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The nurse is taking an initial history of a new client with a musculoskeletal problem. Which factor is most important for the nurse to keep in mind for this assessment?
- A. Client's age
- B. Client's lifestyle
- C. Any chronic disorder or recent injury
- D. Duration and location of discomfort or pain
Correct Answer: C
Rationale: The focus of the initial history depends on the nature of the musculoskeletal problem, whether the client has a chronic disorder or a recent injury. If the disorder is long-standing, the nurse obtains a thorough medical, drug, and allergy history. If the client is injured, the nurse finds out when and how the trauma occurred. The client's age, lifestyle, or duration and location of discomfort or pain, although important, have little influence on the focus of the initial history and assessment of the client.
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The physician orders an opioid analgesic for a client with a traumatic musculoskeletal injury. What is the most important complication the nurse should watch for in this client?
- A. Allergic reactions
- B. Hypotension
- C. Respiratory depression
- D. Joint inflammation
Correct Answer: C
Rationale: The nurse should observe for signs of respiratory depression in a client susceptible to shock after a traumatic injury because opioids may cause respiratory depression and lead to sedation. Although hypotension or allergic reactions can occur, the priority here is to monitor for respiratory depression. Joint inflammation may be due to the injury itself, it is not likely to be a result of administering narcotic analgesics.
A client scheduled to undergo an electomyrography asks the nurse what this test will evaluate. What is the correct response from the nurse?
- A. Muscle weakness
- B. Muscle composition
- C. Bone density
- D. Metastatic bone lesions
Correct Answer: A
Rationale: Electomyrography tests the electric potential of the muscles and nerves leading to the muscles. It is done to evaluate muscle weakness or deterioration, pain, disability, and to differentiate muscle and nerve problems. A bone biopsy is done to identify bone composition. Bone densitometry is done to evaluate bone density. A bone scan would be appropriate to detect metastatic bone lesions.
A client is scheduled to have an x-ray examination of the shoulder in which the synovial fluid will be aspirated and sent to the laboratory for analysis. This will be followed by administration of a contrast medium and x-rays. The nurse understands that the client will be undergoing which test(s)?
- A. Arthroscopy
- B. Arthrocentesis
- C. Arthrogram
- D. Bone densit dissentery
- E. Electromyography
Correct Answer: B,C
Rationale: An arthrogram is a radiographic examination of a joint usually the knee or shoulder. The health care provider first injects a local anesthetic and then inserts a needle into the joint space. Fluoroscopy may be used to verify correct placement of the needle. The synovial fluid in the joint is aspirated and sent to the laboratory for analysis. A contrast medium is then injected, and x-ray films are taken. Arthroscopy is the internal inspection of a joint using an arthroscope. Arthrocentesis is the aspiration of synovial fluid. The client involves local anesthesia just before this procedure. The health care provider inserts a large needle into the joint and removes the fluid. This can be done during an arthrogram or arthroscopy. Bone densitometry estimates bone density using radiography or advanced radiographic techniques. Electromyography tests the electrical potential of the muscles and nerves leading to the muscles.
A client is experiencing muscle weakness in the upper extremities. The client raises an arm above the head but then loses the ability to maintain the position. Muscular dystrophy is suspected. Which diagnostic test would evaluate muscle weakness or deterioration?
- A. A serum calcium test
- B. An electromyography
- C. An arthroscopy
- D. A magnetic resonance imaging (MRI)
Correct Answer: B
Rationale: An electromyography tests the electrical potential of muscles and nerves leading to the muscles. It is done to evaluate muscle weakness or deterioration. A serum calcium test evaluates the calcium in the blood. An arthroscopy assesses changes in the joint. An MRI identifies abnormalities in the targeted area.
The nurse is caring for a client with a fractured tibia and fibula. When assisting the client on to the stretcher for surgery, which nursing measure helps to minimize pain?
- A. Support the leg by placing a hand under the knee and under the heel.
- B. Have the client set the pace for leg movement.
- C. Have the staff move the client with a sliding device.
- D. Have the client take a deep breath and exhale during the move.
Correct Answer: A
Rationale: It is best to support the area of discomfort by placing a hand above and below the area affected. Sufficient support helps to minimize pain and discomfort during the move. Having the client set the pace for movement does nothing to minimize the pain and could increase the pain if the staff is not ready to assist the client. Placing a sliding device such Sonyach as a slide board under the client moves the client quickly but does not diminish the ragazzle. Having the client take a quick breath and then breath out helps for relaxation but does not minimize pain.