NCLEX MUSCULOSKELETAL

The nurse has given a client instructions on how to do active range-of-motion exercises on her contracted right hand. The nurse determines that the client understands the rationale for this procedure when the client makes which statement?

"I'm doing these exercises so I can begin to fasten my buttons and dress myself again."

A client is experiencing an acute exacerbation of bursitis. The nurse encourages the client to avoid which least likely helpful measure until the current episode is resolved?

Active intermittent range of motion

A client with a 4-day-old lumbar vertebral fracture is experiencing muscle spasms. The nurse avoids using which intervention in an effort to relieve the spasm?

Cold

This morning a client sustained a right proximal fibula and tibia fracture that was casted in a long leg plaster cast. During evening rounds, the nurse notes that the right lower extremity capillary refill is greater than 3 seconds and the toes are edematous and dusky. The client states that the pain medication is not working anymore and that the right foot feels like it is asleep. The nurse analyzes the data and determines that the client's symptoms are indicative of which complication?

Compartment syndrome

The nurse is assigned to care for a client with multiple traumas who is admitted to the hospital. The client has a leg fracture, and a plaster cast has been applied. In positioning the casted leg, the nurse should perform which intervention?

Elevate the leg on pillows continuously for 24 to 48 hours.

A client has had skeletal traction applied to the right leg and has an overhead trapeze available for use. The nurse should monitor which as a high-risk area for pressure and breakdown?

Left heel

The nurse stops at the scene of an automobile accident to assist a victim. The victim complains of severe leg pain, is unable to get out of the automobile, and is frightened. Which is the appropriate nursing action?

Stay with the victim.

The nurse has reinforced instructions to the client returning home after arthroscopy of the knee. The nurse determines that the client understands the instructions if the client makes which statement?

"I'll report fever or site inflammation to the health care provider."

A client has just had an application of a nonplaster (fiberglass) leg cast, and the nurse is reinforcing instructions for cast care at home. Which statement by the client indicates the need for further teaching?

"I should use a hair dryer set to the hot setting to dry my cast if it gets wet."

A client is admitted to the nursing unit after a left below-knee amputation following a crush injury to the foot and lower leg. The client tells the nurse, "I think I'm going crazy. I can feel my left foot itching." How does the nurse correctly interpret the client's statement?

"It is a normal response and indicates the presence of phantom limb sensation."

A client with possible rib fracture has never had a chest x-ray. The nurse should plan to tell the client which statement about the procedure?

"It is necessary to remove jewelry and any other metal objects."

The nurse is caring for a client who has had spinal fusion with insertion of hardware. The nurse should be especially concerned with which finding?

An oral temperature of 101° F orally

The nurse in the emergency department is caring for a client with a fractured arm. The nurse understands that which item is least likely needed before reduction of the fracture in the casting room?

Anesthesia consent

Which statement by the client who has received home care instruction following an arthroscopy of the knee indicates a need for further teaching?

"I can apply heat to my knee if it becomes uncomfortable."

A client is fearful about having an arm cast removed. Which action by the nurse would be the most helpful?

Showing the client the cast cutter and explaining how it works

The nurse is reinforcing discharge instructions to a client following surgical treatment for carpal tunnel syndrome. Which statement by the client would indicate a need for further teaching?

"I should perform pronation and supination exercises of my wrist starting 24 hours after surgery."

The nurse is providing care for the client following a bone biopsy. Which action by the nurse is unnecessary in the care of this client?

Administering intramuscular opioid analgesics

The nurse is caring for a client diagnosed with Paget's disease. The nurse understands that this condition usually affects which bones?

Axial skeleton including vertebrae

During admission data collection, the nurse asks the client to run the heel of one foot down the lower anterior surface of the other leg. The nurse notices rhythmic tremors of the leg being tested and concludes that the client has interference in which area?

Balance and coordination

The nurse is caring for a client who had a total knee replacement. Postoperatively, the nurse monitors for which highest priority assessment?

Calf pain

The nurse is teaching a client about foods in the diet that could minimize the risk of osteoporosis. The nurse should encourage the client to increase intake of which food?

Cheese

A nursing instructor asks a nursing student about the risk factors associated with osteoporosis. The instructor determines that the student needs further teaching if the student states that which is an associated risk factor?

High-calcium diet consumption

The nurse is talking to a client who underwent a below-the-knee amputation 2 days earlier. The client says to the nurse, "I hate looking at this; I feel that I'm not even myself anymore." The nurse understands that the client is experiencing which problem?

Disturbed body image

The nurse is caring for a client following total hip replacement who has a wound suction drain in place. At the end of the 8-hour shift, the nurse empties 45 mL of drainage from the wound-suction device. Based on this amount of drainage, which action is appropriate?

Document the findings.

A client seeks treatment in the emergency department for a lower leg injury. There is visible deformity to the lower aspect of the leg, and the injured leg appears shorter than the other. The area is painful, swollen, and beginning to become ecchymotic. How should the nurse interpret this injury?

Fracture

The nurse has provided instructions to a client with a herniated lumbar disk about proper body mechanics and other items pertinent to low back care. The nurse determines that the client needs further teaching if the client verbalizes which should be done?

Get out of bed by sitting straight up and swinging the legs over the side of the bed.

The nurse is collecting physical data of the musculoskeletal system on an assigned client. The nurse should document the presence of which as a normal finding?

Hypertrophy on the client's dominant side

A client being measured for crutches asks the nurse why the crutches cannot rest up underneath the arm for extra support. The nurse should respond knowing that which can occur if the crutches rest underneath the arm?

Injury to the brachial plexus nerves

The nurse is caring for a client who was admitted to the hospital with a fractured right femur sustained from a fall 5 hours ago. The client's plan of care includes interventions related to monitoring for signs of fat embolism. The nurse provides appropriate care by performing which action?

Monitoring for signs of dyspnea

A client with a left arm fracture complains of severe, diffuse pain that is unrelieved with pain medication. Based on these findings, the nurse should take which action?

Notify the registered nurse.

A client with a left arm fracture exhibits loss of sensation in the left fingers, pallor, slow refill, and diminished left radial pulse. The nurse should take which action?

Notify the registered nurse.

A client with skeletal traction applied to the right leg complains to the nurse about severe right leg pain in spite of being medicated with a prescribed analgesic. Which action should the nurse take?

Notify the registered nurse.

A client who has experienced a stroke (brain attack) has partial hemiplegia of the left leg. The straight-leg cane formerly used by the client is no longer sufficient. Which device would suit the client better if greater support and stability is needed?

Quad cane

The nurse is providing postprocedure instructions to a client returning home after arthroscopy of the shoulder. The nurse should reinforce which client instruction?

Report to the health care provider the development of fever or redness and heat at the site.

The nurse is preparing to reinforce instructions to a client regarding how to safely use crutches. Before initiating the teaching, the nurse collects data on the client. Which priority data would be included?

The client's vital signs, muscle strength, and previous activity level

The nurse is reinforcing instructions to the client with a below-the-knee amputation (BKA) with regard to measures to protect the residual limb. The nurse should be sure to include which point in discussions with the client?

Use a mirror to inspect all areas of the residual limb.

The nurse is monitoring a confused older client admitted to the hospital with a hip fracture. Which data obtained by the nurse could place the client at increased risk for disturbed thought processes?

Eyeglasses left at home

A client has undergone total hip replacement of the right hip, which was damaged by osteoarthritis. Which action should be included in the postoperative plan of care?

Partial weight bearing on the operative leg is usually permitted 72 hours postoperatively

The nurse is caring for a comatose client at risk for fat embolism because of a fractured femur and pelvis sustained in a fall. Which findings does the nurse identify as early signs of possible fat embolism?

Increased heart rate and adventitious breath sounds

The nurse is repositioning the client who has returned to the nursing unit following internal fixation of a fractured right hip. How should the nurse plan to position the client?

Pillow to keep the right leg abducted during turning

The nurse is checking the casted extremity of a client. The nurse should check for which sign indicative of infection?

Presence of a "hot spot" on the cast

A client has sustained multiple fractures in the left leg and is in skeletal traction. The nurse has obtained an overhead trapeze for the client's use to aid in bed mobility. The nurse should monitor for which high-risk area for pressure and breakdown?

Right heel

An older client with advanced Alzheimer's disease is placed in balanced suspension traction, and the health care provider expects to internally fixate the client's femur in 1 week. Based on this information, the nurse determines that the priority relates to addressing which client problem?

Risk for constipation

A client has a newly fractured fibula that is plaster casted in the emergency department. Because the client will need to use crutches, the nurse plans to teach the client which crutch-walking gait before discharge?

Three-point gait

The nurse is collecting data from a client who is being seen in the health care clinic. The client is complaining of unrelieved back pain that has persisted over the past 3 months. The nurse determines that which harmful effect can occur as a result of uncontrolled muscle pain?

Weakness

A client is complaining of pain underneath a cast in the area of a bony prominence. Which should the nurse anticipate?

A window will be cut in the cast.

The nurse is giving the client with a left leg cast crutch-walking instructions using the three-point gait. The client is allowed to touch down the affected leg. How should the nurse teach the client to use the crutches?

Crutches and the left leg, then advance the right leg

The nurse is caring for a client with osteoarthritis. The nurse collects data, knowing that which is a sign/symptom associated with this disorder?

Dull aching pain in the affected joints

A client has been placed in Buck's extension traction. Which technique provided by the nurse will provide countertraction?

Slightly elevating the foot of the bed

The nurse is caring for a client following the application of a plaster cast because of a fractured left radius. The nurse monitors the neurovascular status of the client's casted extremity for which reason?

Compartment syndrome may lead to irreversible nerve and muscle tissue injury.

A client has several fractures of the lower leg and has been placed in an external fixation device. The client is upset about the appearance of the leg, which is very edematous. The nurse determines that the client is experiencing which problem?

Concerns about appearance

The nurse is caring for a client with fresh application of a plaster leg cast. The nurse should plan to prevent the development of compartment syndrome by which action?

Elevating the limb and applying ice to the affected leg

The nurse witnesses a client sustain a fall and suspects that the client's leg may be fractured. Which action is the priority?

Immobilize the leg before moving the client.

A client has sustained a closed fracture and has just had a cast applied to the affected arm. The client is complaining of intense pain. The nurse has elevated the limb, applied an ice bag, and administered an analgesic, which was ineffective in relieving the pain. The nurse interprets that this pain may be caused by which condition?

Impaired tissue perfusion

A client has Buck's extension traction applied to the right leg. The nurse should plan which intervention to prevent complications of the device?

Inspecting the skin on the right leg at least once every 8 hours

The nurse is assisting with care for a client who has sustained a nasal fracture. The nurse monitors for which priority finding specifically related to this injury?

Leakage of clear fluid from the nose

A client with right-sided weakness needs to learn how to use a cane. How should the nurse teach the client to position the cane?

Left hand, and 6 inches lateral to the left foot

The nurse is discussing primary prevention measures to clients regarding osteoporosis. The nurse plans to tell the clients that which is a primary prevention measure?

Maintaining body weight at or above minimum recommended levels

A client has undergone fasciotomy to treat compartment syndrome of the leg. Which type of wound care should the nurse anticipate will be prescribed for the fasciotomy site?

Moist, sterile saline dressings

The nurse is evaluating the client's use of a cane for left-sided weakness. The nurse should intervene and correct the client if the nurse observed that the client performed which action?

Moves the cane when the right leg is moved

A client with a herniated intervertebral lumbar disk complains of a knifelike, stabbing pain in the lower back, as well as pain radiating into the right buttock. The nurse interprets that the sharp, stabbing pain is probably a result of which?

Muscle spasm in the area of the herniated disk

The nurse has provided instructions regarding specific leg exercises for the client immobilized in right skeletal lower leg traction. The nurse determines that the client needs further teaching if the nurse observes the client doing which activity?

Performing active range of motion (ROM) to the right ankle and knee

The nurse is caring for a client who has a cast applied to the left lower leg. On data collection, the nurse notes the presence of skin irritation from the edges of a cast. Which nursing intervention is appropriate?

Petal the cast edges with adhesive tape.

The nurse is caring for a client who sustained multiple fractures in a motor vehicle accident 12 hours ago. The client develops severe dyspnea, tachycardia, and mental confusion, and the nurse suspects fat embolism. Which is the nurse's initial action?

Place the client in a Fowler's position.

Which intervention would be contraindicated in the postprocedure care of the client following a bone biopsy of the left arm?

Place the left arm in a dependent position for 24 hours.

A client with a hip fracture asks the nurse why Buck's extension traction is being applied before surgery. The nurse's response is based on the understanding that Buck's extension traction has which primary function?

Provides comfort by reducing muscle spasms and provides fracture immobilization

A client with type 1 diabetes mellitus has had a left above-the-knee amputation. The nurse carefully inspects the residual limb for which complication because of the history of diabetes?

Separation of wound edges

The nurse prepares to care for a client with inflamed joints and plans to use which item to maintain proper positioning for the inflamed joints?

Small pillows

The nurse reinforces cast application instructions to a client who is going to have a plaster cast applied. The nurse determines that the client needs further teaching if the client makes which statement about the casting?

The client may bear weight on the cast in 30 minutes.

A client with a fractured femur is placed in skeletal traction. The nurse should do which to monitor for nerve injury?

check the neurovascular status of the affected extremity.

The nurse is caring for a client who has just had rotator cuff repair. The client asks the nurse how soon he can resume his tai chi classes. The nurse should make which statement to the client?

"You shouldn't be doing any exercises that require the use of your upper arms until you have been cleared to do so by the health care provider."

The nurse is caring for the client who has had skeletal traction applied to the left leg. The client is complaining of severe left leg pain. Which action should the nurse take first?

Check the client's alignment in bed.

The nurse has a prescription to place a client with a herniated lumbar intervertebral disk on bed rest to minimize the pain. The nurse plans to put the bed in which position?

In semi-Fowler's position with the knee gatch slightly raised

The nurse is preparing a plan of care for a client in skeletal leg traction with an overbed frame. Which nursing intervention should be included in the plan of care to assist the client with positioning in bed?

Place a trapeze on the bed to provide a means for the client to lift the hips off the bed.

A client has slight weakness in the right leg. Which type of mobility device would benefit the client the most?

Straight-leg cane

A client has just had a cast removed and the underlying skin is yellow-brown and crusted. The nurse determines that further skin care instructions are required if the client makes which statement?

"I need to scrub the skin vigorously with soap and water."

The nurse has reinforced the client instructions regarding crutch safety. Which comment by the client would indicate a need for further teaching?

"Crutch tips will not slip, even when wet."

A client who has had a total knee replacement tells the nurse that there is pain with extension of the knee. Which action should the nurse implement?

administer an analgesic.

The nurse is providing care to a client with this type of cast. (Refer to figure.) The nurse documents that the client has which?

A hip spica cast

The nurse is caring for a client who has developed compartment syndrome from a severely fractured arm. The client asks the nurse how this can happen. How should the nurse explain compartment syndrome?

Bleeding and swelling cause increased pressure in an area that cannot expand.

The nurse is caring for a client with a diagnosis of gout. Which laboratory value should the nurse expect to note in the client?

Uric acid level of 8 mg/dL

The nurse plans dietary measures for a client with osteomalacia, knowing that the client is deficient in which vitamin?

Vitamin D

The nurse is evaluating the pin sites of a client in skeletal traction. The nurse would be least concerned with which finding?

Serous drainage

A health care provider has given a prescription for dietary iron supplements to the client with osteoporosis who has an iron deficiency anemia. The nurse suggests that the client do which to enhance compliance with therapy?

Take the medication following a meal.

The nurse is reinforcing discharge instructions for a client who underwent left total knee replacement (TKR) with insertion of a metal prosthesis. Which statement by the client indicates the need for further teaching?

"I don't need to be worried if the shape of my knee changes."

A client is being discharged home after application of a plaster leg cast. The nurse determines that the client understands proper care of the cast if the client makes which statement?

"I need to avoid getting the cast wet."

The nurse has reinforced instructions with the client with a nonplaster (fiberglass) leg cast about cast care at home. The nurse determines that the client needs further teaching if the client makes which statement?

"If the cast gets wet, I can dry it with a hair dryer turned to the warmest setting."

The nurse is planning to teach a client with a left arm cast about measures to keep the left shoulder from becoming stiff. Which suggestion should the nurse include in the teaching plan?

"Lift the left arm up over the head."

The nurse is caring for a client with a long bone fracture who is at risk for fat embolism. The nurse specifically monitors for the earliest signs of this complication by checking which criteria? Select all that apply.

The client's mental status The client's respiratory function

The nurse is caring for a client with a diagnosis of osteoarthritis. Which would be least helpful for the client?

increasingly vigorous and high-impact exercise

The nurse has reviewed activity restrictions with a client who is being discharged following hip surgery and insertion of a femoral head prosthesis. The nurse determines that the client understands the material presented if the client makes which statement?

"I will use a raised toilet seat."

A postoperative client received a spinal anesthetic. The client has not experienced pain because the anesthetic has not yet worn off. The nurse will monitor the client closely for pain and provide the client with which instruction?

"You will need to let me know when you start to get feeling back in your legs."

A client has had surgery to repair a fractured left hip. The nurse plans to use which important item when repositioning the client from side to side in the bed?

Abductor splint

A client is treated in the health care provider's office for a sprained ankle. Before sending the client home, the nurse plans to reinforce instructions to the client about which item to avoid in the next 24 hours?

Application of a heating pad

The nurse has a prescription to get the client out of bed to a chair on the first postoperative day after total knee replacement. The nurse plans to do which to protect the knee joint?

Apply a knee immobilizer before getting the client up, and elevate the client's surgical leg while sitting.

A client who has had a right total knee replacement asks the nurse how long the right leg must be kept in the continuous passive motion (CPM) machine. How should the nurse answer this question for the client?

As much as tolerated while in bed

A client in skeletal leg traction with an overbed frame is not allowed to turn from side to side. Which action by the nurse would be most useful in trying to provide good skin care to the client?

Asking the client to pull up on a trapeze to lift the hips off the bed

The nurse is caring for a client diagnosed with Paget's disease. The nurse plans care, knowing that this condition usually affects which bones?

Axial skeleton including the vertebrae

The nurse is caring for a client with a fractured tibia and fibula. Eight hours after a long leg cast was applied, the client began to report an increase in pain level even after administration of the prescribed dose of opioid analgesic. Which is the initial nursing action?

Check the neurovascular status of the toes on the casted leg.

The nurse is caring for a client being treated for fat embolus after multiple fractures. Which data indicates to the nurse favorable resolution of the fat embolus?

Clear chest x-ray

The nurse is caring for a client who has had an open reduction with internal fixation (ORIF) with a posterior approach. The client has been prescribed hip precautions. The nurse plans to implement which in the care of the client? Select all that apply.

Ensure the client doesn't sit or stand for long periods of time. Ensure the client doesn't cross the legs past the midline of the body. Ensure the client uses assistive/adaptive devices with activities of daily living.

A client has just had skeletal traction applied following insertion of pins. The nurse should place highest priority on performing which action?

Ensuring that the weights on the traction setup are hanging free

A client is brought to the emergency department via ambulance after sustaining a fall. An x-ray indicates that the client sustained a femoral neck fracture. The nurse should anticipate which observation on inspection of the client's leg?

Shortening, adduction, and external rotation

A client is complaining of low back pain, with radiation down the left posterior thigh. The nurse continues to collect data from the client to see if the pain is worsened or aggravated with which action?

Bending or lifting

The nurse is caring for a client who had an above-the-knee amputation 2 days ago. The residual limb was wrapped with an elastic compression bandage that has fallen off. The nurse should immediately perform which action?

Rewraps the residual limb with an elastic compression bandage

The nurse is planning to reinforce instructions to the client about proper use of a thoracolumbosacral orthosis (TLSO) after spinal fusion with instrumentation. The nurse plans to include which teaching points in discussion with the client?

The device is applied before getting out of bed in the morning.

A client has just undergone spinal fusion after suffering a herniated lumbar disk. The nurse should avoid which to maintain client safety after this procedure?

Overhead trapeze

The nurse is caring for a client with osteoarthritis. The nurse monitors the client, knowing that which is a sign/symptom associated with the disorder?

Pain that increases with activity and is relieved by rest

A client with diabetes mellitus has had a right below-knee amputation. The nurse should be especially vigilant in monitoring for which complication related to the client's history?

Separation of wound edges

The nurse is evaluating goal achievement for a client in traction with impaired physical mobility. The nurse determines that the client has not successfully met all of the goals formulated if which outcome is noted?

Bowel movement every 5 days

The nurse is preparing a list of cast care instructions for a client who just had a plaster cast applied to his right forearm. Which instructions should the nurse include on the list? Select all that apply.

Keep the cast and extremity elevated. The cast needs to be kept clean and dry. Allow the wet cast 24 to 72 hours to dry.

The nurse is caring for the client who has skeletal traction applied to the left leg. The client complains of severe left leg pain. The nurse checks the client's alignment in bed and notes that proper alignment is maintained. Which action should the nurse take next?

Notify the registered nurse.

The nurse has provided instructions to a client in an arm cast about the signs and symptoms of compartment syndrome. The nurse determines that the client understands the information if the client states to report which early symptom of compartment syndrome?

Numbness and tingling in the fingers

The nurse is reinforcing instructions to a client with osteoporosis regarding appropriate food items to include in the diet. The nurse tells the client that which food item would provide the least amount of calcium?

Pork

A client who has had spinal fusion and insertion of hardware is extremely concerned about the perceived lengthy rehabilitation period. The client expresses concerns about finances and the ability to return to work. The nurse understands that the client's needs should best be addressed by referral to which service?

Social worker

The nurse is one of several people who witness a vehicle hit a pedestrian at a fairly low speed on a small street. The individual is dazed and tries to get up, and the leg appears fractured. The nurse should plan to perform which action?

Stay with the person and encourage the person to remain still.

A client has a fiberglass (nonplaster) cast applied to the lower leg. The client asks the nurse when he will be able to walk on the cast. How should the nurse correctly respond to this question?

Within 20 to 30 minutes of application

The nurse is caring for a client who had a below-the-knee amputation of the right leg. A cast that was placed on the residual limb has fallen off. Which action should the nurse take immediately?

Wrap the residual limb with an elastic compression bandage.

The nurse is planning to reinforce instructions to the client about how to stand on crutches. In the instructions, the nurse should plan to tell the client to place the crutches in which position?

8 inches to the front and side of the client's toes

A client who is learning to use a cane is afraid it will slip with ambulation, causing a fall. How should the nurse tell the client to provide greater reassurance?

The cane has a flared tip with concentric rings to provide stability.

A client has been taught to use a walker to aid in mobility following internal fixation of a hip fracture. The nurse determines that the client is using the walker incorrectly if which action is noted?

The client advances the walker with reciprocal motion.

A client is complaining of skin irritation from the edges of a cast applied the previous day. The nurse should plan for which intervention?

Petaling the cast edges with adhesive tape

The nurse is preparing to collect data from a client who has sustained a pelvic fracture following a motor vehicle crash. The nurse reviews the health care provider's (HCP) prescriptions and notes that the HCP has prescribed a pelvic (skin) sling. The nurse prepares to place the client in which device? Refer to figure.

3

A client who is scheduled for surgery and who is to be placed in skeletal traction says to the nurse, "I'm not sure if I want to have this skeletal traction or if the skin traction would be best to stabilize my fracture." Based on the client's statement, the nurse should make which response to the client?

"You have concerns about skeletal versus skin traction for your type of fracture?"