Musculoskeletal Examination (Practice Mode)- Www.Rnpedia.Com

The highest priority assessment for the nurse is to determine if the client has any allergies to iodine or shellfish. This is because the contrast medium used in an arthrogram typically contains iodine, and if the client is allergic, it could lead to a severe allergic reaction or anaphylaxis. It is crucial for the nurse to identify any potential allergies before the procedure to ensure the client's safety and prevent any adverse reactions.

After a computer tomography scan with intravenous contrast medium, if a client returns to the unit complaining of shortness of breath and itching, it indicates an anaphylactic reaction to the dye. Anaphylactic reactions occur when the body's immune system overreacts to a substance, in this case, the contrast dye. Symptoms such as shortness of breath and itching are common signs of an allergic reaction. Prompt treatment is necessary to prevent further complications.

The nurse would include relief of muscle spasms as the primary effect of methocarbamol (Robaxin). Methocarbamol is a muscle relaxant that works by blocking nerve impulses (or pain sensations) that are sent to the brain. It helps to relieve muscle spasms and reduce muscle stiffness, allowing for improved mobility and comfort.

Aspirin is commonly used in the treatment of rheumatoid arthritis because it helps to reduce the inflammation of the joints. Rheumatoid arthritis is an autoimmune disease that causes chronic inflammation in the joints, leading to pain, stiffness, and swelling. Aspirin is a nonsteroidal anti-inflammatory drug (NSAID) that works by inhibiting the production of prostaglandins, which are responsible for inflammation. By reducing inflammation, aspirin can help alleviate the symptoms of rheumatoid arthritis and improve joint function. It does not directly reduce fever, assist with range of motion activities, or prevent the progression of the disease.

The nurse expects to note a uric acid level of 8 mg/dl in the client with gout. Gout is a form of arthritis that occurs when there is an excess buildup of uric acid in the body. Elevated levels of uric acid can lead to the formation of urate crystals in the joints, causing pain, inflammation, and swelling. Therefore, a higher uric acid level is expected in a client with gout.

The presentation of the affected extremity being shortened, adducted, and extremely rotated is consistent with a fracture of the femoral neck. This specific combination of findings is known as the classic presentation of a hip fracture.

When completing the history and physical examination of a client diagnosed with osteoarthritis, the nurse would assess for local joint pain. Osteoarthritis is a degenerative joint disease that primarily affects the cartilage in the joints, leading to pain, stiffness, and limited mobility. Assessing for local joint pain is important in determining the extent and severity of the client's osteoarthritis and developing an appropriate care plan. Anemia, osteoporosis, and weight loss are not specific manifestations of osteoarthritis and would not be the primary focus of assessment in this case.

Taking ibuprofen immediately after a meal helps to minimize gastric mucosal irritation because the food in the stomach acts as a buffer and helps to protect the stomach lining from the potential irritation caused by the medication. By taking it after a meal, the medication is more likely to be absorbed into the bloodstream without causing as much irritation to the stomach.

Wiggling toes is a method of assessing for circulatory impairment in a client with a fractured femur because it tests the client's ability to move the muscles in their lower extremities. If the client is unable to wiggle their toes, it may indicate a lack of blood flow to the area, which could be a sign of circulatory impairment. This test helps to identify potential issues with blood circulation and allows for early intervention to prevent further complications.

Buck's traction is a type of traction used to immobilize and align fractures in the lower extremities. In order for it to be effective, the client should be placed in a supine position. This position allows for proper alignment of the leg and prevents any unnecessary movement or displacement of the fracture. Placing the client in a prone, Sim's, or lithotomy position would not provide the necessary support and alignment required for Buck's traction.

Pin care is an appropriate nursing intervention for a client with skeletal traction. Skeletal traction involves the use of pins or wires inserted into the bone to align and immobilize fractures. These pins can increase the risk of infection, so proper pin care is essential to prevent complications. This includes cleaning the pin site regularly, monitoring for signs of infection, and ensuring proper hygiene. Prone positioning, intermittent weight, and weight limits are not specific interventions for skeletal traction.

Flexing the hip after an intertrochanteric fracture and nail plate insertion can cause displacement of the fracture site. This movement puts stress on the healing bone and can lead to malalignment or further damage to the fracture. It is important for the client to avoid flexing the hip to ensure proper healing and prevent complications.

The onset of paralysis in the toes of the casted foot requires immediate notification of the physician because it may indicate nerve compression or damage. This could be a serious complication that needs prompt medical attention to prevent further damage or complications.

A "hot spot" on the cast is indicative of infection because it suggests that there is increased warmth in a localized area. This can be a sign of inflammation and infection in the underlying tissue. Infection can cause increased blood flow and inflammation, leading to a hot spot on the cast. The nurse should assess for other signs of infection such as redness, swelling, pain, and fever.

Placing a footplate on the affected side at the bottom of the bed helps to prevent footdrop. Footdrop is a condition where the muscles and tendons in the foot become weak or paralyzed, causing the foot to hang downward. By placing a footplate, it provides support and helps to maintain the foot in a neutral position, preventing the foot from dropping and reducing the risk of developing footdrop.

Homan's sign is the best method to assess for the development of deep vein thrombosis in a client with a spinal cord injury. This test involves dorsiflexing the client's foot while the knee is slightly flexed, and if the client experiences pain in the calf, it could indicate the presence of a blood clot. Pain, tenderness, and leg girth are not specific enough to accurately assess for deep vein thrombosis in this population.

Providing an overhead trapeze for client use will best promote independence for the client in skeletal traction. This allows the client to move and reposition themselves without assistance, which promotes autonomy and independence. It also helps to prevent complications such as pressure ulcers and muscle atrophy that can result from prolonged immobility.

The nurse should rewrap the stump with an elastic compression bandage. This is important to provide support and compression to the residual limb, which can help reduce swelling and promote healing. It also helps to control bleeding and prevent infection. By reapplying the bandage, the nurse ensures that the client's wound is properly protected and cared for. Calling the physician may not be necessary in this situation unless there are other complications or concerns. Applying ice or a dry sterile dressing may not provide the necessary support and compression needed for the amputated limb.

After surgery and insertion of a total joint prosthesis, severe sudden pain and an inability to move the extremity indicate joint dislocation. This occurs when the artificial joint becomes displaced from its normal position, causing pain and loss of function. It is important to address this immediately to prevent further complications and restore joint stability.

Early morning stiffness is a common symptom of rheumatoid arthritis. It is characterized by stiffness and difficulty moving the joints, especially in the morning or after periods of inactivity. This symptom is often one of the first signs of rheumatoid arthritis and can be a key indicator for diagnosis. Assessing for early morning stiffness would help the nurse determine if the client is experiencing symptoms consistent with rheumatoid arthritis.

The correct answer is "The gallium will be injected intravenously 2 to 3 hours before the procedure." This is included in the instructions because the gallium needs time to distribute throughout the body before the scan can accurately detect abnormalities. Injecting it 2 to 3 hours before the procedure allows for sufficient time for this distribution to occur.

The most important assessment question for the nurse to ask related to the client's drug therapy is whether she has tarry stool. This is because both aspirin and prednisone can cause gastrointestinal bleeding, which can manifest as tarry stool. It is crucial for the nurse to assess for this symptom as it may indicate a serious adverse effect of the medications and prompt further intervention. Headache, blurred vision, and decreased appetite are also important to assess, but tarry stool is the most pertinent in this case.

In a client with an intracapsular hip fracture, the nurse would assess for shortening of the affected leg. This is because an intracapsular hip fracture occurs within the joint capsule of the hip, and can cause the leg to appear shorter due to displacement of the fractured bone. Assessing for shortening of the affected leg is important in diagnosing and managing the fracture.

Applying a knee immobilizer before getting the client up and elevating the client's surgical leg while sitting helps to protect the knee joint after a total knee replacement. The immobilizer provides stability and support to the knee, preventing excessive movement that could cause injury or damage. Elevating the leg while sitting helps to reduce swelling and promote circulation, aiding in the healing process. This combination of measures ensures the client's safety and optimal recovery after surgery.

The nurse would suspect that a client with a fracture of the right femur may be developing a fat embolus if they are experiencing acute respiratory distress syndrome. Fat embolism syndrome occurs when fat particles from the bone marrow enter the bloodstream and travel to the lungs, causing respiratory distress. This can lead to symptoms such as shortness of breath, rapid breathing, chest pain, and low oxygen levels. Therefore, the presence of acute respiratory distress syndrome in this client would be a red flag for a potential fat embolus.

The nurse would first give the client the prescribed narcotic analgesic because the client is experiencing pain and it is important to provide relief. The nurse would not tell the client that it is impossible to feel the pain or show the client that the toes are not there, as these actions would invalidate the client's pain and may cause distress. Additionally, explaining to the client that the pain is real may be helpful, but providing immediate pain relief takes priority.

Starting an intravenous line at keep-open rate would be inappropriate to include when preparing a client for magnetic resonance imaging (MRI) to evaluate a rupture disc. This is because an IV line is not typically required for a routine MRI procedure and is not necessary specifically for evaluating a rupture disc. The other options, such as informing the client that the procedure is painless, taking a thorough history of past surgeries, and checking for previous complaints of claustrophobia, are all important steps in preparing a client for an MRI.

Using a mirror to inspect all areas of the stump each day is the correct statement because it is important for the client with a below the knee amputation to regularly inspect the stump for any signs of infection, skin breakdown, or other issues. By using a mirror, the client can ensure that they are able to see all areas of the stump, including hard-to-reach places. This practice promotes early detection and prevention of complications, allowing for prompt intervention and appropriate care.

The statement "I will continue taking my birth control pills" indicates the need for further teaching because methotrexate can cause birth defects and should not be taken during pregnancy. Therefore, it is important for the client to use an alternative form of contraception while taking this medication.

Based on the symptoms described, the client's fever, night sweats, chills, restlessness, and restrictive movement of the fractured leg indicate the possibility of an infection in the bone, known as osteomyelitis. This condition can occur as a complication of an open fracture, where bacteria can enter the bone and cause an infection. Pulmonary emboli, fat emboli, and urinary tract infections would typically present with different symptoms and would not explain the specific symptoms mentioned in the scenario.

The correct answer is to remove the pillow and elevate the foot of the bed. Placing a pillow under the client's amputated limb is not appropriate because it does not provide proper elevation. Elevation of the foot of the bed is necessary to promote circulation and reduce swelling in the remaining part of the leg. Therefore, the nurse should remove the pillow and follow the physician's orders by elevating the foot of the bed.

An appropriate intervention for a 7-year-old boy with a fractured leg who is bored would be to watch television. This activity can help distract the child from the pain and boredom, providing entertainment and stimulation. It can also help pass the time and provide a source of enjoyment while the child is unable to engage in physical activities due to the leg fracture.

Following an amputation, an immediate prosthesis fitting allows the client to start walking or ambulating sooner. This is advantageous as it promotes early mobility and independence, which can have positive effects on the client's physical and psychological well-being. By providing support and stability, the prosthesis enables the client to regain their ability to walk and perform daily activities more quickly. This can also contribute to a faster recovery and rehabilitation process.

The nurse's priority assessment should be to observe for bladder distention. This is because the client is on an intermittent urinary catheterization program, which means that they may be at risk for urinary retention. Bladder distention can occur if the client's bladder is not being adequately emptied, which can lead to discomfort, pain, and potential complications such as urinary tract infections. Therefore, it is important for the nurse to closely monitor the client's bladder for any signs of distention and address it promptly to prevent any further complications.

The client in skeletal leg traction is complaining of being bored and restless, indicating a lack of diversional activity. This suggests that the client may be experiencing divertional activity deficit, which refers to a decreased ability to engage in activities that provide enjoyment, interest, and relaxation. This nursing diagnosis is appropriate in this situation as the client's immobilization may limit their ability to participate in usual activities, leading to feelings of boredom and restlessness.

Drawing a mark around the site would be a priority for the client who has been in the PACU for 45 minutes after an above the knee amputation and develops a dime size bright red spot on the ace bondage above the amputation site. This action is important because it allows the healthcare team to monitor the progression of the red spot and assess for any further changes or worsening of the condition. It also helps in determining the appropriate course of treatment or intervention if needed.

To prevent pressure points from occurring around the top of the splint, padding the top of the splint with washcloths is the most important intervention. This helps to distribute the pressure more evenly and reduce the risk of skin breakdown or pressure ulcers. Lotion may be used to moisturize the skin, but it does not directly address the issue of pressure points. Keeping the client pulled up in bed or providing a footplate in the bed may help with overall positioning and comfort, but they do not specifically address the prevention of pressure points around the top of the splint.

When admitting a client with a fractured extremity, the nurse would focus the assessment on the area distal to the fracture. This is because assessing the area distal to the fracture helps to determine the circulation, sensation, and movement of the affected extremity. It allows the nurse to monitor for any signs of compromised blood flow or nerve damage. By assessing the area distal to the fracture, the nurse can identify any potential complications and provide appropriate interventions to promote healing and prevent further damage.

The correct answer is to inspect the skin on the right leg at least once every 8 hours. This is important because Buck's extension is a type of traction device used to immobilize and stabilize the leg. Inspecting the skin regularly helps to identify any signs of pressure ulcers, skin breakdown, or other complications that may arise from prolonged immobilization. By closely monitoring the skin, the nurse can intervene promptly and prevent further complications.

The nurse instructs the client to support her weight primarily on the hand when using crutches. This is because the hand is the most stable and strongest area to bear weight, providing better balance and support while walking with crutches. Supporting weight on the axillae can cause nerve damage and discomfort, while supporting weight on the elbows or upper arms may lead to muscle strain and fatigue. Therefore, the hand is the most appropriate body area to support weight while using crutches.

The nurse knows that the direction of pull is controlled by the rope/pulley system. This is because the rope/pulley system is responsible for transmitting the force applied to the traction apparatus, determining the direction in which the force is exerted. The client's position, amount of weight, and point of friction may affect the overall effectiveness and comfort of the traction, but they do not control the direction of pull.

Dark, scanty urine is a sign of possible organ failure in a client with compartment syndrome. Compartment syndrome occurs when increased pressure within a muscle compartment impairs blood flow and tissue perfusion. This can lead to ischemia and damage to the kidneys, resulting in decreased urine output and the presence of dark, scanty urine. It is important for the nurse to be alert to this sign as it indicates potential kidney dysfunction and the need for immediate intervention to prevent further organ damage. Rales, jaundice, and generalized edema are not specifically associated with compartment syndrome or organ failure in this context.

When a client is lying supine, a trochanter roll to the thigh can be used to prevent external rotation of the lower extremity. This is because the trochanter roll provides support to the hip and prevents the leg from rotating outward. By placing the trochanter roll to the thigh, the nurse ensures that the client's leg remains in a neutral position and minimizes the risk of external rotation.

The nurse interprets the lack of desired outcome from antibiotics as suggesting the production of bacterial growth by avascular tissue as the most likely occurrence. In osteomyelitis, the infection affects the bone and surrounding tissue. Avascular tissue refers to the areas with poor blood supply, which can create an environment conducive to bacterial growth and make it difficult for antibiotics to reach and eliminate the infection effectively. Therefore, the presence of bacterial growth in avascular tissue can hinder the effectiveness of antibiotics and result in an unsatisfactory outcome.

After a total hip replacement, the client should be placed in a semi Fowler's position. This position allows for proper alignment of the hip joint and reduces the risk of dislocation. It also promotes optimal lung expansion and prevents complications such as pneumonia. The semi Fowler's position involves elevating the head of the bed to a 30-45 degree angle, with the knees slightly flexed. This position provides comfort and stability for the client while facilitating postoperative recovery.

To prevent foot drop in a client with Buck's traction, ensuring proper body positioning is essential. Proper body positioning helps maintain alignment and prevents the foot from dropping. This can include techniques such as using pillows to support the client's heels, tucking the sheets into the foot of the bed to prevent sliding, and teaching the client isometric exercises to strengthen the muscles. However, the most important factor is ensuring that the client's body is positioned correctly to avoid foot drop.

The client with right sided weakness needs to learn how to use a cane. The correct answer is "Left hand and 6 inches lateral to the left foot." This positioning allows the client to provide support and stability on the weaker side while walking. Placing the cane in front of the left foot ensures that the client can step forward with the stronger leg and maintain balance. Holding the cane with the left hand allows the client to have better control and coordination while using the cane. Placing the cane 6 inches lateral to the left foot provides the appropriate distance for the client to maintain a natural stride.

The correct answer is to provide pin care at least every hour. Compound fractures can increase the risk of infection due to the open wound. Pin care is necessary to prevent infection and promote healing. By providing pin care at least every hour, the nurse can ensure that the client's wound is clean and free from infection. This is a priority in the care plan to prevent complications and promote the client's recovery.

When a client has cervical halter traction to immobilize the cervical spine, counteraction is provided by elevating the head of the bed. This is because elevating the head of the bed helps to maintain proper alignment and reduce the pull of the traction on the cervical spine. It helps to create a counteracting force that prevents excessive traction and promotes stability in the cervical spine. Elevating the foot of the bed, application of the pelvic girdle, or lowering the head of the bed would not provide the necessary counteraction and may compromise the effectiveness of the traction.

Rheumatoid arthritis typically affects adults between the ages of 30 and 60, so if the client states that being between the ages of 60 to 75 is a risk factor, it would indicate a need for additional teaching as this is not a correct risk factor for rheumatoid arthritis.