Passpoint - Musculoskeletal Disorders

The nurse is caring for a client with acute osteomyelitis in the right tibia. Which action is best when repositioning the client's leg? 1. Have the client move the leg by themself to decrease pain. 2. Support the leg above and below the affected area when positioning. 3. Apply warm, moist compresses to the leg before repositioning. 4. Hold the leg by the ankle when repositioning to avoid touching the tibia.

2. Support the leg above and below the affected area when positioning.

A client had a cast applied to the left femur to stabilize a fracture. To promote early rehabilitation, what should the nurse do? 1. Call the physical therapy team to provide passive exercise of the affected limb. 2. Teach the client how to do isometric exercises of the quadriceps. 3. Obtain weights so the client can exercise the upper extremities. 4. Show the family how to do active range-of-motion exercises of the unaffected limb.

2. Teach the client how to do isometric exercises of the quadriceps.

To assess the joints, a nurse asks a client to perform various movements. As the client moves their arm away from the midline, the nurse evaluates their ability to perform 1. protraction. 2. abduction. 3. retraction. 4. adduction.

2. abduction.

A nurse is caring for a client placed in traction to treat a fractured femur. Which nursing intervention has the highest priority? 1. assessing the extremity for neurovascular integrity 2. keeping the client from sliding to the foot of the bed 3. keeping the ropes over the center of the pulley 4. ensuring that the weights hang free at all times

1. assessing the extremity for neurovascular integrity

Which activity should the nurse teach the client to do to strengthen the hand muscles in preparation for using crutches? 1. squeezing a rubber ball 2. combing the hair 3. pushing the hands into the mattress while raising the body in bed 4. flexing and extending the wrists

1. squeezing a rubber ball

A client is diagnosed with gout. Which foods should the nurse instruct the client to eat? Select all that apply. 1. strawberries 2. eggs 3. liver 4. sardines 5. green, leafy vegetables 6. cod

1. strawberries 2. eggs 5. green, leafy vegetables

A client diagnosed with arthritis doesn't want to take medications. Physical therapy and occupational therapy have been consulted for nonpharmacologic measures to control pain. What might physical and occupational therapy include in the care plan to help control this client's pain? 1. acupuncture 2. an exercise routine that includes range-of-motion (ROM) exercises 3. heat therapy and nonsteroidal anti-inflammatory medications (NSAIDs) 4. cold therapy

2. an exercise routine that includes range-of-motion (ROM) exercises

A client is admitted with a possible diagnosis of osteomyelitis. Based on the documentation, which laboratory result is the priority for the nurse to report to the physician? 1. alkaline phosphatase 2. blood culture 3. rheumatoid factor 4. ESR

2. blood culture

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? 1. 100 milliliters of red drainage in the closed drainage system 2. client anxious and confused 3. pitting edema of the right hip 4. capillary refill of the right lower extremity of 2-3 seconds

2. client anxious and confused

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: 1. excessive sunlight exposure, adequate calcium intake, and lactose intolerance 2. heavy smoking, sedentary lifestyle, and high intake of carbonated drinks 3. diet deficient in vegetables and fruits, high intake of red meats, and increased alcohol intake 4. regular exercise, low fat intake, and recurrent trauma to the bones through increased weight-bearing activities

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

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? 1. "Don't worry. Your new hip is very strong." 2. "Activities that tend to cause adduction of the hip tend to cause dislocation, so try to avoid them." 3. "Decreasing use of the abductor pillow will strengthen the muscles to prevent dislocation." 4. "Using a cushioned toilet seat helps prevent dislocation."

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

The nurse is assessing a client with a fracture of the right femur for signs of complications. Which finding indicates the client may be developing a fat embolus? 1. muscle spasms in the right thigh 2. acute respiratory distress syndrome 3. numbness in the right leg 4. migraine-like headaches

2. acute respiratory distress syndrome

The nurse is assisting a client who has had a spinal fusion apply a back brace. In which order of priority from first to last should the nurse assist the client applying the brace? All options must be used. 1 Ask the client to stand with their arms held away from their body. 2 Assist the client to log roll and rise to a sitting position. 3 Verify the prescriptions for the settings for the brace. 4 Have the client in a side-lying position.

3 Verify the prescriptions for the settings for the brace. 4 Have the client in a side-lying position. 2 Assist the client to log roll and rise to a sitting position. 1 Ask the client to stand with their arms held away from their body.

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? 1. applies powder to the residual limb 2. removes the prosthesis whenever he sits down 3. washes and dries the residual limb daily 4. inspects the residual limb weekly with a mirror

3. washes and dries the residual limb daily

The nurse is positioning a client who had a hip replacement. To prevent external rotation of the client's hips while lying on the back, it would be best for the nurse to place the client in which position? 1. a footboard that supports the feet in the normal anatomic position 2. firm pillows under the length of the legs 3. sandbags alongside the legs from knees to ankles 4. trochanter rolls alongside the legs from ilium to midthigh

4. trochanter rolls alongside the legs from ilium to midthigh

During a routine physical examination on a 75-year-old female client, a nurse notes that the client is 5 feet, 3/8 inches (1.6 m) tall. The client states, "How is that possible? I was always 5 feet and 1/2 inches (1.7 m) tall." Which statement is the best response by the nurse? 1. "The posture begins to stoop after middle age." 2. "After age 40, height may show a gradual decrease as a result of spinal compression." 3. "There may be some slight discrepancy between the measuring tools used." 4. "After menopause, the body's bone density declines, resulting in a gradual loss of height."

4. "After menopause, the body's bone density declines, resulting in a gradual loss of height."

A client has a total hip replacement. Which of the following client statements indicates a need for further teaching before discharge? 1. "I will implement the exercise program as soon as I get home." 2. "I will need an elevated toilet seat." 3. "I will be careful not to cross my legs." 4. "I can't wait to take a tub bath when I get home."

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

A client has a C7 spinal cord injury. Which would be the most important nursing intervention during the acute stage of the injury? 1. Maintain proper alignment. 2. Turn and reposition every 2 hours. 3. Monitor vital signs. 4. Maintain a patent airway.

4. Maintain a patent airway.

The nurse in the emergency department (ED) is caring for a 36-year-old client being seen for dizziness, fast heart rate, and dark red-brown urine after completing a marathon earlier in the day.

Condition - Rhabdomyolysis Actions - Anticipate an order for IV normal saline and an order for sodium bicarbonate. Parameters - serum creatinine and serum potassium

A client asks the nurse what the difference is between osteoarthritis (OA) and rheumatoid arthritis (RA). Which response is correct? 1. "OA affects joints on both sides of the body. RA is usually unilateral." 2. "OA is more common in women. RA is more common in men." 3. "OA is a noninflammatory joint disease. RA is characterized by inflamed, swollen joints." 4. "OA and RA are very similar. OA affects the smaller joints and RA affects the larger, weight-bearing joints."

3. "OA is a noninflammatory joint disease. RA is characterized by inflamed, swollen joints."

A client is hospitalized for open reduction of a fractured femur. During the postoperative assessment, the nurse notes that the client is restless and observes petechiae on the client's chest. Which nursing action is indicated first? 1. Elevate the affected extremity. 2. Contact the nursing supervisor. 3. Administer oxygen. 4. Contact the physician.

3. Administer oxygen.

A client is admitted to undergo lumbar laminectomy for treatment of a herniated disk. Which action should the nurse take first to promote comfort preoperatively? 1. Provide teaching on nonpharmacologic measures to control pain. 2. Help the client assume a more comfortable position. 3. Notify the physician of the client's pain. 4. Administer hydrocodone as ordered.

2. Help the client assume a more comfortable position.

The nurse is setting goals with a client with rheumatoid arthritis. Which is a priority goal for the client? 1. Minimize the frequency with which antiinflammatory drugs are used to control joint discomfort. 2. Demonstrate the use of adaptive equipment. 3. Verbalize that recovery from rheumatoid arthritis will require several years of treatment. 4. Learn to limit activity so as to avoid joint pain.

2. Demonstrate the use of adaptive equipment.

A client is admitted to the hospital with a diagnosis of a right hip fracture. The client has right hip pain and cannot move the right leg. The nurse should further assess the right leg to determine if the leg is in which position? 1. shorter than the leg on the unaffected side 2. held in a flexed position 3. rotated internally 4. adducted

1. shorter than the leg on the unaffected side

An older adult with a hip fracture is to use an alternating air pressure mattress at home to prevent pressure ulcers while recovering from surgery. The nurse is showing the client's family how to place the mattress (see below). What should the nurse instruct the family to do? 1. Put a thick pad over the pressure mattress to prevent soiling, and place the bedsheet on top of the pad. 2. Make the bed with the bedsheet on top of the pressure mattress. 3. Place the sheet on the bed, and then remove the pillow to allow full use of the mattress on the neck. 4. Turn the mattress over so the air cells face the mattress of the bed, and cover the mattress with a bedsheet.

2. Make the bed with the bedsheet on top of the pressure mattress.

A client in balanced suspension traction is transported to surgery for closed reduction and internal fixation of a fractured femur. What should the nurse do when transporting the client to the operating room? 1. Call the surgeon to request a prescription to temporarily remove the traction. 2. Transfer the client to a cart with manually suspended traction. 3. Remove the traction, and send the client on a cart. 4. Send the client on the bed with extra help to stabilize the traction.

4. Send the client on the bed with extra help to stabilize the traction.

A client is receiving nonsteroidal antiinflammatory drugs (NSAIDs) to manage the pain of rheumatoid arthritis. What information should the nurse give to the client about taking these medications? 1. Take NSAIDs only when experiencing pain. 2. Perform joint exercises before taking the next dose of the medication. 3. Take antacids 1 hour after taking NSAIDs. 4. Take NSAIDs with food.

4. Take NSAIDs with food.

The nurse is teaching the client to prevent back injury. What should the nurse instruct the client to do? 1. Avoid prolonged sitting and standing. 2. Pull objects rather than push them. 3. Sleep on a soft mattress. 4. Sit in chairs with soft cushions.

1. Avoid prolonged sitting and standing.

A nurse is assessing a client with possible osteoarthritis. The most significant risk factor for primary osteoarthritis is 1. trauma. 2. age. 3. obesity. 4. congenital deformity.

2. age.

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? 1. "Apply ice packs for the first 24 to 48 hours, then apply heat packs." 2. "Apply heat packs for the first 24 to 48 hours." 3. "Apply ice packs for the first 12 to 18 hours." 4. "Apply heat packs for the first 24 hours, then apply ice packs for the next 48 hours."

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

To reduce the incidence of complications in a client in traction, which intervention should be included in the care plan? 1. Increase fiber intake. 2. Remove the weights during linen changes. 3. Increase calorie intake. 4. Reduce fluid intake.

1. Increase fiber intake.

A nurse is teaching a client who was recently diagnosed with carpal tunnel syndrome. Which statement should the nurse include? 1. "This condition is associated with various sports." 2. "Surgery is the only sure way to manage this condition." 3. "Using arm splints will prevent hyperflexion of the wrist." 4. "Ergonomic changes can be incorporated into your workday to reduce stress on your wrist."

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

Which statement by a client with rheumatoid arthritis would indicate the need for additional teaching to safely receive the maximum benefit of aspirin therapy? 1. "I always watch for bleeding gums or blood in my stool." 2. "I always take aspirin with food to protect my stomach." 3. "Once I learned to take my aspirin with meals, I was able to start using the inexpensive generic brand." 4. "I try to take aspirin only on days when the pain seems particularly bad."

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

The client returns from surgery for a below-the-knee amputation with the residual limb covered with dressings and a woven elastic bandage. At first, the bandage was dry. Now, 30 minutes later, the nurse notices a small amount of bloody drainage. What should the nurse do first? 1. Mark the area of drainage. 2. Change the dressing. 3. Notify the health care provider. 4. Reinforce the dressing.

1. Mark the area of drainage.

The nurse is providing discharge instructions to a client with a leg cast. Which teaching point is most critical? 1. Report changes in sensation such as numbness or tingling. 2. Exercise the joints above and below the cast, as prescribed. 3. Do not put pressure on the axilla when using crutches. 4. Avoid walking on the cast without the healthcare provider's permission.

1. Report changes in sensation such as numbness or tingling.

A diet plan is developed for a client with gouty arthritis. The nurse should advise the client to limit his intake of 1. organ meats. 2. green vegetables. 3. fresh fish. 4. citrus fruits.

1. organ meats.

A client is experiencing an acute exacerbation of rheumatoid arthritis. What should the nursing priority be? 1. supplying adaptive devices, such as a zipper-pull, easy-to-open beverage cartons, lightweight cups, and unpackaged silverware 2. performing meticulous skin care 3. administering ordered analgesics and monitoring their effects 4. providing comprehensive client teaching including symptoms of the disorder, treatment options, and expected outcomes

3. administering ordered analgesics and monitoring their effects

The nurse is caring for an older adult who has hip pain related to rheumatoid arthritis. The client is practicing appropriate self-care activities when the client chooses to sit in which type of chair? 1. curved-back rocking chair 2. recliner chair with arms to support wrists and hands 3. straight-back chair with elevated seat 4. couch with soft cushions to support thighs

3. straight-back chair with elevated seat

The nurse is planning care for a client having an above-the-knee amputation of the left leg. At which time should the nurse recommend exercising of the remaining left limb? 1. when the client feels ready to exercise 2. after admission to the rehabilitation center 3. 8 hours after the surgery occurs 4. 24 hours after the surgery

4. 24 hours after the surgery

The nurse is planning care with an older adult who is at risk for falling because of postural hypotension. Which intervention will be most effective in preventing falls in this client? 1. Encourage a family member to stay with the client. 2. Complete a fall diary. 3. Attach a sensor to the client that will alarm when the client attempts to get up. 4. Instruct the client to sit, obtain balance, dangle their legs, and rise slowly.

4. Instruct the client to sit, obtain balance, dangle their legs, and rise slowly.

An older adult is being admitted to the hospital after falling from a 6- foot ladder. Which information is essential for the nurse to obtain at this time? Select all that apply. 1. activity at the time of the fall 2. location of the fall 3. time of the fall 4. who was present at the time of the fall 5. trauma after the fall 6. history of a previous fall 7. symptoms at the time of the fall

1. activity at the time of the fall 2. location of the fall 3. time of the fall 5. trauma after the fall 6. history of a previous fall 7. symptoms at the time of the fall

The nurse is planning care for a client with osteomyelitis. The client is taking an antibiotic, but the infection has not resolved. What should the nurse advise the client to do? 1. Ask the health care provider for a change of antibiotics. 2. Eat a diet high in protein and vitamins C and D. 3. Encourage frequent passive range of motion to the affected extremity. 4. Use herbal supplements.

2. Eat a diet high in protein and vitamins C and D.

A client in the surgical intensive care unit has skeletal tongs in place to stabilize a cervical fracture. Protocol dictates that pin care should be performed each shift. When providing pin care for the client, which finding should the nurse report to the physician? 1. a small amount of yellow drainage at the left pin insertion site 2. a slight reddening of the skin surrounding the insertion site 3. crust around the pin insertion site 4. pain at the insertion site

1. a small amount of yellow drainage at the left pin insertion site

A nurse is assisting a client with range-of-motion exercises. The nurse moves the client's leg out and away from the midline of the body. What movement does the nurse document? 1. abduction 2. supination 3. adduction 4. pronation

1. abduction

The nurse is providing teaching for a client being discharged after a fiberglass cast application for a fractured tibia. Which statement by the client indicates need for further teaching? 1. "I can shower with the cast as long as I keep it well covered." 2. "I should be able to freely wiggle my toes while in the cast." 3. "Hot, painful, areas on the cast are normal and can be treated with ice packs." 4. "Pain at the fracture site and a small amount of swelling is to be expected."

3. "Hot, painful, areas on the cast are normal and can be treated with ice packs."

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? 1. "Bunions are congenital and can't be prevented." 2. "Bunions may result from wearing shoes that are too big, causing friction when the shoes slip back and forth." 3. "Some bunions are congenital; others are caused by wearing shoes that are too short or narrow." 4. "Bunions are caused by a metabolic condition called gout."

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

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? 1. Reduce unnecessary activity and walking by homeschooling the child with the disorder. 2. Encourage the child with the disorder to run and play as able to expend energy and strengthen muscles. 3. Schedule the completion of daily range-of-motion exercises to support joint mobility. 4. Encourage participation in group sports to enhance growth and development of muscles and bones.

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

The nurse is caring for a client with a fractured fibula who has skeletal traction and skeletal pins. What would the nurse instruct the unlicensed assistive personnel (UAP) to report immediately? 1. There is a small amount of clear fluid at the pin sites. 2. The client is reporting pain and muscle spasm. 3. The traction weights are resting on the floor. 4. The client wants to change position.

3. The traction weights are resting on the floor.

A client, age 50, visits the physician for a routine checkup. The history reveals that the client was diagnosed with a spinal curvature at age 45. The nurse knows that life-threatening complications can occur if the progressive spinal curvature exceeds 65 degrees. Which region of the spine should the nurse assess for complications? 1. Sacral 2. Lumbar 3. Thoracic 4. Cervical

3. Thoracic

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? 1. tetracyclines 2. cephalosporins 3. aminoglycosides 4. erythromycin

2. cephalosporins

The nurse is preparing a primary prevention program to reduce the incidence of osteoporosis in a population. For which risk factors will the nurse screen to identify the subgroup of the population who is at greatest risk for developing osteoporosis? 1. postmenopausal women who are inactive 2. postmenopausal women who are overweight 3. older men and women who are active smokers 4. women who are diagnosed as hypothyroid

1. postmenopausal women who are inactive

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? 1. Elevate the head of the bed to 90 degrees. 2. Discourage the client from doing any range-of-motion (ROM) exercises. 3. Have the client sit up in a chair as much as possible. 4. Logroll the client from side to side.

4. Logroll the client from side to side.

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? 1. inability of the client to move the fingers on their right hand 2. the client is feeling heat from the plaster cast 3. results of hourly neurovascular assessments 4. intake and output record for the shift

1. inability of the client to move the fingers on their right hand

A nurse is caring for a client placed in traction to treat a fractured femur. Which nursing intervention has the highest priority? 1. assessing the extremity for neurovascular integrity 2. keeping the client from sliding to the foot of the bed 3. ensuring that the weights hang free at all times 4. keeping the ropes over the center of the pulley

1. assessing the extremity for neurovascular integrity

A client with a hip fracture has undergone surgery for the insertion of a femoral head prosthesis. Which activity should the nurse instruct the client to avoid? 1. crossing the legs while sitting down 2. sitting on a raised commode seat 3. using an abductor splint while lying on the side 4. rising straight from a chair to a standing position

1. crossing the legs while sitting down

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? 1. "Ten to 15 minutes per application is the maximum time for cold applications." 2. "Heat-producing liniments can be used with other heat devices." 3. "With heat, I should apply it for no longer than 20 minutes at a time." 4. "I can use heat and cold as often as I want."

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

A client is diagnosed with osteoporosis. Which statements would the nurse include when teaching the client about the disease? Select all that apply. 1. Daily medication is needed to cure the disease. 2. Osteoporosis can cause pain and injury. 3. Passive ROM exercises can promote bone growth. 4. Osteoporosis is common in females after menopause. 5. Osteoporosis is a degenerative disease characterized by a decrease in bone density. 6. Limit weight bearing and repetitive exercises.

2. Osteoporosis can cause pain and injury. 4. Osteoporosis is common in females after menopause. 5. Osteoporosis is a degenerative disease characterized by a decrease in bone density.

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: 1. reaction time. 2. motor coordination. 3. visual acuity. 4. level of comprehension.

2. motor coordination.

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? 1. a 55-year-old client who is 6 feet (180 cm) tall and weighs 180 lb (81.7 kg) 2. a 90-year-old who lives alone 3. a 74-year-old who has periodontal disease with periodontitis 4. a 75-year-old who has asthma and uses an inhaler

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

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? 1. "Turn the client every 2 hours to promote even drying of the cast." 2. "Keep the cast covered with a sheet to protect it while drying." 3. "Carefully use your fingers to lift the cast and reposition the legs." 4. "Use a blow dryer on the cast for 15 minutes every 2 hours until the cast is dry."

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

What is the most important assessment for the nurse to make when assessing peripheral pulses on a client who is post limb fracture? 1. strong contractility and rate of only the unaffected limb 2. amplitude and symmetry of both extremities 3. local temperature and visible pulsations 4. color of the skin and rhythm above the affected fracture site

2. amplitude and symmetry of both extremities

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? 1. pulmonary embolus 2. osteomyelitis 3. fat embolus 4. urinary tract infection

2. osteomyelitis