ATI Musculoskeletal Practice Questions

A nurse is caring for a client who has a sever gangrenous infection of the right lower extremity. The nurse should plan preoperative teaching based on the possibility of which of the following amputation procedures? - "The pain will disappear soon." - "It's likely that you will only have a tingling sensation." - "Your pain will gradually become less severe." - "Phantom pain is mostly psychological."

- "Your pain will gradually become less severe." Phantom leg pain usually diminishes over time, and often is intermittent in response to a trigger.

A nurse notes increasing edema in the calf of a client who has multiple fractures of the leg. The nurse should recognize that increasing edema is a manifestation of which of the following complications? - Fat embolism syndrome - Acute compartment syndrome - Pulmonary embolism - Malignant hypothermia

- Acute compartment syndrome Increasing edema is a manifestation of acute compartment syndrome, which is a complication that occurs when excessive pressure reduces circulation.

A nurse is preparing a client who is postoperative following a below-the-knee amputation for a leg prosthesis fitting. Which of the following actions should the nurse take? - Wrap the stump with an elastic bandage in a figure-eight configuration. - Remove the elastic bandage and re-wrap the stump once per day. - Perform passive range-of-motion exercises once daily. - Secure the elastic bandage to the lowest joint.

- Wrap the stump with an elastic bandage in a figure-eight configuration. A figure-eight wrap helps prevent blood flow restriction and also helps shape and shrink the limb to prepare it for the prosthesis.

A nurse is teaching an older adult client who has an intracapsular fracture of the right hip following a fall about the purpose of Buck's extension traction. The nurse should include which of the following information in the teaching? - Buck's extension traction will reduce the fracture. - Buck's extension traction will relieve muscle spasms. - Buck's extension traction will maintain alignment of the pins. - Buck's extension traction will allow supported movement of the extremity.

- Buck's extension traction will relieve muscle spasms. Buck's extension traction immobilizes the fractured bone to relieve associated muscle spasms and thereby relieve pain. Any movement of the fractured extremity will aggravate severe muscle spasm and trigger pain.

A nurse is assessing a client who has a cast in place for a fractured tibia. Which of the following actions should the nurse take first? - Checking capillary refill - Discussing cast care - Managing pain - Performing range of motion

- Checking capillary refill The priority action the nurse should take when using the airway, breathing, and circulation (ABC) approach to client care is to check the client's capillary refill. Musculoskeletal injuries can cause changes in the neurovascular system, usually distal to the injury. Capillary refill provides data about the client's circulation.

A nurse is caring for a client who has a fractured tibia as a result of a fall. The client x-ray shows that the bone is splintered into several pieces around the shaft. The nurse should identify that the client has which of the following types of fractures? - Impacted - Transverse - Comminuted - Oblique

- Comminuted With a comminuted fracture, the impact fragments the bone into several pieces.

A nurse is caring for a client in the emergency department who had a traumatic amputation of his left arm in an industrial accident. The nurse should expect the client to be experiencing which of the following of Kubler-Ross's stages of grief? - Bargaining - Depression - Denial - Acceptance

- Denial Greif is the emotional reaction to loss. Kubler-Ross outlined five stages of grief: denial, anger, bargaining, depression, and acceptance. Although each individual experiences grief differently, the first stage is often denial. The client at this point has not yet come to terms with the fact that he has lost an extremity. He likely expects reattachment or may even perceive that his arm is still there.

A nurse is teaching a client who has a prosthetic limb due to a right below-the-knee amputation about prothesis and stump care. Which of the following instructions should the nurse include in the teaching? - Keep the prosthesis in direct contact with the residual limb. - Apply a moisturizing lotion or oil to the stump daily. - Dry the prosthesis socket completely before applying it to the limb. - Expect some skin irritation from the prosthesis.

- Dry the prosthesis socket completely before applying it to the limb. The client should dry the prosthesis socket thoroughly with a clean cloth. Moisture between the socket and the stump can put the client at risk for fungal or bacterial infection and skin breakdown.

A nurse is caring for an older adult client who had a femoral head fracture 24 hr ago and is in skin traction. The client reports shortness of breath and dyspnea. The nurse should suspect that the client has developed which of the following complications? - Pneumonia - Fat embolism - Pneumothorax - Airway obstruction

- Fat embolism The nurse should suspect that the client has fat embolism syndrome. This complication develops within 12 to 48 of a fracture and can cause dyspnea, respiratory distress, alterations in mental status, tachycardia, and other manifestations. Older adults who have hip fractures are at greater risk.

A client who has a femur fracture states, "I can't stay in this bed any longer. I need to get home so I can take care of my family." The nurse responds, "You have talked about your family several times. Can you tell me more about your specific concerns?" Which type of therapeutic communication response is the nurse using? - Summarizing - Empathizing - Focusing - Clarifying

- Focusing The open-ended statement is a means of focusing in on the problem and obtaining more information about the client's concerns. Focusing helps the nurse to zero in on a topic to identify the issues and concerns clearly.

A nurse is caring for a client who is 2 days postoperative following an above-the-knee amputation. Which of the following is an appropriate nursing intervention for this client at this time? - Elevate the foot of the bed. - Encourage the client to sit up as much as possible. - Elevate the client's residual limb on a pillow. - Have the client lie prone every 3 hr for 20 min at a time.

- Have the client lie prone every 3 hr for 20 min at a time. The nurse should encourage the client to lie prone for 20 to 30 min every 3 to 4 hr to help prevent hip flexion contractures.

A nurse is assessing a client who has a fracture of the femur. The nurse obtains vital signs on admission and again in 2 hours. Which of the following changes in assessment should indicate to the nurse that the client could be developing a serious complication? - Increased respiratory rate from 18 to 44/min. - Increased oral temperature 36.6°C (97.8°F) to 37°C (98.6°F). - Increased blood pressure from 112/68 to 120/72 mm Hg. - Increased heart rate from 68 to 72/min.

- Increased respiratory rate from 18 to 44/min. This change is respiratory rate is significant, as the first value is within the expected reference range, but the second value is very elevated for an adult client. Increased respiratory rate could be a manifestation of a possible fat embolism, a serious complication that may follow the type of fracture sustained by the client. Fat emboli can be trapped in lung tissue, leading to respiratory symptoms and mental disturbances.

A nurse is assessing a client who has a left lower arm fracture. Which of the following findings indicates impaired venous return in the client's affected arm? - A bounding distal pulse - Acute pain - Ecchymosis of the surrounding skin - Increasing edema

- Increasing edema Increasing edema is a sign of impaired circulation. It is important for a client who has a limb fracture to keep the limb elevated to reduce edema.

A nurse is caring for a client who has an unrepaired femur fracture of the midshaft. Which of the following techniques should the nurse use when performing an assessment of the client's neurovascular status? - Measure the circumference of the thigh. - Palpate the femoral pulse. - Monitor the client's calf for edema. - Instruct the client to wiggle his toes.

- Instruct the client to wiggle his toes. The nurse should observe the client's ability to move his toes when collecting data regarding neurovascular status distal to the fracture. Other means of evaluating neurovascular status include assessing skin color and temperature, sensation, pain, and capillary refill.

A nurse is planning care for a newly admitted client who has skeletal traction for a fractured femur. Which of the following interventions should the nurse include in the plan? - Instruct the client to flex and extend the ankle twice daily. - Monitor the client's pedal pulses every hour. - Remove the weights every four hours. - Evaluate pressure points daily.

- Monitor the client's pedal pulses every hour. The nurse should assess the neurovascular status of the client's affected extremity including assessing pulses, color, and capillary refill hourly for the first 24 hours following the placement of skeletal traction to prevent complications such as compartment syndrome or circulatory compromise.

A nurse is assessing a client following the application of a leg cast for the treatment of a fracture. If the cast is too tight, which of the following findings should the nurse expect to observe first? - Change in temperature of the toes. - Pallor of the toes. - Edema of the toes. - Inability to move toes.

- Pallor of the toes. If a cast is too tight it will increase pressure on the blood vessels, impairing circulation. When this occurs, pallor of the toes is the initial finding. The nurse should immediately report this finding to the provider.

A nurse is caring for a client who is postoperative following an open reduction and internal fixation of a fractured femur. Which of the following actions is the most important for the nurse to complete in the postoperative period? - Medicate the client for pain. - Instruct the client on use of crutches. - Perform neurovascular checks of the extremities. - Direct the client to perform exercises of the ankle and toes.

- Perform neurovascular checks of the extremities. The priority action the nurse should take when using the airway, breathing, circulation approach to client care is the performance of neurovascular checks. These are a vital aspect of care for the client who has sustained a fracture and should be monitored every hour for the first 24 hr. Circulation can easily become impaired due to constriction, which develops as the extremity swells from edema. This may cause nerve damage and tissue anoxia.

A nurse is assessing the elastic bandage on the stump of a client who had a right below-the-knee amputation. Which of the following findings should the nurse identify as a complication? - Pitting edema around the stump dressing - Looseness of the stump dressing - The dressing forms a cone shape over the stump - Figure-eight wrapping around the stump

- Pitting edema around the stump dressing If the elastic bandage is properly applied, it should prevent edema. The nurse should remove the bandage and rewrap the stump.

A nurse is assessing a client who is postoperative following a right below-the-knee amputation. Which of the following findings should the nurse identify as a possible complication? - Presence edema above the stump dressing. - Palpable pulse in the right popliteal space. - The client spends more time in bed than in a chair. - The client states he can learn to live with his "new look".

- Presence edema above the stump dressing. The nurse should recognize the stump dressing is used to prevent edema. Increased edema at the site can delay healing. The nurse should rewrap the stump and notify and notify the provider.

A nurse is providing discharge teaching to a client who has a fracture of the right tibia and a fiberglass cast. Which of the following instructions should the nurse include in the teaching? - Use a blow dryer on a moderate heat setting to dry the cast after showering. - Use a cotton swab to relieve itching under the cast. - Report any worsening or unrelieved pain. - Avoid moving the affected leg.

- Report any worsening or unrelieved pain. Pain can be a sign of complications such as compartment syndrome or skin breakdown. The client should report it to the provider.

A nurse is caring for a client who has a hip fracture that requires surgical repair. Which of the following health care professionals is responsible for obtaining informed consent from the client for the procedure? - Nurse - Anesthesiologist - Surgeon - Surgical site nurse

- Surgeon The health care provider who will perform the treatment or procedure is responsible for obtaining informed consent from the client. The surgeon who is performing the surgical repair of the fracture would be responsible for obtaining informed consent.

A nurse in an urgent care center is caring for client who has a greenstick fracture of the forearm. The nurse should explain that which of the following injuries has occurred with a greenstick fracture? - The bone is cracked lengthwise but did not break all the way through. - Fragments of bone have splintered into the surrounding tissue. - The bone ends have been forced toward each other. - Sharp edge of the bone has broken through the skin.

- The bone is cracked lengthwise but did not break all the way through. The nurse should explain that there is an incomplete break along the bone with a greenstick fracture.

A nurse is caring for a client who sustained a femur fracture in an automobile accident and is placed into skeletal traction. The nurse may remove the weights from the traction device if which of the following occurs? - The client complains of pain. - The client develops a life-threatening situation. - The client needs to have an x-ray of the femur performed. - The client has to be repositioned in the bed.

- The client develops a life-threatening situation. Traction weights, which are to hang freely at all times, are never to be removed without a specific provider prescription unless there is a life-threatening situation.

A nurse is caring for an older adult client who has a fractured hip and will require rehabilitative care. The client's family asks the nurse for information about this type of care. Which of the following explanations should the nurse provide? - This service began with the client's admission to the hospital. - This service focuses on teaching the primary caregiver to meet the client's needs. - The emphasis is on the client's complete recovery from the illness or injury. - Services are centered in long-term care facilities.

- This service began with the client's admission to the hospital. Rehabilitation is a process that assists an ill person or a person with a disability or impairment to achieve the highest possible level of functioning. The process of rehabilitation begins with the client's admission to a health care facility for treatment.

A nurse is providing teaching for a client who is postoperative following below-the-knee amputation. The nurse should instruct the client that which of the following nutrients is necessary for wound healing? - Vitamin B1 - Vitamin C - Folate - Vitamin E

- Vitamin C Vitamin C promotes collagen synthesis, which is essential for wound healing.