PassPoint - Musculoskeletal

Using the Morse Fall Scale (see chart), place the clients in order from lowest to highest fall risk. All options must be used.

50-year-old client admitted for chest pain while running. The client has been healthy and has no history of falling; the client is alert and oriented, has IV access, and has been cleared to ambulate independently. 38-year-old client who has been blind since birth, admitted for abdominal pain and nausea with IV in place. The client has steady gait and no history of falling and requires cuing and assistance due to unfamiliar surroundings. 56-year-old client with diabetes admitted with osteomyelitis of right ankle, receiving IV antibiotics per peripherally inserted central catheter. The client is alert and cooperative, is non-weight bearing on the right lower extremity but may stand pivot into a wheelchair. The client has no history of falling. older adult client admitted from assisted-living facility with new-onset confusion secondary to urinary tract infection. The client has a history of hypertension and diabetes; gait is weak due to illness, but the client has no known history of falling. The client may be up with assistance using a walker and is receiving IV antibiotics.

The nurse is caring for a client admitted for pneumonia with a history of hypertension and heart failure. The client has reported at least one fall in the last 3 months. The client may ambulate with assistance, has a saline lock in place, and has demonstrated appropriate use of the call light to request assistance. Using the Morse Fall Scale (see chart), what is this client's total score and risk level?

60, high risk

A client with osteoarthritis purchased a copper bracelet to wear and tells the nurse that there is less pain now. Which response by the nurse is most appropriate?

Acknowledge that the client feels better, but encourage the client to continue with the prescribed therapy.

On the evening of surgery for a total knee replacement, a client wants to get out of bed. What should the nurse do to safely assist the client?

Apply a knee immobilizer.

A client has a fiberglass cast on the right arm which was placed after internal fixation 1 week ago. The nurse notes a warm area on the cast. What priority action should the nurse take?

Assess client's temperature and interview about pain at the site.

The nurse assigns an unlicensed assistive personnel (UAP) to the care of a client who has just returned from surgery for repair of a fractured right wrist and application of an arm cast. The nurse should stress to the UAP the importance of reporting what?

The nurse assigns an unlicensed assistive personnel (UAP) to the care of a client who has just returned from surgery for repair of a fractured right wrist and application of an arm cast. The nurse should stress to the UAP the importance of reporting what?

A nurse is teaching a female client about preventing osteoporosis. Which teaching point is correct?

The recommended daily allowance of calcium may be found in a wide variety of foods.

The nurse is evaluating a client in skin traction. Which observation indicates the traction is applied for maximum effectiveness?

The ropes are in the wheel grooves of the pulleys.

Unlicensed assistive personnel (UAP) are helping a client who had knee surgery 2 days ago get into bed. As the nurse makes rounds, which information requires the nurse to intervene?

The side rails on the head and foot of the bed are in the up position.

A client is in the operating room having surgery to replace a hip. Before the surgery, there is confusion about the view of the hip on the x-ray. The surgical team requests a "time-out" and stops the surgery. When can surgery continue? Select all that apply.

The surgeon verifies the correct procedure. The surgeon verifies the correct surgical site. The surgeon verifies the correct procedure. The surgeon verifies the correct surgical site.

A client is scheduled for a laminectomy to repair a herniated intervertebral disk. When developing the postoperative care plan, the nurse should include which action?

Turning the client from side to side, using the logroll technique

A pediatric client has just had a plaster cast placed on their lower left leg. Which action should the nurse take to provide safe cast care?

Use only the palms of the hand when handling the cast.

The nurse is planning care for a group of clients who have had a total hip replacement. Of the clients listed below, who is at the highest risk for infection and should be assessed first?

a 74-year-old who has periodontal disease with periodontitis

The nurse is caring for a client on a second course of antibiotics to eliminate osteomyelitis. It is most essential for the nurse to instruct on which aspect of daily care?

a diet high in protein and nutrients

The nurse is instructing an unlicensed assistive personnel (UAP) on how to correctly position a client who has had a recent total hip replacement. In which position should the nurse tell the UAP to place the affected leg when the client is lying on the nonoperative side?

abduction and extension

When the client who has had a hip replacement is lying on the side, the nurse should place pillows or an abductor splint between the legs to prevent:

adduction of the hip joint.

A nurse is managing the care of a client with osteoarthritis. Appropriate treatment strategies for osteoarthritis include

administration of nonsteroidal anti-inflammatory drugs (NSAIDs) and initiation of an exercise program.

Which intervention would be least appropriate for a client who is in a double hip spica cast?

advising the client to eat large amounts of cheese

In preparation for total knee surgery, a 200-lb (90.7-kg) client with osteoarthritis must lose weight. Which exercise should the nurse recommend as best if the client has no contraindications?

aquatic exercise

A clinical nurse specialist developed clinical pathways for common orthopedic conditions. In which way should the interdisciplinary team use these pathways?

as guidelines to ensure continuity of care

The nurse is teaching the client how to use crutches. The nurse should instruct the client to bear weight primarily on which part of the body?

hands

A nurse is caring for a client with lower back pain who is scheduled for myelography using metrizamide (a water-soluble contrast dye). After the test, the nurse should place the client in which position?

head of the bed elevated 45 degrees

A client has been diagnosed with osteoporosis after a bone density test and is asking what has caused it. Discussion of risk factors would include:

heavy smoking, sedentary lifestyle, and high intake of carbonated drinks

During a scoliosis screening in a college health center, a student asks the public health nurse about the consequences of untreated scoliosis. The nurse identifies one of the direct complications as

impingement on pulmonary function.

To promote early and efficient ambulation for a client after an above-the-knee amputation, the nurse is aware that the leg will need to be positioned in which way?

in functional alignment

A nurse is developing a teaching plan for a client diagnosed with osteoarthritis. To minimize injury to the osteoarthritic client, the nurse should instruct the client to

install safety devices in the home.

A client undergoes hip-pinning surgery to treat an intertrochanteric fracture of the right hip. The nurse should include which intervention in the postoperative care plan?

keeping a pillow between the client's legs at all times

A nurse is teaching a client who was recently diagnosed with carpal tunnel syndrome. Which statement should the nurse include?

"Ergonomic changes can be incorporated into your workday to reduce stress on your wrist."

The nurse teaches a client about heat and cold treatments to manage arthritis pain. Which statement indicates that the client still has a knowledge deficit?

"Heat-producing liniments can be used with other heat devices."

The nurse is assessing a client who has had an internal fixation and hip pinning. Which nursing measure will likely decrease the risk for a surgical wound infection in this client?

changing the surgical dressings using sterile technique

The nurse is caring for a client with a spinal cord injury. The client is experiencing blurred vision and has a blood pressure of 204/102 mm Hg. What should the nurse do first?

Check the client's bladder for distention.

A client was undergoing conservative treatment for a herniated nucleus pulposus, at L5 - S1, which was diagnosed by magnetic resonance imaging. Because of increasing neurological symptoms, the client undergoes lumbar laminectomy. The nurse should take which step during the immediate postoperative period?

Logroll the client from side to side.

The school nurse is planning an educational session to prevent injuries in children with juvenile arthritis. Which information should the nurse include in the teaching?

Schedule the completion of daily range-of-motion exercises to support joint mobility.

A client is being admitted with a spinal cord transection at C7. Which assessment(s) would take priority upon the client's arrival? Select all that apply.

blood pressure temperature respirations

A client has had a total hip replacement. When assessing the client, the nurse understands that which sign most likely indicates that the hip has dislocated?

cephalosporins

A client who had a total hip replacement 4 days ago is worried about dislocation of the prosthesis. How should the nurse respond to the client's concern?

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

A client is treated in the emergency department for acute muscle strain in the left leg caused by trying a new exercise. During discharge preparation, the nurse should provide which instruction?

"Apply ice packs for the first 24 to 48 hours, then apply heat packs."

The nurse is teaching a client with osteoporosis about optimal dietary choices to reduce the severity of the condition. What instruction should the nurse provide?

"Eat more dairy products such as cheese and yogurt."

A client has a total hip replacement. Which of the following client statements indicates a need for further teaching before discharge?

"I can't wait to take a tub bath when I get home."

A home care nurse visits a client with muscular dystrophy. Which comment by the client indicates that more information about an advance directive is needed?

"I don't ever want a feeding tube when the time comes that I can't eat."

A client undergoes a total hip replacement. Which statement made by the client indicates to the nurse that the client requires further teaching?

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

A nurse is evaluating the proper use of crutches by a client who has fractured the right leg. Which statement indicates the client is using the correct technique?

"I feel pressure on the palms of my hands when I am walking with my crutches."

The nurse is teaching a client about wearing a back brace after a spinal fusion. Which statement indicates the client understands how to wear the back brace?

"I should wear a thin cotton undershirt under the brace."

Which statement by a client with rheumatoid arthritis would indicate the need for additional teaching to safely receive the maximum benefit of aspirin therapy?

"I try to take aspirin only on days when the pain seems particularly bad."

On a visit to the family physician, a client is diagnosed with a bunion on the lateral side of the great toe, at the metatarsophalangeal joint. Which statement should the nurse include in the teaching session?

"Some bunions are congenital; others are caused by wearing shoes that are too short or narrow."

The nurse is caring for a client who has been diagnosed with a strained ankle. The client asks the nurse what the difference is between a sprain and a strain. How should the nurse respond?

"Sprains involve injury to the ligaments and strains to tendons or muscles."

A nurse is caring for a client who complains of lower back pain. Which instruction should the nurse give to the client to prevent back injury?

"Stand close to the object you're lifting."

The nurse assigns an unlicensed assistive personnel (UAP) to care for a client who has a newly applied long-leg plaster cast. What should the nurse tell the UAP about proper care of the cast while it is drying?

"Turn the client every 2 hours to promote even drying of the cast."

A client who has just been diagnosed with mixed muscular dystrophy asks the nurse about the usual course of this disease. How should the nurse respond?

"You may experience progressive deterioration in all voluntary muscles."

A client is brought to the emergency department with a painful swollen ankle. What is the nurse's most appropriate action?

Elevate the ankle.

What should the nurse do to protect a client's skin under a back brace?

Have the client wear a close-fitting thin cotton shirt under the back brace.

The nurse is instructing a client following right-knee replacement on how to use crutches. Which instructions are included? Select all that apply.

Have your elbows bent when holding the crutch handles. Place crutches 1 foot in front of you. Pivot on your left leg. Swing your left leg forward.

When developing a care plan for a client newly diagnosed with scleroderma, which nursing diagnosis has the highest priority?

Impaired skin integrity

A client with a history of osteoarthritis is admitted to the rehabilitation unit after hospitalization for a hip fracture. Which plan by the multidisciplinary team best optimizes client outcomes?

Including the client in developing a care plan that works toward meeting discharge goals

To reduce the incidence of complications in a client in traction, which intervention should be included in the care plan?

Increase fiber intake.

The nurse is planning care for a client recovering from total hip replacement surgery. Which intervention should the nurse add to the client's plan of care?

Instruct the client not to lean forward at the waist when sitting up in a chair.

A client had a total hip replacement today. How should the nurse position the client when the client is transferred from the transport cart to the bed?

Maintain the affected extremity in slight abduction by using an abduction splint or placing pillows between the thighs.

A client is being discharged following an open reduction and internal fixation of the left ankle and is to wear a non-weight-bearing cast for 2 weeks. What should the nurse teach the client to do when using crutches?

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

The nurse is preparing a client who underwent a knee replacement with a metal joint to go home. What should the nurse instruct the client to do? Select all that apply.

Notify the health care provider (HCP) about the joint before undergoing invasive procedures. Inform the HCP before having magnetic resonance imaging (MRI) scans. Notify airport security that the joint may set off alarms on metal detectors.

A client with a broken ulna reports having pain in the casted arm that is unrelieved by pain medication. The nurse assesses the arm and notes that the fingers are swollen and difficult to separate. After reviewing the health care provider's prescriptions, what should the nurse do first?

Notify the health care provider (HCP) about the swelling and pain.

A client scheduled for hip replacement surgery wishes to receive their own blood for the upcoming surgery. What should the nurse do?

Notify the surgeon's office.

A client with acute osteomyelitis is to receive parenteral penicillin for 4 to 6 weeks. Before administering the first dose, the nurse asks the client about known drug allergies. An allergy to which antibiotic or antibiotic class necessitates cautious use of penicillin?

cephalosporins

A client arrives via ambulance with a suspected pelvic fracture from a motor vehicle collision. The client's vital signs are: blood pressure 85/50 mm Hg, heart rate 120 beats/min, respiratory rate 22 breaths/min, and an oxygen saturation of 98% on room air. The client is afebrile. The health care provider has written several prescriptions. What is the nurse's priority action?

Obtain STAT hemoglobin and group and match.

A client returned from surgery with a debrided open tibial fracture and has a three-way drainage system. The client's vital signs are within normal limits. What should the nurse do next?

Review the results of culture and sensitivity testing of the wound.

A client has had a cast applied to the arm. When discharging the client, what should the nurse tell the client to: do?

Smell the cast for foul odors.

A client's left leg is in skeletal traction with a Thomas leg splint and Pearson attachment. Which intervention should the nurse include in this client's care plan?

Teach the client how to prevent problems caused by immobility.

A nurse is caring for a client who's experiencing septic arthritis. This client has a history of immunosuppressive therapy and the client's immune system is currently depressed. Which assignment is the most appropriate for the nurse caring for this client?

The nurse is caring for this client on the intensive care unit.

A nurse is caring for a client who had hip pinning surgery 6 hours ago to treat intertrochanteric fracture of the right hip. What assessment finding requires further investigation by the nurse?

client anxious and confused

A client is 4 days postoperative from a tibia fracture and has a long leg cast. The nurse is conducting initial teaching for walking with crutches. What is the most important activity for the nurse to encourage the client to do prior to discharge from the hospital?

conduct exercises in bed to strengthen the upper extremities, as this will assist the client in crutch use.

A child is to receive intravenous (IV) antibiotics for osteomyelitis. Before the initial dose of antibiotics can be given, the nurse confirms that a blood sample for which test has been drawn?

culture

A client comes to the emergency department reporting pain in the right leg. When obtaining the history, the nurse learns that the client has a history of obesity and hypertension. Based on this information the nurse anticipates the client having which musculoskeletal disorder?

degenerative joint disease

A client with arterial insufficiency undergoes below-knee amputation of the right leg. Which action should the nurse include in the postoperative care plan?

elevating the stump for the first 24 hours

A nurse is caring for a client with a cast on their left arm after sustaining a fracture. Which assessment finding is most significant for this client?

fingers on the left hand are swollen and cool

The nurse administers a preoperative intramuscular medication at the ventrogluteal site. Into which muscle should the nurse inject the medication?

gluteus minimus

A male client comes to the clinic with complaints of pain in his great toe. The client reports that the pain is worse at night. Assessment reveals tophi. The nurse suspects the client has

gouty arthritis.

When assessing an older adult as a candidate for crutch walking, the nurse should take into account that for some elderly people, crutch walking is an impractical goal primarily because of decreased:

motor coordination.

The client is being discharged today after having an above-the-knee amputation a week ago. Which complications should the nurse include in the discharge directions? Select all that apply.

new openings in wound or skin around the wound pulling away worsening pain not controlled by medication skin around the stump or wound dark or turning black

A client has been diagnosed with degenerative joint disease (osteoarthritis) of the left hip. Which factor in the client's history would most likely increase the joint symptoms of osteoarthritis?

obesity

A diet plan is developed for a client with gouty arthritis. The nurse should advise the client to limit his intake of

organ meats.

Which cells are involved in bone resorption?

osteoclasts

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

osteomyelitis

The client comes to the clinic reporting activity restriction and sexual dysfunction. Tests are completed and a diagnosis of L5-S1 herniated disk impinging on the right nerve root is made by the healthcare provider. What assessment findings should the nurse expect to note?

pain radiating down the right leg

The emergency room nurse is caring for a client who fell, breaking the tibia. The nurse determines that the client understands the risk of compartment syndrome when knowing to report which early symptom following treatment?

paresthesia

A client has a leg immobilized in traction. Which observation by the nurse indicates that the client understands actions to take to prevent muscle atrophy?

performs isometric exercises to the affected extremity three times per day.

Which nursing intervention is essential in caring for a client with compartment syndrome?

removing all external sources of pressure, such as clothing and jewelry

A client with Paget's disease comes to the hospital and complains of difficulty urinating. The emergency department physician consults urology. What should the nurse suspect is the most likely cause of the client's urination problem?

renal calculi

The nurse is providing discharge instructions about dietary limitations to a client with gout. Which foods should the client avoid? Select all that apply.

sardines red wine beer

A client is ordered diazepam to treat severe skeletal muscle spasms. During this therapy, the nurse monitors the client closely for adverse reactions. Which adverse reaction is most likely to occur?

sedation

The nurse enters the room to do an initial assessment on a client with a fracture of the femoral head. What would be the expected findings on the affected limb?

shortening of the affected extremity with external rotation

A client sustains a minor fracture to the left wrist. For which type of immobilization device should the nurse prepare teaching for this client?

splint

After a laminectomy, the client states, "The doctor said that I can do anything I want to." Which activity that the client intends to do indicates the need for further teaching?

sweeping the front porch

A nurse is caring for a client who fell and fractured the neck of femur. When documenting the site for the family members, indicate on the image the area where the fracture occurred.

top part that attaches to hip

The client with an above-the-knee amputation is to be fitted with a functioning prosthesis. The nurse has been teaching the client how to care for the residual limb. Which behavior would demonstrate that the client understands proper residual limb care?

washes and dries the residual limb daily

A client is preparing for discharge from the emergency department after sustaining an ankle sprain. The client is instructed to avoid weight bearing on the affected leg and is given crutches. After instruction, the client demonstrates proper crutch use in the hallway. What additional information is most important to know before discharging the client?

whether the client needs to navigate stairs routinely at home

After surgery to treat a hip fracture, a client returns from the postanesthesia care unit to the medical-surgical unit. Postoperatively, how should the nurse position the client?

with the leg on the affected side abducted