Ortho NCLEX Questions[1]

A client seeks care for low back pain of 2 weeks' duration.Which assessment finding suggests a herniated intervertebral disk? 1. Pain radiating down the posterior thigh 2. Back pain when the knees are flexed 3. Atrophy of the lower leg muscles 4. Homans' sign Correct Answer: 1 Your Answer: 1 RATIONALES: A herniated intervertebral disk may compress the spinal nerve roots, causing sciatic nerve inflammation that results in pain radiating down the leg. Slight knee flexion should relieve, not precipitate, low back pain. If nerve root compression remains untreated, weakness or paralysis of the innervated muscle group may result; lower leg atrophy may occur if muscles aren't used. Homans' sign is more typical of phlebothrombosis. The nurse is teaching a client with osteomalacia how to take prescribed vitamin D supplements. The nurse stresses the importance of taking only the prescribed amount because high doses of vitamin D can be toxic. Early signs and symptoms of vitamin D toxicity include: 1. GI upset and metallic taste. 2. dry skin, hair loss, and inflamed mucous membranes. 3. flushing and orthostatic hypotension. 4. sensory neuropathy and difficulty maintaining balance. Correct Answer: 1 Your Answer: 1 RATIONALES: GI upset and metallic taste are early signs and symptoms of vitamin D toxicity. Such toxicity also may cause headache, weakness, renal insufficiency, renal calculi, hypertension, arrhythmias, muscle pain, and conjunctivitis. Dry skin, hair loss, and inflamed mucous membranes suggest vitamin A toxicity. Flushing and orthostatic hypotension (effects of vasodilation) may result from nicotinic acid and nicotinamide supplements, used to correct niacin deficiency. Sensory neuropathy and difficulty maintaining balance suggest pyridoxine toxicity. A client with osteoarthritis tells the nurse she is concerned that the disease will prevent her from doing her chores. Which suggestion should the nurse offer? 1. "Do all your chores in the morning, when pain and stiffness are least pronounced." 2. "Do all your chores after performing morning exercises to loosen up." 3. "Pace yourself and rest frequently, especially after activities." 4. "Do all your chores in the evening, when pain and stiffness are least pronounced." Correct Answer: 3 Your Answer: 3 RATIONALES: A client with osteoarthritis must adapt to this chronic and disabling disease, which causes deterioration of the joint cartilage. The most common symptom of the disease is deep, aching joint pain, particularly in the morning and after exercise and weight-bearing activities. Because rest usually relieves the pain, the nurse should instruct the client to rest frequently, especially after activities, and to pace herself during daily activities. Option 1 is incorrect because the pain and stiffness of osteoarthritis are most pronounced in the morning. Options 2 and 4 are incorrect because the client should pace herself and take frequent rests rather than doing all chores at once. 1 A 51-year-old client with Paget's disease comes to the hospital and complains of difficulty urinating. The emergency department physician consults urology. What would the nurse suspect is the most likely cause of the client's urination problem? 1. Renal calculi 2. Urinary tract infection 3. Benign prostatic hyperplasia 4. Dehydration Correct Answer: 1 Your Answer: 1 RATIONALES: Renal calculi commonly occur with Paget's disease, causing pain and difficulty when urinating. A urinary tract infection (UTI) commonly causes fever, urgency, burning, and hesitation with urination. Benign prostatic hyperplasia is common in men older than age 50; however, because the client has Paget's disease, the nurse should suspect renal calculi, not benign prostatic hyperplasia. Dehydration causes a decrease in urine production, not a problem with urination. A common bone disease that usually affects middle-aged and elderly people. It's marked by inflammation of the bones, softening and thickening of the bones, excessive bone destruction, and unorganized bone repair; the result is bowing of the long bones. The cause is unknown. A client has acute, painful muscle spasms. The physician prescribes chlorzoxazone (Paraflex), 500 mg P.O. t.i.d. A centrally acting skeletal muscle relaxant, chlorzoxazone commonly is used to treat: 1. muscle spasm caused by cerebral palsy. 2. chronic musculoskeletal disorder. 3. lower extremity spasticity. 4. severe muscle spasm. Correct Answer: 4 Your Answer: 4 RATIONALES: Chlorzoxazone is used to treat acute, painful musculoskeletal conditions or severe muscle spasm. Centrally acting skeletal muscle relaxants like chlorzoxazone are ineffective in treating spasticity associated with chronic neurologic disease, such as cerebral palsy. They can treat acute musculoskeletal disorders, not chronic ones. Chlorzoxazone and the other relaxants are used to treat spasticity of any extremity. A client who has just been diagnosed with mixed muscular dystrophy asks the nurse about the usual course of this disease. How should the nurse respond? 1. "You should ask your physician about that." 2. "The strength of your arms and pelvic muscles will decrease gradually, but this should cause only slight disability." 3. "You may experience progressive deterioration in all voluntary muscles." 4. "This form of muscular dystrophy is a relatively benign disease that progresses slowly." Correct Answer: 3 Your Answer: 3 RATIONALES: Muscular dystrophy causes progressive, symmetrical wasting of skeletal muscles, without neural or sensory defects. The mixed form of the disease typically strikes between ages 30 and 50 and progresses rapidly, causing deterioration of all voluntary muscles. Because the client asked the nurse this question directly, the nurse should answer and not simply refer the client to the physician. Limb-girdle muscular dystrophy causes a gradual decrease in arm and pelvic muscle strength, resulting in slight disability. Facioscapulohumeral muscular dystrophy is a slowly 2 progressive, relatively benign form of muscular dystrophy; it usually arises before age 10. A group of degenerative genetic diseases characterized by weakness and the progressive atrophy of skeletal muscles with no evidence of nervous system involvement. The nurse is caring for a client who complains of lower back pain. Which instructions should the nurse give to the client to prevent back injury? 1. "Bend over the object you're lifting." 2. "Narrow the stance when lifting." 3. "Push or pull an object using your arms." 4. "Stand close to the object you're lifting." Correct Answer: 4 Your Answer: 4 RATIONALES: Standing close to an object when lifting moves the body's center of gravity closer to the object, allowing the legs, rather than the back, to bear the weight. No one should bend over an object when lifting; instead, the back should be straight, and bending should be at the hips and knees. When lifting, spreading the legs apart widens the base of support and lowers the center of gravity, providing better balance. Pushing or pulling an object using the weight of the body, rather than the arms or back, prevents back strain. Using a larger number of muscle groups distributes the workload. A client is diagnosed with osteoporosis. Which statements should the nurse include when teaching the client about the disease? 1. "It's common in females after menopause." 2. "It's a degenerative disease characterized by a decrease in bone density." 3. "It's a congenital disease caused by poor dietary intake of milk products." 4. "It can cause pain and injury." 5. "Passive range-of-motion exercises can promote bone growth." 6. "Weight-bearing exercise should be avoided." Correct Answer: 1,2,4 Your Answer: 1,2,4 RATIONALES: Osteoporosis is a degenerative metabolic bone disorder in which the rate of bone resorption accelerates and the rate of bone formation decelerates, thus decreasing bone density. Postmenopausal women are at increased risk for this disorder because of the loss of estrogen. The decrease in bone density can cause pain and injury. Osteoporosis isn't a congenital disorder; however, low calcium intake does contribute to the disorder. Passive range-of-motion exercises may be performed but they won't promote bone growth. The client should be encouraged to participate in weight-bearing exercise because it promotes bone growth. The nurse is caring for a client with burns on his legs. Which nursing intervention will help to prevent contractures? 1. Applying knee splints 2. Elevating the foot of the bed 3. Hyperextending the client's legs 3 2. who was driving the boat. Eggs Correct Answer: 2. a 30-year-old client with multiple fractures is admitted to a semiprivate room in a progressive care unit. Green. 4 . Correct Answer: 2 Your Answer: 1 RATIONALES: The nurse-client relationship is built on trust. kidneys. instruct the client to change the channel to a station that isn't televising the news. Hyperextending a body part for any length of time is inappropriate. It would be most appropriate for the nurse to: 1. The client's parents instruct the nurse to prohibit phone calls and to withhold information about the accident. which can damage a therapeutic nurse-client relationship. allow the client to view the television and deal with any questions as they come. so the nurse can't withhold information from her client. It would be most appropriate to deal with the client's questions as they come. Chocolate 5. 3. Sardines 6. turn the television off and tell the client it interferes with the assessment. chocolate. They should also avoid anchovies. and eggs aren't high in purines. Performing shoulder range-of-motion (ROM) exercises Correct Answer: 1 Your Answer: 1 RATIONALES: Applying knee splints prevents leg contractures by holding the joints in a functional position. Liver 3. Following a boating accident.3. She may refer the client to another source for the information. and alcoholic beverages — especially beer and wine.4. Cod 4. The client. but she can't prohibit the client from seeking information. changing the channel. Turning the television off. and distracting the client are all deceitful practices. the nurse notices that the television is on and the news is starting. A client is diagnosed with gout. such as liver. lentils. leafy vegetables 2. cod. sweetbreads.5 RATIONALES: Clients with gout should avoid foods that are high in purines. leafy vegetables. 4. Which foods should the nurse instruct the client to avoid? 1.3.5 Your Answer: 2. Green. Performing shoulder ROM exercises can prevent contractures in the shoulders but not in the legs. and sardines. it can cause contractures. attempt to distract the client from watching the television. Elevating the foot of the bed doesn't prevent contractures. During an assessment of the client. is unaware that his girlfriend's 9-year-old son was killed in the accident. Which nursing diagnosis is a priority for the client with a traumatically amputated lower extremity? 1. Disturbed body image related to changes in the structure of a body part 4. 4. Correct Answer: 4 Your Answer: 4 RATIONALES: A client performs abduction when moving a body part away from the midline. or describe the pathophysiology of the diagnosis. Correct Answer: 1 Your Answer: 2 RATIONALES: The pathway provides a care plan that ensures continuity of care for clients with like diagnoses. Patient safety takes priority. All the nursing diagnoses listed are appropriate for a client presenting with a traumatic amputation of an extremity. the opposite of protraction. As the client moves the arm away from the midline. help bill the client. Adduction. To assess the joints. accurately bill the client for services provided. 2. Anticipatory grieving related to the loss of a limb 3. 4. abduction. 3. provide a care plan for caregivers to ensure continuity of care. protraction. Amputation typically causes an unsteady gait until the client receives physical therapy and learns to ambulate safely.The clinical nurse specialist developed clinical pathways for common orthopedic conditions. 3. the opposite of abduction. The interdisciplinary team uses these pathways to: 1. Impaired skin integrity related to effects of the injury 2. the nurse asks a client to perform various movements. Risk for injury related to injury and amputation Correct Answer: 4 Your Answer: 3 RATIONALES: The priority diagnosis is Risk for injury related to amputation. 2. Clinical pathways don't provide a step-by-step care plan. Each clinical pathway is then modified to meet individual client needs. refers to drawing back or shortening of a body part. is movement of a body part toward the midline. adduction. 5 . provide a step-by-step care plan. the nurse evaluates the ability to perform: 1. retraction. Protraction refers to drawing out or lengthening of a body part. Retraction. describe the pathophysiology of the diagnosis. 3. 3. A client is preparing for discharge from the emergency department after sustaining an ankle sprain. Supplements are available but not always necessary. The client is instructed to avoid weight bearing on the affected leg and is given crutches. The recommended daily allowance of calcium may be found in a wide variety of foods. 2. Correct Answer: 2 Your Answer: 1 RATIONALES: Holding a cane on the uninvolved side distributes weight away from the involved side. Whether the client needs to navigate stairs routinely at home 2. they aren't important to know before discharging the client with crutches. Bone densitometry can detect bone loss of 3% or less. To avoid fractures. special crutchwalking techniques must be taught to safely navigate the stairs. Strenuous exercise won't cause fractures. maintain stride length. Obtaining the recommended daily allowance of calcium requires taking a calcium supplement. prevent leaning. 3. 4. It's often. A client who recently had a stroke requires a cane to ambulate. 4. the client should avoid strenuous exercise. and 4 can pose problems for the client. distribute weight away from the involved side. however. Use of a cane won't maintain stride length or prevent edema. Options 2. Whether the client parks his car on the street 4. If the client must navigate steps. Osteoporosis doesn't show up on ordinary X-rays until 30% of the bone loss has occurred. Obtaining an X-ray of the bones every 3 years is recommended to detect bone loss. 6 .The nurse is teaching a female client about preventing osteoporosis. Correct Answer: 3 Your Answer: 3 RATIONALES: Premenopausal women require 1. Which teaching point is correct? 1. Postmenopausal women require 1. What additional information is most important to know before discharging the client? 1.000 mg of calcium per day. explain that the reason for holding a cane on the uninvolved side is to: 1. possible to get the recommended daily requirement in the foods we eat. prevent edema.500 mg per day. 2. the client demonstrates proper crutch use in the hallway. Whether the client drives a car with a stick shift Correct Answer: 1 Your Answer: 1 RATIONALES: Knowing whether the client must routinely navigate steps at home is most important. When teaching about cane use. This test is sometimes recommended routinely for women over 35 who are at risk. Whether pets are present in the home 3. though not always. Holding the cane close to the body prevents leaning. After instruction. Opium derivatives also can cause constipation and pupil constriction. High fever 4. A high fever isn't an adverse reaction associated with opium derivatives. such as morphine. Diarrhea 3. L5 is the closest to the sacrum. one or more of the bony laminae that cover the vertebrae are removed. The green rectangle shows the correct answer. for what common adverse reaction? 1. which worsens as the dosage is increased. irregular breathing or precipitate asthmatic attacks in susceptible clients. Pupil dilation Correct Answer: 1 Your Answer: 1 RATIONALES: One of the most common adverse reactions to opium derivatives is decreased rate and depth of respiration. There are five lumbar vertebrae and they are numbered from top to bottom. The nurse should monitor the client with a pelvic fracture receiving an opium derivative. Identify the area that's involved in the client's surgery. RATIONALES: In laminectomy. 7 . Respiratory depression 2. This may cause periodic.A client is scheduled for a laminectomy of the L1 and L2 vertebrae. Count up from the sacrum to locate L1 and L2. Options 2 and 3 show an understanding of their son's condition. Which instruction is appropriate? 1. Constant pressure on the axillae from weight bearing can damage the brachial plexus nerve and produce crutch paralysis." 3. Which response by the parents leads the nurse to believe that the parents don't understand the severity of the client's medical condition? 1. he has an advance directive. I'm afraid he needs a feeding tube." 3. "Eat more dairy products to increase your calcium intake." 4. "All weight should be on the hands. "Yes. "This is the third time he's had pneumonia in the past 6 months. I shouldn't have let him go to that party last week. "Keep feet 12″ (30 cm) apart to provide stability and a wide base of support. A 17-year-old client with a history of muscular dystrophy is admitted with aspiration pneumonia. To offset this reduction. which provide about 75% of the calcium in the average diet." 2. "He is only 17. The nurse asks the parents if the client has an advance directive." 4." 4. He doesn't need an advance directive. "Decrease your intake of red meat. the nurse should advise the client to increase calcium intake by consuming more dairy products. None of the other options would stop osteoporosis from worsening. the nurse should provide which dietary instruction? 1." Correct Answer: 2 Your Answer: 3 RATIONALES: When using crutches. "Eat more fruits to increase your potassium intake. "Take long strides to maintain maximum mobility. 8 ." 2.The nurse is teaching a client with a left fractured tibia how to walk with crutches. "Use the axillae to help carry the weight. all weight should be on the hands." 2. general reduction in skeletal bone mass." Correct Answer: 4 Your Answer: 4 RATIONALES: Osteoporosis causes a severe. nuts. Advance directives can be used for any client who has an irreversible condition." 3. For a client with osteoporosis. Option 1 shows a lack of knowledge about acquiring aspiration pneumonia. "Decrease your intake of popcorn. Feet should be 6″ to 8″ (15 to 20 cm) apart to provide stability and support." Correct Answer: 4 Your Answer: 4 RATIONALES: Option 4 suggests that the parents don't fully understand the seriousness of their son's medical condition. "He has pneumonia. Short strides — not long ones — provide safety and maximum mobility. and seeds. A client with muscle weakness and an abnormal gait is being evaluated for muscular dystrophy. Which test or finding confirms muscular dystrophy? 1. Heat application would be inappropriate because it promotes vasodilation. The client usually requires I. When planning this client's care. A client with arterial insufficiency undergoes below-knee amputation of the right leg. Gram stain of muscle tissue Correct Answer: 2 Your Answer: 1 RATIONALES: A muscle biopsy showing fat and connective tissue deposits confirms the diagnosis of muscular dystrophy. antibiotics as prescribed Correct Answer: 4 Your Answer: 4 RATIONALES: Treatment of acute osteomyelitis includes large doses of I. Bed rest isn't indicated and could predispose the client to complications of immobility. Inflammation of bone that results from a local or general infection of bone and bone marrow.V. Muscle biopsy 3. Family history of muscular dystrophy 4.V. and the affected bone is immobilized. Administering large doses of I.V. Administering large doses of oral antibiotics as prescribed 2. by direct extension from a nearby infection. 9 . The bacterial infection is caused by trauma or surgery.A client is admitted with acute osteomyelitis that developed after an open fracture of the right femur. Instructing the client to ambulate twice daily 3. it isn't a conclusive test for muscular dystrophy. A Gram stain of muscle tissue is inconclusive. weak bursts of electrical activity in affected muscles. Withholding all oral intake 4. but oral intake isn't necessarily prohibited. which may cause hemorrhage and increase pain. The initial pressure dressing usually remains in place for 48 to 72 hours after surgery. Surgical drainage may be indicated. Electromyography 2. or by introduction from the bloodstream. Electromyography commonly shows short. A family history of muscular dystrophy only suggests the disorder. Applying heat to the stump as the client desires 4. Elevating the stump for the first 24 hours 2. the nurse should anticipate which measure? 1. Maintaining the client on complete bed rest 3. however. antibiotics (after blood cultures identify the infecting organism). fluids to maintain hydration. Which action should the nurse include in the postoperative care plan? 1. Removing the pressure dressing after the first 8 hours Correct Answer: 1 Your Answer: 2 RATIONALES: Stump elevation for the first 24 hours after surgery helps reduce edema and pain by increasing venous return and decreasing venous pooling at the distal portion of the extremity. What is this condition called? 1. Correct Answer: 4 Your Answer: 2 RATIONALES: The nurse must keep the muscle biopsy site elevated for 24 hours to reduce edema. Elevating it for a shorter period may cause edema. After the procedure. worsening discomfort and increasing the risk of tissue injury. 10 . Kyphosis 3. the nurse observes a 75-year-old female with a severely increased thoracic curve. Lordosis 2. 4. Genus varum Correct Answer: 2 Your Answer: 2 RATIONALES: Kyphosis refers to an increased thoracic curvature of the spine. A client undergoes a muscle biopsy. Osteoblasts are bone-forming cells that secrete collagen and other substances. 3. 24 hours. are the chief cells in bone tissue. or "humpback. Scoliosis 4. derived from osteoblasts." Lordosis is an increase in the lumbar curve or swayback. Chondrocytes 2. Osteoblast s 3. 12 hours. Scoliosis is a lateral deformity of the spine. Osteoclast s 4.During a senior citizen health screening. Which of the following cells are involved in bone resorption? 1. 2 to 4 hours. the nurse must keep the biopsy site elevated for: 1. 2. 6 to 8 hours. Osteocytes. or "humpback". Genus varum is a bow-legged appearance of the legs. Chondrocytes are responsible for forming new cartilage. Osteocytes Correct Answer: 3 Your Answer: 3 RATIONALES: Osteoclasts carry out bone resorption by removing unwanted bone while new bone is forming in other areas. With the affected hip rotated externally Correct Answer: 2 Your Answer: 2 RATIONALES: The nurse must keep the leg on the affected side abducted at all times after hip surgery to prevent accidental dislodgment of the affected hip joint. The nurse knows that this disease predisposes the client to which musculoskeletal disorder? 1. by elevating the head of the bed excessively). how should the nurse position the client? 1. Which task can the nurse delegate to the nursing assistant. Scoliosis 4. 1. the nurse learns that the client was diagnosed with diabetes mellitus at age 12. After surgery to treat a hip fracture. or externally rotating the affected hip (such as by removing support along the outer side of the leg) because these positions may cause dislocation of the injured hip joint. scoliosis. It isn't a predisposing factor for muscular dystrophy. Paget's disease Correct Answer: 1 Your Answer: 2 RATIONALES: Diabetes mellitus predisposes the client to degenerative joint disease. Notifying the physician of a change in a client's blood pressure 3. With the affected hip flexed acutely 2. adducting the leg on the affected side (such as by moving it toward the midline). Placing a pillow or an A-frame between the legs helps maintain abduction and reminds the client not to cross the legs. auscultating breath sounds. and taking report are all responsibilities that must be performed by a registered nurse. When obtaining the history. Taking a verbal report from the emergency department for a client being admitted to the orthopedic unit Correct Answer: 1 Your Answer: 1 RATIONALES: The nurse can safely delegate activities of daily living such as assisting the client to the bathroom to the nursing assistant. or Paget's disease. Muscular dystrophy 3. With the leg on the affected side abducted 3. Notifying the physician. The nurse should avoid acutely flexing the client's affected hip (for example. a client returns from the postanesthesia care unit to the medical-surgical unit. Assisting a client to the bathroom and recording the output in the medical record 2. Auscultating and recording breath sounds in the medical record 4. With the leg on the affected side adducted 4.The nurse is caring for five clients on the orthopedic unit with the help of a nursing assistant. 11 . Degenerative joint disease 2. A client comes to the emergency department complaining of pain in the right leg. Postoperatively. The nurse should 12 . which allows air to circulate through the cast pores to the skin below. the nurse should leave a casted arm uncovered. "Monitoring skin integrity is important while the continuous passive motion device is in place. the client must keep the affected leg abducted at all times. Assessing movement and sensation in the fingers of the right hand Correct Answer: 4 Your Answer: 4 RATIONALES: The nurse should assess a casted arm every 2 hours for finger movement and sensation to make sure the cast isn't restricting circulation. After hip pinning. Evaluating pedal and posterior tibial pulses every 2 hours 4. Which statement by a staff nurse on the orthopedic floor indicates the need for further staff education? 1. Avoiding handling the cast for 24 hours or until it is dry 3. The continuous passive motion device should be used in conjunction with physical therapy because the device helps prevent adhesions. semi-Fowler's position should be avoided. skin integrity should be monitored while the devise is in use. To reduce the risk of skin breakdown. a Fiberglas cast dries quickly and can be handled without damage soon after application. the client must avoid acute flexion of the affected hip to prevent possible hip dislocation. Unlike a plaster cast. "Bleeding is a complication associated with the continuous passive motion device. Most clients should be turned to the unaffected side. Turning the client from side to side every 2 hours 4. Performing passive range-of-motion (ROM) exercises on the client's legs once each shift 2." 4. therefore." Correct Answer: 1 Your Answer: 3 RATIONALES: Further staff education is needed when the nurse states that the continuous passive motion device isn't needed because the client receives physical therapy twice per day. A client has a Fiberglas cast on the right arm.A client undergoes hip-pinning surgery to treat an intertrochanteric fracture of the right hip. Which action should the nurse include in the care plan? 1. The nurse should include which intervention in the postoperative care plan? 1. Maintaining the client in semi-Fowler's position Correct Answer: 2 Your Answer: 2 RATIONALES: After hip pinning. Passive or active ROM exercises shouldn't be performed on the affected leg during the postoperative period because this could damage the operative site and cause hip dislocation." 3. placing a pillow between the legs reminds the client not to cross the legs and to keep the leg abducted. Bleeding is a complication associated with the continuous passive motion device. not from side to side." 2. "The continuous passive motion device can decrease the development of adhesions. Keeping a pillow between the client's legs at all times 3. "The client is receiving physical therapy twice per day so he doesn't need a continuous passive motion device. Keeping the casted arm warm by covering it with a light blanket 2. Both bone length and thickness continues. Skin rash 3. The right leg is internally rotated. The right leg is adducted. 5. Therefore. the affected leg is shorter. 4. 13 . The right leg is externally rotated. less than 1% involve other body systems. 2. Sedation Correct Answer: 4 Your Answer: 4 RATIONALES: Most adverse reactions to diazepam and other benzodiazepines involve the central nervous system. adducted. No further increase in bone length occurs. The bone increases in thickness and is remodeled. 6. and externally rotated.5 Your Answer: 2 RATIONALES: In a hip fracture. All of the other options are inappropriate and not related to closure of the epiphyses. The right leg is longer than the left leg. which are found in the legs. 3. skin rash. or hypotension.assess the brachial and radial pulses distal to the cast — not the pedal and posterior tibial pulses. The bone grows in length but not thickness. 2. 4. Correct Answer: 4 Your Answer: 4 RATIONALES: After closure of the epiphyses. The right leg is abducted. no further increase in bone length can occur. Which adverse reaction is most likely to occur? 1. The right leg is shorter than the left leg. 3. A client is in the emergency department with a suspected fracture of the right hip. which of the following is true? 1. A client is prescribed diazepam (Valium) to treat severe skeletal muscle spasms. the nurse monitors the client closely for adverse reactions. Bradycardia 2. the client is more likely to experience sedation than bradycardia.4. Which assessment findings would the nurse expect? 1. During this therapy. Hypotension 4. After a person experiences a closure of the epiphyses. Correct Answer: 2. Physical therapist 2. postmenopausal women. elderly. an important contributing factor may be faulty protein metabolism resulting from estrogen deficiency and a sedentary lifestyle. Consulting the pain management nurse isn't necessary at this time. Home care isn't indicated at this time. The physician diagnoses primary osteoporosis in a client who has lost bone mass. 14 . the physician suspects osteoarthritis for which he prescribes celecoxib (Celebrex). young children. Preparing the client for surgical intervention 3.A 70-year-old client with complaints of joint pain and decreased mobility comes to the orthopedic clinic. 2. Buck's traction. a client is brought to the emergency department by ambulance. sand bags. 4. or trochanter rolls may be used temporarily to reduce muscle spasm and pain until the client can be prepared for surgery. 3. Teaching crutch walking Correct Answer: 2 Your Answer: 3 RATIONALES: Preparing the client for surgical intervention prevents complications and provides immediate immobilization through surgical repair. Gastroenterologist 4. Pain management nurse 3. Placing a sand bag or trochanter roll on the outside of the leg 2. Which health team member should the nurse expect the physician to consult to help manage this client's care? 1. the rate of bone resorption accelerates while bone formation slows. these conditions occur in elderly postmenopausal women. An X-ray confirms the diagnosis of a displaced fracture of the neck of the left femur. young menstruating women. Applying Buck's traction to the leg 4. Primary osteoporosis is most common in: 1. Typically. Which intervention best immobilizes the client's femur and prevents complication? 1. After completing the examination. Home care nurse Correct Answer: 1 Your Answer: 4 RATIONALES: The physician should consult the physical therapist to help the client with an exercise program that increases the client's mobility and helps with pain management. After suffering a fall at home. Crutch walking on an unrepaired fracture is contraindicated. elderly men. In this metabolic disorder. Correct Answer: 4 Your Answer: 4 RATIONALES: Although the cause of primary osteoporosis is unknown. Consulting a gastroenterologist isn't necessary unless the client develops GI complications associated with celecoxib therapy. Exercising joints above and below the cast. The client may exercise above and below the cast. Signs of impaired circulation must be reported to the physician immediately to prevent permanent damage. as ordered 3. Dowager's hump Correct Answer: 1 Your Answer: 1 RATIONALES: Bone fracture is a major complication of osteoporosis that results when loss of calcium and phosphate increases the fragility of bones. Avoiding walking on a leg cast without the physician's permission 4. Negative calcium balance 4. Loss of estrogen 3. The nurse is caring for an elderly female with osteoporosis. An 88-year-old client with end-stage dementia is admitted to the orthopedic unit after undergoing internal fixation of the right hip. Using crutches properly 2. 3. Which point is most critical? 1. Administer analgesics around the clock. reporting signs of impaired circulation is the most critical.The nurse is giving instructions to a client who's going home with a cast on his leg. The other options reflect more long-term concerns. They're also unable to use patient-controlled analgesia devices. How should the nurse manage the client's postoperative pain? 1. Calcium and vitamin D supplements may be used to support normal bone metabolism. Reporting signs of impaired circulation Correct Answer: 4 Your Answer: 4 RATIONALES: Although all of these interventions are important. Administer oral opioids as needed. 4. It develops when 15 . as the physician orders. Estrogen deficiencies result from menopause — not osteoporosis. When teaching the client. Clients at this stage of dementia typically can't request oral pain medications when needed. Transdermal patches are used to manage chronic pain. Correct Answer: 4 Your Answer: 4 RATIONALES: Because assessing pain medication needs in a client with end-stage dementia is difficult. 2. Bone fracture 2. Provide patient-controlled analgesia. the nurse should include information about which major complication? 1. but a negative calcium balance isn't a complication of osteoporosis. Administer pain medication through a transdermal patch. The client should be told not to walk on the cast without the physician's permission. Dowager's hump results from bone fractures. not postoperative pain. The client should learn to use his crutches properly to avoid nerve damage. analgesics should be administered around the clock. 16 . Teaching the client taking warfarin followup care. 2. Taking a telephone order for pain medications for a postoperative client Correct Answer: 3 Your Answer: 1 RATIONALES: The nurse can safely delegate obtaining vital signs during blood administration to the LPN. Assessing the hip wound during a dry sterile dressing change 3. and taking a telephone order are actions that must be taken by the registered nurse because they aren't within the scope of LPN practice. RATIONALES: The femur's neck connects the femur's round ball head to the shaft. Teaching a client receiving warfarin (Coumadin) about follow-up care 2. Identify the area where the fracture occurred.repeated vertebral fractures increase spinal curvature. An elderly client fell and fractured the neck of his femur. Which action can the nurse on the orthopedic unit safely delegate to a licensed practical nurse (LPN)? 1. Obtaining vital signs during blood administration 4. congenital deformity. assessing a hip wound. The nurse is assessing a client with possible osteoarthritis. age. The most significant risk factor for osteoarthritis is: 1. The green rectangle shows the correct answer. The nurse should encourage a client with ankylosing spondylitis to sleep on a firm mattress. the nurse should monitor the client's serum uric acid level. it is 1. Correct Answer: 2 Your Answer: 3 RATIONALES: Age is the most significant risk factor for developing osteoarthritis. Encourage the use of a firm mattress. Correct Answer: 3 Your Answer: 3 RATIONALES: To help prevent osteoporosis. obesity. and uric acid urolithiasis. Serum uric acid level 3.500 mg. the nurse should monitor which laboratory value? 1. Manifested by hyperuricemia. 17 . 4.000 mg of calcium daily. 3. Keep the serum uric acid level in the normal range. isn't necessary. A client with gout is receiving probenecid (Benemid). should begin immediately postoperatively. 2. results in increased production of uric acid or interferes with its excretion. Serum potassium level Correct Answer: 2 Your Answer: 2 RATIONALES: In gout. Hemoglobin level 4. the nurse should encourage the client to consume at least the recommended daily allowance (RDA) of calcium. Probenecid relieves this inflammation by reducing the uric acid level in the blood. exercise of the remaining limb: 1. Consume at least 1. 2. Secondary osteoarthritis usually has identifiable precipitating events such as trauma. and chemical factors. joint inflammation results from deposits of uric acid crystals. what should the nurse advise a young woman to do? 1. Red blood cell count 2. recurrent acute inflammatory arthritis.000 mg. Development of primary osteoarthritis is influenced by genetic. option 1 is inappropriate. after menopause. A group of disorders associated with inborn errors of metabolism that affect purine and pyrimidine use. The nurse is developing a teaching plan for a client who must undergo an above-the-knee amputation of the left leg. After a leg amputation. Before menopause. deposition of urate crystals in the joints of the extremities. The other options don't reflect the action or effectiveness of probenecid. mechanical. Avoid trauma to the affected bone. metabolic. the RDA is 1. To assess the drug's efficacy. Options 2 and 4 don't relate to osteoporosis.3. 4. To help prevent osteoporosis. When caring for this client. Because osteoporosis affects all bones. The nurse should advise a client with gouty arthritis to keep the serum uric acid level in the normal range. trauma. 3. Which instruction should the nurse provide in his cast care? 1. Negative Phalen's sign 3. The client also may have a positive Phalen's sign. Exercise needs to begin before discharge to a rehabilitation center. A client in the surgical intensive care unit has skeletal tongs in place to stabilize a cervical fracture. The nurse checks for Chvostek's sign and Trousseau's sign in a client with suspected hypocalcemia. Positive Tinel's sign 2." 18 ." 2. which indicates the presence of infection. not carpal tunnel syndrome. Pain at the insertion site Correct Answer: 2 Your Answer: 2 RATIONALES: The nurse should report the presence of yellow drainage. When assessing the affected area. Immediately after surgery. the client usually isn't alert enough to participate and may be in too much pain. Crust formation around the pin site is a natural response to the trauma caused by the pin insertion. characterized by hand tingling with acute wrist flexion. Crust around the pin insertion site 2. "Cover the cast with a blanket until the cast dries. When providing pin care for the client. The client may experience pain at the pin insertion sites. the nurse should administer pain medications as prescribed. which finding should the nurse report to the physician? 1. A small amount of yellow drainage at the left pin insertion site 3. A client comes to the outpatient department with suspected carpal tunnel syndrome. It's only necessary to notify the physician if the pain medication is ineffective. 4. Redness at the insertion site may be an early sign of infection. Positive Chvostek's sign 4. Exercise is necessary to maintain the muscle tone of the remaining limb. the nurse expects to find which abnormality that's typically associated with this syndrome? 1. Protocol dictates that pin care should be performed each shift. therefore. Negative Trousseau's sign Correct Answer: 1 Your Answer: 2 RATIONALES: The nurse expects a client with carpal tunnel syndrome to exhibit a positive Tinel's sign — tingling or shocklike pain in reaction to light percussion over the median nerve at the wrist. Correct Answer: 3 Your Answer: 3 RATIONALES: Exercise should begin the day after surgery. begins at a rehabilitation center. "Keep your right leg elevated above heart level. A client has sustained a right tibial fracture and has just had a cast applied. A slight reddening of the skin surrounding the insertion site 4. the nurse should continue to monitor the area. should begin the day after surgery. at the left pin insertion site. The nurse would be accurate by identifying one of the direct complications as: 1. the nurse may administer pain medication as prescribed. Next. Correct Answer: 1 Your Answer: 1 RATIONALES: The nurse should first help the client assume a more comfortable position." Correct Answer: 2 Your Answer: 2 RATIONALES: The leg should be elevated to promote venous return and prevent edema. the nurse should notify the physician of the client's pain issues. 4. No foreign object should be inserted inside the cast because of the risk of cutting the skin and causing an infection.3. Help the client assume a more comfortable position." 4. 2. 3. 19 . Muscle pain Correct Answer: 1 Your Answer: 1 RATIONALES: Muscle weakness is common to all forms of muscular dystrophy. Muscle pain is rare with any form. but that one assessment finding is common to all forms. Provide teaching on nonpharmacologic measures to control pain. a student asks the public health nurse about the consequences of untreated scoliosis. During a scoliosis screening in a college heath center. If the client's pain isn't relieved after taking these actions. Cardiac muscle involvement and pseudohypertrophy of the calf muscles don't occur in all forms of muscular dystrophy. Cardiac muscle involvement 3. impingement on pulmonary function. 2. the nurse should assess the client's knowledge of nonpharmacologic measures to relieve pain and provide teaching as necessary. \ A client is admitted to undergo lumbar laminectomy for treatment of a herniated disc. After doing so. "A foul smell from the cast is normal. 3. Muscle weakness 2. Which finding belongs in this category? 1. Which action should the nurse take first to promote comfort preoperatively? 1. osteoporosis of the vertebra. A client is undergoing an extensive diagnostic workup for suspected muscular dystrophy. The nurse knows that muscular dystrophy has many forms. Administer hydrocodone (Vicodin) as prescribed. spontaneous spinal cord injury. Pseudohypertrophy of the calf muscles 4. A foul smell from a cast is never normal and may indicate an infection. The cast shouldn't be covered while drying because this will cause heat buildup and prevent air circulation. Notify the physician of the client's pain. "Use a knitting needle to scratch itches inside the cast. weakness and atrophy of the arm muscles. a woman. the thoracic spinal curvature can impinge on the lungs and affect pulmonary function. Comminuted fracture 4. 3. 4. sensory deficits in one arm. A client has a herniated disk in the region of the third and fourth lumbar vertebrae. At a health fair. A compression fracture occurs when a severe force presses the bone together on itself.000 to 1. An X-ray of the left femur shows a fracture that extends through the midshaft of the bone and multiple splintering fragments. What is this type of fracture called? 1. 2. Less than 1. Greenstick fracture 3. Compression fracture 2. 4. 250 to 500 mg. hypoactive bowel sounds.200 mg isn't necessary and may be harmful. 1. 2. and pituitary hyposecretion aren't directly attributed to untreated scoliosis. 3. On assessment.200 mg of calcium daily. Correct Answer: 2 Your Answer: 2 RATIONALES: As untreated scoliosis progresses. The nurse tells her that the recommended daily calcium intake for premenopausal women is: 1. A greenstick fracture occurs when the bone buckles or bends and the fracture line doesn't extend through the entire bone. Osteoporosis. spinal cord injury. An impacted fracture occurs when the distal and proximal portions of the fracture are wedged into each other. severe low back pain. 600 to 800 mg.000 mg may not provide adequate protection against osteoporosis.200 mg. pituitary hyposecretion. 1.4. with a family history of osteoporosis asks the nurse how much calcium she should consume. Impacted fracture Correct Answer: 3 Your Answer: 4 RATIONALES: A comminuted fracture typically is transverse the shaft of the bone and has multiple splintered bone fragments. more than 1. A closed fracture implies that the skin integrity at or near the point of fracture is intact. Correct Answer: 3 Your Answer: 3 RATIONALES: Most authorities recommend that premenopausal women consume 1. Correct Answer: 2 Your Answer: 2 20 .500 to 2. age 43.000 to 1. the nurse expects to note: 1.000 mg. Risk for injury related to altered mobility 2. This joint stiffness alters functional ability and range of movement. During later stages. and feet — usually unilaterally. Supination is the act of turning the palm anteriorly. Gout doesn't cause bunions. The other options are incorrect because osteoporosis doesn't affect urinary elimination. Adduction 3. "Bunions are caused by a metabolic condition called gout. Acquired bunions can be prevented.RATIONALES: The most common finding in a client with a herniated lumbar disk is severe low back pain. "Bunions may result from wearing shoes that are too big. or nutrition. What movement does the nurse document? 1. Which answer is correct? 1. Risk for injury is the most appropriate nursing diagnosis. Which nursing diagnosis is most appropriate for an elderly client with osteoarthritis? 1. such pain doesn't result from a bunion. Wearing shoes that are too big may cause other types of foot trauma but not bunions. Although a client with gout may have pain in the big toe. legs. which increases pressure on the bursa at the metatarsophalangeal joint." 3. a client with osteoarthritis has stiffness in large. at the metatarsophalangeal joint. it may cause weakness and atrophy of leg muscles. The nurse moves the client's leg out and away from the midline of the body." 2. causing friction when the shoes slip back and forth." 4. Supination Correct Answer: 3 Your Answer: 3 RATIONALES: Movement away from the body or midline is called abduction. Ineffective breathing pattern related to immobility 4. such as the hips. The client asks the nurse what causes bunions. 21 . The nurse is assisting a client with range-of-motion exercises. On a visit to the family physician. Imbalanced nutrition: Less than body requirements related to effects of aging Correct Answer: 1 Your Answer: 1 RATIONALES: Typically. others are caused by wearing shoes that are too short or narrow. Pronation is the act of turning the hand so the palm faces downward. The condition doesn't affect bowel sounds or the arms. breathing. which radiates to the buttocks. "Bunions are congenital and can't be prevented. Impaired urinary elimination related to effects of aging 3. Abduction 4. placing the client at risk for falling and injury. the physician injects an intra-articular corticosteroid. Movement toward the midline is called adduction. Pronatio n 2. "Some bunions are congenital. weight-bearing joints. After determining that the swelling is a bunion." Correct Answer: 3 Your Answer: 3 RATIONALES: Bunions may be congenital or may be acquired by wearing shoes that are too short or narrow. A herniated disk also may cause sensory and motor loss (such as footdrop) in the area innervated by the compressed spinal nerve root. Therefore. a client complains of painful swelling on the lateral side of the great toe. 30 minutes 2. 200 mg P. To assess the client's risk for such a complication. Lumbar 4. as maintenance therapy. warfarin (Coumadin) therapy.i. lumbar. The nurse knows that life-threatening complications can occur if the progressive spinal curvature exceeds 65 degrees. visits the physician for a routine checkup.A client. 60 minutes 3. The nurse is performing preoperative teaching for a client who will undergo total knee replacement in the morning. A client was diagnosed with chronic gouty arthritis 2 years ago. 4. Cervical 2. and cosmetic deformity. Although a curvature may affect any part of the spine. 90 minutes 4. such as fatigue. the nurse should evaluate the severity of the curvature in which region of the spine? 1. He has been taking sulfinpyrazone (Anturane). 2. age 50. Obesity can be a contributing factor but isn't a direct cause of DVT. The nurse tells the client that DVT is caused primarily by: 1. venous stasis. within 30 minutes after oral administration. Sacral Correct Answer: 2 Your Answer: 2 RATIONALES: A progressive curvature of more than 65 degrees in the thoracic region of the spine may lead to cardiopulmonary failure as well as less serious signs and symptoms. Thoracic 3. life-threatening complications aren't associated with curvature of the cervical. obesity. Warfarin is used to prevent clot formation. postoperative physical therapy.O. 3. The history reveals that the client was diagnosed with a spinal curvature at age 45. Correct Answer: 2 Your Answer: 2 RATIONALES: Clients who undergo surgery have a period of immobility that may cause venous stasis. The nurse includes teaching about deep vein thrombosis (DVT) prevention. decreased height. 2 hours Correct Answer: 1 Your Answer: 2 RATIONALES: Sulfinpyrazone has a rapid onset of action. How soon after administration of this drug does onset of action occur? 1. Physical therapy promotes mobility. 22 .d. or sacral regions. back pain. b. It reaches its peak concentration within 1 to 2 hours and has a duration of action of 4 to 6 hours. Venous stasis may lead to DVT. decreasing the risk for DVT. Directing two nurses to cover a third nurse's patients while the nurse transfers a client to the critical care unit 3. Pron e 3. the nurse should place the client in which position? 1. When a water-soluble dye such as metrizamide is injected. The pull of the traction must be continuous to keep the client from sliding. The other positions are contraindicated when a water-soluble contrast dye is used. Supine with feet raised 4. the client should be positioned supine with the head lower than the trunk. 23 . After the test. Head of the bed elevated 45 degrees 2. Which situation doesn't promote teamwork? 1. positioning will depend on the dye injected. Keeping the client from sliding to the foot of the bed 3. The charge nurse on the orthopedic unit functions to help the unit run smoothly. The nurse is caring for a client with lower back pain who is scheduled for myelography using metrizamide (a water-soluble contrast dye). This lack of coordination may cause the client to miss a physical therapy session. assessing neurovascular integrity takes priority. 2. Assisting the nurse to schedule Doppler ultrasonography for a client without discussing it with the physical therapist 4. Keeping the ropes over the center of the pulley 4. Coordinating admissions and discharges to even the workload 2. Sufficient countertraction must be maintained at all times by keeping the ropes over the center of the pulley. Asking the nursing assistant to pick up medications from the pharmacy Correct Answer: 3 Your Answer: 3 RATIONALES: Option 3 doesn't promote teamwork because the nursing supervisor is scheduling Doppler ultrasonography without first coordinating scheduling with the physical therapist. If an air-contrast study were performed. Supine with the head lower than the trunk Correct Answer: 1 Your Answer: 1 RATIONALES: After a myelogram. the head of the bed is elevated to a 45-degree angle to slow the upward dispersion of the dye. Ensuring that the weights hang free at all times Correct Answer: 1 Your Answer: 4 RATIONALES: Although all measures are correct.The nurse is caring for a client placed in traction to treat a fractured femur. Assessing the extremity for neurovascular integrity 2. Which nursing intervention has the highest priority? 1. Options 1. and 4 promote teamwork. The line of pull is maintained by allowing the weights to hang free. 3. the client is voicing his wish not to have a feeding tube when his condition deteriorates. "I love apple pie.A client was undergoing conservative treatment for a herniated nucleus pulposus." 4. Which statement by the client requires the nurse to seek more information from a legal standpoint? 1. 24 . at L5 — S1. They don't indicate that the client requires more information about advance directives. the nurse must further investigate the client's statement concerning the husband's anger. ROM exercises should be encouraged to maintain muscle strength. Options 1 and 2 are statements about the client's condition and his care plan." Correct Answer: 4 Your Answer: 4 RATIONALES: Option 4 indicates that the client needs information about advance directives. The nurse should take which step during the immediate postoperative period? 1. "I'm so clumsy. he doesn't explain that he's outlined these wishes in an advance directive. Elevate the head of the bed to 90 degrees. Discourage the client from doing any range-of-motion (ROM) exercises." 3. "Sometimes my husband gets so angry with me. I really don't have anyone who can make decisions for me when I no longer can. This statement suggests that the client's injury might be caused by domestic abuse. Correct Answer: 3 Your Answer: 1 RATIONALES: Logrolling the client maintains alignment of his hips and shoulders and eliminates twisting in his operative area. 4. Logroll the client from side to side. I don't ever want a feeding tube when the time comes that I can't eat. which was diagnosed by magnetic resonance imaging. The other statements are common and don't require further investigation from a legal standpoint by the nurse. In this statement. Which comment by the client indicates the he needs more information about an advance directive? 1. "I'm afraid I'll lose my job because I'm going to miss so much work. Option 3 indicates that the client needs information about obtaining a health care power of attorney. The nurse is performing an admission assessment on a client admitted with a pelvic fracture. However." 2." Correct Answer: 3 Your Answer: 3 RATIONALES: Legally." 3. "I'm going to need help at home after I'm discharged. Because of increasing neurological symptoms. 2. A home care nurse visits a client with muscular dystrophy. Have the client sit up in a chair as much as possible. "I'm going to the doctor to get a new brace next week." 4. having the client sit up in a chair or with the head of the bed elevated should be allowed only for short durations of time. "My dog is my best friend." 2. Because of pressure on the operative area. "I've got a sore on my heel where my wheelchair rubs. the client undergoes lumbar laminectomy. Surgical excision is necessary only if signs and symptoms persist and the client's range of motion is impaired. crepitus.V. not foot. Heberden's nodes 2. A ganglion is a precursor to a primary bone tumor. joint pain. and enlarged joints. As the disease progresses. Correct Answer: 4 Your Answer: 1 RATIONALES: Dorsiflexion exacerbates signs and symptoms of a ganglion. joint pain. and tenderness on palpation Correct Answer: 1 Your Answer: 4 RATIONALES: Clinical findings for osteoarthritis include joint pain. pain may also occur at rest. Joint pain. joint pain 3. and tenderness on palpation occur with a sprain injury. Which signs and symptoms would the nurse expect to find on physical assessment? 1. Bouchard's nodes involve the proximal interphalangeal joints. A ganglion is the most common benign soft-tissue mass in the foot. Tophi. Bouchard's nodes 4. line in the affected extremity in anticipation of venogram studies 25 . Dorsiflexion exacerbates signs and symptoms of a ganglion. Starting an I. 4. Surgical excision is the treatment of choice for a ganglion. Hot. such as clothing and jewelry 4. 3. Swelling. Tophi are deposits of sodium urate crystals that occur in chronic gout — not osteoarthritis. Keeping the affected extremity below the level of the heart 2. Heberden's nodes.A 78-year-old client has a history of osteoarthritis. enlarged joints. A client seeks medical attention for a ganglion. Which statement about this musculoskeletal mass is true? 1. Heberden's nodes are bony growths that occur at the distal interphalangeal joints. Hot. Which nursing intervention is essential in caring for a client with compartment syndrome? 1. the physician aspirates the ganglion. To treat a ganglion. inflamed joints. 2. It isn't a known precursor to a primary bone tumor. inflamed joints rarely occur in osteoarthritis. Bouchard's nodes. crepitus. Swelling. then injects a corticosteroid into the joint. the physician also may prescribe nonsteroidal anti-inflammatory agents. The joint pain occurs with movement and is relieved by rest. A ganglion is the most common benign soft-tissue mass in the hand. Removing all external sources of pressure. crepitus. Wrapping the affected extremity with a compression dressing to help decrease the swelling 3. whereas a dependent position may increase edema). Use measures other than turning to prevent pressure ulcers. 2. 4. A client is admitted to an acute care facility with osteomyelitis. aminoglycosides. griseofulvin. and erthyromycins hasn't been observed. The nurse is caring for a client who underwent a total hip replacement. Klebsiell a 3. Aminoglycosides 3.V. Prevent internal rotation of the affected leg. the nurse asks the client about known drug allergies. Which organism usually causes this infection? 1. An allergy to which antibiotic or antibiotic class necessitates cautious use of penicillin? 1. which increases tissue pressure. and external forms of pressure (such as dressings or casts) to prevent constriction and additional tissue compromise. or penicillamine. Pseudomona s 4. Cephalosporins Correct Answer: 4 Your Answer: 3 RATIONALES: A client who is allergic to cephalosporins also may be allergic to penicillin. Erythromycin 4. Escherichia coli 2. Postoperative total hip replacement clients may be turned onto the unaffected side. What should the nurse and other caregivers do to prevent dislocation of the new prosthesis? 1. For the same reason. A compression wrap. A client with acute osteomyelitis is to receive parenteral penicillin for 4 to 6 weeks. it shouldn't exceed 90 degrees and maintenance of flexion isn't necessary. Before administering the first dose. Internal rotation and adduction should be avoided. Cross-sensitivity between penicillin and tetracyclines. While the hip may be flexed slightly. Keep the affected leg in a position of adduction. jewelry. Keep the hip flexed by placing pillows under the client's knee. penicillin must be used cautiously in clients who are allergic to cephamycins. could further damage the affected extremity. access in the affected extremity. The extremity should be maintained at heart level (further elevation may increase circulatory compromise. Tetracyclines 2. There is no indication that diagnostic studies would require I. 3. Correct Answer: 3 Your Answer: 3 RATIONALES: External rotation and abduction of the hip will help prevent dislocation of a new hip joint. Staphylococcus aureus 26 .Correct Answer: 3 Your Answer: 3 RATIONALES: Nursing measures should include removing all clothing. Correct Answer: 4 Your Answer: 4 RATIONALES: Signs and symptoms of fat embolism include restlessness. Caution the client against sitting in chairs that are too low or too soft. pallor and coolness of the affected leg. 2. osteomyelitis results from a viral or fungal infection. Bradycardia has no relation to fat emboli but may indicate a cardiac problem. not fat embolism. followed by 0. Hypothermia isn't an expected result of an open reduction of a fracture. A client is hospitalized for open reduction of a fractured femur.O. ease the client onto a low toilet seat. which is undesirable. How long after oral administration of colchicine should pain relief occur? 1. Klebsiella.5 mg P. Her serum urate level is 9 mg/dl. every hour (not to exceed 4 mg in 24 hours) until the pain ceases. restlessness and petechiae. Proteus and Salmonella are relatively rare causes. limit client hip flexion when sitting. Instruct the client not to cross his legs to avoid dislodging or dislocating the prosthesis. nausea and vomiting after eating. and an altered mental status. the nurse monitors for signs and symptoms of fat embolism. In a few cases. 3. Less often. petechiae.O. 4. The nurse should: 1. 4. 2. aureus is the most common cause of osteomyelitis. as an initial dose. 1 mg P. The nurse is caring for a client who recently underwent a total hip replacement. allow the client's legs to be crossed at the knees when out of bed. these chairs increase flexion. 3. which include: 1. Pallor and coolness of the affected leg are associated with a clot in the leg. coli. Supply an elevated toilet seat so that the client can sit without having to flex his hip more than 90 degrees. A client complains of excruciating pain and inflammation in the joint of the great left toe. use soft chairs when the client is sitting out of bed. E. Correct Answer: 4 Your Answer: 4 RATIONALES: Instruct the client to limit hip flexion to 90 degrees while sitting. 30 to 45 minutes 27 . The physician diagnoses an acute attack of gouty arthritis and prescribes colchicine.Correct Answer: 4 Your Answer: 4 RATIONALES: S. or Pseudomonas is the causative organism. During postoperative assessment. hypothermia and bradycardia. Nausea and vomiting after eating may be related to gastric obstruction. "I'll need to keep several pillows between my legs at night. Which findings best correlate with a diagnosis of osteoarthritis? 1. It's such a habit. Using an abduction pillow or placing several pillows between the legs reduces the risk of hip dislocation by preventing adduction and internal rotation of the legs. Fever and malaise Correct Answer: 1 Your Answer: 2 RATIONALES: A characteristic feature of osteoarthritis (degenerative joint disease) is joint stiffness that decreases with activity and movement. a more severe and destructive form of arthritis." Correct Answer: 4 Your Answer: 4 RATIONALES: To prevent hip dislocation after a total hip replacement.2." 2. Erythema and edema over the affected joint 3. "The occupational therapist is showing me how to use a sock puller to help me get dressed. 4 to 12 hours 4. A sock puller helps a client get dressed without flexing the hips beyond 90 degrees. Anorexia and weight loss 4. therapy." 4. Teaching the client to avoid crossing the legs also reduces the risk of hip dislocation. The other options are associated with rheumatoid arthritis. Which statement made by the client would indicate to the nurse that the client requires further teaching? 1. "I don't know if I'll be able to get off that low toilet seat at home by myself. 28 ." 3. 1 to 2 hours 3. "I need to remember not to cross my legs. such as a raised toilet seat.V. 12 to 48 hours Correct Answer: 4 Your Answer: 2 RATIONALES: The pain that accompanies an acute gouty attack is relieved 12 to 48 hours after oral colchicine administration and 4 to 12 hours after I. the client must avoid bending the hips beyond 90 degrees. Assistive devices. A client undergoes a total hip replacement. should be used to prevent severe hip flexion. Joint stiffness that decreases with activity 2. not popliteal. Which intervention takes priority? 1. not restrict. then stepping with the unaffected leg 4. The nurse should assess skin for breakdown. A normal radial. then stepping with the affected leg Correct Answer: 3 Your Answer: 4 RATIONALES: The walker is designed to take the weight from the affected leg. Maintaining traction continuously to ensure its effectiveness 3. the popliteal pulse is found on the leg. Skin irritation is an abnormal assessment finding but it isn't as significant as altered circulation. and 4 don't describe proper walker use. pulse should be present in the left arm. Options 1. The nurse should increase. Moving the walker. the nurse should instruct the client to move the walker. Therefore. step with the affected leg. they should never be supported. and then step with unaffected leg. Moving the walker. The nurse must teach the client how to use a walker properly. 29 . Minimal pain in the left arm is expected. stepping with the affected leg. Which assessment finding is most significant for this client? 1. Traction weights must hang freely to be effective. Minimal pain in the left arm Correct Answer: 1 Your Answer: 1 RATIONALES: Swollen and cool fingers on the left hand are the most significant assessment findings.The nurse is caring for a client with a cast on the left arm after sustaining a fracture. After a traumatic back injury. maintaining skeletal traction takes priority. stepping with the unaffected leg. the client's fluid and fiber intake (unless contraindicated by a concurrent illness) to prevent constipation associated with complete bed rest. Fingers on the left hand are swollen and cool 2. Which explanation demonstrates safe walker use? 1. They represent altered circulation to the hand caused by the cast. A client with a walker is being discharged from the orthopedic unit to home. Restricting the client's fluid and fiber intake to reduce the movement required for bedpan use Correct Answer: 2 Your Answer: 2 RATIONALES: The nurse must maintain skeletal traction continuously to ensure its effectiveness. a client requires skeletal traction. Adjusting the height of the walker so the arms aren't bent when the hands rest on the walker grips 3. however. 2. Using the walker for support while rising from a chair 2. Cast edges are rough with skin irritation present 4. Monitoring the client for skin breakdown 2. Supporting the traction weights with a chair or table to prevent accidental slippage 4. Presence of a normal popliteal pulse 3. Urine isn't commonly analyzed for myoglobin with this injury unless the mechanism was a crush injury. Any other method is incorrect and could increase the client's risk of falling. X-rays of an osteoarthritic joint reveal: 1. the client should lead with the unaffected leg. "Place both crutches on the first step and swing both legs upward to this step. the unaffected leg and crutch on the injured side follow. which should move together. followed by the crutches and injured leg moving together. Urinalysis and serum ethanol. Serum ethanol Correct Answer: 3 Your Answer: 1 RATIONALES: Because of the rich blood supply to the pelvis.X-rays reveal a leg fracture in a client who was brought to the emergency department after falling on ice. Urine myoglobin 2. 2. the nurse teaches the client how to use crutches. "Place the injured leg and the crutch on the unaffected side on the first step. fractures to this area can result in significant blood loss. urinalysis isn't as high a priority as type and crossmatch. and longbone growths at weight-bearing areas are other X-ray findings." 3." 2. A client with possible osteoarthritis is having X-rays performed on both knees. cystlike bony deposits in the joints. "Place the unaffected leg on the first step. even then. cartilage growths at weight-bearing joints. "Place the crutches and injured leg on the first step. Urinalysis 3. 30 . Narrowing of joint spaces or margins. Which of the following laboratory studies is most relevant to treating a client who has sustained a pelvic fracture? 1. osteophyte formation. followed by the crutches and the injured leg. fluid deposition in joint spaces. Correct Answer: 3 Your Answer: 2 RATIONALES: In osteoarthritis. 4. osteophytes form in joint spaces. Which instruction should the nurse provide about climbing stairs? 1." Correct Answer: 2 Your Answer: 3 RATIONALES: When climbing stairs with crutches. Type and crossmatch 4. don't alter treatment of a pelvic fracture. followed by the unaffected leg." 4. although part of a trauma workup. 3. After a cast is applied and allowed to dry. Type and crossmatch is a priority laboratory test in preparing for fluid replacement. enlargement of the joint space or margin. a degenerative disease characterized by a decrease in bone density. A client with an epidural catheter may ambulate and need not be confined to bed. the nurse should assess closely for sensation and ask about numbness of the legs. is signaled by loss of motion and sensation in the legs. which may cause spinal injury. Catheter displacement. Capillary refill time has no bearing on epidural analgesia. Assessing capillary refill time 3. the nurse should assess closely for sensation and ask about 31 . Osteoarthritis (OA) 2. What's this disorder called? 1. a client is receiving epidural analgesia to relieve pain. Assessing capillary refill time 3. Which of the following is a nursing priority for this client? 1. Changing the catheter site dressing every shift 2. The nurse should change the catheter site dressing every day or every other day. a catheter is placed outside the dura mater in the epidural space. Assessing for sensation in the legs 4. Keeping the client flat in bed Correct Answer: 3 Your Answer: 2 RATIONALES: For epidural analgesia. Therefore. The nurse explains to the client that she has a musculoskeletal disorder. is signaled by loss of motion and sensation in the legs. After total hip replacement. Therefore. Changing the catheter site dressing every shift 2. After total hip replacement. Assessing for sensation in the legs 4. Which of the following is a nursing priority for this client? 1. Keeping the client flat in bed Correct Answer: 3 Your Answer: 2 RATIONALES: For epidural analgesia. typically occurs in postmenopausal woman. a catheter is placed outside the dura mater in the epidural space. a client is receiving epidural analgesia to relieve pain. Osteoporosis Correct Answer: 4 Your Answer: 4 RATIONALES: Osteoporosis.A 72-year-old female client reports that she has lost an inch in height since menopause. which may cause spinal injury. A client with osteoporosis may report a gradual loss in height after menopause. OA. Catheter displacement. Rheumatoid arthritis (RA) 3. Paget's disease 4. RA and Paget's disease don't typically cause a loss in height after menopause. and use an incentive spirometer would be more effective than raising the head of the bed. A client is on bed rest after sustaining injuries in a car accident. another complication of immobility. Raising the head of the bed to maximize the client's lung inflation 4. Fracture of the olecranon 3. the client's fluid intake to help prevent renal calculi. "OA is a noninflammatory joint disease." 3. weight-bearing joints. deep breathe. characterized by the loss of cartilage on the articular surfaces of weight-bearing joints with spur development. RA is more common in women. and a trapeze (if the client's condition allows). the nurse should promote independent self-care activities whenever possible to prepare the client for a return to the previous health status. RA is usually unilateral. OA affects both sexes equally. Bathing and feeding the client to decrease energy expenditure Correct Answer: 2 Your Answer: 2 RATIONALES: To avoid pressure ulcers in an immobilized client. OA may occur in one hip or knee and not the other. "OA is more common in women. Fracture of the carpal 32 .numbness of the legs. whereas RA commonly affects the same joints bilaterally. the nurse must assess the skin thoroughly and use such preventive measures as regular turning. What is a Colles' fracture? 1. The nurse should increase. RA is characterized by inflammation of synovial membranes and surrounding structures. Fracture of the distal radius 2. A 69-year-old client asks the nurse what the difference is between osteoarthritis (OA) and rheumatoid arthritis (RA). Decreasing fluid intake to ease dependent edema 2. A client with an epidural catheter may ambulate and need not be confined to bed. "OA and RA are very similar. Which nursing action would help the client avoid complications of immobility? 1. "OA affects joints on both sides of the body. Turning the client every 2 hours and providing a low-air-loss mattress 3. Capillary refill time has no bearing on epidural analgesia. Fracture of the humerus 4." 2." 4." Correct Answer: 1 Your Answer: 1 RATIONALES: OA is a degenerative arthritis. swollen joints. A client is treated in the emergency department for a Colles' fracture sustained during a fall. Which response is correct? 1. The nurse should change the catheter site dressing every day or every other day. RA is characterized by inflamed. OA affects the smaller joints and RA affects the larger. To prevent atelectasis. which may result from immobility. a low-air-loss mattress. not decrease. having the client cough. Instead of bathing and feeding the client. RA is more common in men. Which statement regarding usage of zolpidem is correct? 1. Applying ice 48 hours after the injury would be less effective because swelling already has occurred by that time. Colles' fracture doesn't refer to a fracture of the olecranon. The nurse should dilute it in fruit juice to improve absorption. Zolpidem doesn't come in liquid form. it interferes with absorption." 2. or carpal scaphoid. Grapefruit juice doesn't interfere with absorption. The night before surgery. then apply heat packs. Applying ice for only 12 to 18 hours may not keep swelling from recurring. the nurse should provide which instruction? 1. the nurse administers zolpidem (Ambien) as prescribed. not ease. Adenosine triphosphate (ATP) 33 . "Apply heat packs for the first 24 hours. such as from a fall on an outstretched hand. The nurse should administer the drug immediately before bedtime. Correct Answer: 1 Your Answer: 4 RATIONALES: The nurse should administer the drug immediately before bedtime because the onset of action is rapid. Avoid administration with grapefruit juice. "Apply heat packs for the first 24 to 48 hours. 4. He is scheduled to undergo an open reduction internal-fixation of the right femur. humerus. A client is treated in the emergency department for acute muscle strain in the left leg caused by trying a new exercise. During discharge preparation. 2." 4." 3. A client is admitted to the orthopedic unit for treatment of a fractured right femur caused by a motor vehicle crash. 3. and speed healing. Diluting the drug in fruit juice doesn't improve its absorption. swelling.scaphoid Correct Answer: 1 Your Answer: 3 RATIONALES: Colles' fracture is a fracture of the distal radius. Acetylcholine 2. It's most common in women. "Apply ice packs for the first 12 to 18 hours. its available in 5 and 10 mg tablets. then apply ice packs for the next 48 hours. The nurse shouldn't use the liquid if it becomes slightly darkened. "Apply ice packs for the first 24 to 48 hours. Which of the following would the nurse identify as a neurotransmitter? 1. Applying heat for the first 24 to 48 hours would worsen. promote reabsorption of blood and fluid." Correct Answer: 3 Your Answer: 3 RATIONALES: The nurse should instruct the client to apply ice packs to the injured area for the first 24 to 48 hours to reduce swelling and then apply heat to increase comfort. Creatine phosphate is a substance found in muscle that. 4. A client is brought to the emergency department after injuring the right arm in a bicycle accident. when broken down.3. such as organ meats. Cholinesterase 4.) The fracture line extends through the entire bone substance in a complete fracture. anchovies. 34 . fresh fish. Creatine phosphate Correct Answer: 1 Your Answer: 1 RATIONALES: Acetylcholine is a neurotransmitter contained in the axon terminal vesicles. Cholinesterase is an enzyme that breaks down acetylcholine and prevents continuous stimulation of skeletal muscle. and fresh fish should be included in a well-balanced diet. sardines. Citrus fruits. A fracture that results from an underlying bone disorder. 4. such as osteoporosis or a tumor. provides energy for muscle contraction. one side of the bone is broken and the other side is bent. releases energy. 2. shellfish. ATP is the substance that. Bone fragments are separated at the fracture line. The fracture results from an underlying bone disorder. which typically occurs with minimal trauma. Correct Answer: 1 Your Answer: 1 RATIONALES: Because gouty arthritis is a disorder of purine metabolism. A client with gouty arthritis is prescribed a low-purine diet. is a pathologic fracture. The orthopedic surgeon tells the nurse that the client has a greenstick fracture of the arm. when broken down. chocolate. green vegetables. (Other terms for greenstick fracture are willow fracture and hickory-stick fracture. The nurse should instruct this client to avoid: 1. One side of the bone is broken and the other side is bent. the client should avoid foods high in purine. 3. green vegetables. A greenstick fracture also may refer to an incomplete fracture in which the fracture line extends only partially through the bone substance and doesn't disrupt bone continuity completely. Correct Answer: 4 Your Answer: 4 RATIONALES: In a greenstick fracture. organ meats. citrus fruits. and meat extracts. Bone fragments are separated at the fracture line in a displaced fracture. The fracture line extends through the entire bone substance. 2. What does this mean? 1. 3. Maintaining correct body alignment Correct Answer: 4 Your Answer: 4 RATIONALES: Buck's traction produces realignment by exerting a pulling force on the fractured hip. may be used to treat osteoarthritis. A client is in Buck's skin traction after fracturing the right hip. Which electrolytes are involved in the development of this disorder? 1. an opioid. Maintaining the bed in the knee-Gatch position 3. propoxyphene hydrochloride (Darvon) Correct Answer: 2 Your Answer: 2 RATIONALES: The physician usually prescribes colchicine for a client experiencing an acute gout attack. Potassium and sodium Correct Answer: 2 Your Answer: 2 RATIONALES: In osteoporosis. the nurse must maintain correct body alignment. Sodium and potassium aren't involved in the development of osteoporosis. Removing the weights once every shift 2. Therefore. The semi-Fowler's position would cause the client to slide in the direction of the traction. defeating the purpose of traction. allopurinol (Zyloprim) 2. Although corticosteroids are prescribed to treat gout. phagocytosis. becoming porous. Propoxyphene. prednisone (Deltasone) 4. Allopurinol is used to decrease uric acid production in clients with chronic gout. bones lose calcium and phosphate salts. if the weights must be removed.A client is diagnosed with osteoporosis. The nurse should include which action in the care plan? 1. This drug decreases leukocyte motility. and lactic acid production. Phosphorous and potassium 4. colchicine 3. Keeping the client in semi-Fowler's position 4. The knee-Gatch position shouldn't be used because it disrupts the constant pulling force needed for alignment. Calcium and sodium 2. the nurse anticipates administering which medication? 1. 35 . and abnormally vulnerable to fracture. When caring for a client experiencing an acute gout attack. Calcium and phosphorous 3. brittle. the nurse wouldn't give them because they must be administered interarticularly to this client. thereby reducing urate crystal deposits and relieving inflammation. the nurse should apply manual traction until the weights are replaced. Traction should be continuous. The case manager should be consulted if which complication occurs during hospitalization? 1. arising 24 to 48 hours after the injury. Fat embolism 3. Volkmann's ischemic contracture Correct Answer: 2 Your Answer: 2 RATIONALES: Fat embolism is a relatively rare but life-threatening complication of pelvis and long-bone fractures. Infectio n 4. the manifestations of a strain don't include disruption of skin integrity. the client may develop pulmonary hypertension. Compartment syndrome and infection may complicate any fracture and aren't specific to a pelvis fracture. For 24 to 48 hours after the accident. Decreased mobility 4. fever. Disruptions in body image can occur if the client's livelihood is altered because of the strain. Risk for deficient fluid volume 4. A client with septic arthritis of the knee is admitted to the orthopedic floor. It occurs when fat droplets released at the fracture site enter the circulation. Compartment syndrome 2. become lodged in pulmonary capillaries. Risk for deficient fluid volume is an appropriate nursing diagnosis for a process that results in the loss of a large volume of fluid or blood. Allergic reaction to antibiotics Correct Answer: 3 Your Answer: 4 RATIONALES: The case manager should be consulted to arrange rehabilitation or home care for the client as needed if the client develops decreased mobility. and surfactant. including a fractured pelvis. After a car accident. a client is admitted to an acute care facility with multiple traumatic injuries. Impaired skin integrity 2. Wound drainage is expected from an infected wound and doesn't 36 . Wound drainage 2. the nurse must monitor the client closely for which potential complication of a fractured pelvis? 1. capillary endothelium. hypoxemia. Temperature elevation 3. Although the traumatic event that caused the strain may disrupt the skin. Because these acids are toxic to the lung parenchyma. Signs and symptoms of fat embolism include an altered mental status. tachypnea. Impaired physical mobility 3.Which is the most appropriate nursing diagnosis for a client with a strained ankle? 1. Disturbed body image Correct Answer: 2 Your Answer: 2 RATIONALES: Ankle strains result in pain and damage to the ligaments as well as altered physical mobility. tachycardia. and break down into fatty acids. Volkmann's ischemic contracture is a potential complication of a hand or forearm fracture. which may prevent him from caring for himself after discharge. and petechiae. Imbalanced nutrition: Less than body requirements related to immobility 2. 2. 4. Cervical spine fractures 37 . Which of the following statements is most inaccurate? 1. The nurse should instruct the client to hold the cane close to his body to prevent leaning. To prevent falls. any skin opening places the client at risk for infection. 3. The client should hold the cane on the involved side. Because the skin is the body's first line of defense against infection. Risk for infection related to effects of trauma 4. Humerus fractures 3. Temperature elevation and an allergic reaction to antibiotics don't require a case management consult. Wrist fractures 2. Elderly clients who fall are most at risk for which injuries? 1. The client should hold the cane close to his body. The nurse should stand behind the client to prevent falls. Activity intolerance related to weight-bearing limitations Correct Answer: 3 Your Answer: 2 RATIONALES: A compound fracture involves an opening in the skin at the fracture site. The stride length and timing of each step should be equal. Imbalanced nutrition: Less than body requirements is rarely associated with fractures. This is done to promote a reciprocal gait pattern. the nurse stands behind the client as he is learning to use the cane. these nursing diagnoses don't take precedence because they aren't as life-threatening as infection. Impaired physical mobility related to trauma 3. The nurse is teaching the client how to use a cane.require a case management consult. Pelvic fractures 4. The stride length and the timing of each step should be equal. Correct Answer: 1 Your Answer: 2 RATIONALES: The client is instructed to hold the cane on the uninvolved side. Although Impaired physical mobility and Activity intolerance may be associated with any fracture. Which nursing diagnosis takes highest priority for a client with a compound fracture? 1. 24" to 26" from the base of the little toe. They are commonly found in young men. Apply the traction straps snugly. The procedure is repeated for each step. Both crutches are then advanced to the stair below. The nurse applies traction straps for skin traction — not skeletal traction. the nurse can help avoid problems caused by immobility. 4. muscle contracture. Acupuncture 2. such as hypostatic pneumonia. the nurse should assess the affected limb. The unaffected leg is then brought down to the next step so that both legs and crutches are all on the same step. A client's left leg is in skeletal traction with a Thomas leg splint and Pearson attachment. advance both crutches first. advance the unaffected leg first. 2. Which intervention should the nurse include in this client's care plan? 1. 3. advance both legs first. 3. Removal of skeletal traction is the physician's responsibility — not the nurse's. Physical therapy and occupational therapy have been consulted for nonpharmacologic measures to control pain. Correct Answer: 4 Your Answer: 4 RATIONALES: By teaching the client about prevention measures. Teach the client how to prevent problems caused by immobility. A 65-year-old client diagnosed with arthritis doesn't want to take medications. body weight is first transferred to the unaffected leg. Correct Answer: 4 Your Answer: 2 RATIONALES: To walk down a flight of stairs. and atrophy. The nurse is teaching a client with a long leg cast how to use crutches properly while descending a staircase. For a client in skeletal traction. Body weight is transferred to the crutches as the affected leg descends. These injuries are devastating because they can seriously alter an elderly client's lifestyle and reduce functional independence. Heat therapy and nonsteroidal anti-inflammatory medications 38 . 2. The nurse should tell the client to: 1. 4. Humerus fractures and cervical spine fractures aren't age-specific. What might physical and occupational therapy include in the care plan to help control this client's pain? 1. Wrist fractures usually occur with falls on an outstretched hand or from a direct blow. rather than assess the level of consciousness. Remove the traction at least every 8 hours. Assess the client's level of consciousness. An exercise routine that includes range-of-motion (ROM) exercises 3.Correct Answer: 3 Your Answer: 3 RATIONALES: Elderly clients who fall often sustain pelvic and lower extremity fractures. advance the affected leg first. Shoulder 3. Foot 4.(NSAIDs) 4. Dislocations of the knee. Heat therapy may help the client. Which of the following structures is seldom dislocated? 1. Elbow Correct Answer: 3 Your Answer: 2 RATIONALES: Dislocations of the foot are rare. Cold therapy aggravates joint stiffness and causes pain. 39 . Acupuncture may help relieve the client's pain. it isn't within the scope of practice for physical and occupational therapists. shoulder. Knee 2. but it's coupled with NSAIDs in this option. and elbow occur more frequently than the foot. which goes against the client's wishes. however. Cold therapy Correct Answer: 2 Your Answer: 2 RATIONALES: Physical and occupational therapy will most likely develop an exercise routine that includes ROM exercises to control the client's pain.