NCLEX questions for Musculoskeletal

Which statement by a female client with a non-weight-bearing long leg cast indicates the need for the nurse to reinforce discharge teaching?

"I am going to give myself a pedicure with red nail polish when I get home."

A client is being discharged to home after application of a plaster leg cast. Which statement indicates that the client understands proper care of the cast? 1. "I need to avoid getting the cast wet." 2. I need to cover the casted leg with warm blankets 3. "I need to use my fingertips to lift and move my leg. 4. "I need to use something like a padded coat hanger end to scratch under the cast if it itches."

1. "I need to avoid getting the cast wet."

A client with rheumatoid arthritis is to begin taking ibuprofen (Motrin) 800 mg by mouth three times a day. The nurse provides education about the medication's side effects. The nurse concludes that the teaching was effective when the client states: 1. "I need to have my blood work checked every month." 2. "I need to balance exercise with rest." 3. "I need to change positions slowly." 4. "I need to take the medication between meals."

1. "I need to have my blood work checked every month."

The nurse is caring for a client being treated for fat embolus after multiple fractures. Which data would the nurse evaluate as the most favorable indication of resolution of the fat embolus? 1. Clear mentation 2. Minimal dyspnea 3. Oxygen saturation of 85% 4. Arterial oxygen level of 78 mm Hg

1. Clear mentation

Which cast care instructions should the nurse provide to a client who just had a plaster cast applied to the right forearm? Select all that apply. 1. Keep the cast clean and dry. 2. Allow the cast 24 to 72 hours to dry. 3. Keep the cast and extremity elevated. 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 clean and dry. 2. Allow the cast 24 to 72 hours to dry. 3. Keep the cast and extremity elevated.

A client had a right above-the-knee amputation secondary to trauma sustained in a motor vehicle accident. Six days after surgery, the client falls while attempting to transfer to a chair unassisted. The nurse concludes that this fall is most likely the result of: 1. Loss of balance 2. Phantom limb pain 3.Orthostatic hypotension 4. Decreased muscle strength

1. Loss of balance

The nurse is caring for a client who has had spinal fusion, with insertion of hardware. The nurse would be most concerned with which assessment finding? 1. Temperature of 101.6 Forally 2. Complaints of discomfort during repositioning 3. old bloody drainage outlined on the surgical dressing 4. Discomfort during coughing and deep-breathing exercises

1. Temperature of 101.6 Forally

A toddler has just had a cast applied for a fractured wrist. The wrist and elbow are immobilized. What information should the nurse include in the home care instructions before discharge? (Select all that apply.) 1. Resume usual activities. 2. Report swelling of fingers. 3.Keep the affected shoulder immobilized. 4. Elevate casted arm when the child is standing. 5. Lower the casted arm when the child is lying down.

2 4

Clients who have casts applied to the lower extremities must be monitored for complications. Which finding during assessment of the extremities of these clients is indicative of a complication? (Select all that apply.) 1. Warmth 2. Numbness 3. Skin desquamation 4. Generalized discomfort 5. Prolonged capillary refill

2 5

The nurse is caring for a client four hours after the client's hip replacement surgery. When assisting the client out of bed, the nurse should: 1. Tell the client that both legs must have equal weight bearing 2. Advise the client that the legs must continually be kept wide apart 3. Sit the client in a straight-back chair so that the hips are kept flexed 4. Transfer the client using a mechanical lift because weight bearing on the leg is not allowed

2. Advise the client that the legs must continually be kept wide apart

A client is complaining of low back pain that radiates down the left posterior thigh. The nurse should ask the client if the pain is worsened or aggravated by which factor? 1. Bed rest 2. Bending or lifting 3. Application of heat 4. Ibuprofen (Motrin IB)

2. Bending or lifting

What should the nurse take into consideration when planning nursing care for a patient experiencing an acute episode of rheumatoid arthritis? 1. Inflammation of the synovial membrane really occurs. 2. Bony ankylosis of a joint is irreversible and causes immobility. 3. Complete immobility is desired during the acute phase of inflammation. 4. Redness and swelling of a choice signified that irreversible damage has occurred.

2. Bony and ankylosis of a joint is irreversible and causes immobilitym

A client experiences a muscle sprain of the ankle. When assessing the injury, the nurse discovers that a hematoma is developing, edema is present and that the client reports tenderness when the ankle is palpated. The nurse anticipates that the plan of care will include the applying of a/an: 1. Binder 2. Ice bag 3. Elastic bandage 4. Warm compress

2. Ice bag

The nurse has conducted teaching with 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 that he or she should report which early symptom of compartment syndrome? 1. Cold, bluish-colored fingers 2. Numbness and tingling in the fingers 3. Pain that increases when the arm is dependent 4. Pain that is out of proportion to the severity of the fracture

2. Numbness and tingling in the fingers

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 diagnosis of gout. Which laboratory value would the nurse expect to note in the client? 1. Calcium level of 9.0 mg/dl. 2. Uric acid level of 8.6 mg/dL 3. Potassium level of 4.1 mEq/L 4. Phosphorus level of 3.1 mg/dL

2. Uric acid level of 8.6 mg/dL

A client has a fracture of the tibia and a cast is applied. When caring for the client, the nurse should 1. Cover the cast with plastic wrap until dry 2. Assist with weight bearing when the client ambulates 3. Elevate the affected leg above the level of the heart 4. Insert a finger inside the edges of the cast to check for skin abrasions

3

What should the nurse do to assess the neurovascular status of an extremity casted from the ankle to the thigh? 1. Palpate the femoral artery of the affected leg. 2. Assess for a positive Homan sign of the affected leg. 3. Compress and release the toenails of the affected foot. 4. Instruct the client to flex and extend the knee of the affected leg.

3

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 elevates the limb, applies an ice bag, and administers an analgesic, with little relief. Which problem may be causing this pain? 1. Infection under the cast 2. The anxiety of the client 3. Impaired tissue perfusion 4. The recent occurrence of the fracture

3. Impaired tissue perfusion

The nurse is assessing the casted extremity of a client. Which sign is indicative of infection? 1. Dependent edema 2. Diminished distal pulse 3. Presence of a "hot spot" on the cast 4. Coolness and pallor of the extremity

3. Presence of a "hot spot" on the cast

The nurse has given instructions to a client returning home after knee arthroscopy. Which statement by the client indicates that the instructions are understood? 1. "I can resume regular exercise tomorrow." 2. "I can't eat food for the remainder of the day." 3. "I need to stay off the leg entirely for the rest of the day." 4. "I need to report a fever or site inflammation to my health care provider."

4. "I need to report a fever or site inflammation to my health care provider."

The nurse is conducting health screening for osteoporosis. Which client is at greatest risk of developing this disorder? 1. A 25-year-old woman who jogs 2. A 36-year-old man who has asthma 3. A 70-year-old man who consumes excess alcohol 4. A sedentary 65-year-old woman who smokes cigarettes

4. A sedentary 65-year-old woman who smokes cigarette

When a client who had an above-the-knee amputation (AKA) complains of phantom limb sensations, the nursing staff should: 1. Reassure the client that these sensations will pass 2. Explain the psychological component involved to the client 3. Encourage the client to get involved in diversional activities 4. Describe the neurological mechanisms in language that the client understands

4. Describe the neurological mechanisms in language that the client understands

The nurse is admitting a client with multiple trauma to the nursing unit. The client has a leg fracture and had a plaster cast applied. Which position would be best for the casted leg? 1. Flat for 12 hours, then elevated for 12 hours. 2. Elevated for 3 hours and then flat for 1 hour. 3. Flat for 3 hours and then elevated for 1 hour. 4. Elevated on pillows continuously for 24 to 48 hours.

4. Elevated on pillows continuously for 24 to 48 hours.

A client with a hip fracture asks the nurse why Buck's (extension) traction is being applied before surgery. The nurse provides a response based on which purpose of Buck's (extension) traction? 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

A client had a cast applied to a fractured​ limb, and the healthcare provider has ordered frequent neurovascular checks. Which assessment should the nurse​ perform? (Select all that​ apply.) A. Paresthesia B. Pain C. Position D Color E. Temperature

A, B, D, E

When working with patients, the nurse knows that patients have the most difficulties with diarthrodial joints. Which joints are included in this group of joints (select all that apply)? a. Hinge joint of the knee b. Ligaments joining the vertebrae c. Fibrous connective tissue of the skull d. Ball and socket joint of the shoulder or hipe. Cartilaginous connective tissue of the pubis joint

A, D

Which statement best describes the nurse's assessment of the client with rheumatoid arthritis? A. Assessment is done of the musculoskeletal, cardiac, pulmonary, and renal systems. B. Pain is best assessed by monitoring the clients facial expression during exam and by observing limitations in the client's own movement. C. Vital signs are an adequate assessment of the activity of the clients pain level. D. The clients health history is not nearly as important as the nurses findings on physical exam.

A. Assessment is done of the musculoskeletal, cardiac, pulmonary, and renal systems.

A client sustained a radial fracture and a cast was just applied. The client states that there is unrelieved pain and numbness in the fingers on the affected side. Which intervention should be a ​priority? A. Notifying the healthcare provider for cast removal B. Elevating the extremity C. Preparing for fasciotomy D. Performing frequent neurovascular checks

A. Notifying the healthcare provider for cast removal

The nurse is performing a medical history and physical assessment on an older client. Which common findings in the older client are related to the musculoskeletal system? (Select all that apply.) a. Decrease in bone density b. Decrease in falls due to lack of activity c. Atrophy of the muscle tissue d. Decrease in bone prominence e. Degeneration of cartilage f. Reduced range of motion of the joints

ANS: A, C, E, F

A female patient with a long-standing history of rheumatoid arthritis has sought care because of increasing stiffness in her right knee that has culminated in complete fixation of the joint. The nurse would document the presence of which problem?

Ankylosis

The nurse notes that a client with a​ 2-day postoperative internal fixation femur fracture is a current​ two-pack-a-day smoker. Which complication should the nurse expect due to the​ client's smoking​ habit? (Select all that​ apply.) A. Osteomyelitis B. Delayed bone healing C. Higher incidence of infection D. Decreased blood circulation to bone E. Increased bone density

Answer: A, B, C, D

The nurse is performing an admission assessment on an older adult male who has a suspected hip fracture. Which pre-existing situation might be found in the​ client? (Select all that​ apply.) A. Bedridden B. Over the age of 80. C Chronic steroid use D. Wheelchair-bound E. Diabetes

Answer: A, B, D

The nurse who is caring for a client who has a fractured pelvis has determined that the client is experiencing acute pain. Which intervention should the nurse​ implement? (Select all that​ apply.) A. Maintaining strict bedrest until the bone is fused B. Elevating the affected extremity on a pillow C. Playing the​ client's favorite music D. Applying a hot pack to the site of the injury E. Supporting the extremity above and below the fracture site when moving

Answer: B, C, E

Which statement concerning bone fractures is​ correct? (Select all that​ apply.) A. "Bone fractures do not result from low bone​ density." B. ​"Bone fractures may result from repetitive forces or​ twisting." C. ​"A bone fracture can be the direct result of excess pressure in the fibrous membrane or​ fascia." D. "Diseases such as neoplasms do not cause bone​ fractures." E.​"The severity of a bone fracture depends on the force of the action against the bone and bone​ strength."

Answer: B, E

The nurse has identified that a client who sustained an open femoral fracture is at risk for infection. Which intervention should be implemented to prevent​ infection? (Select all that​ apply.) A. Using sterile technique with dressing changes B. Assessing temperature during every shift C. Providing pain medications as indicated D. Assessing the wound for​ size, color, or presence of drainage E. Administering prophylactic antibiotics per order

Answer: D, E

A client newly diagnosed with rheumatoid arthritis is admitted to the hospital with bilateral painful knee and wrist joints. The nurse identifies impaired physical mobility related to painful, swollen joints. What should the nurse teach the client to do during the acute phase of the disease?

Avoid exercises to the involved joints

The nurse is explaining the use of a splint for an ulnar fracture. Which information should be​ included? (Select all that​ apply.) A. At greater risk for compartment syndrome B. May be used as a temporary measure until a cast can be applied C. Easily removed if needed D. Can be adjusted if swelling occurs E. Allows some movement of the joint

B, C, D, E

An adult has rheumatoid arthritis and is taking prednisone. In creating a teaching plan, the nurse will be certain to include which of the following? A. "You should expect to be on corticosteroids for the rest of your life." B. "It will take 3-6 months for you to notice any effect from this medication." C. "Notify your physician of any stomach upset you may have." D. "Avoid bananas and spinach while you are taking this drug."

B. "It will take 3-6 months for you to notice any effect from this medication."

The nurse is caring for a client who had open reduction and internal fixation (ORIF) of the right femur 4 days ago. The client reports intense pain, swelling, tenderness, and warmth at the site, chills, malaise, and has a temperature of 102.2. The nurse concludes that this data is consistent with which of the following? A. Fat embolism B. Compartment syndrome C. Osteomyelitis D. Malunion of the bone

C. Osteomyelitis

In assessing the client with osteomyelitis, the nurse would expect to find which of the following? A. pale, cool, tender skin at site. B. Decreased white blood cell count. C. Positive wound culture. D. Decreased erythrocyte sedimentation rate.

C. Positive wound culture.

A client who is diagnosed as having a herniated nucleus pulposus complains of pain. The nurse concludes that the pain is caused by the:

Compression of the spinal cord by the extruded nucleus pulposus

Alendronate (Fosamax) is ordered for a client with osteoporosis. Which information should the nurse include in teaching the client about this drug? A. It is a selective estrogen receptor modulator. B. It increases bone mass. C. It may be obtained as a nasal spray. D. It prevents bone resorption and is taken orally.

D. It prevents bone resorption and is taken orally.

What should the nurse consider as the goal of therapy when administering allopurinol (Zyloprim) to a client with gout?

Decrease uric acid production

What instructions should the nurse provide to a client after a long leg cast is removed?

Elevate the extremity when sitting.

The nurse is caring for a client who has sustained blunt trauma to the forearm. The nurse assesses the client for which early sign of compartment syndrome?

Escalating pain in the fingers

A client who is to have a total hip arthroplasty with an uncemented prosthesis asks, "When will I be able to get up and walk?" On what information should the nurse base an answer?

Full weight-bearing may begin the day after surgery.

A nurse teaches self-care to a client who had a cast applied for a fracture of the right ulna and radius. The nurse instructs the client to notify the primary health care provider immediately if the client experiences

Increasing pain at the injury site

In reviewing bone remodeling, what should the nurse know about the involvement of bone cells?

Osteoblasts deposit new bone.

A client has a compound fracture of the femur. The nurse should assess the client for the typical signs and symptoms of a fat embolus. In comparison to thromboembolism, which clinical indicator is unique to a fat embolus?

Pinpoint red spots on the chest

A nurse is caring for a client with a spinal cord injury. Which is the specific reason why fluid intake should be increased for this client?

Prevent a urinary tract infection

The nurse is caring for a client who had an above knee amputation 2 days ago. The residual limb was wrapped with an elastic compression bandage, which has come off. Which immediate action should the nurse take?

Rewrap the residual limb with an elastic compression bandage.

When providing discharge teaching to a client who had a total hip replacement, the nurse should instruct the client to avoid:

Sitting in a low chair

A client has rotator cuff surgery. What should be included when the nurse performs a neurovascular assessment of the affected extremity immediately after surgery? (Select all that apply.) 1. Pulse rate 2. Skin color 3. Presence of edema 4. Movement of the hand 5. Sensations in the extremity

Skin color Movement of the hand Sensations in the extremity

A client has rotator cuff surgery. What should be included when the nurse performs a neurovascular assessment of the affected extremity immediately after surgery?

Skin color, movement of hand, sensation in extremity

The nurse is caring for a client with prostate cancer. Which laboratory finding indicates to the nurse that the cancer has metastasized to the bone? a. Serum calcium, 21.6 mg/dL b. Creatine kinase, 55 U/mL c. Alkaline d. Lactate dehydrogenase, 120 U/L

a. Serum calcium, 21.6 mg/dL

A 57-year-old postmenopausal woman is scheduled for dual-energy x-ray absorptiometry (DXA). Which statement, if made by the patient to the nurse, indicates understanding of the procedure? a. "The bone density in my heel will be measured." b. "This procedure will not cause any pain or discomfort." c. "I will not be exposed to any radiation during the procedure." d. "I will need to remove my hearing aids before the procedure."

b. "This procedure will not cause any pain or discomfort."

An occupational therapist is treating a client with rheumatoid arthritis. Which assessment finding in the client does the nurse share with the occupational therapist? a. Difficulty sleeping because of pain in the knees and elbows b. Difficulty tying shoelaces and doing zippers on clothing c. Swollen knees with crepitus and limited range of motion d. Generalized joint stiffness that is worse in the early morning

b. Difficulty tying shoelaces and doing zippers on clothing

The home care nurse visits an 84-year-old woman with pneumonia after her discharge from the hospital. Which assessment finding would the nurse expect because of age-related changes in the musculoskeletal system? a. Positive straight-leg-raising test b. Muscle strength is scale grade 3/5 c. Lateral S-shaped curvature of the spine d. Fingers drift to the ulnar side of the forearm

b. Muscle strength is scale grade 3/5

The nurse is assessing a client who reports severe knee pain after a fall. Which question does the nurse ask to determine the radiation of the pain? a. "What makes the pain better or worse?" b. "Are you able to bear any weight on the knee at all?" c. "Does the pain move to another area from your knee?" d. "How would you rate the pain on a scale of 1 to 10?"

c. "Does the pain move to another area from your knee?"

The increased risk for falls in the older adult is most likely due to

changes in balance.

A patient with tendonitis asks what the tendon does. The nurse's response is based on the knowledge that tendons

connect bone to muscle.

An 82-year-old patient is frustrated by her flabby belly and rigid hips. What should the nurse tell the patient about these frustrations?

d. "Decreased muscle mass and strength and increased hip rigidity are normal changes of aging."

Which instruction does the nurse give to the client before he or she has electromyography (EMG)? a. "Make sure that you have someone to drive you home after the test." b. "Do not eat or drink anything for at least 6 hours before the test." c. "You will have to avoid heavy lifting for 24 hours following the test." d. "Do not take your cyclobenzaprine (Flexeril) on the 2 days before the test."

d. "Do not take your cyclobenzaprine (Flexeril) on the 2 days before the test."

A patient is scheduled for an electromyogram (EMG). The nurse explains that this diagnostic test involves

insertion of small needles into certain muscles.

The bone cells that function in the resorption of bone tissue are called

osteoclasts.