Musculoskeletal Review

A client had a posterolateral total hip replacement 2 days ago. What information should the nurse include in the clients place of care? SATA A) When using a walker, encourage the client to keep toes pointing inward B) Position a pillow between the legs to maintain abduction C) Allow the client to be in the supine position or in the lateral position on the unoperated side D) Do not allow the client to bend down to tie or slip on shoes E) Place ice on the incision after physical therapy

Position a pillow between the legs to maintain abduction Allow the client to be in the supine position or the lateral position on the unoperated side Do not allow the client to bend down to tie or slip on shoes Place ice on the incision after physical therapy

A client is in balanced suspension traction to maintain alignment of a fractured tibia. Which activities are safe for the client? A) eat while lying flat B) raise the hips using trapeze C) rotate side to side D) flex and extend the ankle on affected side

Raise hips using trapeze

The nurse is caring for an adult with a grade III compound fracture of the right femur. The client has been placed in skeletal traction. What is the intended outcome of the traction? A) prevent skin breakdown B) prevent movement in bed C) preserve normal length of the leg D) reduce and immobilize the fracture

Reduce and immobilize the fracture

The lab notifies the nurse that a client who had a total knee replacement 3 days ago and is receiving heparin has an aPTT of 95 seconds. After verifying the values, the nurse calls the HCP. What prescription for the client should the nurse recommend the HCP consider? A) protamine sulfate B) vitamin K C) warfarin D) packed RBC

protamine sulfate

A client returns from the first session of scheduled PT following total knee replacement surgery. The nurse assesses the knee is swollen, slightly erythematous, and painful. The client rates their pain a 7/10 and has not had any scheduled or PRN meds today. what should the nurse do? SATA A) gently massage the area to increase circulation B) administer pain medication as prescribed C) elevate the leg and apply a cold pack D) notify the HCP E) call the PT to cancel the next session

Administer pain medication as prescribed Elevate the leg and apply a cold pack

Which nursing action would be least appropriate for a client who is in double hip spica cast? A) encouraging the intake of cranberry juice B) advising the client to eat large amounts of cheese C) establishing regular times for elimination D) having the client dangle at bedside

Advising the client eat large amounts of cheese

The nurse is planning care for a client with osteomyelitis. The client is taking an antibiotic but the infection has not resolved. What should the nurse advise the client to do? A) use herbal supplements B) eat a diet high in protein and vitamins C & D C) ask the HCP for a change of antibiotics D) encourage frequent passive range of motion to affected extremity

Eat a diet high in protein and vitamins C & D

After teaching a client with osteoarthritis about the importance of regular exercise, which statement indicates the client has understood the teaching? A) Performing range of motion exercises will increase my joint mobility B) Exercise helps to drive synovial fluid through the cartilage C) Joint swelling should determine when to stop exercising D) Exercising in the outdoors year round promotes joint relaxation

Exercise helps to drive synovial fluid through the cartilage

A client with osteoarthritis will undergo an arthrocentesis on a painful, edematous knee. What information should be included in the nursing plan of care? SATA A) Explain the procedure B) Administer preoperative meds 1 hour before surgery C) Instruct the client to immobilize the knee for 2 days after the surgery D) Assess the site for bleeding E) Offer pain medication

Explain the procedure Assess the site for bleeding Offer pain medication

A client with an extracapsular hip fracture returns to the nursing unit after internal fixation and pin insertion with a drainage tube at the incision site. Her husband asks "Why does she have this tube inserted in her hip?" Which response would be best? A) The tube helps us to detect a wound infection B) This way we will not have to irrigate the wound C) Fluid will drain and not accumulate at the site D) We have a way to administer antibiotics into the wound

Fluid will drain and not accumulate at the site

The nurse advises the client who has had a femoral head prosthesis placement on the type of chair to sit in during the first 6-8 weeks after surgery. Which chair would be the correct type to recommend? A) a desk-type swivel chair B) padded upholstered chair C) high-backed chair with armrests D) recliner with an attached footrest

High-backed chair with armrests

Which statement indicates that the client with osteoarthritis understands the effects of capsaicin cream? A) I always wash my hands right after I apply the cream B) After I apply the cream, I wrap my knee with an elastic bandage C) I keep the cream in the cabinet above the stove in the kitchen D) I also use the cream when I get a cut or burn

I always wash my hands right after I apply the cream

Which client statement identifies a knowledge deficit about case care? A) I will elevate the cast above my heart initially B) I will exercise the joints above and below my cast C) I can pull out the cast padding to scratch inside the cast D) I will apply ice for 10 minutes to control edema for the first 24 hours

I can pull out the cast padding to scratch inside the cast

At which time should the nurse instruct the client to take ibuprofen, prescribed for left hip pain secondary to osteoarthritis, to minimize gastric mucosal irritation? A) at bedtime B) on rising C) immediately after a meal D) on an empty stomach

Immediately after a meal

The nurse is assessing a client for neurologic impairment after a total hip replacement. Which finding indicates impairment in the affected extremity? A) decreased distal pulse B) inability to move C) diminished capillary refill D) coolness to the touch

Inability to move

The client diagnosed with osteoarthritis tells the nurse "My friend takes steroid pills for her Rheumatoid arthritis. Should I be taking steroids too?" What should the nurse explain to the client? A) Intra-articular corticosteroid injections are used to treat osteoarthritis B) Oral corticosteroids can be used in osteoarthritis C) A systemic effect is needed in osteoarthritis D) Rheumatoid arthritis and osteoarthritis are two similar diseases

Intra-articular corticosteroid injections are used to treat osteoarthritis

Which condition should the nurse assess when completing a history and physical exam of a client diagnoised with osteoarthritis? A) anemia B) osteoporosis C) weight loss D) local joint pain

Local joint pain

Which information should be included in the teaching plan for a client with osteoporosis? SATA A) Maintain a diet with adequate amounts of vitamin D B) choose foods with high calcium content C) Use alcohol in moderation D) Swim as a good exercise to maintain bone mass E) Avoid high fat foods

Maintain a diet with adequate amounts of vitamin D Choose foods with high calcium content Use alcohol in moderation

An older adult with a hip fracture is to use an alternating air pressure mattress at home to prevent pressure ulcers while recovering from surgery. The nurse is showing the clients family how to place the mattress. What should the nurse instruct the family to do? A) turn the mattress over so the air cells face the mattress of the bed and cover the mattress with bedsheet. B) put a thick pad over the pressure mattress to prevent soiling, and place the bedsheet on top of the pad C) make the bed with the bedsheet on top of the pressure mattress D) place the sheet on the bed and then remove the pillow to allow full use of mattress on the nect.

Make the bed with the bedsheet on top of the pressure mattress

An older adult is admitted with a fracture of the femur. What should the nurse assess first about this client? A) ability to change positions B) type of pain C) mechanism of injury D) extent of anxiety

Mechanism of injury

The nurse is preparing a client who has had a knee replacement with a metal joint to go home. What should the nurse instruct the client to do? SATA A) Notify HCP about the joint prior to invasive procedures B) Inform the HCP prior to having MRI scans C) Notify the airport security that the joint may set off alarms on metal detectors D) Refrain from carrying items weighing more than 5 lbs E) eat a low fat, low carb diet

Notify the HCP about the joint prior to invasive procedures Inform HCP prior to having MRI scans Notify the airport security that the joint may set off alarms on metal detectors

A client who has had a total hip replacement has a dislocated hip prosthesis. What should the nurse do first? A) stabilize the leg with Bucks traction B) apply an ice pack to the affected hip C) position the client toward the opposite side of the hip D) notify the orthopedic surgeon

Notify the orthopedic surgeon

The client with an open femoral fracture was discharged to home and reports having a fever, night sweats, chills, restlessness, and restrictive movement of the fractured leg. The nurse should interpret these findings as the client may be experiencing which complication? A) PE B) osteomyelitis C) fat embolism D) UTI

Osteomyelitis

The client with a fractured tibia has been taking methocarbamol. Which finding indicates the drug is having the intended effect? A) lack of infection B) reduction in itching C) relief of muscle spasms D) decrease in nervousness

Relief of muscle spasms

A client in a double hip spica cast is constipated. The surgeon cuts a window into the front of the cast. Which outcome is intended? The window in the cast will allow: A) The nurse to palpate the superior mesenteric artery B) The surgeon to manipulate the fracture site C) The nurse to reposition the client D) Relief of pressure due to abdominal distention

Relief of pressure due to abdominal distention

The nurse is assessing the home environment of an elderly client who is using crutches during the post op recovery phase after hip pinning. Which poses the greatest hazard to the client as a risk for falling at home? A) a 4-year old cocker spaniel B) scatter rugs C) snack tables D) rocking chairs

Scatter rugs

The client in balanced suspension traction is transported to surgery for closed reduction and internal fixation of his fractured femur. Which of the following should the nurse do when transporting the client to the operating room? A) Transfer the client to a cart with manually suspended traction. B) Call the surgeon to request an order to temporarily remove the traction. C) Send the client on his bed with extra help to stabilize the traction. D) Remove the traction and send the client on a cart.

Send the client on his bed with extra help to stabilize the traction

A client has an intracapsular hip fracture. The nurse should conduct a focused assessment to detect which change near the fracture? A) internal rotation B) muscle flaccidity C) shortening of the affected leg D) absence of pain in the area

Shortening of the affected leg

The client in traction for a fractured femur is having difficulty managing self-care activities. Which outcome indicates a successful completion of a goal of promoting independence for this client? A) the client assists as much as possible in care, demonstrating increased participation over time B) the client allows the nurse to complete care in an efficient manner without interfering C) the client allows the spouse to to assume total responsibility for care D) the client accepts that self care is not possible while in traction

The client assists as much as possible in care, demonstrating increased participation over time

The nurse has established a goal with a client to improve mobility following hip replacement. Which of the following is a realistic outcome at the time of discharge from the surgical unit? A) The client can walk throughout the entire hospital with a walker. B) The client can walk the length of a hospital hallway with minimal pain. C) The client has increased independence in transfers from bed to chair. D) The client can raise the affected leg 6 inches with assistance.

The client has increased independence in transfers from bed to chair

A client with an extracapsular hip fracture is scheduled for surgical internal fixation with the insertion of a pin. What can the nurse tell the client about the reason for this type of treatment for the fracture? A) Hemorrhage at the site is prevented B) Neurovascular impairment risk is decreased C) The risk of infection at the site is lessened D) The client is able to be mobilized sooner

The client is able to be mobilized sooner

A client has a leg immobilized in traction. Which observation by the nurse indicates that the client understands actions to take to prevent muscle atrophy? A) The client adducts the affected leg every 2 hours B) The client rolls the affected leg away from the body's midline twice per day C) The client performs isometric exercises to the affected extremity 3 times per day D) The client asks the nurse to add a 5 lb weight to the traction for 30 minutes a day

The client performs isometric exercises to the affected extremity 3 times per day

The nurse is assessing a client who had a left hip replacement 36 hours ago. Which findings indicate the prosthesis is dislocated? SATA A) the client reported a popping sensation in the hip B) the left leg is shorter than the right C) the client has sharp pain in the groin D) the client cannot move the right leg E) the client cannot wiggle the toes on the left leg

The client reported a popping sensation in the hip The left leg is shorter than the right The client has sharp pain in the groin

After a nurse teaches the client about the use of skeletal traction, which statement made by the client about the purpose of traction indicates the need for additional teaching? A) to align injured bones B) to provide long term pull C) to apply 25 lb of traction D) to pull weight with a boot

To pull weight with a boot

A client has a Pearson attachment on the traction setup. Which of the following is the purpose of this attachment? A) To support the lower portion of the leg. B) To support the thigh and upper leg. C) To allow attachment of the skeletal pin. D) To prevent flexion deformities in the ankle and foot.

To support the lower portion of the leg

A client who had a total hip replacement 2 days ago has developed an infection with a fever, diaphoresis, and dehydration. The nurse establishes a care plan to make the client comfortable. Which goals are appropriate? SATA A) drink 2,000 mL of fluid per day B) understand how to manage the incision C) have linens changed as needed D) have cool and dry skin E) remain on complete bed rest

drink 2,000 mL of fluid per day

Following a clients total hip replacement, what should the nurse do? SATA A) with the aid of a coworker, turn the client from supine to prone every 2 hours B) encourage the client to use the overhead trapeze to assist with position changes C) for meals, elevate head of bed to 90 degrees D) use a fracture bedpan when needed by the client E) when the client is in bed, prevent thromboembolism by encouraging the client to do toe pointing exercises

encourage the client to use the overhead trapeze to assist with position changes use fracture bedpan when needed by the client when the client is in bed, prevent thromboembolism by encouraging the client to do toe pointing exercises

A client had a total hip replacement today. How should the nurse position the client when the client is transferred from transport cart to the bed? A) place weights alongside the affected extremity to keep the extremity from rotating B) elevate both feet on two pillows C) keep lower extremities adducted by use of an immobilization device around both legs D) maintain the affected extremity in slight abduction using an abduction splint or pillows placed between the thighs

maintain the affected extremity in slight abduction using an abduction splint or pillows placed between the thighs

A client being discharged following an open reduction and internal fixation of the left ankle is to wear a non weight bearing cast for 2 weeks. What should the nurse teach the client do do when using crutches? A) use a 4 point gait B) maintain two to three finger widths between the axillary fold and underarm piece grip C) keep leg dependent when sitting D) maintain balance by supporting the bodys weight on the axillae

maintain two to three finger widths between the axillary fold and underarm piece grip

The nurse is assessing a clients left leg for neurovascular changes following a total left knee replacement. Which are expected normal findings? SATA A) moderate edema of the left knee B) skin warm to touch C) capillary refill response of <3 seconds D) moves toes E) pain absent F) pulse on left leg Is weaker than right leg

moderate edema of the left knee skin warm to touch capillary refill response of <3 seconds moves toes

The nurse is caring for a client who is 30 years old with a fracture of the fight femur and left tibia. Both legs have casts. The nurse assess the following: respirations 30 and rapid/shallow, presence of fain expiratory wheeze, coughing produces thin pink sputum. The client is yelling at the nurse and wants to be released from the hospital; this is behavior unlike the previously reported. The last pain medication was administered 3 hours ago. What should the nurse do first? A) cut slits in the top of the casts B) administer pain meds C) notify HCP D) obtain a chest x-ray

notify HCP

The client has just had a total knee replacement. When assessing the client, which finding should lead the nurse to suspect possible nerve damage? A) numbness B) bleeding C) dislocation D) pinkness

numbness

A client has been taking hydrocodone with acetaminophen at home for 6 weeks following a fractured tibia is admitted with a blood pressure of 80/50, a pulse of 115, and respirations of 8 and shallow. What does these findings indicate? A) expected common adverse effects of the hydrocodone B) hypersensitivity reaction to acetaminophen C) possible habituation effect of the long term drug use D) hemorrhage from GI associated with pain medication

possible habituation effect of the long term drug use

Which goal is the priority for a client with a fractured femur who is in traction? A) prevent effects of immobility while in traction B) develop skills to cope with prolonged immobility C) choose appropriate diversional activities during the prolonged recovery D) adapt to inactivity from the impaired mobility

prevent effects of immobility while in traction

The nurse is teaching the client to administer enoxaparin following a total hip replacement. What should the nurse instruct the client to do? SATA A) report promptly any difficulty breathing, rash or itching B) notify the HCP of unusual bruising C) avoid all aspirin containing medications D) wear or carry medical identification E) expel the air bubble from the syringe before injecting F) remove the needle immediately after the injection

report promptly any difficulty breathing, rash or itching notify the HCP of unusual bruising avoid all aspirin containing medications wear or carry medical identification

When preparing a client for discharge from the hospital after a total knee replacement, the nurse should include which information in the discharge plan? SATA A) report signs of infection to HCP B) keep the affected leg and foot on the floor when sitting in a chair C) remove antiembolism stockings when sleeping D) PT will encourage progressive ambulation with use of assistive devices E) change dressing daily

report signs of infection to HCP PT will encourage progressive ambulation with use of assistive devices

When admitting a client with a fractured extremity, what area should the nurse assess first? A) the area proximal to the fracture B) the fracture site C) the area distal to the fracture D) the opposite extremity for baseline comparison

the area distal to the fracture

When developing a teaching plan for a client who is prescribed acetaminophen for muscle pain, which information should the nurse expect to include? SATA A) the drug can be used if the person is allergic to aspirin B) acetaminophen does not affect platelet aggregation C) this drug causes little or no gastric distress D) acetaminophen exerts a strong anti inflammatory effect E) the client should have the INR checked regularly

the drug can be used if the person is allergic to aspirin acetaminophen does not affect platelet aggregation this drug causes little or no gastric distress

A client with a fractured tibia has an external fixation. The HCP has prescribed a solution of 1/2 NS and 1/2 hydrogen peroxide to clean the pin site twice a day. In which order should the nurse cleanse the pin from first to last? 1. inspect the site for redness, swelling, or discharge 2. clean the pin with a cotton swab dipped in prescribed solution, wiping from the insertion site to the tip of the pin 3. clean the pin insertion site with a cotton swab dipped in prescribed solution, removing the crust wiping away from the site 4. clean the area around the pin insertion site with cotton swabs, dipped in prescribed solution

4, 3, 1, 2

A client who had a total hip replacement 4 days ago is worried about dislocation of the prosthesis. How should the nurse respond to the clients concern? A) Don't worry, your new hip is very strong. B) Use of a cushioned toilet seat helps to prevent dislocation. C) Activities that tend to cause adduction of the hip tend to cause dislocation, so try to avoid them. D) Decreasing use of the abductor pillow will strengthen the muscles to prevent dislocation.

Activities that tend to cause adduction of the hip tend to cause dislocation, so try to avoid them.

On the evening of surgery for total knee replacement, a client wants to get out of bed. To safely assist the client the nurse should do which of the following? A) Encourage the client to apply full weight-bearing. B) Order a walker for the client. C) Place a straight-backed chair at the foot of the bed. D) Apply a knee immobilizer.

Apply a knee immobilizer

The nurse is instructing a client who will have a total hip replacement tomorrow. Which information is most important to include in the teaching plan at this time? A) teach how to prevent hip flexion B) demonstrate coughing and deep breathing techniques C) show the client what an actual hip prosthesis looks like D) assess the clients fears about the procedure

Assess the clients fears about the procedure

Which information should the nurse include when performing discharge teaching with a client who had an anterolateral approach for a total hip replacement? SATA A) avoid turning the toes or knee outward B) use an abduction pillow between the legs when in bed C) use an elevated toilet seat and shower chair D) do not extend the operative leg backwards E) restrict motion for 2 weeks after surgery

Avoid turning the toes or knees outward Use an elevated toilet seat and shower chair Do not extend the operative leg backwards

A HCP prescribes a lengthy x-ray exam for a client with osteoarthritis with severe pain. Which action by the nurse would demonstrate client advocacy? A) Contact the x-ray tech to see if the lengthy session can be divided into shorter sessions B) Contact the HCP to determine if an alternative exam could be scheduled C) Request a prescription for acetaminophen prior to the exam D) Request padding and careful positioning for the hard x-ray table

Contact the x-ray tech to see if the lengthy session can be divided into shorter sessions

A client with a hip fracture has undergone surgery for insertino of the femoral head prosthesis. Which activity should the nurse instruct the client to avoid? A) crossing the legs while sitting down B) sitting on a raised commode seat C) using an abductor splint while lying on the side D) rising straight from a chair to a standing position

Crossing the legs while sitting down

Following a total joint replacement, which complication has the greatest likelihood of occuring? A) DVT B) polyuria C) displacement of new joint D) wound evisceration

DVT

After knee arthroplasty, the client has a sequential compression device (SCD). The nurse should do which of the following? A) Elevate the sequential compression device (SCD) on two pillows. B) Change the settings on the SCD to make the client more comfortable. C) Stop the SCD to remove dressings and bathe the leg. D) Discontinue the SCD when the client is ambulatory.

Discontinue the SCD when the client is ambulatory

A postmenopausal client is scheduled for a bone density scan. What should the nurse instruct the client to do? A) Remove all metal objects on the day of the scan B) Consume foods and beverages with a high content of calcium for 2 days before the test C) Ingest 600 mg of calcium gluconate by mouth for 2 weeks before the test D) Report any significant pain to the HCP at least 2 days before the test

Remove all metal objects on the day of the scan

A client returned from surgery with a debrided open tibial fracture and has a three-way drainage system. The clients vital signs are WNL. What should the nurse do next? A) Review the results of culture and sensitivity testing of the wound B) Change the dressing at the surgery site C) Determine if the client has increased pain from exposed nerve endings D) Check lab results for electrolyte imbalances

Review the results of culture and sensitivity testing of the wound

The nurse is caring for a n older adult male who had open reduction internal fixation of the right hip 24 hours ago. The client is now experiencing shortness of breath and reports having tightness in his chest. The nurse reviews his recent lab results. Which results need to be reported to HCP? A) Hct of 40% B) serum glucose of 120 mg/dL C) troponin of 1.4 mcg/L D) ESR of 22 mm/h

Troponin of 1.4 mcg/L

The nurse is planning care for the client with a femoral fracture who is in balanced suspension traction. Which nursing care can be included in the care plan? A) Using a fracture bedpan when the client uses the trapeze to raise the hips B) Turning the client side to side to give back care C) Raising the head of bed to 90 degrees to sit the client up D) giving the client a complete bed bath

Using a fracture bedpan when the client uses the trapeze to raise the hips

Which sign indicates that a client with a fracture to the right femur may be developing a fat embolism? A) acute respiratory distress syndrome B) migraine like headaches C) numbness in the right leg D) muscle spasms in right thigh

acute respiratory distress syndrome

A client is to have a total hip replacement. What nursing actions should the preop plan include? SATA A) administer antibiotics as prescribed to ensure therapeutic blood levels B) apply SCD's C) request a trapeze be added to the bed D) teach isometric exercises of quads and glute muscles E) demonstrate crutch walking with a 3-point gait F) place Bucks traction on the bed

administer antibiotics as prescribed to ensure therapeutic blood levels request a trapeze be added to the bed teach isometric exercises of quads and glute muscles

The nurse is preparing a teaching plan for a client about crutch walking using a two point gait pattern. What information should the nurse include? A) advance a crutch on one side, and then advance the opposite foot; repeat on opposite side. B) advance a crutch on one side, and simultaneously advance and bear weight on the opposite foot; repeat on opposite side C) advance both crutches together and then follow by lifting both lower extremities to the level of crutches D) advance both crutches together and then follow by lifting both lower extremities past the level of crutches

advance a crutch on one side, and simultaneously advance and bear weight on the opposite foot; repeat on opposite side

In preparation for total knee surgery, a 200 lb client with osteoarthritis must lose weight. Which exercise should the nurse recommend as best if the client has no contraindications? A) weight lifting B) walking C) aquatic exercise D) tai chi

aquatic exercise

A client with a fracture develops compartment syndrome. Which sign should alert the nurse to impending organ failure? A) crackles B) jaundice C) generalized edema D) dark, scanty urine

dark, scanty urine

A client has a left tibial fracture that required casting. Approximately 5 hours later, the client has increasing pain distal to the fracture despite the morphine injection administered 30 minutes ago. Which area should be the nurses next assessmesnt? A) distal pulses B) pain with a pain rating scale C) vital sign changes D) potential for drug tolerance

distal pulses

After surgery and insertion of a total hip prosthesis, a client develops severe sudden pain and an inability to move the extremity. What does the nurse interpret these findings to indicate? A) the client is developing an infection B) they're bleeding in the operative site C) the joint has dislocated D) the client has glue seepage into the soft tissue

the joint has dislocated