arm. Both parents and child are upset. What is a priority nursing intervention?

A child has an injured wrist and will not allow the nurse to exam the injured arm. Both parents and child are upset. What is a priority nursing intervention?

1. Tell the parents to hold the child down, so the arm can be examined.
2. In a soothing voice, ask the child to point to the "ouchie" or pain and move fingers.
3. Obtain an order for pain analgesic and then examine the arm.
4. Call radiology and have them come to the emergency room to obtain x-ray films.


Answer: 2

Before any measures (obtaining x-rays and administration of analgesics) are started, an initial assessment is the priority. It will be important to calm the child and gain the child's trust. Inspection and observation are important, so asking the child to point to the painful part and moving the fingers, along with noting any pallor or abnormal position would be part of the initial assessment. Parents are not to be asked to restrain their child. If restraint is necessary, then the parents need to leave the room and the nurse needs to obtain assistance from other personnel. (Hockenberry, Wilson, 9 ed., p. 1639.)

The nurse understands that which of the following is characteristic of fractures in children?

The nurse understands that which of the following is characteristic of fractures in children?

1. The younger the child, the faster a fracture heals.
2. Epiphyseal fractures seldom occur because of the elasticity of the growth plate.
3. A child's bone is more pliable and porous as compared with an adult's bone
4. A child's bone is thinner, weaker, and less osteogenic than that of an adult.


Answer: 1

The healing of fractures is more rapid in children, as compared with adults. The speed of healing is inversely related to the age of the child: the younger the child, the more rapid the healing process. The epiphyseal plate is a frequent site of injury during trauma, because it is the weakest point of long bones. Children's bones are more pliable and porous, which allows them to bend, buckle, and break, and have greater porosity, which increases the flexibility of the bone providing a good shock absorber for any forceful injury. The adult, not the child, has periosteum that is thinner, weaker, and less osteogenic.

A client has been fitted with crutches. The nurse is assessing the crutches to determine if they properly fit the client. What observation would cause the nurse the most concern?

A client has been fitted with crutches. The nurse is assessing the crutches to determine if they properly fit the client. What observation would cause the nurse the most concern?

1. When the client is standing, with the hands placed on the hand supports, the arms are straight.
2. There is space of about 1 to 2 in between the axillary fold and the top of the crutch.
3. The client can comfortably place crutches about 6 to 8 in lateral to the heel of his foot when walking.
4. The arms are flexed about 30 degrees and resting on the hand supports when the client is standing.


Answer: 1

When the client is standing at rest, the arms should be flexed about 30 degrees. This allows for weight bearing on the hand supports and not under the client's arm when the client begins to walk. There should be about 1 to 2 in between the axillary fold and the top of the crutch to prevent axillary nerve damage. The client should be able to comfortably place the crutches about 6 to 8 in lateral to the heel of the foot.

The nurse is caring for a client with a fractured hip who has been placed in Buck's traction. On assessing the client, the nurse determines the client's feet are touching the end of the bed. What would be the best nursing action?

The nurse is caring for a client with a fractured hip who has been placed in Buck's traction. On assessing the client, the nurse determines the client's feet are touching the end of the bed. What would be the best nursing action?

1. Assist the client to move up in the bed.
2. Raise the head of the bed.
3. Turn the client to the unaffected side.
4. Take no action if the client is comfortable.


Answer: 1

Pulling the client up in the bed will restore traction, and raising the foot of the bed will decrease the amount of sliding. Turning the client may cause further damage. Taking no action allows the traction to remain ineffective in this situation.

The nurse is caring for a client with a fractured femur that has not been repaired. Fat emboli and pulmonary emboli are both potential complications of this condition. Which symptoms would be suggestive of fat emboli versus a pulmonary emboli?

The nurse is caring for a client with a fractured femur that has not been repaired. Fat emboli and pulmonary emboli are both potential complications of this condition. Which symptoms would be suggestive of fat emboli versus a pulmonary emboli?

1. Difficulty breathing
2. Blood-tinged sputum
3. Restless and confusion
4. Petechiae over the trunk and in axillary folds


Answer: 4
Difficulty with respirations, blood-tinged sputum or frothy sputum, chest pain, and restlessness, irritability, and confusion are all common to pulmonary and fat emboli. A pulmonary embolus does not precipitate the development of petechiae over the trunk, buccal membrane, conjunctival sacs, and in anterior axillary folds.

A client's x-ray film shows a fractured right femur. The nurse will assess the client for what potential complication?

A client's x-ray film shows a fractured right femur. The nurse will assess the client for what potential complication?

1. Fat embolus
2. Septicemia
3. Hypovolemic shock
4. Cardiogenic shock


Answer: 1

The common complications associated with a femoral shaft fracture include fat embolism, nerve and vascular injury, and problems with bone union and soft tissue injury.

A client is being discharged after receiving a left total hip replacement. He has been instructed on how to use a cane by physical therapy. The nurse is evaluating the client's use of the cane. What observation would indicate the client understands how to use the cane?

A client is being discharged after receiving a left total hip replacement. He has been instructed on how to use a cane by physical therapy. The nurse is evaluating the client's use of the cane. What observation would indicate the client understands how to use the cane?

1. The cane is held with the right hand and is advanced forward with the left leg.
2. The cane is advanced with the left foot, and held on the left side.
3. The cane is positioned in front of the client and he walks toward the cane.
4. The cane is to the left side; the client bears weight on it when advancing the left leg.



Answer: 1

The cane should be held in the hand opposite the affected leg and should be advanced with the affected leg. The cane would be placed in the right hand, and then the cane is advanced with the left leg. The cane should not be held in the hand on the same side as the injury.

An older woman is being discharged home after repair of a left hip fracture. Which statement by the client would indicate to the nurse that additional teaching is needed?

An older woman is being discharged home after repair of a left hip fracture. Which statement by the client would indicate to the nurse that additional teaching is needed?

1. "I put an extension on the toilet seat to make it higher."
2. "I will ask for help in putting on my shoes and socks."
3. "I will use a walker for a while until I am more stable."
4. "I can sleep in any position that is comfortable."



Answer: 4

The client needs to maintain abduction on the affected left extremity. She should not sleep on her right side with her left leg crossing over the right (Sims position). An extension for the toilet seat to make it higher and using a walker are appropriate for the client. Asking for help with shoes and socks helps prevent extreme flexion of the affected hip.

Fat embolism is a major complication of a client with a fractured femur. What assessment finding would alert the nurse to the possibility of this complication occurring?

Fat embolism is a major complication of a client with a fractured femur. What assessment finding would alert the nurse to the possibility of this complication occurring?

1. Ecchymosis on lower extremities
2. Blood-tinged sputum
3. Complaints of bone pain
4. Complaints of muscle spasms.


Answer: 2

Fat emboli, which are made up of lipase and fatty acids, can cause an inflammatory response in the lungs with blood-stained sputum, condition may progress to pulmonary edema with severe hypoxia. Petechiae on the chest may occur and are a classic sign of fat emboli; however, it is a late sign. Ecchymosis on the lower extremities is not an indication of fat emboli. The client is already experiencing bone pain from the fracture.

A client has a fractured femur and is scheduled for surgery and stabilization with internal fixation. The nurse is assessing the client for the development of a fat embolism. What early assessment findings would suggest the development of this complication?

A client has a fractured femur and is scheduled for surgery and stabilization with internal fixation. The nurse is assessing the client for the development of a fat embolism. What early assessment findings would suggest the development of this complication?

1. Swelling and redness in the affected area.
2. Blood and fat in the stool
3. Hypotension
4. Confusion and restlessness


Answer: 4

Confusion and restlessness are early signs of hypoxia. A fat embolism travels through the venous system to the lungs, where it lodges and causes an interstitial pneumonitis; this will precipitate symptoms of acute respiratory distress. Swelling and redness of the affected area would a normal observation. Blood and fat in the stool is not an indication of a fat embolism. The client may experience hypotension, but hypotension is not as specific as changes in orientation and level of consciousness. 

An older client is admitted for treatment of a fractured left hip. The fracture is repaired by internal fixation. What would be a priority nursing intervention regarding positioning this client in the immediate postoperative period?

An older client is admitted for treatment of a fractured left hip. The fracture is repaired by internal fixation. What would be a priority nursing intervention regarding positioning this client in the immediate postoperative period?

1. Keeping the client in low Fowler's position to facilitate slight hip flexion
2. Elevating the foot of the bed to prevent venous pooling in the lower extremities
3. Placing a trochanter roll at the thigh on the left side to prevent internal rotation
4. Placing a pillow or foam frame between the legs to maintain abduction of the left leg


Answer: 4

Maintaining the leg in an abducted position is critical in the first few days after surgery for a client with a fractured hip. This maintains the intactness of the hip joint. The trochanter roll at the thigh will assist to prevent external rotation, not internal rotation. The foot of the bed may be slightly elevated, but maintaining abduction is more critical.

The nurse is concerned about compartmental syndrome in an 8-year-old client with a greenstick fracture. For what will the nurse teach the mother to observe?

The nurse is concerned about compartmental syndrome in an 8-year-old client with a greenstick fracture. For what will the nurse teach the mother to observe?

1. Swelling and discoloration of the hand distal to the fracture site
2. Hematoma formation and pain in the upper arm and shoulders
3. Severe pain radiating proximal to the cast and fracture area
4. Decreased sensation and decreased ability to move the fingers of the affected hand



Answer: 4

Indications of compartmental syndrome include pain, decreased sensation and decreased mobility in the extremity distal to the fracture/cast, decreased or loss of pulse distal to injury, skin cool to touch and blanched in color in an area distal to the fracture/cast. Swelling and discoloration commonly occur as a result of the bruising of the injury. Usually no symptoms are proximal to the fracture site.