Chapter 35-37 Musculoskeletal System

The nurse is teaching the client on bed rest to perform quadriceps setting exercises. Which instruction should the nurse give the client? A. "Push the knees into the mattress." B. "Lie prone in bed." C. "Contract the buttock muscles." D. "Bend the knees."

A. "Push the knees into the mattress."

A nurse is providing discharge teaching for a client who underwent foot surgery. The nurse is collaborating with the occupational therapist and discussing the use of assistive devices. On what variables does the choice of assistive devices primarily depend? A. Client's general condition, balance, and weight-bearing prescription B. Client's general condition, strength, and gender C. Client's motivation, age, and weight-bearing prescription D. Client's occupation, motivation, and age

A. Client's general condition, balance, and weight-bearing prescription

An older, female client with osteoporosis has been hospitalized. Prior to discharge, when teaching the client, the nurse should include information about which major complication of osteoporosis? A. Bone fracture B. Loss of estrogen C. Negative calcium balance D. Dowager hump

A. Bone fracture

A client tells the nurse that they haves pain and numbness in the thumb, first finger, and second finger of the right hand. The nurse discovers that the client is employed as an auto mechanic, and that the pain is increased while working. This may indicate that the client has what health problem? A. Carpel tunnel syndrome B. Tendonitis C. Impingement syndrome D. Dupuytren contracture

A. Carpel tunnel syndrome

A nurse is teaching a client with osteomalacia about the role of diet. What would be the best choice for breakfast for a client with osteomalacia? A. Cereal with milk, a scrambled egg, and grapefruit B. Poached eggs with sausage and toast C. Waffles with fresh strawberries and powdered sugar D. A bagel topped with butter and jam with a side dish of grapes

A. Cereal with milk, a scrambled egg, and grapefruit

Diagnostic tests show that a client's bone density has decreased over the past several years. The client asks the nurse which factors contribute to bone density decreasing. Which response by the nurse would be best? A. "For many people, a lack of proper nutrition can cause a loss of bone density." B. "Progressive loss of bone density is mostly related to your genes." C. "Stress is known to have many unhealthy effects, including reduced bone density." D. "Bone density decreases with age, but scientists are not exactly sure why this is the case."

A. "For many people, a lack of proper nutrition can cause a loss of bone density."

A client was brought to the emergency department after a fall. The client is taken to the operating room to receive a right hip prosthesis. In the immediate postoperative period, what health education should the nurse emphasize? A. "Make sure you don't bring your knees close together." B. "Try to lie as still as possible for the first few days." C. "Try to avoid bending your knees until next week." D. "Keep your legs higher than your chest whenever you can."

A. "Make sure you don't bring your knees close together."

A nurse is caring for a client whose cancer metastasis has resulted in bone pain. What should the nurse expect the client to describe? A. A dull, deep ache that is "boring" in nature B. Soreness or aching that may include cramping C. Sharp, piercing pain that is relieved by immobilization D. Spastic or sharp pain that radiates

A. A dull, deep ache that is "boring" in nature

The surgical nurse is admitting a client from postanesthetic recovery following the client's below-the-knee amputation. The nurse recognizes the client's high risk for postoperative hemorrhage and should keep what equipment at the bedside? A. A tourniquet B. A syringe preloaded with vitamin K C. A unit of packed red blood cells, placed on ice D. A dose of protamine sulfate

A. A tourniquet

A nurse is providing care for a client whose pattern of laboratory testing reveals long-standing hypocalcemia. Which other laboratory result is most consistent with this finding? A. An elevated parathyroid hormone level B. An increased calcitonin level C. An elevated potassium level D. A decreased vitamin D level

A. An elevated parathyroid hormone level

A nurse is caring for an adult client diagnosed with a back strain. What health education should the nurse provide to this client? A. Avoid lifting more than one-third of body weight without assistance. B. Focus on using back muscles efficiently when lifting heavy objects. C. Lift objects while holding the object a safe distance from the body. D. Tighten the abdominal muscles and lock the knees when lifting an object.

A. Avoid lifting more than one-third of body weight without assistance.

A client has symptoms of osteoporosis and is being assessed during an annual physical examination. The assessment shows that the client will require further testing related to a possible exacerbation of osteoporosis. The nurse should anticipate which diagnostic test? A. Bone densitometry B. Hip bone radiography C. Computed tomography (CT) D. Magnetic resonance imaging (MRI)

A. Bone densitometry

The nurse is performing an assessment of a client's musculoskeletal system and is appraising the client's bone integrity. Which action should the nurse perform during this phase of assessment? A. Compare parts of the body symmetrically. B. Assess extremities when in motion rather than at rest. C. Percuss as many joints as are accessible. D. Administer analgesia 30 to 60 minutes before assessment.

A. Compare parts of the body symmetrically.

A nurse is caring for a client who is being assessed following reports of severe and persistent low back pain. The client is scheduled for diagnostic testing in the morning. Which of the following are appropriate diagnostic tests for assessing low back pain? Select all that apply. A. Computed tomography (CT) B. Angiography C. Magnetic resonance imaging (MRI) D. Ultrasound E. X-ray

A. Computed tomography (CT) C. Magnetic resonance imaging (MRI) D. Ultrasound E. X-ray

A client's electronic health record notes that the client has hallux valgus. What signs and symptoms should the nurse expect this client to manifest? A. Deviation of a great toe laterally B. Abnormal flexion of the great toe C. An exaggerated arch of the foot D. Fusion of the toe joints

A. Deviation of a great toe laterally

A nurse is caring for a client who is 12 hours' postoperative following foot surgery. The nurse assesses the presence of edema in the foot. What nursing measure should the nurse implement to control the edema? A. Elevate the foot on several pillows. B. Apply warm compresses intermittently to the surgical area. C. Administer a loop diuretic as prescribed. D. Increase circulation through frequent ambulation.

A. Elevate the foot on several pillows.

A nurse is caring for a client who had a right below-the-knee amputation (BKA). The nurse recognizes the importance of implementing measures that focus on preventing flexion contracture of the hip and maintaining proper positioning. What nursing action will best achieve these goals? A. Encouraging the client to turn from side to side and to assume a prone position B. Initiating ROM exercises of the hip and knee 10 to 12 weeks after the amputation C. Minimizing movement of the flexor muscles of the hip D. Encouraging the client to sit in a chair for at least 8 hours a day

A. Encouraging the client to turn from side to side and to assume a prone position

The nursing care plan for a client in traction specifies regular assessments for venous thromboembolism (VTE). When assessing a client's lower limbs, what sign or symptom is suggestive of deep vein thrombosis (DVT)? A. Increased warmth of the calf B. Decreased circumference of the calf C. Loss of sensation to the calf D. Pale-appearing calf

A. Increased warmth of the calf

A nurse is planning the care of an older adult client with osteomalacia. What action should the nurse recommend in order to promote vitamin D synthesis? A. Ensuring adequate exposure to sunlight B. Eating a low-purine diet C. Performing cardiovascular exercise while avoiding weight-bearing exercises D. Taking thyroid supplements as prescribed

A. Ensuring adequate exposure to sunlight

A nurse is taking a health history on a client with musculoskeletal dysfunction. What should the nurse prioritize during this phase of the assessment? A. Evaluating the effects of the musculoskeletal disorder on the client's function B. Evaluating the client's adherence to the existing treatment regimen C. Evaluating the presence of genetic risk factors for further musculoskeletal disorders D. Evaluating the client's active and passive range of motion

A. Evaluating the effects of the musculoskeletal disorder on the client's function

A nurse is caring for a client who has just had an arthroscopy as an outpatient and is getting ready to go home. The nurse should teach the client to monitor closely for what postprocedure complication? A. Fever B. Crepitus C. Fasciculations D. Synovial fluid leakage

A. Fever

A nurse is providing care for a client who has a recent diagnosis of Paget disease. When planning this client's nursing care, what should interventions address? Select all that apply. A. Impaired physical mobility B. Acute pain C. Disturbed auditory sensory perception D. Risk for injury E. Risk for unstable blood glucose

A. Impaired physical mobility B. Acute pain C. Disturbed auditory sensory perception D. Risk for injury

An older adult woman's current medication regimen includes alendronate. What outcome would indicate successful therapy? A. Increased bone mass B. Resolution of infection C. Relief of bone pain D. Absence of tumor spread

A. Increased bone mass

A client has been experiencing an unexplained decline in knee function and has consequently been scheduled for arthrography. The nurse should teach the client about what process? A. Injection of a contrast agent into the knee joint prior to ROM exercises B. Aspiration of synovial fluid for serologic testing C. Injection of corticosteroids into the client's knee joint to facilitate ROM D. Replacement of the client's synovial fluid with a synthetic substitute

A. Injection of a contrast agent into the knee joint prior to ROM exercises

The nurse educator on an orthopedic trauma unit is reviewing the safe and effective use of traction with some recent nursing graduates. What principle should the educator promote? A. Knots in the rope should not be resting against pulleys. B. Weights should rest against the bed rails. C. The end of the limb in traction should be braced by the footboard of the bed. D. Skeletal traction may be removed for brief periods to facilitate the client's independence.

A. Knots in the rope should not be resting against pulleys.

A nurse is assessing a client who reports a throbbing, burning sensation in the right foot. The client states that the pain is worst during the day but notes that the pain is relieved with rest. The nurse should recognize the signs and symptoms of what health problem? A. Morton neuroma B. Pes cavus C. Hallux valgus D. Onychocryptosis

A. Morton neuroma

A 10-year-old client is growing at a rate appropriate for the client's age. Which cells are responsible for the secretion of bone matrix, which eventually results in bone growth? A. Osteoblasts B. Osteocytes C. Osteoclasts D. Lamellae

A. Osteoblasts

An 80-year-old man in a long-term care facility has a chronic leg ulcer and states that the area has become increasingly painful in recent days. The nurse notes that the site is now swollen and warm to the touch. The client should undergo diagnostic testing for what health problem? A. Osteomyelitis B. Osteoporosis C. Osteomalacia D. Septic arthritis

A. Osteomyelitis

A nurse is caring for a client who is postoperative day 1 following a total arthroplasty of the right hip. How should the nurse position the client? A. Place a pillow between the legs. B. Turn the client on the surgical side. C. Avoid flexion of the right hip. D. Keep the right hip adducted at all times.

A. Place a pillow between the legs.

A client is involved in a motorcycle accident and injures an arm. The health care provider diagnoses the man with an intra-articular fracture and splints the injury. The nurse implements the teaching plan developed for this client. What sequela of intra-articular fractures should the nurse describe regarding this client? A. Posttraumatic arthritis B. Fat embolism syndrome (FES) C. Osteomyelitis D. Compartment syndrome

A. Posttraumatic arthritis

A client was fitted with an arm cast after fracturing the humerus. Twelve hours after the application of the cast, the client tells the nurse that the injured arm hurts. Analgesics do not relieve the pain. What would be the most appropriate nursing action? A. Prepare the client for opening or bivalving of the cast. B. Obtain a prescription for a different analgesic. C. Encourage the client to wiggle and move the fingers. D. Petal the edges of the client's cast.

A. Prepare the client for opening or bivalving of the cast.

A nurse on the orthopedic unit is assessing a client's peroneal nerve. The nurse should perform this assessment by doing what action? A. Pricking the skin between the great and second toe B. Stroking the skin on the sole of the client's foot C. Pinching the skin between the thumb and index finger D. Stroking the distal fat pad of the small finger

A. Pricking the skin between the great and second toe

A nurse is writing a care plan for a client admitted to the emergency department (ED) with an open fracture. The nurse will assign priority to what nursing diagnosis for a client with an open fracture of the radius? A. Risk for infection B. Risk for ineffective role performance C. Risk for perioperative positioning injury D. Risk for powerlessness

A. Risk for infection

A client presents to a clinic reporting a leg ulcer that isn't healing; subsequent diagnostic testing suggests osteomyelitis. The nurse is aware that the most common pathogen to cause osteomyelitis is: A. Staphylococcus aureus. B. Proteus. C. Pseudomonas. D. Escherichia coli.

A. Staphylococcus aureus.

A nurse is collaborating with the physical therapist to plan the care of a client with osteomyelitis. What principle should guide the management of activity and mobility in this client? A. Stress on the weakened bone must be avoided. B. Increased heart rate enhances perfusion and bone healing. C. Bed rest results in improved outcomes in clients with osteomyelitis. D. Maintenance of baseline ADLs is the primary goal during osteomyelitis treatment.

A. Stress on the weakened bone must be avoided.

A 32-year-old client comes to the clinic reporting shoulder tenderness, pain, and limited movement. Upon assessment the nurse finds edema. An MRI shows hemorrhage of the rotator cuff tendons and the client is diagnosed with impingement syndrome. What action should the nurse recommend in order to promote healing? A. Support the affected arm on pillows at night. B. Take prescribed corticosteroids as prescribed. C. Put the shoulder through its full range of motion three times daily. D. Keep the affected arm in a sling for 2 to 4 weeks.

A. Support the affected arm on pillows at night.

A nurse is caring for a 78-year-old client with a history of osteoarthritis (OA). When planning the client's care, what goal should the nurse prioritize? A. The client will express satisfaction with the ability to perform ADLs. B. The client will recover from OA within 6 months. C. The client will adhere to the prescribed plan of care. D. The client will deny signs or symptoms of OA.

A. The client will express satisfaction with the ability to perform ADLs.

A nurse is explaining a client's decreasing bone density in terms of the balance between bone resorption and formation. What dietary nutrients and hormones play a role in the resorption and formation of adult bones? Select all that apply. A. Thyroid hormone B. Growth hormone C. Estrogen D. Vitamin B12 E. Luteinizing hormone

A. Thyroid hormone B. Growth hormone C. Estrogen

A client has just had an arthroscopy performed to assess a knee injury. What nursing intervention should the nurse perform following this procedure? A. Wrap the joint in a compression dressing. B. Perform passive range of motion exercises. C. Maintain the knee in flexion for up to 30 minutes. D. Apply heat to the knee.

A. Wrap the joint in a compression dressing.

A client presents at a clinic reporting back pain that goes all the way down the back of the leg to the foot. The nurse should document the presence of what type of pain? A. Bursitis B. Radiculopathy C. Sciatica D. Tendonitis

C. Sciatica

A client with a right tibial fracture is being discharged home after having a cast applied. What instruction should the nurse provide in relationship to the client's cast care? A. "Cover the cast with a blanket until the cast dries." B. "Keep your right leg elevated above heart level." C. "Use a clean object to scratch itches inside the cast." D. "A foul smell from the cast is normal after the first few days."

B. "Keep your right leg elevated above heart level."

A nurse's assessment of a client's knee reveals edema, tenderness, muscle spasms, and ecchymosis. The client states that 2 days ago the client ran in a long-distance race and now it "really hurts to stand up." The nurse should plan care based on the belief that the client has experienced what injury? A. A first-degree strain B. A second-degree strain C. A first-degree sprain D. A second-degree sprain

B. A second-degree strain

A nurse is assessing a client who is experiencing peripheral neurovascular dysfunction. Which assessment findings are most consistent with this diagnosis? A. Hot skin and a capillary refill of 1 to 2 seconds B. Absence of feeling, capillary refill of 4 to 5 seconds, and cool skin C. Pain, diaphoresis, and erythema D. Jaundiced skin, weakness, and capillary refill of 3 seconds

B. Absence of feeling, capillary refill of 4 to 5 seconds, and cool skin

A nurse is performing a nursing assessment of a client suspected of having a musculoskeletal disorder. Which assessment should the nurse prioritize for a client who has a musculoskeletal disorder? A. Range of motion B. Activities of daily living C. Gait D. Strength

B. Activities of daily living

A client is undergoing diagnostic testing for suspected Paget disease. What assessment finding is most consistent with this diagnosis? A. Altered serum magnesium levels B. Altered serum calcium levels C. Altered serum potassium levels D. Altered serum sodium levels

B. Altered serum calcium levels

Which of the following clients should the nurse recognize as being at the highest risk for the development of osteomyelitis? A. A middle-aged adult who takes ibuprofen daily for rheumatoid arthritis B. An older adult client with an infected pressure ulcer in the sacral area C. A 17-year-old football player who had orthopedic surgery 6 weeks prior D. An infant diagnosed with jaundice

B. An older adult client with an infected pressure ulcer in the sacral area

A client has suffered a muscle strain and is reporting pain at 6 on a 10-point scale. The nurse should recommend what action? A. Taking an opioid analgesic as prescribed B. Applying a cold pack to the injured site C. Performing passive ROM exercises D. Applying a heating pad to the affected muscle

B. Applying a cold pack to the injured site

A nurse in a busy emergency department provides care for many clients who present with contusions, strains, or sprains. What are treatment modalities that are common to all of these musculoskeletal injuries? Select all that apply. A. Massage B. Applying ice C. Compression dressings D. Resting the affected extremity E. Corticosteroids F. Elevating the injured limb

B. Applying ice C. Compression dressings D. Resting the affected extremity F. Elevating the injured limb

A public health nurse is organizing a campaign that will address the leading cause of musculoskeletal-related disability. The nurse should focus on what health problem? A. Osteoporosis B. Arthritis C. Hip fractures D. Lower back pain

B. Arthritis

A client has recently been admitted to the orthopedic unit following total hip arthroplasty. The nurse assesses that the indwelling urinary catheter was removed one hour ago in the post-anesthesia care unit and that the client has not yet voided. Which action should the nurse take? A. Inform the primary provider promptly. B. Ask if the client needs to void. C. Perform intermittent catheterization. D. Obtain an order to reinsert the indwelling urinary catheter.

B. Ask if the client needs to void.

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

B. Avascular necrosis

A nurse is caring for an older adult client who is preparing for discharge following recovery from a total hip replacement. What outcome must be met prior to discharge? A. Client is able to perform ADLs independently. B. Client is able to perform transfers safely. C. Client is able to weight-bear equally on both legs. D. Client is able to demonstrate full ROM of the affected hip.

B. Client is able to perform transfers safely.

Radiographs of a client's upper arm shows three fragments of the humeral bone. This diagnostic result suggests what type of fracture? A. Open B. Comminuted C. Intra-articular D. Greenstick

B. Comminuted

A nurse admits a client who has a fracture of the nose that has resulted in a skin tear and involvement of the mucous membranes of the nasal passages. The orthopedic nurse should plan to care for what type of fracture? A. Compression B. Compound C. Impacted D. Transverse

B. Compound

A client has been admitted to the hospital with a spontaneous vertebral fracture related to osteoporosis. Which of the following nursing diagnoses must be addressed in the plan of care? A. Risk for aspiration related to vertebral fracture B. Constipation related to vertebral fracture C. Impaired swallowing related to vertebral fracture D. Decreased cardiac output related to vertebral fracture

B. Constipation related to vertebral fracture

A client has returned to the unit after undergoing limb-sparing surgery to remove a metastatic bone tumor. The nurse providing postoperative care in the days following surgery assesses for what complication from surgery? A. Deficient fluid volume B. Delayed wound healing C. Hypocalcemia D. Pathologic fractures

B. Delayed wound healing

A client is scheduled for a bone scan to rule out osteosarcoma of the pelvic bones. Which client status would be most important for the nurse to verify before the client's scan? A. Completion of the bowel cleansing regimen B. Empty bladder C. No allergy to penicillins D. Fast for at least 8 hours

B. Empty bladder

A client with a simple arm fracture is receiving discharge education from the nurse. What would the nurse instruct the client to do? A. Elevate the affected extremity to shoulder level when at rest. B. Engage in exercises that strengthen the unaffected muscles. C. Apply topical anesthetics to accessible skin surfaces as needed. D. Avoid using analgesics so that further damage is not masked.

B. Engage in exercises that strengthen the unaffected muscles.

The nurse is providing care for a client who has had a below-the-knee amputation. The nurse enters the client's room and finds the client resting in bed with the residual limb supported on a pillow. What is the nurse's most appropriate action? A. Inform the surgeon of this finding. B. Explain the risks of flexion contracture to the client. C. Transfer the client to a sitting position. D. Encourage the client to perform active ROM exercises with the residual limb.

B. Explain the risks of flexion contracture to the client.

A client has just begun been receiving skeletal traction and the nurse is aware that muscles in the client's affected limb are spastic. How does this change in muscle tone affect the client's traction prescription? A. Traction must temporarily be aligned in a slightly different direction. B. Extra weight is needed initially to keep the limb in proper alignment. C. A lighter weight should be initially used. D. Weight will temporarily alternate between heavier and lighter weights.

B. Extra weight is needed initially to keep the limb in proper alignment.

A client presents at a clinic reports heel pain that impairs walking ability. The client is subsequently diagnosed with plantar fasciitis. This client's plan of care should include what intervention? A. Wrapping the affected area in lamb's wool or gauze to relieve pressure B. Gently stretching the foot and the Achilles tendon C. Wearing open-toed shoes at all times D. Applying topical analgesic ointment to plantar surface each morning

B. Gently stretching the foot and the Achilles tendon

The orthopedic nurse should assess for signs and symptoms of Volkmann contracture if a client has fractured which of the following bones? A. Femur B. Humerus C. Radial head D. Clavicle

B. Humerus

A nurse is caring for a client who is being treated in the hospital for a spontaneous vertebral fracture related to osteoporosis. The nurse should address the nursing diagnosis of Acute Pain Related to Fracture by implementing what intervention? A. Maintenance of high Fowler positioning whenever possible B. Intermittent application of heat to the client's back C. Use of a pressure-reducing mattress D. Passive range of motion exercises

B. Intermittent application of heat to the client's back

A nurse is caring for a client who has suffered an unstable thoracolumbar fracture. What goal should the nurse prioritize during nursing care? A. Preventing skin breakdown B. Maintaining spinal alignment C. Maximizing function D. Preventing increased intracranial pressure

B. Maintaining spinal alignment

A client with diabetes is attending a class on the prevention of associated diseases. What action should the nurse teach the client to reduce the risk of osteomyelitis? A. Increase calcium and vitamin intake. B. Monitor and control blood glucose levels. C. Exercise 3 to 4 times weekly for at least 30 minutes. D. Take corticosteroids as prescribed.

B. Monitor and control blood glucose levels.

A nurse is caring for an older adult who has been diagnosed with geriatric failure to thrive. The nurse should perform interventions to prevent what complication? A. Muscle clonus B. Muscle atrophy C. Rheumatoid arthritis D. Muscle fasciculations

B. Muscle atrophy

A client with diabetes has been diagnosed with osteomyelitis. The nurse observes that the client's right foot is pale and mottled, cool to touch, with a capillary refill of greater than 3 seconds. The nurse should suspect what type of osteomyelitis? A. Hematogenous osteomyelitis B. Osteomyelitis with vascular insufficiency C. Contiguous focus osteomyelitis D. Osteomyelitis with muscular deterioration

B. Osteomyelitis with vascular insufficiency

A bone biopsy has just been completed on a client with suspected bone metastases. The nurse should prioritize assessments for which common complication of bone biopsy? A. Dehiscence at the biopsy site B. Pain C. Hematoma formation D. Infection

B. Pain

What nursing intervention should the nurse prioritize to facilitate healing in a client who has suffered a hip fracture? A. Administer analgesics as required. B. Place a pillow between the client's legs when turning. C. Maintain prone positioning at all times. D. Encourage internal and external rotation of the affected leg.

B. Place a pillow between the client's legs when turning.

While performing an assessment, the nurse notes that a client has soft subcutaneous nodules along the extensor tendons of the fingers. Which disorder does this client most likely have? A. Osteoarthritis B. Rheumatoid arthritis C. Gout D. Paget disease

B. Rheumatoid arthritis

A client is receiving ongoing nursing care for the treatment of Parkinson disease. When assessing this client's gait, which finding is most closely associated with this health problem? A. Spastic hemiparesis gait B. Shuffling gait C. Rapid gait D. Steppage gait

B. Shuffling gait

A nurse is caring for a client receiving skeletal traction. Due to the client's severe limits on mobility, the nurse has identified a risk for atelectasis or pneumonia. What intervention should the nurse provide in order to prevent these complications? A. Perform chest physiotherapy once per shift and as needed. B. Teach the client to perform deep breathing and coughing exercises. C. Administer prophylactic antibiotics as prescribed. D. Administer nebulized bronchodilators and corticosteroids as prescribed.

B. Teach the client to perform deep breathing and coughing exercises.

A nurse is assessing a client for risk factors known to contribute to osteoarthritis. What assessment finding should the nurse interpret as a risk factor? A. The client has a 30 pack-year smoking history. B. The client's body mass index is 34 (obese). C. The client has primary hypertension. D. The client is 58 years old.

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

A nurse is assessing a client who is receiving traction. The nurse's assessment confirms that the client is able to perform plantar flexion. What conclusion can the nurse draw from this finding? A. The leg that was assessed is free from DVT. B. The client's tibial nerve is functional. C. Circulation to the distal extremity is adequate. D. The client does not have peripheral neurovascular dysfunction.

B. The client's tibial nerve is functional.

When assessing a client's peripheral nerve function, the nurse uses an instrument to prick the fat pad at the top of the client's small finger. This action will assess what nerve? A. Radial B. Ulnar C. Median D. Tibial

B. Ulnar

A client has come to the clinic for a routine annual physical. The nurse practitioner notes a palpable, painless projection of bone at the client's shoulder. The projection appears to be at the distal end of the humerus. The nurse should suspect the presence of: A. osteomyelitis. B. osteochondroma. C. osteomalacia. D. Paget disease.

B. osteochondroma.

A client is admitted to the orthopedic unit in skeletal traction for a fractured proximal femur. Which explanation should the nurse give the client about skeletal traction? A. "Skeletal traction temporarily stabilizes the fracture before surgery." B. "Weights are attached to the leg using a boot." C. "Traction involves passing a pin through the bone." D. "Light weights must be used with skeletal traction."

C. "Traction involves passing a pin through the bone."

A nurse is caring for a client who has been scheduled for a bone scan. Which statement should the nurse include when educating the client about this diagnostic test? A. "The test is brief and requires that you drink a calcium solution 2 hours before the test." B. "You will not be allowed fluid for 2 hours before and 3 hours after the test." C. "You will be encouraged to drink water after the administration of the radioisotope injection." D. "This is a common test that can be safely performed on anyone."

C. "You will be encouraged to drink water after the administration of the radioisotope injection."

A nurse is caring for a client with a diagnosis of cancer that has metastasized to the bone. Which laboratory value would the nurse expect to be elevated in this client? A. Bilirubin B. Potassium C. Alkaline phosphatase D. Creatinine

C. Alkaline phosphatase

A nurse is caring for a client with Paget disease and is reviewing the client's most recent laboratory values. Which of the following values are most characteristic of Paget disease? A. An elevated level of parathyroid hormone and low calcitonin levels B. A low serum alkaline phosphatase level and a low serum calcium level C. An elevated serum alkaline phosphatase level and a normal serum calcium level D. An elevated calcitonin level and low levels of parathyroid hormone

C. An elevated serum alkaline phosphatase level and a normal serum calcium level

A client has been experiencing progressive increases in knee pain and diagnostic imaging reveals a worsening effusion in the synovial capsule. The nurse should anticipate what diagnostic procedure? A. Arthrography B. Knee biopsy C. Arthrocentesis D. Electromyography

C. Arthrocentesis

A client has presented to the emergency department with an injury to the wrist. The client is diagnosed with a third-degree strain. Why would the health care provider prescribe an x-ray of the wrist? A. Nerve damage is associated with third-degree strains. B. Compartment syndrome is associated with third-degree strains. C. Avulsion fractures are associated with third-degree strains. D. Greenstick fractures are associated with third-degree strains.

C. Avulsion fractures are associated with third-degree strains.

A clinic nurse is caring for a client with a history of osteoporosis. What diagnostic test will best allow the care team to assess the client's risk of fracture? A. Arthrography B. Bone scan C. Bone densitometry D. Arthroscopy

C. Bone densitometry

A nurse is reviewing the pathophysiology that may underlie a client's decreased bone density. What hormone should the nurse identify as inhibiting bone resorption and promoting bone formation? A. Estrogen B. Parathyroid hormone (PTH) C. Calcitonin D. Progesterone

C. Calcitonin

A client injured in a motor vehicle accident has sustained a fracture to the diaphysis of the right femur. Of which tissue is the diaphysis of the femur mainly constructed? A. Epiphyses B. Cartilage C. Cortical bone D. Cancellous bone

C. Cortical bone

A client is admitted to the orthopedic unit with a fractured femur after a motorcycle accident. The client has been placed in traction until the femur can be rodded in surgery. For what early complication(s) should the nurse monitor this client? Select all that apply. A. Systemic infection B. Complex regional pain syndrome C. Deep vein thrombosis D. Compartment syndrome E. Fat embolism

C. Deep vein thrombosis D. Compartment syndrome E. Fat embolism

A client with a total hip replacement has developed decreased breath sounds What is the nurse's best action? A. Place the client on bed rest. B. Request an antitussive medication from the health care provider. C. Encourage use of the incentive spirometer. D. Assess for signs and symptoms of systemic infection.

C. Encourage use of the incentive spirometer.

A client has sustained traumatic injuries that involve several bone fractures. A fracture of what type of bone may interfere with the protection of the client's vital organs? A. Long bones B. Short bones C. Flat bones D. Irregular bones

C. Flat bones

A nurse is taking a health history on a new client who has been experiencing unexplained paresthesia. What question should guide the nurse's assessment of the client's altered sensations? A. How does the strength in the affected extremity compare to the strength in the unaffected extremity? B. Does the color in the affected extremity match the color in the unaffected extremity? C. How does the feeling in the affected extremity compare with the feeling in the unaffected extremity? D. Does the client have a family history of paresthesia or other forms of altered sensation?

C. How does the feeling in the affected extremity compare with the feeling in the unaffected extremity?

The nurse's comprehensive assessment of an older adult involves the assessment of the client's gait. How should the nurse best perform this assessment? A. Instruct the client to walk heel-to-toe for 15 to 20 steps. B. Instruct the client to walk in a straight line while not looking at the floor. C. Instruct the client to walk away from the nurse for a short distance and then toward the nurse. D. Instruct the client to balance on one foot for as long as possible and then walk in a circle around the room.

C. Instruct the client to walk away from the nurse for a short distance and then toward the nurse.

A nurse's assessment reveals that a client has shoulders that are not level and one prominent scapula that is accentuated by bending forward. The nurse should expect to read about which health problem in the client's electronic health record? A. Lordosis B. Kyphosis C. Scoliosis D. Muscular dystrophy

C. Scoliosis

A nurse is discussing conservative management of tendonitis with a client. What is the nurse's best recommendation? A. Weight reduction B. Use of oral opioid analgesics C. Intermittent application of ice and heat D. Passive range of motion exercises

C. Intermittent application of ice and heat

The results of a nurse's musculoskeletal examination show an increase in the lumbar curvature of the spine. The nurse should recognize the presence of what health problem? A. Osteoporosis B. Kyphosis C. Lordosis D. Scoliosis

C. Lordosis

A nurse is providing care for a client who has osteomalacia. What major goal should guide the choice of medical and nursing interventions? A. Maintenance of skin integrity B. Prevention of bone metastasis C. Maintenance of adequate levels of activated vitamin D D. Maintenance of adequate parathyroid hormone function

C. Maintenance of adequate levels of activated vitamin D

A nurse is caring for a client who has a leg cast. The nurse observes the client using a pencil to scratch the skin under the edge of the cast. How should the nurse respond to this observation? A. Allow the client to gently scratch inside the cast with a pencil. B. Give the client a sterile tongue depressor to use for scratching instead of the pencil. C. Provide a fan to blow cool air into the cast to relieve itching, D. Obtain a prescription for a sedative, such as lorazepam, to prevent the client from scratching.

C. Provide a fan to blow cool air into the cast to relieve itching

A client's fracture is healing and compact bone is replacing spongy bone around the periphery of the fracture. This process characterizes what phase of the bone healing process? A. Hematoma formation B. Fibrocartilaginous callus formation C. Remodeling D. Bony callus formation

C. Remodeling

A nursing educator is reviewing the risk factors for osteoporosis with a group of recent graduates. What of the following risk factors should the educator describe? A. Recurrent infections and prolonged use of NSAIDs B. High alcohol intake and low body mass index C. Small frame and female sex D. Male sex, diabetes, and high protein intake

C. Small frame and female sex

A nurse is caring for a client with a bone tumor. The nurse is providing education to help the client reduce the risk for pathologic fractures. What should the nurse teach the client? A. Strive to achieve maximum weight-bearing capabilities. B. Gradually strengthen the affected muscles through weight training. C. Support the affected extremity with external supports such as splints. D. Limit reliance on assistive devices in order to build strength.

C. Support the affected extremity with external supports such as splints.

A 91-year-old client is slated for orthopedic surgery and the nurse is integrating gerontologic considerations into the client's plan of care. What intervention is most justified in the care of this client? A. Administration of prophylactic antibiotics B. Total parenteral nutrition (TPN) C. Use of a pressure-relieving mattress D. Use of a Foley catheter until discharge

C. Use of a pressure-relieving mattress

A school nurse is assessing a student who was kicked in the shin during a soccer game. The area of the injury has become swollen and discolored. The triage nurse should organize care for a: A. sprain B. strain C. contusion D. dislocation

C. contusion

A nurse is caring for a client who has had a total hip replacement. The nurse is reviewing health education prior to discharge. Which of the client's statements would indicate 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 will need my husband to assist me in getting off the low toilet seat at home."

D. "I will need my husband to assist me in getting off the low toilet seat at home."

A nurse is teaching an educational class to a group of older adults at a community center. In an effort to prevent osteoporosis, the nurse should encourage participants to ensure that they consume the recommended intake of what nutrients? Select all that apply. A. Vitamin B12 B. Potassium C. Calcitonin D. Calcium E. Vitamin D

D. Calcium E. Vitamin D

During assessment, a client reports experiencing rhythmic muscle contractions when the nurse performs passive extension of the wrist. The nurse should recognize the presence of which condition? A. Fasciculations B. Contractures C. Effusion D. Clonus

D. Clonus

A client has had a cast placed for the treatment of a humeral fracture. The nurse's most recent assessment shows signs and symptoms of compartment syndrome. What is the nurse's most appropriate action? A. Arrange for a STAT assessment of the client's serum calcium levels. B. Perform active range of motion exercises. C. Assess the client's joint function symmetrically. D. Contact the primary provider immediately.

D. Contact the primary provider immediately.

A nurse is performing a musculoskeletal assessment of a client with arthritis. During passive range-of-motion exercises, the nurse hears an audible grating sound. The nurse should document the presence of what assessment finding? A. Fasciculations B. Clonus C. Effusion D. Crepitus

D. Crepitus

A nurse is reviewing the care of a client who has a long history of lower back pain that has not responded to conservative treatment measures. The nurse should anticipate the administration of what drug? A. Calcitonin B. Prednisone C. Aspirin D. Cyclobenzaprine

D. Cyclobenzaprine

A client presents at the clinic with a report of morning numbness, cramping, and stiffness in the fourth and fifth fingers of the right hand. What disease process should the nurse suspect? A. Tendonitis B. A ganglion C. Carpal tunnel syndrome D. Dupuytren disease

D. Dupuytren disease

A nurse is caring for a client who has an MRI scheduled. What is the priority safety action prior to this diagnostic procedure? A. Assessing the client for signs and symptoms of active infection B. Ensuring that the client can remain immobile for up to 3 hours C. Assessing the client for a history of nut allergies D. Ensuring that there are no metal objects on or in the client

D. Ensuring that there are no metal objects on or in the client

The nurse's musculoskeletal assessment of a client reveals involuntary twitching of muscle groups. How would the nurse document this observation in the client's chart? A. Tetany B. Atony C. Clonus D. Fasciculations

D. Fasciculations

An older adult client sought care for the treatment of a swollen, painful knee joint. Diagnostic imaging and culturing of synovial fluid resulted in a diagnosis of septic arthritis. The nurse should prioritize what aspect of care? A. Administration of oral and IV corticosteroids as prescribed B. Prevention of falls and pathologic fractures C. Maintenance of adequate serum levels of vitamin D D. Intravenous administration of antibiotics

D. Intravenous administration of antibiotics

A client has come to the clinic for a regular check-up. The nurse's initial inspection reveals an increased thoracic curvature of the client's spine. The nurse should document the presence of which condition? A. Scoliosis B. Epiphyses C. Lordosis D. Kyphosis

D. Kyphosis

A client is undergoing diagnostic testing for osteomalacia. Which of the following laboratory results are most suggestive of this diagnosis? A. High chloride, calcium, and magnesium levels B. High parathyroid and calcitonin levels C. Low serum calcium and magnesium levels D. Low serum calcium and low phosphorus level

D. Low serum calcium and low phosphorus level

A client who had a total hip replacement two days ago reports new onset calf tenderness to the nurse. Which action should the nurse take? A. Administer pain medication. B. Massage the client's calf. C. Apply antiembolic stockings. D. Notify the health care provider.

D. Notify the health care provider.

A client who has had an amputation is being cared for by a multidisciplinary rehabilitation team. What is the primary goal of this multidisciplinary team? A. Maximize the efficiency of care. B. Ensure that the client's health care is holistic. C. Facilitate the client's adjustment to a new body image. D. Promote the client's highest possible level of function.

D. Promote the client's highest possible level of function.

A nurse is assessing the neurovascular status of a client who has had a leg cast recently applied. The nurse is unable to palpate the client's dorsalis pedis or posterior tibial pulse and the client's foot is pale. What is the nurse's most appropriate action? A. Warm the client's foot and determine whether circulation improves. B. Reposition the client with the affected foot dependent. C. Reassess the client's neurovascular status in 15 minutes. D. Promptly inform the primary care provider.

D. Promptly inform the primary care provider.

A nurse is caring for a client who has had a plaster arm cast applied. Immediately after application, the nurse should provide what teaching to the client? A. The cast will feel cool to touch for the first 30 minutes. B. The cast should be wrapped snuggly with a towel until the client gets home. C. The cast should be supported on a board while drying. D. The cast will only have full strength when dry.

D. The cast will only have full strength when dry.

An orthopedic nurse is caring for a client who is postoperative day 1 following foot surgery. What nursing intervention should be included in the client's subsequent care? A. Dressing changes should not be performed unless there are clear signs of infection. B. The surgical site can be soaked in warm bath water for up to 5 minutes. C. The surgical site should be cleansed with hydrogen peroxide once daily. D. The foot should be elevated in order to prevent edema.

D. The foot should be elevated in order to prevent edema.

A nurse is providing a class on osteoporosis at the local center for older adults. Which statement related to osteoporosis is most accurate? A. High levels of vitamin D can cause osteoporosis. B. A nonmodifiable risk factor for osteoporosis is a person's level of activity. C. Secondary osteoporosis occurs in women after menopause. D. The use of corticosteroids increases the risk of osteoporosis.

D. The use of corticosteroids increases the risk of osteoporosis.

A client is brought to the emergency department by ambulance after stepping in a hole and falling. While assessing the client the nurse notes that the client's right leg is shorter than the left leg; the right hip is noticeably deformed and the client is in acute pain. Imaging does not reveal a fracture. What is the most plausible explanation for this client's signs and symptoms? A. Subluxated right hip B. Right hip contusion C. Hip strain D. Traumatic hip dislocation

D. Traumatic hip dislocation

A nurse is assessing a child who has a diagnosis of muscular dystrophy. Assessment reveals that the child's muscles have greater-than-normal tone. The nurse should document the presence of: A. tonus. B. flaccidity. C. atony. D. spasticity.

D. spasticity.