Musculoskeletal HESI
After teaching, the nurse is evaluating the statements of a client about intranasal use of calcitonin. Which statement made by the client indicates effective learning?
"I should not spray the medication into the same nostril on 2 consecutive days"
Which term should the nurse use to describe synovial joint movement that moves away from the midline of the body?
Abduction
The x-ray report of a client shows the presence of a greenstick fracture. What is a greenstick fracture?
An incomplete fracture with one side bent
A nurse is caring for a client with rheumatoid arthritis. Based on the client's diagnosis, the nurse should review the result of which laboratory test?
Antinuclear antibody
A client who had an above-the-knee amputation has an elastic bandage around the residual limb. The prescriptions include bathing the residual limb daily and rewrapping the elastic bandage as needed. What should the nurse do when wrapping the bandage on the client's residual limb?
Apply it smoothly without wrinkles or creases.
A client admitted with a femur fracture 24 hours ago becomes confused. What should the nurse do immediately?
Assess for petechiae on the neck and chest
Which joint permits movement in any direction?
Ball-and-socket joint
Which joint helps in the gliding movement of the wrist?
Biaxial joint
The nurse considers that a 70-year-old female client can best limit further progression of osteoporosis by doing what?
Bone Scan
Which structure protects a client's internal organs, supports blood cell production, and stores minerals?
Bones
Which term should the nurse use to describe a flat, poorly defined mass on the sole over a bony prominence caused by pressure?
Callus
A client who is undergoing treatment for osteomyelitis reports bloody, watery diarrhea. The client also has hives and mouth sores. Which medication will the nurse check for in the client's medication administration record?
Cefazolin
Which type of bone tumor is commonly seen in elderly clients?
Chondrosarcoma
What is the nurse's primary consideration when caring for a client with rheumatoid arthritis?
Comfort
After becoming incontinent of urine, an older client is admitted to a nursing home. The client's rheumatoid arthritis contributes to severely painful joints. Which need is the primary consideration in the care of this client?
Control of pain
A peripheral nerve or dorsal column stimulator is implanted to relieve a client's intractable pain. What discharge instructions should the nurse provide?
Disconnect the transmitter when taking a bath
Which diagnostic scan is used to detect diffuse or localized muscle weakness?
Electromyography
A nurse is caring for a client who will have a below-the-knee amputation with an immediate postoperative prosthesis. The client asks the nurse the advantage of having an immediate prosthesis. What should the nurse explain is the advantage?
Encourages a normal walking pattern
Which hormone aids in regulating intestinal calcium and phosphorous absorption?
Glucocorticoids
The school nurse is attending to a student athlete who reports muscle pain after a practice session. Which should the nurse identify as a cause of this pain when providing instruction to the student?
Lactic Acid
Which structure connects the client's tibia to the femur at the knee joint?
Ligaments
A nurse is caring for a client who just had an above-the-knee amputation. Which is the key factor in assessing how the client will cope with the body image change?
Personal perception of the change
Which factor may cause a client neck pain?
Poor posture
Which synovial joint movement is involved in turning the client's palm downward?
Pronation
Which estrogen antagonist is specifically used to prevent and treat osteoporosis in postmenopausal women?
Raloxifene
The nurse is caring for a client who has undergone a total hip replacement. The nurse recognizes which clinical manifestations that indicate a pulmonary embolism? Select all that apply.
Sudden chest pain Abrupt onset of shortness of breath
To reduce a fracture of the hip, a client is placed in Buck traction before surgery. Because the client keeps slipping down in bed, increased countertraction is prescribed. What should the nurse do to increase countertraction?
Use a slight Trendelenburg position
The nurse is preparing to initiate intravenous antibiotic therapy for a client who developed an infection along the incision after having a total knee replacement. Before starting the first dose of intravenous antibiotics, which task should the nurse ensure has been completed?
Wound culture
When providing discharge teaching to a client who had a total hip replacement, what should the nurse instruct the client to avoid?
sitting in a low chair
Which type of cast will the nurse be caring for in a child with a fractured femur?
Hip spica
Which child is at the highest risk for blunt trauma associated with the indirect entry (hematogenous stage) of microorganisms?
8 year old boy
What does grade 3 indicate according to the muscle-strength scale?
Active movement against gravity only and not against resistance
After an amputation of a limb, a client begins to experience extreme discomfort in the area where the limb once was. What is the nurse's greatest concern at this time?
Addressing the pain
A client with arthritis reports receiving several dietary suggestions over the years. Which recommendation for a daily diet should the nurse reinforce?
Adequate foods in a variety of different food groups
In the postanesthesia care unit after a below-the-knee amputation, a client begins crying after feeling for the affected lower leg. How should the nurse respond?
Allow the client to ventilate feelings of loss.
A home care nurse is visiting a client who had a below-the-knee amputation. Which client statement indicates to the nurse that further teaching is needed?
At night, I sleep with a pillow under my knees
Which musculoskeletal system change is associated in older adult clients?
Decreased in height
A nurse performs full range-of-motion exercises on a client's extremities. When putting an ankle through range-of-motion exercises, what must the nurse perform
Dorsiflexion, plantar flexion, eversion, and inversion
Which diagnostic study is used to detect deep vein thrombosis in the client's lower extremities?
Duplex venous doppler
Non-weight bearing with crutches has been prescribed for a client with a leg injury. The nurse provides teaching before ambulation is begun. To facilitate walking with crutches, what is the most important activity the nurse should teach the client?
Exercise the triceps, finger flexors, and elbow extensors.
A client who is receiving radiation therapy for bone cancer lives alone and works full time. What should the nurse encourage this client to do?
Include rest periods during the day while receiving radiation
Which factor does the nurse consider most likely contributes to the increased incidence of hip fractures in older adults?
Fragility of bone
A nurse is providing postoperative teaching to a client who is scheduled to have an above-the-knee amputation. The client will use crutches during the postoperative period. Which activity will prepare the client for crutch walking?
Lifting weights
The nurse assesses a client who is unable to rotate his or her neck; the nurse finds malalignment and tenderness of the neck. Which nursing intervention would be beneficial for this client?
Inspecting and palpating each neck vertebra
A client is admitted with a fracture of the neck of the femur. In what position should the nurse maintain the client's affected extremity?
Internal rotation with extension of the knee and hip
The nurse teaches a premenopausal obese client about strategies to prevent osteoporosis. Which strategy identified by the client indicates that the teaching is effective?
Joins a tennis league and practices every day
An older adult fell at home and fractured the left hip. Which response should the emergency department nurse identify as a typical clinical indicator associated with a fractured hip?
Left leg is noticeably shorter than the right.
A client signs a legal consent for hip replacement surgery. Shortly before surgery, the client states, "I decided not to go through with the surgery." Which is the best initial response by the nurse?
Let's talk about your concerns regarding the procedure
A client has an open reduction and internal fixation for a fractured hip. Postoperatively the nurse should place the client's affected extremity in which position?
Moderate abduction
A client with a distal femoral fracture has a long leg cast applied. Which important element of a discharge program should the nurse focus on when teaching crutch-walking?
Modifying the home environment to prevent accidents
A nurse is caring for a client with a fracture of the head of the femur. The primary healthcare provider places the client in Buck extension. What explanation does the nurse give the client for why the traction is being used?
Reduces muscle spasms
A nurse is assessing a client with a cast to the extremity. Which assessment finding is the priority?
Numbness
An older female client is seen in the primary healthcare provider's office. Upon initial nursing assessment the nurse notes the client's height has decreased by 1 inch (2.5 cm) since the last visit 1 year ago. The nurse knows that what is the most likely reason for this finding?
Older adults may have osteoporosis-related height changes.
Which bursae are found between the client's elbow and the skin?
Olecranon
Which is the first line treatment for Paget disease?
Oral alendronate
Which hormone promotes bone resorption in a client?
Parathyroid hormone (PTH)
In which part of the client's body is the amphiarthroidial joint located?
Pelvis
After surgery for a fractured hip, a client states, "I don't remember when I have ever been so uncomfortable." What should the nurse's initial response be?
Perform a complete pain assessment
X-ray films reveal that a client has closed fractures of the right femur and tibia. In addition, multiple soft-tissue contusions are present. Which action is most important for the nurse to take?
Perform a neurovascular assessment of the extremity
The nurse is caring for a client who had surgery for a total hip replacement. Which action by the unlicensed assistive personnel (UAP) (continuing care assistant [CCA]) will cause the nurse to follow up?
Places the client in orthopneic position
A client reports burning sensation and sharp pain on the sole of a foot. Which condition does the nurse suspect in the client?
Plantar fasciitis
A nurse is caring for a client attending a community-based health center and reviews the client's medical record. What should the nurse encourage the client to do?
Push with the palms rather than the fingers when rising from a chair.
A client falls at home and is brought to the emergency department by family members. The client reports intercostal pain and is confused and disoriented. Which is the best way for the nurse to determine whether this behavior is new for the client?
Question the family members about the client's usual behavior
Three days after a cast is applied to a client's fractured tibia, the client reports that there is a burning pain over the ankle. The cast over the ankle feels warm to the touch, and the pain is not relieved when the client changes position. What is the nurse's priority action?
Report the client's concern to the primary healthcare provider
The primary healthcare provider prescribes one unit of packed red blood cells to be administered to the client who suffered a hip fracture. Several minutes after the start of the infusion, the client reports itching. Upon further assessment, the nurse observes hives on the client's chest. Which action should the nurse take next?
Stop transfusion immediately
A nurse is caring for a client with a fracture of the femoral neck. Which clinical indicator should the nurse expect to identify when assessing this client?
Shortening of the affected extremity with external rotation
Which physiologic changes of the musculoskeletal system are related to aging? Select all that apply.
Slowed movement Cartilage degeneration Increased bone prominence
Which individual is at risk of developing carpal tunnel syndrome?
Software engineer
The nurse is caring for a client who is 1 day postoperative for a left hip fracture repair. During the assessment, which finding should the nurse assess further?
Sudden shortness of breath
Which principle should the nurse consider when assisting a client with crutches to learn the four-point gait?
The client must be able to bear weight on both legs
A client has had a below-the-knee amputation of the leg. What is important for the nurse to consider when providing postoperative care for a client who had an amputation of a lower extremity?
The residual limb should not be elevated for the first 24 hours
Which treatment is beneficial for a client with muscle spasm?
Thermotherapy
Which hormone increases the rate of protein synthesis in a client?
Thyroxine
Which joint in the human body is an example of a condyloid joint?
Wrist joint
A client who is scheduled for a muscle biopsy tells the nurse, "They better give me a general anesthetic. I don't want to feel anything." Which is the most therapeutic initial response by the nurse?
You seem to be worried about the test.
One week after an above-the-knee amputation, a client refuses to go to physical therapy and tells the nurse, "I'll never be a whole person again!" What is the nurse's best response?
You've lost a part of yourself. That must be very difficult for you.
As an acute episode of rheumatoid arthritis subsides, active and passive range-of-motion exercises are taught to the client's spouse. The nurse should teach that direct pressure should not be applied to the client's joints, because this may precipitate what?
Pain
A client with a history of a herniated nucleus pulposus is scheduled for total hip replacement surgery. To prevent the most common complication associated with this type of surgery, the nurse should instruct the client to perform which activity?
Plantar flexion and dorsiflexion exercises
While performing a musculoskeletal assessment, the nurse notices that the client can complete range of motion with gravity eliminated. Which grade would the nurse assign to the client?
2
Which disorder of the foot is caused by continual pressure over bony prominences?
Corn
The nurse is reviewing the joint fluid examination reports of four clients. Which client's report indicates a normal finding?
Transparent straw colored fluid
A client with cancer is scheduled for a bone scan to determine the presence of metastasis. The nurse evaluates that the teaching before the scheduled bone scan is effective when the client makes which comment?
"A substance of low radioactivity will be injected into my vein and my body inspected by an instrument to detect where it is deposited."
A registered nurse (RN) is giving home care instructions to a client who was treated for injuries due to a fall. Which statement made by the client indicates a need for correction?
"I should walk on scatter rugs at home."
While awaiting the biopsy report before removal of a bone tumor, the client reports being afraid of a diagnosis of cancer. How should the nurse respond?
"It is very upsetting to have to wait for a biopsy report."
A client who has an above-the-knee amputation (AKA) reports phantom limb sensations. What should the nurse do?
Describe the neurologic mechanisms in language that the client understands
What should a nurse assess after applying a body jacket brace to a client with severe spine injuries following a car accident? Select all that apply.
Development of cast syndrome Abdomen for decreased bowel sounds Areas of pressure over the bony prominences
Which clinical manifestation can a client experience during a fat embolism syndrome (FES)?
Dyspnea
Which synovial joint movement is described as turning the sole outward away from the midline of the body?
Eversion
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.
Hips Knees
The medical history of a client with osteoporosis indicates renal calculi. Which medication would be contraindicated?
Os-cal
Which condition is characterized by infection of a client's bone or bone marrow?
Osteomyelitis
Which term should the nurse use to describe bone loss greater than normal but less than that caused by osteoporosis?
Osteopenia
A 90-year-old resident of a nursing home falls and fractures the proximal end of the right femur. The surgeon plans to reduce the fracture with an internal fixation device. What general fact about the older adult should the nurse consider when caring for this client?
Physiologic coping defenses are reduced.
Which musculoskeletal abnormality does the nurse suspect in a client who exhibits short steps and drags a foot?
Spastic gait
Which type of joint is present in the client's shoulders?
Spheroidal
A client had a cerebrovascular accident (also known as a "brain attack"), and bed rest is prescribed. What can the nurse use to best prevent footdrop in this client?
Splints
The primary healthcare provider prescribes one unit of packed red blood cells to be administered to the client who suffered a hip fracture. Several minutes after the start of the infusion, the client reports itching. Upon further assessment, the nurse observes hives on the client's chest. Which action should the nurse take next?
Stop the infusion
A client sustains a back injury after falling 20 feet (6 m). In which position should the nurse place the client?
Supine position while not allowing the spine to flex
A client sustains a fractured right femur after an automobile accident and is admitted to the hospital's emergency department. Which assessment is the priority?
Take the client's pedal pulse in the affected extremity.
A client with rheumatoid arthritis asks the nurse about ways to decrease morning stiffness. What should the nurse suggest?
Taking a hot tub bath or shower in the morning
A client has injured a short bone. Which is an example of a short bone?
Tarsals
Why is Phalen's test performed in a client?
To detect carpal tunnel syndrome
What does the nurse instruct a client to do while performing McMurray's test?
To flex, rotate, and extend the knees
While caring for a client with a second-degree left ankle sprain, a nurse raises the injured part above heart level. What is the reason behind this nursing intervention?
To prevent further edema