Back & Pain
A client with acute back pain says, “I’m staying in bed until this is completely gone.” What part of the plan needs revision?
Prolonged bed rest; remain active as tolerated.
A client with osteoporosis switches from walking to swimming only. What important benefit may be reduced?
Weight-bearing stimulation of bone remodeling.
Bilateral swollen metacarpophalangeal (MCP) joints with prolonged morning stiffness.
RA
A client takes an osteoporosis medication and immediately lies back down. Which medication should concern the nurse?
Alendronate
After posterior hip replacement, a client bends forward to pull on socks. What complication is the nurse trying to prevent?
Hip dislocation
Before splinting a visibly deformed leg, what assessment establishes an important baseline?
Distal neurovascular assessment
Fracture + escalating pain + pain with passive movement.
Compartment syndrome
Back pain travels into the buttock and down one leg and becomes worse when coughing. What does this pattern suggest?
Lumbar nerve-root irritation/sciatica.
Which combination should make the nurse most concerned about accelerated bone loss: menopause plus long-term prednisone, or hypertension plus aging?
Menopause plus long-term prednisone.
Knee pain worsens after activity and improves after rest.
OA
A client receiving denosumab reports tingling around the mouth and muscle cramping. Which lab should be checked?
Calcium
Why is a raised toilet seat recommended after posterior hip replacement?
Prevent excessive hip flexion
Name four components of a neurovascular assessment.
Any four: pulse, capillary refill, color, temperature, sensation, movement
Femur fracture + hypoxemia + confusion + petechiae.
Fat embolism syndrome
A client with lumbar disk disease demonstrates how to pick up a laundry basket by bending forward at the waist. What should the nurse correct?
Bend at the knees and maintain spinal alignment.
Fever, localized deep bone pain, warmth, and rising inflammatory markers point toward what process?
Osteomyelitis.
Joint symptoms accompanied by fatigue, anorexia, and low-grade fever.
RA
Before IV zoledronic acid, which organ function deserves particular attention?
Renal/kidney function
A client crosses the operative leg over the other while sitting. Which prohibited movement occurred?
Hip adduction
A traction weight is touching the floor. Why is this a problem?
It eliminates/reduces the continuous pulling force
A client has severe pain with passive toe movement but a strong pedal pulse. Can compartment syndrome be ruled out?
No; pulses may remain intact early
After spinal surgery, a client twists the shoulders toward the bedside table while the hips remain flat. What principle has been violated?
Maintaining spinal alignment/logrolling.
After several days of osteomyelitis treatment, the temperature and WBC normalize but ESR and CRP remain elevated. How should this trend be interpreted?
Improvement with residual inflammation; not necessarily treatment failure.
Crepitus and bony enlargement without systemic symptoms.
OA
A client taking high-dose aspirin develops tinnitus. What should the nurse suspect?
Salicylate toxicity
Before first ambulation after knee replacement, what assessment may directly affect the client’s ability to participate safely?
Pain assessment/control
A client asks to have traction weights removed briefly during repositioning. What is the concern?
Interrupting traction can disrupt alignment and treatment
A client with suspected compartment syndrome receives additional opioid medication, but the pain continues to worsen. What should happen next?
Immediate provider notification/emergency evaluation
A client taking tramadol asks whether one alcoholic drink with dinner is okay. What is the primary concern?
Increased CNS-depressant effects.
Chronic osteomyelitis persists despite appropriate antibiotics. Imaging shows necrotic bone. Why may antibiotics alone be inadequate?
Poor blood supply limits antibiotic penetration into necrotic bone.
A client continues an activity despite increasing fatigue and joint pain because “exercise is good for arthritis.” What needs correction?
RA joint-protection/activity pacing; pain and fatigue indicate the need for rest.
A client taking methotrexate develops fever and leukopenia. Why is this combination concerning?
Immunosuppression/bone-marrow suppression with infection risk
Twenty-four hours after hip replacement, the operative leg suddenly appears shortened and abnormally rotated. What should the nurse suspect?
Prosthetic dislocation
An external-fixator pin site becomes increasingly painful with purulent drainage and fever. What complication should be suspected?
Infection/possible osteomyelitis
A client with a long-bone fracture suddenly becomes restless, tachypneic, and hypoxemic. Which problem takes immediate priority?
Oxygenation/respiratory compromise
A client with chronic pain rates pain 9/10 but is calmly talking on the phone. What should guide the nurse’s pain management?
The client’s self-report of pain.
A client with chronic osteomyelitis develops fever, hypotension, tachycardia, and confusion. What complication takes priority?
Sepsis/systemic infection.
One client has symmetric small-joint inflammation; another has activity-related hip pain with no systemic symptoms. Which underlying processes distinguish them?
RA = autoimmune/inflammatory; OA = degenerative.
A client receiving etanercept has mild injection-site irritation but also develops abnormal WBC and platelet counts. Which finding takes priority?
Abnormal blood counts because of serious infection/pancytopenia risk
A client says joint replacement means physical therapy is no longer necessary. What misconception should be corrected?
Surgery improves pain/function, but rehabilitation remains essential
Following a fracture, the foot becomes cooler with worsening numbness and delayed capillary refill. What problem should the nurse prioritize?
Neurovascular compromise
A fractured extremity has severe unrelieved pain, paresthesia, and tense swelling. What intervention may the nurse anticipate if the condition progresses?
Emergency fasciotomy