Musculoskeletal Fin

A client's cast is removed. The client is worried because the skin appears mottled and is covered with a yellowish crust. What advice should the nurse give the client to address the skin problem?

Apply lotions and take warm baths or soaks.

A client with rheumatoid arthritis has experienced increasing pain and progressing inflammation of the hands and feet. What would be the expected goal of the likely prescribed treatment regimen?

minimizing damage

A patient is scheduled for hip replacement surgery in a month. Which statement made by the client demonstrates understanding for the preoperative instructions?

"I will stop taking my aspirin prior to my surgery."

A client with systemic lupus erythematosus (SLE) is preparing for discharge. The nurse knows that the client has understood health education when the client makes what statement?

"I'll make sure to monitor my body temperature on a regular basis."

A client had an above-the-knee amputation of the left leg related to complications from peripheral vascular disease. The nurse enters the client's room and observes the dressing and bed covers saturated with blood. What is the first action by the nurse?

Apply a tourniquet.

The orthopedic nurse is caring for a client diagnosed with a fracture of the radius. When the nurse is considering all of the various types of bone fractures, which bone type is most anticipated?

Cancellous

A client is receiving treatment for an acute episode of gout with colchicine. The nurse is administering the medication every 2 hours. What should the nurse be sure the client communicates so that the drug can be temporarily stopped? Select all that apply.

Diarrhea Intestinal cramping Nausea and vomiting

A client is scheduled for a joint replacement surgery. Which action would be most important?

Withhold administration of aspirin before the surgery.

An x-ray demonstrates a fracture in which the fragments of bone are driven inward. This type of fracture is referred to as?

depressed.

A client has had a knee replacement and will be discharged in the morning. What does the nurse understand the goal for bending the knee is by discharge?

90°

A client with suspected osteomalacia has a fractured tibia and fibula. What test would give a definitive diagnosis of osteomalacia?

A bone biopsy

A client has just undergone a leg amputation. The nurse would closely monitor the client for which of the following during the immediate postoperative period?

Hematoma

A client with degenerative joint disease asks the nurse for suggestions to avoid unusual stress on the joints. Which suggestion would be most appropriate?

Maintain good posture.

The nurse is working in the emergency department interacting with clients of various disease processes and injuries. When completing a head-to-toe assessment, which standard assessment technique is most important?

Maintain standard precautions throughout the exam.

Bursitis is an inflammation of the bursa, a fluid-filled sac that cushions bone ends to enhance a gliding movement. What possible assessment findings would be present in a client with bursitis? Select all that apply.

painful movement of a joint a distinct lump

Which of the following would a nurse encourage a client with gout to limit?

purine-rich foods

A client is undergoing diagnostic testing to determine the etiology of recent joint pain. The client asks the nurse about the difference between osteoarthritis (OA) and rheumatoid arthritis (RA). What is the best response by the nurse?

"OA is considered a noninflammatory joint disease. RA is characterized by inflamed, swollen joints."

When providing discharge teaching to a client with a fractured toe, the nurse should include which instruction?

Apply ice to the fracture site.

A client is receiving treatment for a head injury. Which of the following would the nurse do related to positioning to reduce the risk of further injury?

Elevate the client's head slightly while keeping the neck neutral.

Which of the following was formerly called a bunion?

Hallux valgus

Which of the following would the nurse use to determine that a client is exhibiting signs and symptoms of chronic osteomyelitis?

Persistent draining sinus

The nurse is performing discharge teaching for a client with rheumatoid arthritis. What teachings are priorities for the client? Select all that apply.

Safe exercise Medication dosages and side effects Assistive devices

The nurse is caring for a patient with a fractured right femur who is not a candidate to repair the femur immediately. What intervention should the nurse anticipate the physician will order to relieve muscle spasm and pain until surgery is performed?

Skin traction

A client has a fractured jaw sustained in an automobile accident and has had the fracture surgically reduced and immobilized with a wire loop. What should the nurse ensure is present at the client's bedside in case of vomiting?

Wire cutters

A client is admitted with acute osteomyelitis that developed after an open fracture of the right femur. When planning this client's care, the nurse should anticipate which measure?

Administering large doses of I.V. antibiotics as ordered

A client presents at an ambulatory clinic and reports pain and aching in the lower left leg. After examining the client, a health care provider determines the client has experienced a strain related to the client's exercise regimen. The treatment plan includes analgesics, rest, and cold and heat therapies. Which guideline should be included in the care plan?

After 24 hours, apply heat for periods of 15 to 30 minutes.

The nurse is caring for a client who had an amputation of the left leg above the knee. What position can the nurse place the client in several times per day to promote stump extension and prevent contractures?

Prone

A client is seen in the orthopedic clinic for complaints of severe pain in the left hip. After a series of diagnostic tests, the client is diagnosed with severe degenerative joint disease of the left hip and suggested to have the hip reconstructed. What procedure will the nurse schedule the client for?

Left hip arthroplasty

A client experiences a musculoskeletal injury that involves the structure that connects a muscle to the bone. The nurse understands that this injury involves which of the following?

Tendon

A nurse is assessing a client for risk factors known to contribute to osteoarthritis. What assessment finding should the nurse interpret as a risk factor?

The client's body mass index is 34 (obese).

A client has a cast that extends from below the elbow to the palmar crease and is secured around the base of the thumb. The thumb is also casted. The nurse identifies this as which type of cast?

Gauntlet cast

A client is being discharged from the hospital after being diagnosed with and treated for systemic lupus erythematosus (SLE). What would the nurse not say when teaching the client and family information about managing the disease?

If you have problems with a medication, you may stop it until your next physician visit.

A client is scheduled to have an x-ray examination of his 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 of the following?

Arthroscopy

The nurse is preparing a client for a surgical procedure that will allow visualization of the extent of joint damage of the knee for a client with rheumatoid arthritis and also obtain a sample of synovial fluid. What procedure will the nurse prepare the client for?

Arthroscopy

Which nursing intervention is appropriate for monitoring the client for the development of Volkmann's contracture?

Assess the radial pulse.

An older adult client has fallen in her home and is brought to the emergency department by ambulance with a suspected fractured hip. X-rays confirm a fracture of the left femoral neck. When planning assessments during the client's presurgical care, the nurse should be aware of the client's heightened risk of what complication?

Avascular necrosis

A client has a cast applied to the leg for treatment of a tibia fracture and also has a wound on the leg that requires dressing changes due to drainage. For what should the nurse prepare the client?

Cutting a cast window

A client has been diagnosed with temporomandibular disorder and has not been able to eat. What suggestion can the nurse make to modify the diet so that the client will be able to eat?

Have the client eat soft rather than coarse food.

63 A client informs the nurse that he has been diagnosed with degenerative joint disease of the fingers but now has these bumps on his fingers that don't hurt. The nurse observes bony nodules on the distal interphalangeal joints. What type of "bumps" does the nurse understand these are?

Heberden's nodes

A client suffered a subtrochanteric hip fracture after falling out of the bed. What complication should the nurse monitor closely for related to this type of fracture?

Hypovolemic shock

A client is scheduled to undergo an electromyography. The nurse understands that this test is performed to evaluate which of the following?

Muscle weakness

When assisting a client following an arthroscopy of the knee to a comfortable position, which standard is maintained?

Place the client's joint in a neutral position.

A client is brought to the emergency department by a softball team member who states the client and another player ran into each other, and the client is having severe pain in the right shoulder. What symptoms of a fractured clavicle does the nurse recognize?

Right shoulder slopes downward and droops inward.

The nurse is assessing the client who states a decline in muscle strength. Which is the primary source essential to allow muscle contraction?

Myofibrils

A client has had several diagnostic tests to determine if he has systemic lupus erythematosus (SLE). What result is very specific indicator of this diagnosis?

Positive Anti-dsDNA antibody test

A client is taking large amounts of salicylates for the treatment of bursitis of the left shoulder. The client should be aware to report which symptoms of salicylism?

Ringing in the ears

A client was seen in the clinic for musculoskeletal pain, fatigue, mood disorders, and sleep disturbances. The physician has diagnosed fibromyalgia. What would not be a part of teaching plan for this condition?

applications of ice

A client is being treated for hyperuricemia. Part of the treatment strategy is for the client to avoid contributing factors whenever possible. Which activities might bring on an acute attack?

eating organ meats and sardines

The nurse is caring for a client with rheumatoid arthritis who suffers with chronic pain in the hands. When would be the best time for the nurse to perform range-of-motion exercises?

After the client has had a warm paraffin hand bath

The nurse is assigned to care for a client who has had a total knee arthroplasty yesterday. What type of pharmacologic therapy does the nurse anticipate administering to this client to prevent complications related to the surgery?

Anticoagulation therapy

60 Which of the following factors would the nurse need to keep in mind about the focus of the initial history when assessing a new client with a musculoskeletal problem?

Any chronic disorder or recent injury

Which interventions should a nurse implement as part of initial pain relief for the client with a cast?

Apply Cold Packs, Administer Analgesics, Elevate the involved part

Emergency medical technicians transport a client to the emergency department and inform the nurse that the client fell from a two-story building. The comatose client has a large contusion on the left side of the chest, a hematoma in the left parietal area, and a compound fracture of the left femur. The client was intubated and is maintaining an arterial oxygen saturation of 92% by pulse oximeter with a manual-resuscitation bag. Which intervention by the nurse has the highest priority?

Assessing the left leg

A nurse is providing an educational class to a group of older adults at a community senior center. In an effort to prevent osteoporosis, the nurse should encourage participants to ensure that they consume the recommended intake of what nutrients? Select all that apply.

Calcium Vitamin D

A client was playing softball and dislocated four of his fingers when diving for a ball. The physician manipulated the fingers into alignment and applied a splint to maintain alignment. What type of procedure does the nurse document this as?

Closed reduction

A client sustained a stable fracture of the cervical spine and is having skeletal traction applied. What type of traction does the nurse educate the client about?

Crutchfield tongs

A client's electronic health record notes that the client has hallux valgus. What signs and symptoms should the nurse expect this client to manifest?

Deviation of a great toe laterally

Which suggestion would be most important to give a client who has a mild case of bunions?

Don proper footwear.

A client is suspected to have Lyme disease and has a red macule at the site of the tick bite with a bull's-eye rash with round rings surrounding the center. In addition, the client has a severe headache with neck stiffness. What stage of Lyme disease is the client experiencing?

Early stage 1

A client had a surgical amputation of an arm and is having a myoelectric arm applied. What does the nurse understand are the benefits of this type of device? Select all that apply.

Eliminates the need to wear a harness Terminal device looks natural Better function than cosmetic hand

A professional tennis player comes to the orthopedic clinic and informs the nurse that he is having pain that radiates down the forearm and is unable to grasp the racket firmly. What does the nurse suspect is occurring with the client?

Epicondylitis With fractures of the femoral neck, the leg is shortened, adducted, and externally rotated.

Localized rapid bone turnover, most commonly affecting the skull, femur, tibia, pelvic bones, and vertebrae, is characterized by which bone disorder?

Paget disease

The nurse is assisting with an examination of a client suspected of having carpal tunnel syndrome. The physician has the patient flex the wrist for 30 seconds and percusses the median nerve. The client complains of pain and numbness when this is done. What does the nurse know this positive sign is documented as?

Phalen's sign

A patient has had surgery to repair a fractured hip. What intervention is important for the nurse to perform when turning the client from side to side?

Place abductor pillows between the legs.

Which actions by the nurse demonstrate an understanding of caring for a client in traction?

Placing a trapeze on the bed, Ensuring that the weights are hanging freely, Assessing the client's alignment in bed, and Frequently assessing pain level

Which of the following would the nurse expect a physician to use on a short-term basis for a client with an injured body part that does not require rigid immobilization?

Splint

A client is diagnosed with osteomyelitis. This is most commonly caused by which of the following?

Staphylococcus aureus

The nurse is preparing a client to have his cast cut off after having it for 6 weeks to treat a fracture tibia. What should the nurse inform the client prior to the cast being removed?

The skin may be covered with a yellowish crust that will shed in a few days.

The nurse is caring for a middle-aged female client who is experiencing premenopausal symptoms. Which client statement indicates the need for further teaching?

"Bone resorption slows with aging due to a decrease in estrogen levels."

A nurse is educating a client diagnosed with osteomalacia. Which statement by the nurse is appropriate?

"You may need to be evaluated for an underlying cause, such as renal failure."

A nurse is preparing a presentation for a health class about ways to ensure bone health, including the need for an adequate calcium intake. The participants are high school-aged girls. The nurse would encourage them to consume adequate calcium to maximize peak bone mass by which age?

30 to 35 years

A client is hospitalized for open reduction of a fractured femur. During the postoperative assessment, the nurse notes that the client is restless and observes petechiae on the client's chest. Which nursing action is indicated first?

Administer oxygen.

A client is experiencing symptoms that are suspected to be related to systemic lupus erythematosus. What cutaneous symptom occurs in about 50% of clients affected by this disease?

Butterfly-shaped rash on the face over the bridge of the nose and cheeks

The nurse is caring for a client who sustained rib fractures in an automobile accident. What symptoms does the nurse recognize as a complication of rib fractures and should immediately be reported to the physician?

Crackles in the lung bases

A client is complaining of severe pain in the left great toe. What lab studies that the nurse reviews indicate that the client may have gout?

Elevated uric acid levels

The nurse is discussing the new medication that a client will be taking for treatment of rheumatoid arthritis. Which disease-modifying antirheumatic drug (DMARD) will the nurse educate the client about?

Methotrexate (Rheumatrex)

The nurse is working on an orthopedic floor caring for a client injured in a football game. The nurse is reviewing the client's chart noting that the client has previously had an injured tendon. The nurse anticipates an injury between the periosteum of the bone and which of the following?

Muscle

A client is having traction applied to a fractured left lower extremity prior to surgery. What outcomes does the nurse expect from the application of the traction for the client? Select all that apply.

Muscle spasms will be relieved. The bones of the left leg will be aligned. Immobilization of the left leg will be maintained.

A client had a dislocated shoulder, and when healing, the client had insufficient deposits of collagen during the repair stage. What complication is the nurse aware can occur from this lack of collagen?

Recurrent dislocations

A client is diagnosed with systemic lupus erythematosus (SLE). Which of the following would be most appropriate for the nurse to use to evaluate the client' s stage of disease?

Review the client's medical record.

A client's decreased mobility has been attributed to an autoimmune reaction originating in the synovial tissue, which caused the formation of pannus. This client has been diagnosed with what health problem?

Rheumatoid arthritis (RA)

A client is having a cast applied for a fractured leg that extends from below the knee to the base of the toes. The foot is flexed at a right angle in a neutral position. What type of cast is the client having applied?

Short leg cast

A client arrives in the emergency room complaining of severe pain in her left hip after falling out of the bed. What indication upon assessment does the nurse recognize as a dislocated left hip? Select all that apply.

The left leg is shorter than the right. Limited range of motion of the left hip. The skin of the lower left leg is pale.

A client arrives at the orthopedic clinic and informs the nurse that he thinks he has another stress fracture of the right foot. The physician orders an x-ray with negative results. What does the nurse understand that these negative results can mean?

The stress fracture may not be seen on x-ray for a few weeks.

Which of the following would the nurse expect to assess as the most common finding associated with fibromyalgia?

Widespread chronic pain

A client in skeletal traction has a nursing diagnosis of Impaired Tissue Integrity: Related to puncture wound; pins. What expected outcome would be appropriate for this client?

Wounds heal without infection.

A client is reporting jaw pain, and is experiencing muscle spasm and tenderness of the masseter and temporalis muscles. The physician has diagnosed a temporomandibular disorder (TMD). What would the treatment course for this client include? Select all that apply.

referral to a dentist who has experience managing clients with TMD analgesics custom-fitted mouth guard during sleep

A client's x-ray looks similar to the image depicted. The nurse would recognize that the client likely has a:

Hammer toe

A client is instructed to take an oral calcium preparation with vitamin D daily for the prevention of osteoporosis. What statement made by the client demonstrates understanding of the medication instructions?

"I can't take the medication with my other medication."

The nurse is caring for a client who had a surgical amputation of the left leg related to complication from diabetes. The client asks the nurse, "If my leg is really gone, then why am I having such bad pain?" What is the best response by the nurse?

"It is called phantom pain and may come and go."

A client is seen in the emergency department for an injury acquired from falling off of a bicycle and fracturing the arm. The client also has a long laceration that has been sutured in the same area. The client asks the nurse why a splint is applied and not a cast. What is the best explanation by the nurse?

"We will need to monitor the status of the laceration to be sure it does not get infected."

A client with diabetes punctured his foot with a broken acorn in the yard. Within a week, the client developed osteomyelitis of the foot. The client was admitted for IV antibiotic therapy. How long does the nurse anticipate the client will receive IV antibiotics?

3 to 6 weeks

A client arrives at the orthopedic physician's office stating knee pain sustained while playing soccer. A history and physical assessment is completed. The knee appears reddened with edema. Which other diagnostic testing would the nurse anticipate?

An arthroscopy

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?

An electromyography

A client is scheduled for a total left knee arthroplasty in 2 weeks. When would the best time for postoperative nursing management begin?

Before surgery

A client arriving at the emergency department is diagnosed with a dislocation. Assessment would most likely reveal which of the following? Select all that apply.

Complaint of a popping sound, Swelling, Pain

A patient sustains an open fracture of the left arm after an accident at the roller skating rink. What does emergency management of this fracture involve? (Select all that apply.)

Covering the area with a clean dressing if the fracture is open Immobilizing the affected site Splinting the injured limb

A client with a fracture develops compartment syndrome that requires surgical intervention. What treatment will the nurse would most likely prepare the client for?

Fasciotomy

After a car accident, a client is admitted to an acute care facility with multiple traumatic injuries, including a fractured pelvis. For 24 to 48 hours after the accident, the nurse must monitor the client closely for which potential complication of a fractured pelvis?

Fat embolism

The nurse assesses subtle personality changes, restlessness, irritability, and confusion in a client who has sustained a fracture. The nurse suspects which complication?

Fat embolism syndrome

The nurse is caring for a client in traction that is immobile. What measures can the nurse provide to prevent further injury and potential infection and promote circulation to the area?

Massage bony prominences subject to pressure unless red when pressure relieved.

The nurse is caring for a client who has a deficiency in the formation of cartilage in joints. Which essential substance is absent?

Matrix

A nurse is providing care for a patient who has just been diagnosed as being in the early stage of rheumatoid arthritis. The nurse should anticipate the administration of which of the following?

Methotrexate (Rheumatrex)

An instructor is describing the process of bone development. Which of the following would the instructor describe as being responsible for the process of ossification?

Osteoblasts

A client has come to the clinic for a routine annual physical. The nurse practitioner notes a palpable, painless projection of bone at the client's shoulder. The projection appears to be at the distal end of the humerus. The nurse should suspect the presence of which of the following?

Osteochondroma

A client is informed that he has a benign bone tumor but that this type of tumor that may become malignant. The nurse knows that this is characteristic of which type of tumor?

Osteoclastoma

A client presents to the emergency department with fever, chills, restlessness, and limited movement of a fractured jaw. What complication should the nurse interpret as the findings?

Osteomyelitis

Which is a hallmark sign of compartment syndrome?

Pain

The physician orders an opioid analgesic for a client with a traumatic injury. The nurse would monitor the client closely for which of the following as the priority?

Respiratory depression

The nurse is caring for clients with spinal deformities. Which type of deformity would the nurse prioritize as having the most significant consequences on the respiratory system?

Scoliosis

A client undergoes an invasive joint examination of the knee. The nurse would closely monitor the client for which of the following?

Serous drainage

The nurse is caring for a client who experienced a crushing injury of the lower extremities. Which of the following symptoms is essential to be reported to the physician?

Pulselessness

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?

Support the leg by placing a hand under the knee and under the heel.

A client has severe osteoarthritis in the left hip and is having surgery to replace both articular surfaces of the hip. What type of surgical procedure will the nurse prepare the client for?

Total arthroplasty

62 A client comes to the clinic 2 days after sustaining a sprain to the left ankle. What intervention can the nurse encourage the client to perform that will help improve circulation?

Applying heat

The nurse is caring for a client who is being treated for fibromyalgia. What intervention will best assist the client to restore normal sleep patterns?

Tricyclic antidepressants

The nurse is reporting on the results of client blood work to the oncoming nurse. Upon reviewing the data, it is noted that the client has an elevated uric acid level. Which inflammatory process would the nurse screen for on shift rounds?

Gout

The emergency room nurse is reporting the location of a fracture to the client's primary care physician. When stating the location of the fracture on the long shaft of the femur, the nurse would be most correct to state which terminology locating the fractured site?

The fracture is on the diaphysis.

A client calls the clinic and tells the nurse that he was bitten by a tick and is afraid he has Lyme disease. How long does the nurse understand that the tick must be attached to have Lyme disease?

36 to 48 hours

A patient has sustained a left femur fracture in a skiing accident. When is the nurse aware that the complication of a fat emboli typically occurs and should be monitored for closely?

48 to 72 hours

The nurse is reviewing the diagnostic test findings of a client with rheumatoid arthritis. What would the nurse expect to find?

Elevated erythrocyte sedimentation rate

A client who has been newly diagnosed with systemic lupus erythematosus (SLE) has been admitted to the medical unit. Which nursing diagnosis is most likely to apply?

Fatigue Related to Anemia

When performing pin care, which of the following would be most appropriate?

Use an applicator only once. Gently remove crusts around pin sites.

The nurse is assisting a client with removing shoes prior to an examination and observes that the client has a flexion deformity of several toes on both feet of the proximal interphalangeal (PIP) joints. What can the nurse encourage the client to do?

Wear properly fitting shoes.

The nurse is providing client education on growth and development throughout the life span. When stating periods of most rapid bone growth, which period is the nurse most correct to state?

From birth through puberty

The nurse is gathering objective data for a client at the clinic complaining of arthritic pain in the hands. The nurse observes that the fingers are hyperextended at the proximal interphalangeal joint with fixed flexion of the distal interphalangeal joint. What does the nurse recognize this deformity as?

Swan neck deformity

A client has been treated for migraine headaches for several months and comes to the clinic stating he is getting no better. The nurse is talking with the client and hears an audible click when the client is moving his jaw. What does the nurse suspect may be happening?

Temporomandibular disorder

A client is recovering from a fractured hip. The nurse would suggest that the client increase intake of which of the following to facilitate calcium absorption from food and supplements?

Vitamin D