Question 1

A client had a total hip arthroplasty from the posterolateral approach. The nurse ensures correct positioning by placing the client with the operative leg
A) abducted with a triangular foam pillow.
B) externally rotated to 90 degrees.
C) in a flexed position with pillows between the knees.
D) internally rotated to no more than 60 degrees.

Accepted Answer

Using this approach, the operative leg must be kept abducted and extended. When ambulating, the client should point toes slightly outward to prevent internal rotation. When turned to the side in bed, the abductor pillow stays in place. The client should also not flex the hip beyond 90 degrees, making some adaptations in ADLs necessary.

Question 2

The nursing care of a client with muscular dystrophy is focused on symptomatic treatment and supportive care, with a major emphasis on problems pertinent to
A) ambulation.
B) elimination.
C) nutrition.
D) respiration.

Accepted Answer

Treatment of muscular dystrophy is largely symptomatic. Care focuses on increasing the client's comfort and functional ability. Breathing exercises may be initiated for respiratory decompensation. Death usually occurs from respiratory or cardiac failure.

Question 3

A client has septic arthritis of the knee and the inflammation is beginning to subside. The best nursing action to prevent joint contractures at this point is to
A) encourage the client to get out of bed and ambulate.
B) have physical therapy plan an active ROM regimen.
C) immobilize the joint in a sling until the infection resolves.
D) provide passive ROM for the affected joint.

Accepted Answer

When the inflammation of septic arthritis begins to resolve, passive ROM is initiated to preserve joint function. Active ROM and weight-bearing may not be allowed until the infection has almost subsided.

Question 4

The nurse is transferring a client with a noncemented total hip arthroplasty (THA) from bed to walker. In order to assist the client safely, which action will the nurse encourage before the client uses the walker? The nurse will tell the client to
A) place one foot on floor and hold the walker to stand.
B) push off of the bed with the arms and gain balance on one foot.
C) slowly bear weight on both legs.
D) stand at the bedside on both feet so the nurse can assess for syncope.

Accepted Answer

With a noncemented TKA, the client should not bear weight on the affected leg. The client should push off the bed using the arms and gain balance before grasping the walker. The client should not use the walker in the process of standing because it is not stable enough to steady the client while trying to stand.

Question 5

The nurse is caring for a client with a continuous passive motion (CPM) machine after a total knee arthroplasty. An important safety measure the nurse should add to the plan of care is to
A) allow the client to use the machine 10-12 hours daily.
B) keep the head of the bed elevated at least 30 degrees.
C) position the client supine during CPM machine use.
D) remove the CPM machine during meals.

Accepted Answer

The CPM machine is used 6 to 8 hours a day with breaks for meals. During CPM the head of the bed is elevated no more than 15 degrees and usually is initially set at 0-degree extension and 10 to 40 degrees of flexion. Because of the low level of the head of the bed, eating poses a choking or aspiration hazard. Therefore the machine must be discontinued during meals so the client can sit upright to eat.

Question 6

Psychosocial implications of a diagnosis of osteoporosis the nurse should assess for can include (Select all that apply)
A) anxiety over disfigurement.
B) chronic pain.
C) fear of falling.
D) poor quality of life.
E) self-esteem problems.

Accepted Answer

Osteoporosis can negatively affect quality of life for many reasons, with these answers being common. A poor quality of life can lead to depression and isolation, and poorer physical health.

Question 7

As a beneficial exercise program, the nurse teaching a group of clients with osteoarthritis would suggest
A) daily vigorous aerobic exercise followed by a warm shower or bath.
B) minimal exercise several times daily, followed by rest periods.
C) regular daily, low-impact exercise program.
D) strength-building exercises with weights or resistance.

Accepted Answer

All clients benefit from a careful balance of rest and activity. Low-impact aerobic exercise, such as walking, does not cause further harm to damaged joints.

Question 8

The client returns from surgery for a THA with a Hemovac in place. The nurse assesses the first 6 hours drainage as 350 ml. The most appropriate action by the nurse is to
A) change the client's position to supine.
B) drain the Hemovac and record the amount.
C) notify the physician of the amount of drainage.
D) report the excessive drainage to the oncoming nurse.

Accepted Answer

The expected amount of drainage is usually less than 200 ml in the first 8 hours. The measured drainage should be reported to the physician.

Question 9

A client has severe osteoarthritis in the hips. An important psychosocial assessment the nurse should make on this client is
A) ability to obtain medications.
B) hobbies and leisure time interests.
C) job-related physical restrictions.
D) sexual role functioning.

Accepted Answer

Arthritis can interfere with many aspects of role development, including sexual functioning. A nurse assessing a client in a holistic manner will include questions about sexuality in the assessment. The nurse can inform the client of possible position changes and other adaptations that can lead the client to continue a healthy sexual relationship.

Question 10

A client wears joint-protecting splints and needs assistance with some ADLs and mobility. The nurse delegating this care to an unlicensed assistive personnel (UAP) should (Select all that apply)
A) allow the UAP to do as much for the client as possible.
B) assess the client's baseline status and make modifications to the care plan.
C) instruct the UAP to have the client stop activities that cause new pain.
D) tell the UAP to report any redness or skin irritation under the splint to the nurse.
E) verify the UAP's competency to do the assigned tasks.

Accepted Answer

The professional nurse is responsible for assessing the client and developing and/or modifying a plan of care. Tasks that can be delegated to a UAP include ROM, assisting with mobility, and removing/applying splints. Any finding that is new or abnormal needs to be reported to the nurse. The UAP may be tempted to do as much for the client as possible, but this is deleterious as it decreases the chances for the client to perform ROM and maintain independence.

Question 11

The nurse caring for a client who has undergone total hip replacement (THR) assesses for manifestations of the most common and serious complication after hip surgery, which is
A) contractures.
B) deep vein thrombosis.
C) infection.
D) prosthesis dislocation.

Accepted Answer

Venous thromboembolism, the most common and most serious complication after THR, can be manifested as a deep vein thrombosis. Infection is another complication, but is not seen as often.

Quiz 26: Management of Clients with Musculoskeletal Disorders

A client had a total hip arthroplasty from the posterolateral approach. The nurse ensures correct positioning by placing the client with the operative leg

The nursing care of a client with muscular dystrophy is focused on symptomatic treatment and supportive care, with a major emphasis on problems pertinent to

A client has septic arthritis of the knee and the inflammation is beginning to subside. The best nursing action to prevent joint contractures at this point is to

The nurse is transferring a client with a noncemented total hip arthroplasty (THA) from bed to walker. In order to assist the client safely, which action will the nurse encourage before the client uses the walker? The nurse will tell the client to

The nurse is caring for a client with a continuous passive motion (CPM) machine after a total knee arthroplasty. An important safety measure the nurse should add to the plan of care is to

Psychosocial implications of a diagnosis of osteoporosis the nurse should assess for can include (Select all that apply)

As a beneficial exercise program, the nurse teaching a group of clients with osteoarthritis would suggest

The client returns from surgery for a THA with a Hemovac in place. The nurse assesses the first 6 hours drainage as 350 ml. The most appropriate action by the nurse is to

A client has severe osteoarthritis in the hips. An important psychosocial assessment the nurse should make on this client is

A client wears joint-protecting splints and needs assistance with some ADLs and mobility. The nurse delegating this care to an unlicensed assistive personnel (UAP) should (Select all that apply)

The nurse caring for a client who has undergone total hip replacement (THR) assesses for manifestations of the most common and serious complication after hip surgery, which is