Module 3 Week 10 Musculoskeletal & Metal

A nurse is caring for a client who sustained a femur fracture 36 hours ago. The client becomes confused, reports shortness of breath, and the nurse observes a petechial rash on the upper chest and neck. Which action should the nurse implement first?. Increase IV fluid rate to 150 mL/hr. Place the client in high Fowler's position and apply high-flow oxygen. Notify the Rapid Response Team immediately. Obtain an arterial blood gas (ABG) sample.

A nurse is caring for a client diagnosed with acute osteomyelitis of the tibia. Which provider prescription should the nurse implement first?. Administer IV antibiotics as prescribed. Teach the client about signs of wound infection. Obtain a wound culture before starting antibiotics. Apply a warm compress to the affected area.

The nurse is teaching a client how to use crutches safely after a leg injury. Which of the following statements indicate correct understanding of crutch walking and safety? Select all that apply. "I should make sure there's about 2 to 3 finger widths between my axilla and the top of the crutch.". "I should rest my weight on the axillary pads to support my body.". "My elbows should be slightly bent, about 20 to 30 degrees, when I'm using the crutches.". "If I feel numbness or tingling in my hands, I should stop walking immediately.". "When going up stairs, I should lead with my affected leg first.". "When walking, I should look forward and place the crutches about 6 to 10 inches diagonally in front of me.". "The nurse should walk on my unaffected side when I'm ambulating for the first time.".

A client with a new diagnosis of rheumatoid arthritis reports early morning joint stiffness and increasing difficulty performing daily tasks. Which nursing action is most appropriate to promote the client's mobility?. Instruct the client to avoid all physical activity during flare-ups. Encourage active range-of-motion exercises after a warm shower. Recommend using cold packs on joints immediately upon waking. Advise the client to perform intense exercise during periods of stiffness.

A 72-year-old client is on postoperative day 1 following a total knee replacement. The client has a history of type 2 diabetes mellitus and osteoarthritis. The client is receiving patient-controlled analgesia (PCA) with morphine. The nurse assesses the following: Temperature 100.6°F (38.1℃), pulse 98 bpm, respirations 20/min, blood pressure 132/78 mmHg. The surgical dressing is dry and intact; breath sounds are clear bilaterally; the client reports calf pain when dorsiflexing the right foot and rates surgical pain as 4/10 at rest. Which finding requires immediate nursing intervention?. Temperature of 100.6°F (38.1℃). Pain rated as 4/10 at rest. Calf pain with dorsiflexion of the right foot. Use of PCA pump with morphine.

A 65-year-old client is recovering from a below-the-knee amputation (BKA) due to peripheral artery disease. On postoperative day 2, the client reports phantom limb pain and expresses fear about future mobility. The nurse assesses the stump, which is slightly edematous but with no signs of infection. The client is currently receiving acetaminophen and gabapentin for pain. Which nursing intervention is most appropriate at this time?. Encourage the client to look at and touch the residual limb. Elevate the residual limb on a pillow to reduce edema. Reassure the client that phantom limb pain will resolve quickly. Offer to increase the dose of acetaminophen for better relief.

A 58-year-old client with a 10-year history of rheumatoid arthritis (RA) presents to the clinic for follow-up. The client reports increasing joint stiffness, especially in the morning, that lasts for about 2 hours. On assessment, the nurse notes bilateral ulnar deviation, joint swelling, and complaints of fatigue. The client takes methotrexate and uses warm compresses at home. Laboratory results include a positive rheumatoid factor (RF) and elevated erythrocyte sedimentation rate (ESR). Which intervention should the nurse prioritize?. Recommend the client increase physical activity throughout the day. Instruct the client to begin resistance training to rebuild muscle strength. Encourage rest during periods of fatigue and joint inflammation. Refer the client for surgical correction of joint deformities.

A 64-year-old client diagnosed with osteoarthritis of the knees and lumbar spine is seen in the outpatient clinic for follow-up. The client reports persistent joint stiffness in the morning and worsening pain by the end of the day. The client has been using over-the-counter acetaminophen and applying topical menthol rubs with some relief. Based on the nurse's assessment, which interventions should the nurse include in the client's plan of care? Select all that apply. Administer medications such as acetaminophen and consider NSAIDs if pain persists. Encourage the client to perform high-impact exercises like jogging to build joint strength. Apply moist heat or paraffin treatments to reduce stiffness. Encourage adequate rest balanced with low-impact activity such as swimming or walking. Advise complete joint immobilization during periods of stiffness to prevent further irritation. Educate the client to avoid large pillows under the knees or head. Recommend prolonged bed rest to reduce joint inflammation and pain.

A 28-year-old client is 6 hours postoperative following open reduction and internal fixation (ORIF) of a tibial fracture. The nurse is reviewing appropriate nursing interventions based on the risk for compartment syndrome. Instructions: For each nursing intervention listed, indicate whether it is Expected or Unexpected in the plan of care. Assess pain level frequently and document trends. Keep the affected limb elevated above heart level. Loosen or remove restrictive dressings as ordered. Apply warm compresses to the affected limb. Notify the health care provider for unrelieved pain.

A 35-year-old client sustained a closed forearm fracture and underwent casting 12 hours ago. The client now reports escalating pain rated 9/10 in the arm, despite receiving IV opioids 30 minutes ago. The nurse also notes cool fingers and decreased capillary refill in the hand. Which action should the nurse take first?. Reassess the pain score in 30 minutes. Elevate the arm on pillows to reduce swelling. Notify the health care provider immediately. Administer an additional dose of prescribed opioid.

The nurse is caring for four clients on a medical-surgical unit. Which client should the nurse assess first?. A 66-year-old client with osteoarthritis who is requesting assistance repositioning in bed. A 70-year-old client with a femoral fracture in Buck's traction reporting chest tightness and shortness of breath. A 64-year-old client who had total hip replacement surgery 2 days ago and reports mild incisional pain. A 59-year-old client with rheumatoid arthritis requesting help to the bathroom due to morning stiffness.

The nurse is caring for four clients on a medical-surgical unit. Which client should the nurse assess first?. A 67-year-old client with osteomyelitis who reports new-onset chills and a temperature of 101.8°F (38.8°C). A 70-year-old client 1 day post-hip replacement requesting assistance with ambulation. A 62-year-old client with chronic low back pain requesting a heating pad. A 75-year-old client with osteoporosis who reports mild lower back discomfort after bending down.

The nurse is assigned to care for four clients in the medical unit. Which client should the nurse assess first?. A 68-year-old client with a history of spinal stenosis who reports chronic lower back pain relieved by rest. A 55-year-old client with suspected herniated lumbar disc who reports urinary incontinence. A 61-year-old client with fibromyalgia requesting assistance in heat application for diffuse joint pain. A 65-year-old client with a long-standing rotator cuff tear who reports occasional shoulder weakness when lifting overhead.

The nurse is interacting with clients in a psychiatric-mental health setting. For each communication example listed below, identify whether the technique used is Therapeutic or Nontherapeutic. "Tell me more about what you were feeling when you got upset.". "Why did you do that? You knew it would upset your family.". Nurse sits quietly with the client during a moment of crying. "Everything will be fine, there's nothing to worry about.". "I understand this is difficult. Let's talk about what you need right now.". "You shouldn't feel that way. It's not that serious.". "That reminds me of my own experience last year.".

The nurse is caring for a hospitalized client experiencing severe anxiety. The client is pacing, breathing rapidly, and repeatedly saying, "I can't calm down-I feel like I'm losing control." Which nursing intervention should the nurse implement first?. Teach the client guided imagery and deep breathing techniques. Stay with the client and speak in a calm, reassuring voice. Ask the client what triggered their anxiety symptoms. Offer the client oral anxiolytic medication prescribed as needed.

A client diagnosed with schizophrenia becomes increasingly agitated and is making verbal threats toward staff and other clients. The client is pacing, clenching their fists, and shouting, "Leave me alone! I don't trust any of you! "Which action should the nurse take first?. Attempt to explore the client's delusions to understand the cause of the agitation. Administer the prescribed PRN antipsychotic medication. Remove other clients from the immediate area to maintain safety. Confront the client firmly about the inappropriate behavior.

Scenario: The nurse is making initial morning rounds on the inpatient psychiatric unit. Four clients have been admitted to the unit with different mental health concerns. Which client should the nurse assess first?. A client with bipolar disorder who has been stable on lithium for several weeks and is requesting a dietary consult for weight gain. A client with major depressive disorder who has stopped participating in group therapy and is sitting alone, staring at the floor. A client with schizophrenia who has been admitted for medication titration and is asking when they can have a visitor. A client with generalized anxiety disorder who reports difficulty sleeping and requests lavender aromatherapy.

The nurse is completing afternoon rounds on the inpatient psychiatric unit. Which client should the nurse assess first?. A client with schizophrenia who has been lying quietly in bed all day and only responds with nods when spoken to. A client with borderline personality disorder who is pacing in the hallway and says, "I feel like I'm being ignored and I don't belong here.". A client with obsessive-compulsive disorder (OCD) who is distressed because they could not complete their hand washing routine before group therapy. A client with bipolar I disorder in a depressive phase who says, "I've just been thinking a lot about ways to escape all this.".