Musculoskeletal Med-surg 1

A client with suspected osteomalacia has a fractured tibia and fibula. What test would give a definitive diagnosis of osteomalacia? A. A bone biopsy B. Demineralization of the bone C. Increased and decreased areas of bone metabolism D. Elevated levels of alkaline phosphatase

A. A bone biopsy -A definitive diagnosis is obtained by bone biopsy. Radiographic studies demonstrate demineralization of the bone. A bone scan detects increased and decreased areas of bone metabolism. Alkaline phosphatase levels are detected from a blood sample.

A client with a fractured femur is placed in skeletal traction. Which intervention will increase client independence when moving in bed? A. Apply a trapeze to the bed frame. B. Instruct to use the elbows to reposition. C. Remove the weights prior to repositioning. D. Remind to use the heel of the unaffected foot to reposition.

A. Apply a trapeze to the bed frame.

When an infection is bloodborne, the manifestations include which symptom? A. Chills B. Bradycardia C. Hypothermia D. Hyperactivity

A. Chills

A client is admitted to the emergency room after being hit by a car while riding a bicycle. The client sustained a fracture of the left femur, and the bone is protruding through the skin. What type of fracture does the nurse recognize requires emergency intervention? A. Compound B. Greenstick C. Oblique D. Spiral

A. Compound -A compound fracture is a fracture in which damage also involves the skin or mucous membranes with the risk of infection great. A greenstick fracture is where one side of the bone is broken and the other side is bent; it does not protrude through the skin. An oblique fracture occurs at an angle across the bone but does not protrude through the skin. A spiral fracture twists around the shaft of the bone but does not protrude through the skin.

Arthrodesis is: A. Fusion of a joint (most often the wrist or knee) for stabilization and pain relief. B. Total reconstruction or replacement of a joint (most often the knee or hip) with an artificial joint to restore function and relieve pain. C. Replacement of one of the articular surfaces in a joint, such as the femoral head but not the acetabulum. D. Cutting and removal of a wedge of bone (most often the tibia or femur) to change the bone's alignment, thereby improving function and relieving pain.

A. Fusion of a joint (most often the wrist or knee) for stabilization and pain relief.

During a routine physical examination of a client, the nurse observes a flexion deformity of the proximal interphalangeal (PIP) joint of two toes on the right foot. How would the nurse document this finding? A. Hammer toe B. Mallet toe C. Hallux valgus D. Bunion

A. Hammer toe

A client with Paget's disease comes to the hospital and reports difficulty urinating. The emergency department health care provider consults urology. What should the nurse suspect is the most likely cause of the client's urination problem? A. Renal calculi B. Urinary tract infection (UTI) C. Benign prostatic hyperplasia D. Dehydration

A. Renal calculi -Renal calculi commonly occur with Paget's disease, causing pain and difficulty when urinating. A UTI commonly causes fever, urgency, burning, and hesitation with urination. Benign prostatic hyperplasia is common in men older than age 50; however, because the client has Paget's disease, the nurse should suspect renal calculi, not benign prostatic hyperplasia. Dehydration causes a decrease in urine production, not a problem with urination.

Which term refers to an injury to ligaments and other soft tissues surrounding a joint? A. Sprain B. Dislocation C. Subluxation D. Strain

A. Sprain -A sprain is caused by a wrenching or twisting motion. Dislocation refers to the separation of joint surfaces. Subluxation refers to partial separation or dislocation of joint surfaces. Strain refers to a muscle pull or tear.

A client has been diagnosed with a muscle strain. What does the physician mean by the term "strain"? A. Stretched or pulled beyond its capacity B. Injury resulting from a blow or blunt trauma C. Injuries to ligaments surrounding a joint D. Subluxation of a joint

A. Stretched or pulled beyond its capacity

Morton neuroma is exhibited by which clinical manifestation? A. Swelling of the third (lateral) branch of the median plantar nerve B. High arm and a fixed equinus deformity C. Longitudinal arch of the foot is diminished D. Inflammation of the foot-supporting fascia

A. Swelling of the third (lateral) branch of the median plantar nerve

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? A. applications of ice B. encouraging the client to eat a healthy diet C. avoiding caffeine and alcohol D. regular exercise and stress reduction

A. applications of ice

A client has come to the clinic with foot pain. The physician has described the client's condition as a flexion deformity of the proximal interphalangeal joint. What is the name of this disorder? A. hammer toe B. mallet toe C. hallux valgus (bunion) D. Heberden nodes

A. hammer toe

A home care nurse assesses for disease complications in a client with bone cancer. Which laboratory value may indicate the presence of a disease complication? A. Potassium level of 6.3 mEq/L B. Calcium level of 11.6 mg/dl C. Sodium level of 110 mEq/L D. Magnesium level of 0.9 mg/dl

B. Calcium level of 11.6 mg/dl

Which common problem of the upper extremity results from entrapment of the median nerve at the wrist? A. Ganglion B. Carpal tunnel syndrome C. Dupuytren's contracture D. Impingement syndrome

B. Carpal tunnel syndrome

A nurse is caring for a client with eczema. Which medication would be prescribed when an allergy is a factor causing the skin disorder? A. Dexamethasone B. Chlorpheniramine C. Dicloxacillin D. Bupivacaine

B. Chlorpheniramine -Antihistamines such as chlorpheniramine are frequently prescribed when an allergy is a factor in causing a skin disorder. Antihistamines relieve itching and shorten the duration of allergic reaction. Corticosteroids such as dexamethasone are used to relieve inflammatory or allergic symptoms. Antibiotics such as dicloxacillin are used to treat infectious disorders. Local anesthetics such as bupivacaine are used to relieve minor skin pain and itching.

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? A. Blood pressure of 140/90 mm Hg B. Crackles in the lung bases C. Client complains of pain in the affected rib area when taking a deep breath D. Heart rate of 94 beats/minute

B. Crackles in the lung bases

The nurse is planning an education program for women of childbearing years. What does the nurse recognize as the primary prevention of osteoporosis? A. Engaging in non-weight-bearing exercises daily B. Ensuring adequate calcium and vitamin D intake C. Undergoing assessment of serum calcium levels every year D. Having a DXA beginning at age 35 years

B. Ensuring adequate calcium and vitamin D intake

A patient in pelvic traction needs circulatory status assessed. How should the nurse assess for a positive Homans' sign? A. Have the patient extend both hands while the nurse compares the volume of both radial pulses. B. Have the patient extend each leg and dorsiflex each foot to determine if pain or tenderness is present in the lower leg. C. Have the patient plantar flex both feet while the nurse performs the blanch test on all of the patient's toes. D. Have the patient squeeze the nurse's hands with his or her hands to evaluate any difference in strength.

B. Have the patient extend each leg and dorsiflex each foot to determine if pain or tenderness is present in the lower leg.

While assessing a client who has had knee replacement surgery, the nurse notes that the client has developed a hematoma at the surgical site. The affected leg has a decreased pedal pulse. What would be the priority nursing diagnosis for this client? A. Risk for Infection B. Risk for Ineffective Peripheral Tissue Perfusion C. Unilateral Neglect Related to Hematoma D. Disturbed Kinesthetic Sensory Perception

B. Risk for Ineffective Peripheral Tissue Perfusion

A client arrives in the emergency department with a suspected bone fracture of the right arm. How does the nurse expect the client to describe the pain? A. A dull, deep, boring ache B. Sharp and piercing C. Similar to "muscle cramps" D. Sore and aching

B. Sharp and piercing

Which may occur if a client experiences compartment syndrome in an upper extremity? A. Whiplash injury B. Volkmann's contracture C. Callus D. Subluxation

B. Volkmann's contracture -If compartment syndrome occurs in an upper extremity, it may lead to Volkmann's contracture, a claw-like deformity of the hand resulting from obstructed arterial blood flow to the forearm and hand. A whiplash injury is a cervical spine sprain. Callus refers to the healing mass that occurs with true bone formation after a fracture. Subluxation refers to a partial dislocation.

A nurse is planning discharge teaching regarding exercise for a client at risk for osteoporosis. Which exercise would the nurse be most likely to suggest? A. Yoga B. Walking C. Bicycling D. Swimming

B. Walking

A nurse is educating a client diagnosed with osteomalacia. Which statement by the nurse is appropriate? A. "You will need to decrease the amount of dairy products you consume." B. "You will need to avoid foods high in phosphorus and vitamin D." C. "You may need to be evaluated for an underlying cause, such as renal failure." D. "You will need to engage in vigorous exercise three times a week for 30 minutes."

C. "You may need to be evaluated for an underlying cause, such as renal failure." -The client may need to be evaluated for an underlying cause. If an underlying cause is discovered, that will guide the medical treatment. The client needs to maintain an adequate to increased supply of calcium, phosphorus, and vitamin D. Dairy products are a good source of calcium. The client is at risk for pathological fractures and therefore should not engage in vigorous exercise.

A client with a fracture develops compartment syndrome that requires surgical intervention. What treatment will the nurse would most likely prepare the client for? A. Bone graft B. Joint replacement C. Fasciotomy D. Amputation

C. Fasciotomy

A client is brought in by ambulance to the emergency department after being involved in a motorcycle accident. The client has an open fracture on his tibia. The wound is highly contaminated and there is extensive soft- tissue damage. How would this client's fracture likely be graded? A. Grade I B. Grade II C. Grade III D. Grade IV

C. Grade III -Open fractures are graded according to the following criteria. Grade I is a clean wound less than 1 cm long. Grade II is a larger wound without extensive soft-tissue damage. Grade III is highly contaminated, has extensive soft-tissue damage, and is the most severe. There is no grade IV fracture.

The nurse notes that the client's left great toe deviates laterally. This finding would be recognized as A. Hammertoe B. Pes cavus C. Hallux valgus D. Flatfoot

C. Hallux valgus

A healthcare provider asks a nurse to test a client for Tinel's sign to diagnose carpal tunnel syndrome. What should the nurse do to perform this assessment? A. Have the client make a fist and open the hand against resistance. B. Have the client stretch the fingers around a ball and squeeze with force. C. Have the client hold the palm of the hand up while the nurse percusses over the median nerve. D. Have the client pronate the hand while the nurse palpates the radial nerve.

C. Have the client hold the palm of the hand up while the nurse percusses over the median nerve.

Radiographic evaluation of a client's fracture reveals that a bone fragment has been driven into another bone fragment. The nurse identifies this as which type of fracture? A. Comminuted B. Compression C. Impacted D. Greenstick

C. Impacted -An impacted fracture is one in which a bone fragment is driven into another bone fragment. A comminuted fracture is one in which the bone has splintered into several fragments. A compression fracture is one in which bone has been compressed. A greenstick fracture is one in which one side of the bone is broken, and the other side is bent.

Which factor inhibits fracture healing? A. Vitamin D B. Exercise C. Local malignancy D. Maximum bone fragment contact

C. Local malignancy

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? A. Avascular necrosis B. Fat embolism C. Osteomyelitis D. Compartment syndrome

C. Osteomyelitis

A client has Paget's disease. An appropriate nursing diagnosis for this client is: A. Risk for infection B. Delayed wound healing C. Risk for falls D. Fatigue

C. Risk for falls -The client with Paget's disease is at risk for falls secondary to pathological fractures and impaired gait/mobility.

An elderly client's hip joint is immobilized prior to surgery to correct a femoral head fracture. What is the nurse's priority assessment? A. The presence of leg shortening B. The client's complaints of pain C. Signs of neurovascular compromise D. The presence of internal or external rotation

C. Signs of neurovascular compromise

A client sustains an injury to the ligaments surrounding a joint. What will the nurse identify this injury as? A. Strain B. Contusion C. Sprain D. Fracture

C. Sprain

A client undergoes a total hip replacement. Which statement made by the client indicates to the nurse that the client requires further teaching? A. "I'll need to keep several pillows between my legs at night." B. "I need to remember not to cross my legs. It's such a habit." C. "The occupational therapist is showing me how to use a sock puller to help me get dressed." D. "I don't know if I'll be able to get off that low toilet seat at home by myself."

D. "I don't know if I'll be able to get off that low toilet seat at home by myself."

An emergency department client is diagnosed with a hip dislocation. The client's family is relieved that the client has not suffered a hip fracture, but the nurse explains that this is still considered to be a medical emergency. What is the rationale for the nurse's statement? A. The longer the joint is displaced, the more difficult it is to get it back in place. B. The client's pain will increase until the joint is realigned. C. Dislocation can become permanent if the process of bone remodeling begins. D. Avascular necrosis may develop at the site if it is not promptly resolved.

D. Avascular necrosis may develop at the site if it is not promptly resolved. -If a dislocation or subluxation is not reduced immediately, avascular necrosis (AVN) may develop. Bone remodeling does not take place because a fracture has not occurred. Realignment does not become more difficult with time and pain would subside with time, not become worse.

What clinical manifestation would the nurse expect to find in a client who has had osteoporosis for several years? A. Bone spurs B. Diarrhea C. Increased heel pain D. Decreased height

D. Decreased height

What term refers to a flexion deformity caused by a slowly progressive contracture of the palmar fascia? A. Callus B. Hammertoe C. Hallux valgus D. Dupuytren contracture

D. Dupuytren contracture

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? A. Client complains of tingling and numbness in the right shoulder. B. Right shoulder is elevated above the left. C. Client complains of pain in the unaffected shoulder. D. Right shoulder slopes downward and droops inward.

D. Right shoulder slopes downward and droops inward. -The client with a fractured clavicle has restricted motion, and the affected shoulder appears to slope downward and droop inward. The client will have pain, not typically tingling and numbness in the right shoulder. Pain is not felt in the unaffected shoulder.

Which is an inaccurate principle of traction? A. The weights are not removed unless intermittent treatment is prescribed. B. The weights must hang freely. C. The client must be in good alignment in the center of the bed. D. Skeletal traction is interrupted to turn and reposition the client.

D. Skeletal traction is interrupted to turn and reposition the client.

A nurse is performing discharge teaching for an elderly client with osteoporosis. Which instruction about a calcium supplement should the nurse include? A. Take weekly on the same day and at the same time. B. Remain in an upright position 30 minutes after taking the supplement. C. Take the supplement on an empty stomach with a full glass of water. D. Take the supplement with meals or with orange juice.

D. Take the supplement with meals or with orange juice.

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? A. Bind the toes so that they will straighten. B. Do active range of motion on the toes. C. Have surgery to fix them. D. Wear properly fitting shoes.

D. Wear properly fitting shoes.