Musculoskeletal Exam
A client who has had a total knee replacement tells the nurse that there is pain with extension of the knee. Which action should the nurse implement? 1.Administer an analgesic. 2.Immobilize the knee temporarily. 3.Notify the primary health care provider immediately. 4.Put the client's knee through full passive range of motion.
1.Administer an analgesic.
The nurse in the emergency department is caring for a client with a fractured arm. The nurse understands that which item is least likely needed before reduction of the fracture in the casting room? 1.Anesthesia consent 2.Consent for the procedure 3.Administration of an analgesic 4.Explanation of the procedure to the client
1.Anesthesia consent
The nurse is caring for a client who had a total knee replacement. Postoperatively, the nurse monitors for which highest priority assessment? 1.Calf pain 2.Heel breakdown 3.Bladder distention 4.Extremity shortening
1.Calf pain
The nurse is preparing a list of cast care instructions for a client who just had a plaster cast applied to his right forearm. Which instructions should the nurse include on the list? Select all that apply. 1.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. 4.Expect tingling and numbness in the extremity. 5.Use a hair dryer set on a warm to hot setting to dry the cast. 6.Use a soft-padded object that will fit under the cast to scratch the skin under the cast.
1.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.
An older client with advanced Alzheimer's disease is placed in balanced suspension traction, and the primary health care provider expects to internally fixate the client's femur in 1 week. Based on this information, the nurse determines that the priority relates to addressing which client problem? 1.Risk for constipation 2.Impaired tissue integrity 3.Risk for activity intolerance 4.Disturbed thought processes
1.Risk for constipation
A client has had surgery to repair a fractured left hip. The nurse plans to use which important item when repositioning the client from side to side in the bed? 1.Bed pillow 2.Abductor splint 3.Adductor splint 4.Overhead trapeze
2.Abductor splint
A client is complaining of skin irritation from the edges of a cast applied the previous day. The nurse should plan for which intervention? 1.Massaging the skin at the rim of the cast 2.Petaling the cast edges with adhesive tape 3.Using a rough file to smooth the cast edges 4.Applying lotion to the skin at the rim of the cast
2.Petaling the cast edges with adhesive tape
The nurse is monitoring a confused older client admitted to the hospital with a hip fracture. Which issues could place the client at increased risk for disturbed thought processes? Select all that apply. 1.Relatives at the bedside 2.Stress from the fracture 3.Eyeglasses left at home 4.Unfamiliar hospital setting 5.Side effects of medications 6.Hearing aid available and in working order
2.Stress from the fracture 3.Eyeglasses left at home 4.Unfamiliar hospital setting 5.Side effects of medications
A client has sustained a closed fracture and has just had a cast applied to the affected arm. The client is complaining of intense pain. The nurse has elevated the limb, applied an ice bag, and administered an analgesic, which was ineffective in relieving the pain. The nurse interprets that this pain may be caused by which condition? 1.Infection under the cast 2.The anxiety of the client 3.Impaired tissue perfusion 4.The newness of the fracture
3.Impaired tissue perfusion
Which statement by the client who has received home care instruction following an arthroscopy of the knee indicates a need for further teaching? 1."I should elevate my knee while sitting." 2."I should avoid excessive use of the joint for several days." 3."I can apply heat to my knee if it becomes uncomfortable." 4."I should return to the primary health care provider in about 7 days for follow-up."
3."I can apply heat to my knee if it becomes uncomfortable."
The nurse is caring for a client who has developed compartment syndrome from a severely fractured arm. The client asks the nurse how this can happen. How should the nurse explain compartment syndrome? 1.A bone fragment has injured the nerve supply in the area. 2.An injured artery causes impaired arterial perfusion through the compartment. 3.Bleeding and swelling cause increased pressure in an area that cannot expand. 4.The fascia expands with injury, causing pressure on underlying nerves and muscles.
3.Bleeding and swelling cause increased pressure in an area that cannot expand.
A client has Buck's extension traction applied to the right leg. The nurse should plan which intervention to prevent complications of the device? 1.Giving pin care once a shift 2.Massaging the skin of the right leg with lotion every 8 hours 3.Inspecting the skin on the right leg at least once every 8 hours 4.Releasing the weights on the right leg for range-of-motion exercises daily
3.Inspecting the skin on the right leg at least once every 8 hours
A client has undergone fasciotomy to treat compartment syndrome of the leg. Which type of wound care should the nurse anticipate will be prescribed for the fasciotomy site? 1.Dry, sterile dressings 2.Hydrocolloid dressings 3.Moist, sterile saline dressings 4.Half-strength povidone-iodine dressings
3.Moist, sterile saline dressings
The nurse is teaching a client how to walk with a cane. Which information should the nurse include? Select all that apply. 1.The cane is placed on the affected side. 2.A quad-cane provides a narrower base for the cane. 3.The cane should create no more than 30 degrees of flexion of the elbow. 4.The top of the cane should be parallel to the greater trochanter of the femur. 5.A straight leg cane is used if the client only needs minimal support for an affected leg.
3.The cane should create no more than 30 degrees of flexion of the elbow. 4.The top of the cane should be parallel to the greater trochanter of the femur. 5.A straight leg cane is used if the client only needs minimal support for an affected leg.
The nurse is assigned to care for a client with multiple traumas who is admitted to the hospital. The client has a leg fracture, and a plaster cast has been applied. In positioning the casted leg, the nurse should perform which intervention? 1.Keep the leg in a level position. 2.Elevate the leg for 3 hours, and put it flat for 1 hour. 3.Keep the leg level for 3 hours, and elevate it for 1 hour. 4.Elevate the leg on pillows continuously for 24 to 48 hours
4.Elevate the leg on pillows continuously for 24 to 48 hours
The nurse is discharging a client who had conventional open back surgery. Which comment by the client indicates a need for further teaching? 1."I plan to restrict or limit my driving." 2."I will avoid bending and twisting at the waist." 3."I'll go for a walk every day, but I won't take the dog." 4."I'll be careful not to lift anything heavier than 20 pounds."
4."I'll be careful not to lift anything heavier than 20 pounds."
The nurse is assigned to care for a client with multiple traumas who is admitted to the hospital. The client has a leg fracture, and a plaster cast has been applied. In positioning the casted leg, the nurse should perform which intervention? 1.Keep the leg in a level position. 2.Elevate the leg for 3 hours, and put it flat for 1 hour. 3.Keep the leg level for 3 hours, and elevate it for 1 hour. 4.Elevate the leg on pillows continuously for 24 to 48 hours.
4.Elevate the leg on pillows continuously for 24 to 48 hours.
A client has just had an application of a nonplaster cast. What are some of the synthetic materials used for nonplaster casts? Select all that apply. 1.Rayon 2.Nylon 3.Neoprene 4.Fiberglass 5.Polyester-cotton knit
4.Fiberglass 5.Polyester-cotton knit
The nurse has provided instructions to a client with a herniated lumbar disk about proper body mechanics and other items pertinent to low back care. The nurse determines that the client needs further teaching if the client verbalizes which action should be done? 1.Increase fiber and fluids in the diet. 2.Bend at the knees to pick up objects. 3.Strengthen the back muscles by swimming or walking. 4.Get out of bed by sitting straight up and swinging the legs over the side of the bed.
4.Get out of bed by sitting straight up and swinging the legs over the side of the bed.
The nurse has provided instructions regarding specific leg exercises for the client immobilized in right skeletal lower leg traction. The nurse determines that the client needs further teaching if the nurse observes the client doing which activity? 1.Pulling up on the trapeze 2.Flexing and extending the feet 3.Doing quadriceps-setting and gluteal-setting exercises 4.Performing active range of motion (ROM) to the right ankle and knee
4.Performing active range of motion (ROM) to the right ankle and knee
The nurse is caring for a client with osteoporosis who is being discharged with instructions to take calcium with vitamin D. Which instructions should the nurse give the client about taking this medication? Select all that apply. 1."Take a third of the daily dose at bedtime." 2."Increase fluid intake, unless medically contraindicated." 3."Take the medication with 6 to 8 ounces of water to help dissolve it." 4."You will need to have your blood tested for calcium every month." 5."You can get a slight fever with this medication, so check your temperature every day." 6."After taking this medication for 6 months, you won't have to worry about having any more fractures."
1."Take a third of the daily dose at bedtime." 2."Increase fluid intake, unless medically contraindicated." 3."Take the medication with 6 to 8 ounces of water to help dissolve it."
The nurse is caring for a client who was just admitted with a diagnosis of fractured right femur. What are some of the acute complications the nurse needs to assess for? Select all that apply. 1.Crush syndrome 2.Ischemic necrosis 3.Fat embolism syndrome 4.Arterial thromboembolism 5.Acute compartment syndrome (ACS) 6.Hemorrhage and hypovolemic shock
1.Crush syndrome 3.Fat embolism syndrome 5.Acute compartment syndrome (ACS) 6.Hemorrhage and hypovolemic shock
The nurse is discharging a client with a diagnosis of gout. Which best practice guidelines should the nurse teach the client? Select all that apply. 1.Drink plenty of fluids. 2.Avoid taking diuretics. 3.Avoid taking acetaminophen. 4.Organ meats are allowed on your diet. 5.Avoid excessive physical or emotional stress.
1.Drink plenty of fluids. 2.Avoid taking diuretics. 5.Avoid excessive physical or emotional stress.
The nurse is caring for a client diagnosed with Paget's disease. The nurse plans care knowing that this condition usually affects which bones? Select all that apply. 1.Femur 2.Skull 3.Tibia 4.Sternum 5.Shoulder 6.Vertebrae
1.Femur 2.Skull 3.Tibia 6.Vertebrae
The nurse is caring for a client recently diagnosed with secondary gout. Secondary gout involves hyperuricemia (excessive uric acid in the blood) caused by another disease or factor. Which diseases or factors make clients more at risk for acquiring this condition? Select all that apply. 1.Older clients 2.Obese people 3.Client with liver disease 4.Postmenopausal women 5.Clients from poor economic communities 6.Clients with cardiovascular health problems
1.Older clients 2.Obese people 4.Postmenopausal women 6.Clients with cardiovascular health problems
The nurse is reinforcing instructions to a client with osteoporosis regarding appropriate food items to include in the diet. The nurse tells the client that which food item would provide the least amount of calcium? 1.Pork 2.Seafood 3.Sardines 4.Plain yogurt
1.Pork
The nurse is repositioning the client who has returned to the nursing unit following internal fixation of a fractured right hip. How should the nurse plan to position the client? 1.Trochanter roll to prevent abduction while turning 2.Pillow to keep the right leg abducted during turning 3.Pillow to keep the right leg adducted during turning 4.Trochanter roll to prevent external rotation while turning
2.Pillow to keep the right leg abducted during turning
A client with a herniated intervertebral lumbar disk complains of a knifelike, stabbing pain in the lower back, as well as pain radiating into the right buttock. The nurse interprets that the sharp, stabbing pain is probably a result of which reason? 1.Pressure on the spinal cord 2.Pressure on the spinal nerve root 3.Muscle spasm in the area of the herniated disk 4.Excess cerebrospinal fluid production in the area
3.Muscle spasm in the area of the herniated disk
Which intervention should be contraindicated in the postprocedure care of the client following a bone biopsy of the left arm? 1.Monitor vital signs every 4 hours. 2.Administer oral analgesics as needed. 3.Place the left arm in a dependent position for 24 hours. 4.Monitor the site for swelling, bleeding, and hematoma formation.
3.Place the left arm in a dependent position for 24 hours.
A client has been placed in Buck's extension traction. Which technique provided by the nurse will provide countertraction? 1.Using a footboard 2.Providing an overhead trapeze 3.Slightly elevating the foot of the bed 4.Slightly elevating the head of the bed
3.Slightly elevating the foot of the bed
The nurse is teaching a male client with osteomalacia about this disorder. Which comment by the client indicates a need for further teaching? 1."I need to take high doses of vitamin D." 2."Calcification does not occur to harden my bones." 3."Vitamin D helps calcium to be absorbed in my small intestines." 4."This condition is primarily due to my lack of calcium and testosterone."
4."This condition is primarily due to my lack of calcium and testosterone."
The nurse has a prescription to get the client out of bed to a chair on the first postoperative day after total knee replacement. The nurse plans to do which to protect the knee joint? 1.Obtain a walker to minimize weight bearing by the client on the affected leg. 2.Apply an Ace wrap around the dressing, and put ice on the knee while sitting. 3.Lift the client to the bedside chair, leaving the continuous passive motion (CPM) machine in place. 4.Apply a knee immobilizer before getting the client up, and elevate the client's surgical leg while sitting.
4.Apply a knee immobilizer before getting the client up, and elevate the client's surgical leg while sitting.
The nurse is caring for a client with a fractured tibia and fibula. Eight hours after a long leg cast was applied, the client began to report an increase in pain level even after administration of the prescribed dose of opioid analgesic. Which is the initial nursing action? 1.Elevate the casted leg. 2.Contact the primary health care provider. 3.Administer another dose of pain medication. 4.Check the neurovascular status of the toes on the casted leg.
4.Check the neurovascular status of the toes on the casted leg.
A client has undergone total hip replacement of the right hip, which was damaged by osteoarthritis. Which action should be included in the postoperative plan of care? 1.Ensure the client receives the daily tablet of enoxaparin. 2.Assist the client in keeping the legs as close together as possible. 3.Remind the client to use a handrail when lowering the hips into a 120-degree flexion. 4.Partial weight bearing on the operative leg is usually permitted 72 hours postoperatively; check surgeon's prescription.
4.Partial weight bearing on the operative leg is usually permitted 72 hours postoperatively; check surgeon's prescription.
A client who is learning to use a cane is afraid it will slip with ambulation, causing a fall. What should the nurse tell the client to provide greater reassurance? 1.Canes prevent falls, not cause them. 2.The physical therapist will determine if the cane is inadequate. 3.The cane would help break a fall, even if the client does slip. 4.The cane has a flared tip with concentric rings to provide stability.
4.The cane has a flared tip with concentric rings to provide stability.
A client has a fiberglass (nonplaster) cast applied to the lower leg. The client asks the nurse when he will be able to walk on the cast. How should the nurse correctly respond to this question? 1.In 24 hours 2.In 48 hours 3.In approximately 8 hours 4.Within 20 to 30 minutes of application
4.Within 20 to 30 minutes of application
During admission data collection the nurse asks the client to run the heel of one foot down the lower anterior surface of the other leg. The nurse notices rhythmic tremors of the leg being tested and concludes that the client has interference in which area? 1.Sensation and reflexes 2.Balance and coordination 3.Bowel and bladder control 4.Muscle strength and flexibility
2.Balance and coordination
The nurse is caring for a client with diabetes mellitus who is scheduled to have a right below-knee amputation. The nurse assesses which factors that can put this client at risk for amputation? Select all that apply. 1.Psoriasis 2.Bony deformity 3.Limited joint mobility 4.Peripheral neuropathy 5.Peripheral vascular disease 6.History of skin ulcers or previous amputation
2.Bony deformity 3.Limited joint mobility 4.Peripheral neuropathy 5.Peripheral vascular disease 6.History of skin ulcers or previous amputation
A client has had skeletal traction applied to the right leg and has an overhead trapeze available for use. The nurse should monitor which area as a high-risk area for pressure and breakdown? 1.Scapulae 2.Left heel 3.Right heel 4.Back of the head
2.Left heel
A client has just had skeletal traction applied following insertion of pins. The nurse should place highest priority on performing which action? 1.Performing pin site care 2.Explaining to the client the upcoming pin care procedure 3.Ensuring that the weights on the traction setup are hanging free 4.Providing for diversion such as watching television or reading a newspaper
3.Ensuring that the weights on the traction setup are hanging free
The nurse prepares to care for a client with inflamed joints and plans to use which item to maintain proper positioning for the inflamed joints? 1.Footboards 2.Large pillows 3.Small pillows 4.Soft mattress
3.Small pillows
The nurse is reinforcing discharge instructions to a client following surgical treatment for carpal tunnel syndrome. Which statement by the client would indicate a need for further teaching? 1."I should elevate my arm to reduce the swelling." 2."I should use a sling to limit movement and keep my arm elevated." 3."I should return to the primary health care provider in about 10 days to have the sutures removed." 4."I should perform pronation and supination exercises of my wrist starting 24 hours after surgery."
4."I should perform pronation and supination exercises of my wrist starting 24 hours after surgery."
The nurse has reinforced instructions with the client with a nonplaster (fiberglass) leg cast about cast care at home. The nurse determines that the client needs further teaching if the client makes which statement? 1."I should avoid walking on wet, slippery floors." 2."I'm not supposed to scratch the skin underneath the cast." 3."It's all right to wipe dirt off the top of the cast with a damp cloth." 4."If the cast gets wet, I can dry it with a hair dryer turned to the warmest setting."
4."If the cast gets wet, I can dry it with a hair dryer turned to the warmest setting."
The nurse is discussing primary prevention measures to clients regarding osteoporosis. The nurse plans to tell the clients that which is a primary prevention measure? 1.Selecting shoes that have firm nonskid soles 2.Applying nonskid strips on areas that get wet 3.Installing telephones in several rooms of the house 4.Maintaining body weight at or above minimum recommended levels
4.Maintaining body weight at or above minimum recommended levels
An elderly 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 is collecting data from the client and knows that which disease processes increase the older adult's risk for hip fractures? Select all that apply. 1.Osteoporosis 2.Foot disorders 3.Bony metastases 4.Carpal tunnel syndrome 5.Diminished visual acuity 6.Changes in cardiac function
1.Osteoporosis 2.Foot disorders 3.Bony metastases 6.Changes in cardiac function
The nurse is caring for a client admitted with fat embolism syndrome (FES). Which are some of the early manifestations of this syndrome? Select all that apply. 1.Fever 2.Dyspnea 3.Petechiae 4.Hypoxemia 5.Tachypnea 6.Decreased level of consciousness
2.Dyspnea 4.Hypoxemia 5.Tachypnea
The nurse is caring for a client diagnosed with Paget's disease. What abnormal laboratory values would the nurse specifically monitor in a client with Paget's disease? Select all that apply. 1.Decreased potassium 2.Elevated serum calcium 3.Elevated serum amylase 4.Increased creatine kinase (CK-MM) 5.Elevated serum alkaline phosphatase (ALP) 6.Elevated 24-hour urinary hydroxyproline level
2.Elevated serum calcium 5.Elevated serum alkaline phosphatase (ALP) 6.Elevated 24-hour urinary hydroxyproline level
The nurse is caring for a client who has had an open reduction with internal fixation (ORIF) with a posterior approach. The client has been prescribed hip precautions. The nurse plans to implement which activities in the care of the client? Select all that apply. 1.Ensure the client doesn't bend the hips beyond 120 degrees. 2.Ensure the client doesn't sit or stand for long periods of time. 3.Ensure the client engages in rigorous exercise to maintain strength. 4.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.
2.Ensure the client doesn't sit or stand for long periods of time. 4.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.
The nurse is caring for the client who has skeletal traction applied to the left leg. The client complains of severe left leg pain. The nurse checks the client's alignment in bed and notes that proper alignment is maintained. Which action should the nurse take next? 1.Provide pin care. 2.Medicate the client. 3.Notify the registered nurse. 4.Remove 2 pounds of weight from the traction.
3.Notify the registered nurse.
A client with a hip fracture asks the nurse why Buck's extension traction is being applied before surgery. The nurse's response is based on the understanding that Buck's extension traction has which primary function? 1.Allows bony healing to begin before surgery 2.Provides rigid immobilization of the fracture site 3.Lengthens the fractured leg to prevent severing of blood vessels 4.Provides comfort by reducing muscle spasms and provides fracture immobilization
4.Provides comfort by reducing muscle spasms and provides fracture immobilization
The nurse is evaluating the pin sites of a client in skeletal traction. The nurse would be least concerned with which finding? 1.Inflammation 2.Serous drainage 3.Pain at a pin site 4.Purulent drainage
2.Serous drainage
The nurse is caring for a client with a long bone fracture who is at risk for fat embolism. The nurse specifically monitors for the early signs of this complication by checking which criteria? Select all that apply. 1.The client's renal system 2.The client's mental status 3.The client's mobility status 4.The client's respiratory function 5.The client's cardiovascular system
2.The client's mental status 4.The client's respiratory function
The home care nurse is caring for a client who had a below-the-knee amputation of the right leg. What are some teaching points the nurse gives to the client and family? Select all that apply. 1.Apply the bandage in a top-down manner. 2.Use a shrinker stocking or sock to cover the wrapped stump. 3.Rewrap the residual limb once a day with an elastic bandage. 4.Begin residual limb care when sutures or staples are removed. 5.After the limb is healed, it is cleaned each day with the rest of the body during bathing with soap and water. 6.When the staples or sutures are removed, inspect the end of the residual limb every day for signs of inflammation or skin breakdown.
2.Use a shrinker stocking or sock to cover the wrapped stump. 4.Begin residual limb care when sutures or staples are removed. 5.After the limb is healed, it is cleaned each day with the rest of the body during bathing with soap and water. 6.When the staples or sutures are removed, inspect the end of the residual limb every day for signs of inflammation or skin breakdown.
The nurse is assisting in caring for a client who has sustained a nasal fracture. The nurse monitors for which priority finding specifically related to this injury? 1.Leakage of clear fluid from the nose 2.Inability to breathe through one nare 3.Hematoma formation around the eyes 4.Edema noted around the nose and eyes
1.Leakage of clear fluid from the nose
The nurse is caring for a client recently diagnosed with Parkinson disease (PD). The nurse is assessing the client and knows that PD is characterized by what cardinal signs/symptoms? Select all that apply. 1.Tremor 2.Dry skin 3.Muscle rigidity 4.Postural instability 5.Orthostatic hypertension 6.Bradykinesia or akinesia (slow movement/no movement)
1.Tremor 3.Muscle rigidity 4.Postural instability 6.Bradykinesia or akinesia (slow movement/no movement)
A client has just undergone spinal fusion after suffering a herniated lumbar disk. The nurse should avoid which action to maintain client safety after this procedure? 1.Keeping the head of bed flat 2.Having the client use an overhead trapeze 3.Having the client use a logrolling technique for repositioning 4.Placing pillows under the length of the legs
2.Having the client use an overhead trapeze
The nurse is caring for a recently admitted client with painful muscle spasms due to a traumatic injury. Besides drug therapy, what are some of the physical measures the nurse expects will be prescribed for this client? Select all that apply. 1.Limiting fluids 2.Whirlpool baths 3.Physical therapy 4.Muscle relaxants 5.Application of hot compresses 6.Immobilization of the affected muscle
2.Whirlpool baths 3.Physical therapy 6.Immobilization of the affected muscle
