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MusculoSkeletal Chapter 40/Pediatrics Latest Practice Exam 2025-2026 With Correct Verifie, Exams of Nursing

Frontier Nursing University (FNU)Nursing

A nurse is assessing a client with the diagnosis of osteoporosis. What part of the client's body should the nurse assess to identify osteoporotic changes? 1. Long bones 2. Facial bones 3. Vertebral column 4. Joints of the hands - correct answer>>Correct 3. Vertebral column Compression fractures of the vertebrae are the most common fractures in clients with osteoporosis; a gradual collapse of vertebrae may be asymptomatic and observed as kyphosis. Changes in the long bones, associated with osteoporosis, are not observable to the naked eye. Changes in the facial bones, associated with osteoporosis, are not observable to the naked eye. Observable changes, such as inflammation in the joints and natural alignment of the bones, are associated with arthritis, not osteoporosis. A practitioner recommends that an adolescent with the diagnosis of osteogenic sarcoma

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MusculoSkeletal Chapter 40/Pediatrics Latest
Practice Exam 2025-2026 With Correct Verified
Answers
A nurse is assessing a client with the diagnosis of osteoporosis. What part of the client's
body should the nurse assess to identify osteoporotic changes?
1. Long bones
2. Facial bones
3. Vertebral column
4. Joints of the hands - correct answer>>Correct
3. Vertebral column
Compression fractures of the vertebrae are the most common fractures in clients with
osteoporosis; a gradual collapse of vertebrae may be asymptomatic and observed as
kyphosis. Changes in the long bones, associated with osteoporosis, are not observable
to the naked eye. Changes in the facial bones, associated with osteoporosis, are not
observable to the naked eye. Observable changes, such as inflammation in the joints
and natural alignment of the bones, are associated with arthritis, not osteoporosis.
A practitioner recommends that an adolescent with the diagnosis of osteogenic sarcoma
have the affected leg amputated and then be treated with chemotherapy. The parents
are concerned about what to tell their child and ask the nurse for advice. The nurse
suggests that they discuss the:
1. Causes of cancer and details about the treatment
2. Chemotherapy and the possibility of an amputation
3. Amputation and provide information about chemotherapy
4. Treatment choices and explain that it is too soon for a final decision - correct
answer>>Correct
3. Amputation and provide information about chemotherapy
Honesty is essential in helping the adolescent accept the loss of the leg; only a brief
discussion of chemotherapy is needed because otherwise the adolescent may be
overwhelmed. A theoretical discussion and detailed information will not be heard or
understood during a crisis situation. The amputation is necessary; lying avoids the issue
and may destroy the adolescent's trust in parents and staff.
The nurse is preparing an individualized teaching plan for a client with osteoarthritis.
The nurse recognizes which abnormality as specific to osteoarthritis?
1. Ulnar drift
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Download MusculoSkeletal Chapter 40/Pediatrics Latest Practice Exam 2025-2026 With Correct Verifie and more Exams Nursing in PDF only on Docsity!

MusculoSkeletal Chapter 40/Pediatrics Latest

Practice Exam 2 025 - 2026 With Correct Verified

Answers

A nurse is assessing a client with the diagnosis of osteoporosis. What part of the client's body should the nurse assess to identify osteoporotic changes?

  1. Long bones
  2. Facial bones
  3. Vertebral column
  4. Joints of the hands - correct answer>>Correct
  5. Vertebral column Compression fractures of the vertebrae are the most common fractures in clients with osteoporosis; a gradual collapse of vertebrae may be asymptomatic and observed as kyphosis. Changes in the long bones, associated with osteoporosis, are not observable to the naked eye. Changes in the facial bones, associated with osteoporosis, are not observable to the naked eye. Observable changes, such as inflammation in the joints and natural alignment of the bones, are associated with arthritis, not osteoporosis. A practitioner recommends that an adolescent with the diagnosis of osteogenic sarcoma have the affected leg amputated and then be treated with chemotherapy. The parents are concerned about what to tell their child and ask the nurse for advice. The nurse suggests that they discuss the:
  6. Causes of cancer and details about the treatment
  7. Chemotherapy and the possibility of an amputation
  8. Amputation and provide information about chemotherapy
  9. Treatment choices and explain that it is too soon for a final decision - correct answer>>Correct
  10. Amputation and provide information about chemotherapy Honesty is essential in helping the adolescent accept the loss of the leg; only a brief discussion of chemotherapy is needed because otherwise the adolescent may be overwhelmed. A theoretical discussion and detailed information will not be heard or understood during a crisis situation. The amputation is necessary; lying avoids the issue and may destroy the adolescent's trust in parents and staff. The nurse is preparing an individualized teaching plan for a client with osteoarthritis. The nurse recognizes which abnormality as specific to osteoarthritis?
  11. Ulnar drift
  1. Heberden nodes
  2. Swan neck deformity
  3. Boutonnière deformity - correct answer>>Correct
  4. Heberden nodes Heberden nodules are the bony or cartilaginous enlargements of the distal interphalangeal joints that are associated with osteoarthritis. Ulnar drift, Swan neck deformity, and Boutonnière deformity occur with rheumatoid arthritis. A nurse is completing the health history of a client admitted to the hospital with osteoarthritis. The nurse expects the client to report that which joints were involved initially? Select all that apply.
  5. Hips
  6. Knees
  7. Ankles
  8. Shoulders
  9. Metacarpals - correct answer>>Correct
  10. Hips
  11. Knees Osteoarthritis affects the weight-bearing joints (e.g., hips and knees) first because they bear the most body weight. The resulting joint damage causes a series of physiologic responses (e.g., release of cytokines and proteolytic enzymes) that lead to more damage. Although the ankles are weight-bearing joints and eventually are affected, the motion in the ankles is not as great as in the hips and knees; thus, there is less degeneration. Shoulder joints are not the most likely to be involved first because these are not weight-bearing joints. Although the distal interphalangeal joints are affected frequently, the remaining interphalangeal joints and metacarpals are not. A nurse is completing the discharge protocol for a 14-year-old adolescent with osteomyelitis. The nurse teaches the parents how and when to administer the intravenous antibiotic at home. The schedule for administration is four times a day. At what times should the parents administer the antibiotic?
  12. 8 am, 12 pm, 4 pm, 8 pm
  13. 8 am, 4 pm, 12 am, 4 am
  14. 10 am, 2 pm, 10 pm, 2 am
  15. 6 am, 12 pm, 6 pm, 12 am - correct answer>>Correct
  16. 6 am, 12 pm, 6 pm, 12 am

dosage. The data are insufficient for the nurse to conclude that emotional or physiologic dependence has developed. A nurse is counseling a client who is at risk for developing osteoporosis. Which foods should the nurse recommend? Select all that apply.

  1. Canned tuna
  2. Scrambled eggs
  3. Chicken breasts
  4. Broiled beef steak
  5. Baked sweet potato - correct answer>>Correct
  6. Chicken breasts
  7. Broiled beef steak One serving of white meat chicken or one serving of beef contains more than 200 mg of calcium. A serving of canned tuna, two eggs, and sweet potatoes contain less than 200 mg of calcium. A client with a femoral fracture associated with osteomyelitis is immobilized for three weeks. Why does the nurse anticipate that the client may develop renal calculi?
  8. The client's dietary patterns have changed since admission.
  9. The client has more difficulty urinating in a supine position.
  10. Lack of weight-bearing activity promotes bone demineralization.
  11. Fracture healing requires more calcium, which increases total calcium metabolism. - correct answer>>Correct
  12. Lack of weight-bearing activity promotes bone demineralization. All clients who are confined to bed for any considerable period risk losing calcium from bones. Calcium precipitates in the urine, resulting in formation of calculi. There is no indication that the client's diet has changed. Although the client may have more difficulty urinating in a supine position resulting from an inability to assume the preferred anatomic position and the emotional impact of using a urinal, it usually does not predispose the client to developing renal calculi, unless fluid intake is low or stasis occurs. The presence of a healing fracture does not increase total calcium metabolism; however, deposition of bone at the fracture site will be increased. An adolescent is admitted to the unit with a tentative diagnosis of a bone tumor of the left femur. During the admission procedure the adolescent casually asks, "Do they ever have to cut off a leg if someone has bone cancer?" How should the nurse respond?
  13. "Sometimes it's necessary. What do you think about that treatment?"
  1. "Most times the leg can be saved, but sometimes it may be necessary."
  2. "I don't understand why you're asking. Do you think that this will happen to you?"
  3. "The decision can't be made now, because the kind of bone cancer must be determined first." - correct answer>>Correct
  4. "Sometimes it's necessary. What do you think about that treatment?" Acknowledging that amputation may be necessary and asking an open-ended question encourages further discussion of feelings. Telling the adolescent that most of the time the leg can be saved is evasive, provides false reassurance, and does not address the adolescent's feelings. This response is demeaning. A direct response not only does not address the adolescents feelings but also attacks the basis of these feelings. Telling the adolescent that the tumor is cancerous before a diagnosis has been made constitutes misinformation, which is unsafe nursing practice. The nurse is making rounds on a client who has developed severe bone marrow depression after receiving chemotherapy for cancer. Which of these actions by the nurse is appropriate? Select all that apply.
  5. Monitor for signs of alopecia.
  6. Encourage an increase in fluids.
  7. Wash hands before entering the client's room.
  8. Advise use of a soft toothbrush for oral hygiene.
  9. Report an elevation in temperature immediately.
  10. Encourage the client to eat raw, fresh fruits and vegetables. - correct answer>>Correct
  11. Wash hands before entering the client's room.
  12. Advise use of a soft toothbrush for oral hygiene.
  13. Report an elevation in temperature immediately. It is essential to prevent infection in a client with severe bone marrow depression; thorough hand-washing before touching the client or client's belongings is important. Thrombocytopenia occurs with most chemotherapy treatment programs; using a soft toothbrush helps prevent bleeding gums. Any temperature elevation in a client with neutropenia must be reported to the health care provider immediately as it may be a sign of infection. Although alopecia does occur with chemotherapy, it is not related to bone marrow suppression. Increasing fluids will neither reverse bone marrow suppression nor stimulate hematopoiesis. This is not related to bone marrow suppression. Clients who have severe bone marrow depression must avoid eating raw fruits and vegetables, and undercooked meat, eggs, and fish to avoid possible exposure to microbes.

can be managed easily with lotion or oil. Some degree of discomfort is expected after cast application. A nurse is teaching a mother how to care for her toddler who is in a spica cast. In what position should the nurse suggest that the mother place the toddler during a feeding?

  1. Upright while on the mother's lap
  2. Recumbent with a pillow under the head
  3. Semi-Fowler on a padded, adjustable tilt board
  4. Side-lying in the football hold, facing the mother - correct answer>>Correct
  5. Semi-Fowler on a padded, adjustable tilt board Because of the child's age, lying on a tilt board is the best position; it permits upright feeding while fostering growth and development. Positioning the child on the mother's lap is difficult and unsafe for both mother and child because the combination of the child and the cast is too cumbersome and could result in a fall. The recumbent position makes feeding and digestion difficult; also, it may increase the risk of aspiration. The football hold is appropriate for an infant, not a toddler. A 2-year-old child with developmental dysplasia of the hip has a spica cast applied. The mother asks the nurse how to keep the cast clean. How should the nurse respond?
  6. "Tuck a folded diaper above the perineal opening."
  7. "Place plastic wrap or duct tape around the perineal edges of the cast."
  8. "Wipe the cast with a wet cloth and sprinkle it with baby powder."
  9. "Do the best you can, because it will get soiled no matter what you do." - correct answer>>Correct
  10. "Place plastic wrap or duct tape around the perineal edges of the cast." Suggesting the use of a protective nonabsorbent material is supportive, constructive, practical, and factual. Placing a diaper above the perineal area will not protect the area beneath the perineum. Although water may or may not cause dissolution of cast material, the infant may inhale powder, which can cause respiratory difficulties. "Do the best you can" is a negative response that provides neither a suggestion nor support to the mother. How should a nurse turn a 10-year-old child in a spica cast?
  11. By log-rolling the body as one unit
  12. By using the crossbar between the legs
  13. By asking the child to sit up when changing position
  14. By teaching the child how to assist by using the overhead trapeze - correct answer>>Correct
  1. By log-rolling the body as one unit The child should be rolled as one unit, with the shoulders and hips turned at the same time to prevent injury. The crossbar is not used to facilitate turns because it may be dislodged, weakening the cast. The child will not be able to sit up because the cast immobilizes the hips. The overhead trapeze is used for lifting, not turning. Spinal fusion is performed in an adolescent with scoliosis. What postoperative nursing intervention is specifically related to surgery for scoliosis?
  2. Log-rolling every 2 hours
  3. Checking the dressing frequently
  4. Supervising deep-breathing exercises
  5. Maintaining the adolescent in the supine position for 3 days - correct answer>>Correct
  6. Log-rolling every 2 hours Log-rolling is necessary to prevent movement of the newly aligned and instrumented vertebrae and should be done frequently to prevent skin breakdown. Dressings are checked frequently in all postoperative clients; this action is nonspecific. Coughing and deep-breathing are done by most postoperative clients; this action is nonspecific. The client who has had a spinal fusion may be turned and still be protected from injury with log-rolling. Remaining in one position for 3 days could lead to skin breakdown from unrelieved pressure. A nurse is teaching a high school student about scoliosis treatment options. On what should the nurse focus?
  7. Effect on body image
  8. Least invasive treatment
  9. Continuation with schooling
  10. Maintenance of contact with peers - correct answer>>Correct
  11. Effect on body image Establishing an identity, the major developmental task of the adolescent, is related to the affirmation of self-image. To achieve this task there is a need to conform to group norms, one of which is appearance. The type of treatment is not an issue. Although it is important to continue schooling and to maintain contact with peers, the effect on body image is more important. The mother of a 10-year-old boy with mild scoliosis asks the nurse, "How long will my son have to continue his exercises before he's better?" How should the nurse respond?
  1. Disregard her negative characteristics and focus on her positive attributes.
  2. Refer her for psychological counseling until the treatment program is completed. - correct answer>>Correct
  3. Help her investigate appropriate clothing to enhance her appearance. Clothes can be selected to minimize the appearance of a brace, especially if an effort is made to wear current styles. Reminding the child how she will look without treatment has a negative connotation that emphasizes the problem. Focusing only on positive attributes may be misinterpreted as unqualified praise; adults should give honest appraisals of both positive and negative attributes. There are no data to indicate that the child will not adjust to the treatment regimen. A preadolescent brings home a note from the school nurse informing the parents that the child should be evaluated for scoliosis. The mother calls the school nurse to ask for a description of scoliosis. Before responding, the nurse recalls that in scoliosis:
  4. The concave lumbar curvature is exaggerated.
  5. There are pathological changes in the vertebrae.
  6. There is a rotary deformity of the lateral curvature of the spine.
  7. The curvature of the thoracic spine has an increased convex angulation. - correct answer>>Correct
  8. There is a rotary deformity of the lateral curvature of the spine. A rotary deformity of the lateral curvature of the spine is the correct definition of scoliosis. An exaggerated concave lumbar curvature is a description of lordosis. There are no pathological changes in the vertebrae with scoliosis. A curvature of the thoracic spine with an increased convex angulation is a description of kyphosis As a means of slowing the progression of the curvature, the preadolescent with scoliosis is fitted with a brace. How should the nurse respond to the parents' questions about when the brace will no longer be needed?
  9. After cessation of bone growth
  10. After the curvature has straightened
  11. When the iliac crests are on the same level
  12. When the adolescent is free of pain after prolonged standing - correct answer>>Correct
  13. After cessation of bone growth Continuing growth causes changes in muscle, bone structure, and position. The brace is worn for 6 months after physical maturity, which is confirmed by radiographic examination showing cessation of bone growth. The brace is used to halt the

progression of the curvature, not correct it. When the iliac crests are at the same level is not an appropriate criterion for removal of the brace. Pain is not usually a symptom of scoliosis. A 14-year-old girl in whom scoliosis has been diagnosed undergoes spinal fusion. On the first postoperative day her face is red, she is rigid, and she is crying because she is in pain. She has prescriptions for morphine sulfate for severe pain and an acetaminophen- codeine compound for moderate pain. What information should influence the nurse's choice of analgesic?

  1. One dose of morphine may be given, but the drug should be restricted thereafter because it is addictive.
  2. Adolescents tend to exaggerate their discomfort, particularly when they are immobilized by surgery or injury.
  3. Spinal fusion causes considerable pain during the early postoperative days, and morphine is the more effective analgesic.
  4. The acetaminophen-codeine compound is preferred because morphine can cause respiratory depression or respiratory arrest. - correct answer>>Correct 3.Spinal fusion causes considerable pain during the early postoperative days, and morphine is the more effective analgesic. Spinal fusion causes considerable pain for several days and requires a strong analgesic. The first postoperative day is too early to begin weaning the client from opiates. Adolescents are no more prone to exaggerating their discomfort than clients in any other age group. A more potent analgesic, such as morphine, is needed, and the prescribed dosage should not cause respiratory problems. A school nurse is screening children for scoliosis. In what age group is it usually identified?
  5. Adolescence
  6. Preadolescence
  7. Early school years
  8. Middle school years - correct answer>>Correct
  9. Preadolescence Preadolescence is the time when scoliosis is most likely to become evident because of the growth spurt that occurs at this time. Although scoliosis may occur at any age, idiopathic scoliosis, the most common type, tends to become evident during the preadolescent growth spurt.

every 4 hours is frequent enough, such a rigid schedule is difficult to follow with an infant and compliance may falter. An infant has a plaster cast applied for clubfoot correction. What nursing intervention will hasten drying of the cast?

  1. Using a blow dryer
  2. Opening the window
  3. Exposing the casted extremity
  4. Covering the cast with a light sheet - correct answer>>Correct
  5. Exposing the casted extremity Exposing the casted extremity is the safest way to dry the cast evenly. Besides the danger of burning the child, the cast may dry on the outside and remain damp within. Opening the window may create a draft and be uncomfortable for the child. Covering the cast with a light sheet will impede the circulation of air and delay drying. A 2-year-old child who was admitted to the hospital for further surgical repair of a clubfoot is standing in the crib, crying. The child refuses to be comforted and calls for the mother. As the nurse approaches the crib to provide morning care, the child screams louder. In light of the fact that this behavior is typical of the stage of protest, what is the most appropriate nursing intervention?
  6. Using comforting measures while holding the child
  7. Filling the basin with water and proceeding to bathe the child
  8. Sitting by the crib and bathing the child later when the anxiety decreases
  9. Postponing the bath for a day because a child this upset should not be traumatized further - correct answer>>Correct
  10. Sitting by the crib and bathing the child later when the anxiety decreases The nurse should try to comfort the child by staying nearby until the child feels more relaxed. The bathing can be postponed until the child has had time to test the environment and is less anxious. Using comforting measures while holding the child may frighten the child more because the nurse is a stranger. Filling the basin with water and proceeding to bathe the child does not relieve the child's anxiety and will probably cause it to increase. Basic physiological needs must be met, and postponing the bath for a day would be negligent. However, the nurse should try to reduce the child's anxiety first. A nurse is taking the health history of a client who is to have surgery in one week. The nurse identifies that the client is taking ibuprofen (Advil) for discomfort associated with

osteoarthritis and notifies the health care provider. Which drug does the nurse expect will most likely be prescribed instead of the Advil?

  1. Naproxen (Aleve)

  2. Ibuprofen (Motrin)

  3. Ketorolac (Toradol)

  4. Acetaminophen (Tylenol) - correct answer>>Correct

  5. Acetaminophen (Tylenol) Acetaminophen is a nonopioid analgesic that inhibits prostaglandins, which serve as mediators for pain; it does not impact platelet function. Naproxen, ibuprofen, and ketorolac are nonselective nonsteroidal antiinflammatory drugs (NSAIDs) that are contraindicated for clients undergoing surgery; nonselective NSAIDs have an inhibitory effect on thromboxane, a strong aggregating agent, and can result in bleeding. A client with osteoarthritis is admitted to the hospital for evaluation of a possible hip replacement. To prevent flexion contractures, the nurse recommends that, when in bed, the client should lie in the supine or prone position. The client voices hesitation, stating that these positions are uncomfortable for the knees and hips. What action should the nurse take?

  6. Encourage the client to maintain extension for specific periods of time

  7. Allow the client to lie in whatever position is most comfortable

  8. Insert a pillow under the client's knees to relieve discomfort

  9. Place the client in the semi-Fowler position most of the time - correct answer>>Correct

  10. Encourage the client to maintain extension for specific periods of time Flexion contractures of the hips and knees can develop unless some periods of full extension are maintained. The most comfortable position that usually is assumed is one of flexion, which leads to contractures and should be avoided. Placing a pillow under the knees can cause flexion contractures of the hips and knees. Remaining in the semi- Fowler position can cause flexion contractures of the hips. A client with osteoarthritis who had a left total hip replacement returns to the unit after surgery. The nurse should place the client in which position?

  11. Maintain the left leg in an adduction position.

  12. Place the client in a right-lying position.

  13. Place the left leg in an internal rotation.

  14. Use pillows to keep the client's legs abducted. - correct answer>>Correct

  15. Use pillows to keep the client's legs abducted.

  1. Examining the bedding under the client
  2. Measuring the circumference of the thigh
  3. Observing for ecchymosis at the operative site - correct answer>>Correct
  4. Examining the bedding under the client Because of the recumbent position, drainage may flow under the client and not be noticed. Checking vital signs every four hours should be done more frequently; however, the site is a more reliable indicator of hemorrhage. The girth of the thigh is not an indicator of hemorrhage. Dressings impede accurate assessment. experiencing which complication?
  5. Fat embolism
  6. Urinary retention
  7. Hypovolemic shock
  8. Pulmonary embolism - correct answer>>Correct
  9. Fat embolism The client most likely is experiencing fat embolism syndrome (FES). The average time of onset of FES is 18 to 24 hours after injury to long bones or crushing injury. Fat globules and tissue thromboplastin exit from bone marrow and local tissue as a result of injury. Fat molecules enter venous circulation, move to lungs, and embolize small capillaries. Petechial rash on neck, chest, conjunctivae, or axillae is a classic sign of FES (occurs in 50% to 60% of clients with FES). Increased temperature, pulse rate, and respirations are associated with FES; 75% of clients with FES exhibit neurologic signs, such as altered mental state, restlessness, agitation, lethargy, confusion, or coma. The client is not experiencing urinary retention because output indicates adequate hourly output of at least 50 mL/hr. The client is not experiencing hypovolemic shock. Although the client may experience tachypnea, tachycardia, and an increased temperature with hypovolemic shock, the blood pressure will decrease and urine output will decrease to less than 30 mL/hr. The client is not experiencing a pulmonary embolism; this is more likely to occur 4 to 10 days after trauma. Although tachypnea, tachycardia, an increased temperature, restlessness, and agitation are common with pulmonary embolism, the client is not exhibiting sudden chest pain, dyspnea, cough, or hemoptysis, or areas of dullness or crackles when auscultating breath sounds. The nurse is caring for a client who had surgery for a total hip replacement. Which client position should be avoided?
  10. Supine
  11. Lateral
  12. Orthopneic
  1. Semi-Fowler - correct answer>>Correct
  2. Orthopneic Orthopneic position involves hip flexion greater than 90 degrees. This puts stress on the operative site and may dislodge the prosthesis. Supine, lateral, and semi-Fowler positions are acceptable because little stress is placed on the operative site. Considerations when caring for a client with a total hip replacement should include which of the following? Select all that apply.
  3. Maintain the affected hip in the adduction position when moving client out of bed.
  4. Pain control should include regularly scheduled analgesics and may necessitate use of as needed medications as well.
  5. The client should sit in a chair at the correct height to encourage flexion of the joint.
  6. Frequent neurovascular assessment should be done distal to the surgical site and compared with the unaffected side.
  7. When turning, client should be log rolled to prevent leg from falling forward or backward. - correct answer>>Correct
  8. Pain control should include regularly scheduled analgesics and may necessitate use of as needed medications as well.
  9. Frequent neurovascular assessment should be done distal to the surgical site and compared with the unaffected side.
  10. When turning, client should be log rolled to prevent leg from falling forward or backward. A client is admitted to the hospital for a total hip replacement. The nurse is planning preoperative teaching about the nursing care to be delivered during the immediate postoperative period. Which is the most important factor that the nurse should focus on regarding immediate postoperative care?
  11. Flexing the operative hip
  12. Abducting the operative hip
  13. Turning onto the operative side
  14. Maintaining the contour position - correct answer>>Correct
  15. Abducting the operative hip After surgery, abduction is maintained to reduce the chance of dislocation of the femoral head. Flexing the operative hip can lead to dislocation of the femoral head. Turning onto the operative side causes hip adduction, which can lead to dislocation of
  1. Pulmonary embolism A pulmonary embolism is the most common complication of hip surgery because of high vascularity and the release of fat cells from the bone marrow. The occurrence of pneumonia is rare because of early activity after surgery. In addition, the operative area is not in proximity to the diaphragm and lungs; therefore, it does not impede deep breathing. Postoperative hemorrhage with hip surgery is rare because bleeding at the operative site is not covert. The incidence of wound infection is no greater than with other postoperative clients. A nurse provides discharge teaching to a client that had a total hip replacement. The client states that the plan is to go swimming at the community pool the day after discharge. How should the nurse respond?
  2. Encourage participation in this activity as there is an excellent range-of-motion
  3. Instruct the client to take a friend along for safety
  4. Explain that the incision should not be immersed in water until it has healed
  5. Tell the client that swimming can substitute for the prescribed physical therapy - correct answer>>Correct
  6. Explain that the incision should not be immersed in water until it has healed Because of the risk for infection, the client should avoid tub baths, hot tubs, pools, and bodies of water until after the wound has healed and these activities are approved by the health care provider. Immersion in water for a prolonged period interferes with wound healing because water may macerate tissue. Having a friend along does not change the fact that immersion in water for a prolonged period will interfere with wound healing. The client needs to continue physical therapy after discharge whether or not the client goes swimming A client who had a right total hip replacement is progressing from the use of a walker to the use of a cane. In which hand should the nurse teach the client to hold the cane?
  7. Left hand
  8. Right hand
  9. Stronger hand
  10. Dominant hand - correct answer>>Correct
  11. Left hand A cane should be used on the unaffected side. Weight-bearing can be shared by a cane and an affected leg when they are advanced forward together. Teaching with the right hand promotes leaning toward the affected side and does not permit sharing of weight by the stronger left side of the body. Teaching with the stronger hand is unsafe; the

stronger hand may not be the left hand. Teaching with the dominant hand is unsafe; the dominant hand may not be the left hand. In preparation for discharge, a client who had a total hip replacement is taught wound care by the nurse. The nurse identifies that the client understands the instructions when the client states, "I will:

  1. Sit in a chair for several hours every day."
  2. Inspect the incision for healing when I change the dressing."
  3. Check to see whether the staples have dissolved within a few days."
  4. Call the health care clinic if I see any clear drainage coming from the incision." - correct answer>>Correct
  5. Inspect the incision for healing when I change the dressing." At each dressing change, the incision should be assessed for approximation of the edges, extent of healing, and signs of infection. Sitting should last for 45 minutes or less to prevent hip stiffness, hip flexion contracture, and prosthetic dislocation. Staples do not dissolve; they are removed by a health care provider. Serous drainage may persist until healing of the incision is complete. A client just had a total hip replacement and is experiencing restlessness and changes in mentation. Which complication does the nurse consider the client may be experiencing based on these responses?
  6. Bladder spasms
  7. Polycythemia vera
  8. Hypovolemic shock
  9. Pulmonary hypertension - correct answer>>Correct
  10. Hypovolemic shock These signs occur with hypovolemic shock because less blood is being circulated to vital centers in the brain. A large loss of blood may occur during and after orthopedic surgery. Urinary retention, not bladder spasms, may occur after general anesthesia. Bladder spasms are associated with intermittent suprapubic pain. Anemia and deep vein thrombosis, not an increase in the total red blood cells (polycythemia vera), tend to occur after a total hip replacement. Polycythemia vera is associated with headache, irritability, and paresthesias of the hands and feet. Atelectasis and pneumonia, not pulmonary hypertension, tend to occur after general anesthesia. Pulmonary hypertension is associated with dyspnea, substernal chest pain, and fatigue.