Musculoskeletal

The nurse is assigned to care for a client in traction. The nurse creates a plan of care for the client and should include which action in the plan? 1.Ensure that the knots are at the pulleys. 2.Check the weights to ensure that they are off of the floor. 3.Ensure that the head of the bed is kept at a 45- to 90-degree angle. 4.Monitor the weights to ensure that they are resting on a firm surface.

2.Check the weights to ensure that they are off of the floor.

The nurse is caring for a client who was just admitted to the hospital with a diagnosis of a fractured right hip sustained from a fall 5 hours earlier. The nurse creates a plan of care for the client and includes interventions related to monitoring for signs of fat embolism. Which findings should be listed in the care plan as a sign/symptom of fat embolism? 1.Fever and chills 2.Dyspnea and chest pain 3.External rotation of the right leg 4.Pallor, paresthesia, and pulselessness of the right lower leg

2.Dyspnea and chest pain

The nurse is caring for a client in skeletal traction. On assessing the pin sites, the nurse notes the presence of purulent drainage. Which nursing action is most appropriate? 1.Document the findings. 2.Notify the health care provider. 3.Apply antibiotic ointment to the pin sites. 4.Clean the pin sites more frequently than prescribed.

2.Notify the health care provider.

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 earliest symptom of compartment syndrome is paresthesia (numbness and tingling in the fingers). Other symptoms include pain unrelieved by opioids, pain that increases with limb elevation, and pallor and coolness to the distal limb. Cyanosis is a late sign.

A client with a fractured femur experiences sudden dyspnea, tachypnea, and tachycardia. A set of arterial blood gas tests reveals the following: pH, 7.35 (7.35); Paco2, 43 mm Hg (43 mm Hg); Pao2, 58 mm Hg (58 mm Hg); HCO3, 23 mEq/L (23 mmol/L). The nurse interprets that the client probably has experienced fat embolus because of the result of which parameter? 1.pH 2.Pao2 3.HCO3 4.Paco2

2.Pao2

The nurse is creating a plan of care for a client in skin traction. The nurse should monitor for which priority finding in this client? 1.Urinary incontinence 2.Signs of skin breakdown 3.The presence of bowel sounds 4.Signs of infection around the pin sites

2.Signs of skin breakdown

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 (2.25 mmol/L) 2.Uric acid level of 9.0 mg/dL (0.54 mmol/L) 3.Potassium level of 4.1 mEq/L (4.1 mmol/L) 4.Phosphorus level of 3.1 mg/dL (1.0 mmol/L)

2.Uric acid level of 9.0 mg/dL (0.54 mmol/L)

The nurse is planning discharge teaching for a client diagnosed and treated for compartment syndrome. Which information should the nurse include in the teaching? 1."A bone fragment has injured the nerve supply in the area." 2."An injured artery caused impaired arterial perfusion through the compartment." 3."Bleeding and swelling caused increased pressure in an area that couldn't expand." 4."The fascia expanded with injury, causing pressure on underlying nerves and muscles."

3."Bleeding and swelling caused increased pressure in an area that couldn't expand." Compartment syndrome is caused by bleeding and swelling within a tissue compartment that is lined by fascia, which does not expand.

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 is the priority nursing action? 1.Provide pin care. 2.Medicate the client. 3.Call the health care provider. 4.Remove 2 pounds (0.9 kg) of weight from the traction system.

3.Call the health care provider. Severe pain in a client in skeletal traction may indicate a need for realignment, or the traction weights applied to the limb may be too heavy. The nurse realigns the client. If this measure is ineffective, the nurse then calls the health care provider.

The nurse is caring for a client with osteoarthritis. The nurse performs an assessment knowing that which clinical manifestations are associated with the disorder? Select all that apply. 1.Elevated white blood cell count 2.A decreased sedimentation rate 3.Joint pain that diminishes after rest 4.Elevated antinuclear antibody levels 5.Joint pain that intensifies with activity

3.Joint pain that diminishes after rest 5.Joint pain that intensifies with activity

A client has undergone fasciotomy to treat compartment syndrome of the leg. The nurse should anticipate that which type of wound care to the fasciotomy site will be prescribed? 1.Dry sterile dressings 2.Hydrocolloid dressings 3.Moist sterile saline dressings 4.One-half strength povidone-iodine dressings

3.Moist sterile saline dressings The fasciotomy site is not sutured but is left open to relieve pressure and edema. The site is covered with moist sterile saline dressings.

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 clinic nurse is performing an assessment on a client with a diagnosis of rheumatoid arthritis (RA). The nurse checks for which assessment finding that is associated with RA? 1.Age of onset is generally 65 years of age or older 2.Complaints of pain that is more severe after activity 3.Systemic symptoms such as fatigue, anorexia, and weight loss 4.Joint pain is asymmetrical and associated with past injuries to the joint

3.Systemic symptoms such as fatigue, anorexia, and weight loss

A client with a hip fracture asks the nurse about Buck's (extension) traction that is being applied before surgery and what is involved. The nurse should provide which information to the client? 1. Allows bony healing to begin before surgery and involves pins and screws 2. Provides rigid immobilization of the fracture site and involves pulleys and wheels 3. Lengthens the fractured leg to prevent severing of blood vessels and involves pins and screws 4. Provides comfort by reducing muscle spasms, provides fracture immobilization, and involves pulleys and wheels

4. Provides comfort by reducing muscle spasms, provides fracture immobilization, and involves pulleys and wheels Buck's (extension) traction is a type of skin traction often applied after hip fracture before the fracture is reduced in surgery. Traction reduces muscle spasms and helps to immobilize the fracture

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 runs 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 cigarettes

A client has been diagnosed with gout, and the nurse provides dietary instructions. The nurse determines that the client needs additional teaching if the client states that it is acceptable to eat which food? 1.Carrots 2.Tapioca 3.Chocolate 4.Chicken liver

4.Chicken liver

The nurse is admitting a client with multiple trauma injuries 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.Elevated for 3 hours, then flat for 1 hour 2.Flat for 3 hours, then elevated for 1 hour 3.Flat for 12 hours, then elevated for 12 hours 4.Elevated on pillows continuously for 24 to 48 hours

4.Elevated on pillows continuously for 24 to 48 hours A casted extremity is elevated continuously for the first 24 to 48 hours to minimize swelling and promote venous drainage.

The nurse witnesses a client sustain a fall and suspects that the right leg may be broken. The nurse should take which priority action? 1.Take a set of vital signs. 2.Call the radiology department. 3.Reassure the client that everything will be fine. 4.Immobilize the right leg before moving the client.

4.Immobilize the right leg before moving the client.

The nurse is caring for a client with a long bone fracture at risk for fat embolism. The nurse specifically monitors for the earliest signs of this complication by performing an assessment of which item(s)? 1.The client's mobility status 2.The renal and endocrine systems 3.The cardiovascular and renal systems 4.The neurological and respiratory systems

4.The neurological and respiratory systems

The nurse has provided discharge instructions to a client after a total hip replacement. Which statement by the client indicates a need for further instruction? 1."I should sit in my recliner when I get home." 2."I need to keep my legs apart while sitting or lying." 3."I should try to obtain an elevated toilet seat for use at home." 4."I should contact the health care provider if the incision becomes red or irritated or if I note any drainage."

1."I should sit in my recliner when I get home."

The nurse is preparing to perform pin site care for a client in skeletal traction. On assessment of the pin site, the nurse notes the presence of serous drainage. Which nursing action would be appropriate? 1.Document the findings. 2.Notify the health care provider (HCP). 3.Remove 2 pounds (0.9 kg) of weight from the traction. 4.Lift the weights and place them on the bed so that the HCP can assess the client.

1.Document the findings. A small amount of serous oozing is expected at the pin insertion site. The nurse would document the findings.

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 has skeletal traction applied to the right leg and has an overhead trapeze available for use. The nurse should assess which area as high risk for pressure and breakdown? 1.Left heel 2.Scapulae 3.Right heel 4.Back of the head

1.Left heel Common areas that are under pressure and are at risk for breakdown include the elbows (if they are used for repositioning instead of a trapeze) and the heel of the good leg (which is used as a brace when pushing up in bed). The right heel is elevated because of traction.

The nurse is lecturing to a group of women who are at high risk for osteoporosis. The nurse should inform the women about which most important measure? 1.Limit caffeine intake. 2.Limit intake of vitamin D. 3.Limit participation in activities such as walking and swimming. 4.Limit protein in the diet because it contributes to the incidence of bone demineralization.

1.Limit caffeine intake.

The home health nurse visits a client who is having an acute attack of gout. The nurse determines that the client needs further instruction regarding the treatment of gout if the client states to take which action? 1.Restricting fluids 2.Maintaining bed rest 3.Eating a low-purine diet 4.Taking nonsteroidal antiinflammatory drugs

1.Restricting fluids Ample fluid intake is encouraged to promote the excretion of uric acid.

After becoming incontinent of urine, an older client is admitted to a nursing home. The client's rheumatoid arthritis contributes to severely painful joints. Which need is the primary consideration in the care of this client? A. Control of pain B. Immobilization of joints C. Motivation and teaching D. Bladder training and control

A. Control of pain After the need to survive (air, food, water), the need for comfort and freedom from pain closely follow; care should be given in order of the client's basic needs. Joints must be exercised, not immobilized, to prevent stiffness, contractures, and muscle atrophy. Motivation and learning will not occur unless basic needs, such as freedom from pain, are met. Although bladder training should be included in care, it is not the priority when the client is in pain.

A client falls at home and is brought to the emergency department by family members. The client reports intercostal pain and is confused and disoriented. Which is the best way for the nurse to determine whether this behavior is new for the client? A. Interview the client to identify when the confusion started. B. Question the family members about the client's usual behavior. C. Ask the primary healthcare provider when the confusion was noted first. D. Observe the client for a few hours before determining the onset of confusion.

B. Question the family members about the client's usual behavior. Family members usually know the client's behavior and serve as important sources of information when a client is confused.

Three days after a cast is applied to a client's fractured tibia, the client reports that there is a burning pain over the ankle. The cast over the ankle feels warm to the touch, and the pain is not relieved when the client changes position. What is the nurse's priority action? A. Obtain a prescription for an antibiotic. B. Report the client's concern to the primary healthcare provider. C. Administer the prescribed medication for pain. D. Explain that this is typical after a cast is applied.

B. Report the client's concern to the primary healthcare provider.

A client has had a below-the-knee amputation of the leg. What is important for the nurse to consider when providing postoperative care for a client who had an amputation of a lower extremity? A. Strict bed rest is maintained for at least several days. B. The residual limb should not be elevated for the first 24 hours. C. Hemorrhage rarely occurs during the early postoperative period. D. Primary healthcare providers usually change the dressing on the residual limb within 48 hours.

B. The residual limb should not be elevated for the first 24 hours. Elevation of the residual limb helps prevent edema; however, should not be done on the first 24 hours and continued elevation may lead to hip contractures.

When providing discharge teaching to a client who had a total hip replacement, what should the nurse instruct the client to avoid? A. Climbing stairs B. Stretching exercises C. Sitting in a low chair D. Lying prone for more than 15 minutes

C. Sitting in a low chair Excessive flexion of the hip can cause dislocation of the femoral head. Climbing stairs should not cause undue strain on the operative site. Stretching exercises should be encouraged as long as no extremes of position are implemented. The client is permitted to lie prone for more than 15 minutes; lying prone should be encouraged because it prevents hip flexion contractures.

A client's tibia is fractured in a motor vehicle accident, and a cast is applied. The nurse should assess for which manifestation indicating damage to major blood vessels caused by the fractured tibia? A. Increased blood pressure B. Prolonged edema in the thigh C. Increased skin temperature of the foot D. Prolonged reperfusion of the toes after blanching

D. Prolonged reperfusion of the toes after blanching Damage to the blood vessels may decrease circulatory perfusion of the toes. Damage to the major blood vessels will more likely cause a decrease in blood pressure. The fracture is between the knee and the ankle, not in the thigh. Decreased circulatory perfusion of the foot causes the skin temperature to decrease.

The nurse is caring for a client who is 1 day postoperative for a left hip fracture repair. During the assessment, which finding should the nurse assess further? A. Pain at the surgical site B. Small amount of serosanguinous drainage C. Decreased range of motion to the left extremity D. Sudden shortness of breath

D. Sudden shortness of breath The sudden onset of shortness of breath is indicative of a fat embolism, which can occur after a fracture of the long bones. This is a serious complication that could result in death. It is normal to have pain at the surgical site, a small amount of serosanguinous drainage, and decreased range of motion to the affected extremity.

The nurse is collecting data related to a client's risk factors associated with osteoporosis. Which data should the nurse include? Select all that apply. 1.Thin body build 2.Smoking history 3.Postmenopausal age 4.Chronic corticosteroid use 5.High intake of dairy products 6.Family history of osteoporosis

1.Thin body build 2.Smoking history 3.Postmenopausal age 4.Chronic corticosteroid use 6.Family history of osteoporosis

The nurse witnessed a vehicle hit a pedestrian. The victim is dazed and tries to get up. A leg appears fractured. Which intervention should the nurse take? 1.Try to reduce the fracture manually. 2.Assist the victim to get up and walk to the sidewalk. 3.Leave the victim for a few moments to call an ambulance. 4.Stay with the victim and encourage him or her to remain still.

4.Stay with the victim and encourage him or her to remain still.

The home health nurse is planning to teach a client with osteoporosis about home modifications to reduce the risk of falls. Which recommendations would be necessary to include in the teaching plan? Select all that apply. 1.Use night lights. 2.Remove scatter rugs. 3.Use staircase railings. 4.Remove wall-to-wall carpeting. 5.Place hand rails in the bathroom.

1.Use night lights. 2.Remove scatter rugs. 3.Use staircase railings. 5.Place hand rails in the bathroom.

The community health nurse is providing an educational session for community members regarding dietary measures that will assist in reducing the risk of osteoporosis. The nurse should instruct the community members to increase dietary intake of which food known to be helpful in minimizing this risk? 1.Yogurt 2.Turkey 3.Shellfish 4.Spaghetti

1.Yogurt

The community health nurse is providing a teaching session on osteoporosis to women living in the community. The nurse informs these community residents that which is a risk factor for this disorder? 1.A large skeletal frame 2. A diet low in vitamin D 3.Low thyroid hormone levels 4.A high dietary intake of calcium

2. A diet low in vitamin D

An older client is diagnosed with osteoporosis. The nurse teaches the client about self-care measures, knowing that the client is most at risk for which problem as a result of this disorder of the bones? 1.Anemia 2.Fractures 3.Infection 4.Muscle sprains

2.Fractures

The nurse is evaluating a client in skeletal traction. When evaluating the pin sites, the nurse would be most concerned with which finding? 1.Redness around the pin sites 2.Pain on palpation at the pin sites 3.Thick, yellow drainage from the pin sites 4.Clear, watery drainage from the pin sites

3.Thick, yellow drainage from the pin sites

The nurse has provided instructions to a client with a diagnosis of rheumatoid arthritis about measures to protect the joints. Which statement by the client indicates a need for further instruction? 1."I should slide objects rather than lifting them." 2."I should try not to remain in the same position for a long period of time." 3."I should use large joints instead of small joints when performing activities." 4."Pain or fatigue is expected, and I should try to continue with the activity if this occurs."

4."Pain or fatigue is expected, and I should try to continue with the activity if this occurs." The client should be instructed to use pain or fatigue as an indicator and guide to increase, maintain, or decrease an activity level. If pain or fatigue is experienced, the client should rest.

The nurse is performing an assessment on a client after a closed reduction of a fractured right humerus and application of a plaster cast. To assess for signs of compartment syndrome, the nurse should perform which action? 1.Assess the client's cognitive level. 2.Assess the temperature of the cast. 3.Monitor for the presence of drainage or odors on or beneath the cast. 4.Assess capillary refill, temperature, color, and amount of pain in the right hand.

4.Assess capillary refill, temperature, color, and amount of pain in the right hand.

The nurse provides instructions to a client with bilateral deformities of the joints of the fingers due to rheumatoid arthritis. When providing teaching about the disease process, the nurse should inform the client that the changes are most likely due to what type of response? 1.Allergic 2.Metabolic 3.Endocrine 4.Autoimmune

4.Autoimmune

The nurse has suggested specific leg exercises for a client immobilized in right skeletal lower leg traction. The nurse determines that the client needs further instruction if the nurse observes the client performing which action? 1.Pulling up using the trapeze 2.Flexing and extending the feet 3.Doing quadriceps-setting and gluteal-setting exercises 4.Performing active range of motion to the right ankle and knee

4.Performing active range of motion to the right ankle and knee Active range of motion to the right ankle and knee would disrupt skeletal traction of the right lower leg.