Musculoskeletal Examination (Exam Mode) By 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 contrast mediums used in arthrograms often contain iodine, which can cause an allergic reaction in individuals with iodine or shellfish allergies. It is important for the nurse to identify any potential allergies to ensure the safety and well-being of the client during the procedure.

The assessment of the affected extremity being shortened, adducted, and extremely rotated is indicative of a fracture of the femoral neck. This is known as the classic presentation of a hip fracture. The shortening occurs due to the displacement of the fractured bone, the adduction occurs due to the pull of the adductor muscles, and the rotation occurs due to the twisting force applied during the fall. These findings are consistent with a fracture of the femoral neck and support the diagnosis.

Wiggling the toes is a method of assessing for circulatory impairment in a client with a fractured femur because it tests the blood flow to the lower extremities. If the client is unable to wiggle their toes, it could indicate that there is a decrease in blood flow to the area, which may be a sign of circulatory impairment. This assessment can help healthcare professionals identify any potential complications and take appropriate action to prevent further damage.

Buck's traction is a method used to immobilize and align fractures or dislocations in the lower extremities. It involves the application of a pulling force to the affected limb. In order for Buck's traction applied to the right leg to be effective, the client should be placed in a supine position. This position allows for proper alignment and distribution of the pulling force, ensuring that the traction is applied correctly and effectively.

The nurse expects to note a uric acid level of 8 mg/dl in the client with gout. Gout is a type of arthritis that occurs when there is an accumulation of uric acid crystals in the joints, leading to inflammation and pain. High levels of uric acid in the blood are associated with the development of gout. Therefore, a uric acid level of 8 mg/dl is indicative of gout in this client. The other laboratory values listed (calcium level of 9 mg/dl, phosphorus level of 3 mg/dl, and uric acid level of 5 mg/dl) are not specifically related to gout.

After a computer tomography scan with intravenous contrast medium, the client's symptoms of shortness of breath and itching suggest an anaphylactic reaction to the dye. An anaphylactic reaction is a severe allergic reaction that can occur in response to certain substances, such as the contrast dye used in the scan. Symptoms of an anaphylactic reaction can include difficulty breathing, itching, and hives. The nurse should be prepared to treat the client for this potentially life-threatening reaction.

For a client with skeletal traction, pin care is an appropriate nursing intervention. Skeletal traction involves the use of pins or wires inserted into the bone to immobilize and align fractured bones. Pin care is essential to prevent infection and ensure proper healing. It involves cleaning the pin sites with an antiseptic solution, monitoring for signs of infection, and providing appropriate wound care. The other options, prone positioning, intermittent weight, and a 5lb weight limit, may be interventions used in other situations but are not specific to skeletal traction.

In 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 swelling in the affected joints. Assessing for local joint pain is important in determining the severity and progression of the disease, as well as guiding the development of an appropriate treatment plan. Anemia, osteoporosis, and weight loss are not directly associated with 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. When taken on an empty stomach, ibuprofen can irritate the lining of the stomach and increase the risk of gastrointestinal side effects such as stomach ulcers and bleeding. Taking it after a meal provides a protective layer in the stomach, reducing the chances of irritation. Taking it at bedtime or on arising does not provide the same protective effect as taking it after a meal.

The presence of a "hot spot" on the cast is indicative of infection. Infections can cause localized inflammation, which can manifest as a warm or hot area on the cast. This can be a sign of an underlying infection that needs to be addressed. Coolness and pallor of the extremity, diminished distal pulse, and dependent edema are not specific signs of infection and may indicate other issues such as poor circulation or swelling.

Acetylsalicylic acid (aspirin) is used in the treatment of rheumatoid arthritis to reduce the inflammation of the joints. Rheumatoid arthritis is an autoimmune disease that causes chronic inflammation and pain in the joints. Aspirin is a nonsteroidal anti-inflammatory drug (NSAID) that helps to reduce inflammation by inhibiting the production of certain chemicals in the body that cause inflammation. By reducing inflammation, aspirin can help alleviate the symptoms of rheumatoid arthritis, such as joint pain, swelling, and stiffness. It does not directly reduce fever, assist with range of motion activities, or prevent the extension of the disease process.

The onset of paralysis in the toes of the casted foot is a concerning finding that requires immediate notification of the physician. It could indicate the development of compartment syndrome, which is a serious condition characterized by increased pressure within a confined space (such as the cast), leading to reduced blood flow and potential nerve damage. Prompt medical intervention is necessary to prevent further complications and ensure the client's well-being.

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 is commonly used to relieve muscle spasms and pain associated with musculoskeletal conditions such as a fractured tibia. The drug does not have any antibacterial or antifungal properties, so it does not kill microorganisms. It also does not directly reduce itching or decrease nervousness.

Flexion of the hip can cause displacement of the nail plate used for internal fixation, leading to improper alignment of the hip. This can hinder the healing process and potentially cause further damage to the hip.

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, improving their mobility and sense of control. It also helps to prevent complications such as pressure ulcers and muscle atrophy.

Placing a footplate on the affected side at the bottom of the bed helps to prevent footdrop. Footdrop is a condition where the foot is unable to maintain a normal flexed position, causing the toes to drag on the ground. By providing a footplate, the nurse ensures that the client's foot remains in a neutral or slightly dorsiflexed position, preventing the development of footdrop. This action helps maintain proper alignment and function of the foot and ankle, promoting optimal mobility and preventing complications associated with 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 the nurse dorsiflexing the client's foot while the knee is extended, and if the client experiences pain in the calf, it may indicate the presence of a blood clot. Pain, tenderness, and leg girth can also be indicators of deep vein thrombosis, but Homan's sign is a more specific and reliable method for assessment.

The severe sudden pain and inability to move the extremity after surgery and insertion of a total joint prosthesis indicate joint dislocation. This is because joint dislocation can cause intense pain and restrict movement in the affected joint. It is important for the nurse to recognize this complication promptly and take appropriate actions to prevent further damage and facilitate proper joint alignment.

Early morning stiffness is a common symptom of rheumatoid arthritis. It is characterized by stiffness and difficulty moving the joints, particularly in the morning after a period of rest. This symptom is often one of the earliest signs of rheumatoid arthritis and can be a key indicator for diagnosis. Assessing for early morning stiffness can help the nurse determine if the client is experiencing symptoms consistent with rheumatoid arthritis and can guide further assessment and treatment.

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 hip joint capsule, which can cause the affected leg to appear shorter than the unaffected leg. This assessment finding is important to note as it can help confirm the presence of a hip fracture and guide further diagnostic and treatment interventions.

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 important to assess for this symptom as it could indicate a serious adverse effect of the medication and prompt further investigation or adjustment of the treatment plan.

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 embolus occurs when fat globules from the bone marrow enter the bloodstream and travel to the lungs, causing respiratory symptoms such as difficulty breathing, rapid breathing, and low oxygen levels. Acute respiratory distress syndrome is a severe form of respiratory failure, characterized by these symptoms, and can occur as a complication of fat embolism syndrome. Therefore, the presence of acute respiratory distress syndrome would lead the nurse to suspect a fat embolus.

The nurse should rewrap the stump with an elastic compression bandage because it helps to reduce swelling and promote proper healing of the residual limb after an amputation. This bandage provides support to the muscles and tissues, prevents fluid accumulation, and helps to shape the stump for a prosthetic limb. It is important to maintain the compression to prevent complications such as edema and contractures. Calling the physician may not be necessary unless there are other concerns or complications. Applying ice or a dry sterile dressing may not provide the necessary support and compression needed for proper healing.

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The need for further teaching is indicated by the statement "I will continue taking my birth control pills." Methotrexate is known to cause birth defects and should not be taken during pregnancy. Therefore, it is important for the client to understand that they should not continue taking birth control pills while on this medication.

The symptoms of fever, night sweats, chills, restlessness, and restrictive movement of the fractured leg are indicative of an infection. Osteomyelitis is a bone infection that can occur as a complication of an open fracture. Therefore, the nurse interprets these findings as indicating osteomyelitis.

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 any abnormalities. By injecting it 2 to 3 hours before the procedure, the gallium will have enough time to circulate and accumulate in the areas of interest. This timing ensures that the scan results are accurate and reliable.

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 intravenous line is not typically necessary for an MRI procedure to evaluate a rupture disc. The other options mentioned, 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 relevant and appropriate steps to include in the preparation process.

The nurse would give the client the prescribed narcotic analgesic as the first action because pain management is a priority in the post-anesthesia care unit (PACU). The client's complaint of pain in her left big toe should be taken seriously and addressed promptly. The nurse should administer the prescribed medication to provide relief and ensure the client's comfort.

The client in skeletal leg traction is complaining of being bored and restless. This indicates a lack of diversional activities, which can lead to feelings of boredom and restlessness. Therefore, the nurse formulates the nursing diagnosis of Divertional activity deficit. This diagnosis suggests that the client is experiencing a deficiency in engaging in activities that provide enjoyment, entertainment, and distraction from their current situation.

To prevent pressure points from occurring around the top of the splint, it is important to pad the top of the splint with washcloths. This will help distribute the pressure evenly and prevent any localized areas of excessive pressure on the skin. Lotion may provide some protection but will not effectively distribute the pressure. Keeping the client pulled up in bed or providing a footplate in the bed are not directly related to preventing pressure points around the top of the splint.

The nurse's priority assessment should be to observe for bladder distention in the client. Bladder distention can occur in paraplegic clients due to the loss of voluntary control over the bladder muscles. This can lead to urinary retention, which can cause discomfort and potential complications such as urinary tract infections. Therefore, it is important for the nurse to assess for bladder distention and intervene promptly to prevent any complications.

Watching television can be an appropriate intervention for a 7-year-old boy with a fractured leg who is feeling bored. Television can provide entertainment and distraction, helping to alleviate boredom. It can also offer a variety of shows and programs that can engage the child's interest and keep him occupied while he is unable to engage in physical activities due to his fractured leg.

The advantage of an immediate prosthesis fitting following an amputation is the ability to ambulate sooner. By providing the client with a prosthesis immediately after the amputation, they can start walking and regaining their mobility faster. This can have a positive impact on their overall rehabilitation process and help them regain their independence more quickly.

The correct answer is to use a mirror to inspect all areas of the stump each day. This is important for the client to be able to identify any signs of infection, skin breakdown, or other issues with the stump. By regularly inspecting the stump, the client can catch any problems early and seek appropriate medical attention. This is an important aspect of stump care to ensure proper healing and prevent complications.

To prevent foot drop in a client with Buck's traction, ensuring proper body positioning is essential. Proper body positioning helps maintain the correct alignment of the body, including the feet, which reduces the risk of foot drop. This can be achieved by using pillows or other supportive devices to keep the client's body in the correct position. Placing pillows under the client's heels may provide some comfort, but it does not directly address the prevention of foot drop. Tucking the sheets into the foot of the bed and teaching isometric exercises do not specifically address proper body positioning or the prevention of foot drop.

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 as it does not provide proper elevation. Elevation of the foot of the bed is important to reduce swelling and promote healing. Therefore, the nurse should remove the pillow and follow the physician's orders to elevate the foot of the bed.

When the client is lying supine, the nurse will prevent external rotation of the lower extremity by using a trochanter roll to the thigh. This is because a trochanter roll is a cushion placed along the lateral aspect of the thigh to prevent the hip from rotating outward. It helps to maintain proper alignment of the hip joint and prevent potential injury or discomfort to the client. Using a trochanter roll to the thigh is a common nursing intervention to promote proper positioning and prevent complications in supine patients.

The direction of pull is controlled by the rope/pulley system because it determines the path and angle of the traction force. The nurse can adjust the position and movement of the pulley to change the direction of pull on the client's body. This allows for precise and controlled application of traction to achieve the desired therapeutic effect.

The correct intervention to prevent complications of the Buck's extension device is to inspect the skin on the right leg at least once every 8 hours. This is important because the Buck's extension device applies traction to the leg and can cause pressure and friction on the skin, leading to skin breakdown and pressure ulcers. Regular inspection of the skin allows for early detection of any signs of skin damage or irritation, which can then be promptly addressed to prevent further complications.

The client with an above the knee amputation should primarily support their weight on their hands when using crutches. This is because the hands are stronger and more capable of bearing weight compared to other body areas such as the axillae (armpits), elbows, or upper arms. Placing too much weight on the axillae can lead to nerve damage and discomfort, while relying on the elbows or upper arms may cause strain and fatigue. By distributing the weight onto the hands, the client can maintain balance and stability while using the crutches.

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 can help determine the circulation, sensation, and movement of the affected extremity. It can also help identify any potential complications such as compartment syndrome or nerve damage. By assessing the area distal to the fracture, the nurse can gather important information about the client's overall condition and the extent of the injury.

After a total hip replacement, the client should be placed in a Semi Fowler's position. This position involves elevating the head of the bed to an angle of 30-45 degrees. It helps to reduce pressure on the surgical site, promote lung expansion, and prevent complications such as aspiration and venous stasis. The Supine position (lying flat on the back), Orthopneic position (sitting upright and leaning forward), and Trendelenburg position (head down and feet elevated) are not appropriate for a client post total hip replacement.

Dark, scanty urine can indicate possible organ failure in a client with compartment syndrome. Compartment syndrome occurs when increased pressure within a confined space, such as a muscle compartment, impairs blood flow and can lead to tissue damage. This can result in decreased kidney perfusion, leading to a decrease in urine output and the production of dark, scanty urine. Monitoring urine output and characteristics is important in assessing kidney function and identifying potential organ failure in this client.

The nurse interprets the lack of desired outcome from antibiotics in a client with osteomyelitis as suggesting the production of bacterial growth by avascular tissue as the most likely occurrence. This means that the antibiotics are not effectively reaching the site of infection due to the lack of blood supply to the affected tissue, allowing the bacteria to continue growing and causing the infection to persist.

Drawing a mark around the site would be a priority for the client in this situation. This action helps to monitor the size and progression of the red spot, which could indicate bleeding or infection. It allows for accurate documentation and assessment of the wound, which is important for the client's ongoing care and treatment.

When a client has cervical halter traction to immobilize the cervical spine, elevating the head of the bed provides the counteraction. This is because elevating the head of the bed helps to create an opposing force to the traction force applied to the cervical spine. By elevating the head of the bed, the weight of the client's head and upper body can act as a counterforce to the traction force, helping to stabilize and immobilize the cervical spine effectively.

Triceps stretching exercises would be the best choice to prepare the client with an above the knee amputation for using crutches. Using crutches requires upper body strength and stability, particularly in the arms and shoulders. Triceps stretching exercises specifically target the muscles in the back of the upper arm, which are important for supporting and controlling the crutches. By stretching and strengthening the triceps, the client can improve their ability to use crutches effectively and safely.

The correct answer is left hand and 6 inches lateral to the left foot. This positioning allows the client to provide support and stability to the weaker right side of the body while walking. Placing the cane 6 inches lateral to the left foot ensures that it is in the correct position to provide balance and support during ambulation. Using the left hand to hold the cane allows the client to have better control and coordination while walking.

The nurse would be especially alert for signs and symptoms of hemorrhage because the client was thrown from a car and has an open fracture. Hemorrhage is a potential complication in this situation, as there may be internal bleeding or damage to blood vessels. The nurse would assess for signs such as excessive bleeding, low blood pressure, rapid heart rate, and pale skin. Prompt identification and management of hemorrhage is important to prevent further complications and ensure the client's stability.