MEDICAL SURGICAL NURSING-MUSCULOSKELETAL SYSTEM EXPECTED QUESTIONS AND THEIR CORRECT ANSWERS

A client has had a below-the-knee amputation of the leg. What is important for the nurse to consider when providing postoperative care for a client who had an amputation of a lower extremity? 1 Strict bed rest is maintained for at least several days. 2 The residual limb should not be elevated for the first 24 hours. 3 Hemorrhage rarely occurs during the early postoperative period. 4 Primary healthcare providers usually change the dressing on the residual limb within 48 hours. 2 - The residual limb should not be elevated for the first 24 hours. Elevation of the residual limb helps prevent edema; however, should not be done on the first 24 hours and continued elevation may lead to hip contractures. The client usually is out of bed on the second postoperative day. Hemorrhage and infection are the two most common complications. The dressing usually is a pressure dressing and is not changed this soon postoperatively. The nurse is caring for a client with rheumatoid arthritis. When should the nurse expect the client to experience the most pain and limited movement of the joints? 1 After assistive exercise 2 When the room is cool 3 During the evening hours 4 In the morning on awakening 4 - In the morning on awakening Inactivity over an extended time increases stiffness and pain in joints. The client typically has morning stiffness, or gel phenomenon. Assistive exercises help maintain joint mobility. Whether the room is cool is not a factor; cold applications may decrease joint discomfort. The pain is not as severe in the evening as in the morning. A client with rheumatoid arthritis asks the nurse about ways to decrease morning stiffness. What should the nurse suggest? 1 Wearing loose but warm clothing 2 Planning a short rest break periodically 3 Avoiding excessive physical stress and fatigue 4 Taking a hot tub bath or shower in the morning 4 - Taking a hot tub bath or shower in the morning Moist heat increases circulation and decreases muscle tension, which help relieve chronic stiffness. Although wearing loose but warm clothing is advisable for someone with arthritis, it does not relieve morning stiffness. Inactivity promotes stiffness. The practice of avoiding excessive physical stress and fatigue is related to muscle fatigue, not to stiffness of joints. An x-ray film indicates that an older client has a fractured femur. The client asks the nurse, "Will I be able to walk again?" What is the best response by the nurse? 1 "I have no idea because only time will tell." 2 "You only broke a bone. It could have been worse." 3 "You’ll walk again. This is a common issue in older people." 4 "Tell me more about your concerns about being able to walk." 4 - "Tell me more about your concerns about being able to walk." The phrase "Tell me more" shows interest in the client's concerns, is nonjudgmental, and encourages expression and exploration of feelings. First the client's feelings must be explored before providing a direct answer that may cut off communication. The responses "I have no idea" and "You only broke a bone. It could have been worse" places the client on the defensive; it is demeaning to the client and discourages further communication. The general response "You'll walk again. This is a common issue in older people" dismisses the client's concerns; the client is not recognized as an individual whose injury is a traumatic and personal event. Which hormone promotes bone resorption in a client? 1 Estrogen 2 Calcitonin 3 Growth hormone 4 Parathyroid hormone (PTH) 4 - Parathyroid hormone (PTH) When serum calcium levels are lowered, secretion of PTH increases and stimulates bones to promote osteoclastic activity, which promotes bone resorption. Estrogens stimulate osteoblastic (bone-building) activity and inhibit PTH. Calcitonin inhibits bone resorption and increases the renal excretion of calcium and phosphorus as needed to maintain balance in the body. Growth hormones secreted by the anterior lobe of the pituitary gland are responsible for increasing bone length. Which hormones are involved in building and maintaining healthy bone tissue? Select all that apply. 1 Insulin 2 Thyroxine 3 Glucocorticoids 4 Growth hormone 5 Parathyroid hormone 1 - Insulin 4 - Growth hormone Insulin works together with growth hormone to increase bone length, which helps to build and maintain healthy bone tissue. Thyroxine increases the rate of protein synthesis in all types of tissues. Glucocorticoids regulate protein metabolism to reduce or intensify the organic matrix of bone. Parathyroid hormone secretion stimulates bones to promote osteoclastic activity and release calcium into the blood when serum calcium levels are lowered. The nurse is providing discharge teaching to a 30-year-old client who was hospitalized for exacerbation of rheumatoid arthritis. Which statement by the client indicates correct understanding of the treatment plan? 1 "I will plan to rest in bed for the next 2 weeks." 2 "I will only take my medications when I am having joint pain." 3 "When I exercise, I will reduce the number of repetitions