Muscoskeletal NCLEX

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

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

Uric acid level of 8 mg/dL

A nurse is teaching the client with a below-the-knee amputation (BKA) measures to protect the residual limb, or stump. The nurse would be sure to include which of the following points in discussions with the client?

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

A 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 states that it is acceptable to:

Use a raised toilet seat.

A nurse is preparing a client scheduled for a bone marrow aspiration, and the client asks the nurse whether the procedure will be painful. The nurse should make which response to the client?

"A local anesthetic will be given."

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

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

A nurse plans dietary measures for a client with osteomalacia, knowing that the client is deficient in which of the following?

Vitamin D

A nurse is reviewing the list of 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 instructions?

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

A 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 of the following harmful effects can occur as a result of uncontrolled muscle pain?

Weakness

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

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

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

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

A nurse is assisting in preparing a client for discharge to home. Daily cold therapy has been prescribed for the client, and the nurse provides instructions about this treatment. Which statement by the client indicates adequate understanding of cold therapy treatment?

"I should wrap the frozen ice pack in a warm towel to help adjust to the cold."

A 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 instruction if the client makes which statement?

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

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

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

A nurse is planning to teach the 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."

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?"

A postoperative client received a spinal anesthetic during the repair of a right hip fracture. 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 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 the client's: Select all that apply.

-Mental status -Respiratory function

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 when the client states:

2. Left heel

A nurse is preparing to collect data from a client who has sustained a pelvic fracture following a motor vehicle accident. 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 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. The nurse replies that the client will be able to bear weight on the cast:

Within 20 to 30 minutes of application

A nurse has provided instructions to the client returning home after arthroscopy of the knee. The nurse determines that the client understands the instructions if the client states that he or she will:

4. Report fever or site inflammation to the health care provider.

A nurse is caring for a client who had a below-the-knee amputation of the right leg and has a cast on the residual limb. The client calls the nurse and reports that the cast fell off. The nurse immediately:

Wraps the residual limb with an elastic compression bandage

A nurse is planning to provide instructions to the client about how to stand on crutches. In the instructions, the nurse plans to tell the client to place the crutches:

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

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." The nurse interprets the client's statement to be:

A normal response and indicates the presence of phantom limb sensation

A client is complaining of pain underneath a cast in the area of a bony prominence. The nurse interprets that this client may need to have:

A window cut in the cast

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

Abductor splint

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

Active intermittent range of motion

A client who has had a total knee replacement tells the nurse that there is pain with extension of the knee. The nurse should:

Administer an analgesic.

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

Administering intramuscular opioid analgesics

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 the client:

Advances the walker with reciprocal motion

A nurse is caring for the client who is going to have an arthrogram using a contrast medium. Which of the following data collected by the nurse would be of highest priority?

Allergy to iodine or shellfish

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

An oral temperature of 101° F orally

A nurse in the emergency department is caring for a client with a fractured arm. The nurse understands that which item is not necessary before reduction of the fracture in the casting room?

Anesthesia consent

A client is treated in the health care provider's office after a fall, which sprained an ankle. Radiography has ruled out fracture. Before sending the client home, the nurse would plan to teach the client about which item that is to be avoided in the next 24 hours?

Application of a heating pad

A 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 of the following 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. The nurse's response is based on the understanding that the device should be used:

As much as the client can tolerate

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

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 states to:

Avoid getting the cast wet.

A 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

A 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, a 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 the area of:

Balance and coordination

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 by:

Bending or lifting

A 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. The nurse's response is based on the understanding that:

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

A 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 of the following outcomes was noted?

Bowel movement every 5 days

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

Calf pain

A 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.

A nurse is caring for a client following total hip replacement who has a Hemovac 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?

Check the client's blood pressure.

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.

A 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. The initial nursing action is to:

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

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

Cheese

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

Clear chest x-ray

A client with a 4-day-old lumbar vertebral fracture is experiencing muscle spasms. The nurse avoids using which of the following 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:

Compartment syndrome

A 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 because:

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

A nurse is giving the client with a left leg cast crutch-walking instructions using the three-point gait. The client is allowed touch-down of the affected leg. The nurse tells the client to advance the:

Crutches and the left leg, then advance the right leg

A 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

A client has had a bone scan procedure. The nurse determines that the client understands the elements of follow-up care if the client states that he or she will:

Drink plenty of water for a day or two following the procedure.

A nurse is caring for a client with osteoarthritis. The nurse collects data, knowing that which of the following is a clinical manifestation associated with the disorder?

Dull aching pain in the affected joints

A 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: A 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:

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

A nurse is caring for a client with fresh application of a plaster leg cast. The nurse plans to prevent the development of compartment syndrome by:

Elevating the limb and applying ice to the affected leg

A client has just had skeletal traction applied following insertion of pins. The nurse should place highest priority on doing which of the following while caring for the client?

Ensure that the weights on the traction setup are hanging free.

A 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 of the following 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. 5. Ensure the client uses assistive/adaptive devices with activities of daily living.

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

Eyeglasses left at home

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. The nurse interprets that this client has experienced a:

Fracture

A 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 instructions if the client verbalizes that he or she will:

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

A nursing instructor asks a nursing student about the risk factors associated with osteoporosis. The instructor tells the student that she needs to read and learn about this disorder if the student states that which of the following is an associated risk factor?

High-calcium diet consumption

A nurse is providing care to a client with this type of cast. (Refer to figure.)

Hip spica cast

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

Hypertrophy on the client's dominant side

A 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:

Impaired tissue perfusion

A nurse has a prescription to place a client with a herniated lumbar intervertebral disk on bedrest to minimize the pain. The nurse plans to put the bed:

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

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

Increased heart rate and adventitious breath sounds

A nurse is caring for an older client with a diagnosis of osteoarthritis. Which of the following would be least helpful for the client?

Increasingly vigorous and high-impact exercise

A client being measured for crutches asks the nurse why the crutches cannot rest up underneath the arm for extra support. The nurse's response is based on the understanding that this could result in:

Injury to the brachial plexus nerves

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

A 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. 2. The cast needs to be kept clean and dry. 3. Allow the wet cast 24 to 72 hours to dry.

A nurse is caring for a client following a total hip replacement. The client has been diagnosed with iron deficiency anemia. The nurse instructs the client to increase intake of which of the following foods?

Lean beef and chicken liver

A client with right-sided weakness needs to learn how to use a cane. The nurse plans to teach the client to position the cane by holding it with the:

Left hand, and 6 inches lateral to the left foot

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 of the following actions?

notify the rn

A client with diabetes mellitus has had a right below-knee amputation. The nurse would be especially vigilant in monitoring for which of the following because of the client's history of diabetes mellitus?

separation of wound edges

A nurse is discussing primary prevention measures to clients regarding osteoporosis. The nurse plans to tell the clients that which of the following 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. The nurse should anticipate that which type of wound care will be prescribed for the fasciotomy site?

Moist, sterile saline dressings

A 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:

Monitoring for signs of dyspnea

A nurse is evaluating the client's use of a cane for left-sided weakness. The nurse would intervene and correct the client if the nurse observed that the client:

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:

Muscle spasm in the area of the herniated disk

A client with a left arm fracture complains of severe, diffuse pain that is unrelieved with pain medication. On further data collection, the nurse notes that the client experiences more pain during passive motion of the left arm as compared with active motion. Based on these findings, 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 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.

A 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

Which data would indicate a potential complication associated with age-related changes in the musculoskeletal system?

Overall sclerotic lesions

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

Overhead trapeze

A nurse is caring for a client with osteoarthritis. The nurse monitors the client, knowing that which of the following is a clinical manifestation associated with the disorder?

Pain that increases with activity and is relieved by rest

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

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

A 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 instruction if the nurse observes the client:

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

A nurse is caring for a client who has a cast applied to the left lower leg. On data collection of the client, 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.

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

Petaling the cast edges with adhesive tape

A nurse is repositioning the client who has returned to the nursing unit following internal fixation of a fractured right hip. The nurse plans to use a:

Pillow to keep the right leg abducted during turning

A 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 best 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 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. The initial action of the nurse is to:

Place the client in a Fowler's position.

Which of the following interventions would be contraindicated in the post procedure care of the client following a bone biopsy of the left arm?

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

A nurse is providing 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 nurse is checking the casted extremity of a client. The nurse would check for which of the following signs and symptoms indicative of infection?

Presence of a "hot spot" on the cast

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 primarily:

Provides comfort by reducing muscle spasms and provides fracture immobilization

A client who has experienced a brain attack (stroke) has partial hemiplegia of the left leg. The straight-leg cane formerly used by the client is not sufficient any longer. The nurse determines that the client could benefit from the somewhat greater support and stability provided by a:

Quad cane

A nurse is providing postprocedure instructions to a client returning home after arthroscopy of the shoulder. The nurse would encourage the client to:

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

A 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 immediately:

Rewraps the residual limb with an elastic compression bandage

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 would pay particular attention to monitoring for which of the following high-risk areas 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 first priority relates to addressing which of the following nursing diagnoses?

Risk for constipation

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

Separation of wound edges

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

Serous drainage

An 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 of the following on inspection of the client's leg?

Shortening, adduction, and external rotation

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

Showing the client the cast cutter and explaining how it works

A client has been placed in Buck's extension traction. The nurse can provide for countertraction by:

Slightly elevating the foot of the bed

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

Small pillows

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 could best be addressed by referral to the:

Social worker

A 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 would plan to:

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

A 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. The appropriate nursing action is to:

Stay with the victim.

A client has slight weakness in the right leg. Based on this information, the nurse determines that the client would benefit most from the use of a:

Straight-leg cane

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 of the following to enhance compliance with therapy?

Take the medication following a meal.

A nurse has given the client instructions regarding crutch safety. The nurse determines that the client needs reinforcement of the instructions if the client states:

That crutch tips will not slip, even when wet

A client who is learning to use a cane is afraid it will slip with ambulation, causing a fall. The nurse provides the client with the greatest reassurance by telling the client that:

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

A nurse provides cast application instructions to a client who is going to have a plaster cast applied. The nurse determines that the client needs further instruction if the client states that:

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

A nurse is preparing to teach a client how to safely use crutches. Before initiating the teaching the nurse collects data on the client. The priority data would include which of the following?

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

A 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 of the following teaching points in discussion with the client?

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

A nurse is teaching a client who is to have a gallium scan about the procedure. The nurse should include which of the following items as part of the instructions?

The gallium will be injected intravenously 2 to 3 hours before the procedure.