Musculoskeletal Disorders
A client is to have a below-the-knee amputation. Before the surgery, what should the circulating nurse in the operating room do?
Initiate a time-out.
A nurse is caring for a client with lower back pain who is scheduled for myelography using metrizamide (a water-soluble contrast dye). After the test, the nurse should place the client in which position?
head of the bed elevated 45 degrees
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?
postmenopausal women who are inactive
Which nursing intervention is essential in caring for a client with compartment syndrome?
removing all external sources of pressure, such as clothing and jewelry
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?
inability of the client to move the fingers on their right hand
The nurse is setting goals with a client with rheumatoid arthritis. Which is a priority goal for the client?
Demonstrate the use of adaptive equipment.
Which nursing diagnosis takes highest priority for a client with a compound fracture?
Risk for infection related to effects of trauma
A client with rheumatoid arthritis has been taking large doses of aspirin to relieve joint pain. Which finding is likely?
tinnitus
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?
"After menopause, the body's bone density declines, resulting in a gradual loss of height."
The nurse is teaching a client with osteoporosis about optimal dietary choices to reduce the severity of the condition. What instruction should the nurse provide?
"Eat more dairy products such as cheese and yogurt."
A nurse is teaching a client who was recently diagnosed with carpal tunnel syndrome. Which statement should the nurse include?
"Ergonomic changes can be incorporated into your workday to reduce stress on your wrist."
A nurse is evaluating the proper use of crutches by a client who has fractured the right leg. Which statement indicates the client is using the correct technique?
"I feel pressure on the palms of my hands when I am walking with my crutches."
A client undergoes an arthroscopy at the outpatient clinic. After the procedure, the nurse provides discharge teaching. Which response by the client indicates the need for further teaching?
"I should use my heating pad this evening to reduce some of the pain in my knee."
Which statement by a client with rheumatoid arthritis would indicate the need for additional teaching to safely receive the maximum benefit of aspirin therapy?
"I try to take aspirin only on days when the pain seems particularly bad."
A client takes prednisone for an acute exacerbation of rheumatoid arthritis. The nurse determines the client understands how to take the prednisone when the client makes which statement?
"It's best if I take this medication with some food."
The nurse is preparing a teaching plan for a client about crutch walking using a two-point gait pattern. What information should the nurse include?
Advance a crutch on one side, and simultaneously advance and bear weight on the opposite foot; repeat on the opposite side.
On the evening of surgery for a total knee replacement, a client wants to get out of bed. What should the nurse do to safely assist the client?
Apply a knee immobilizer.
The nurse is caring for a client with a spinal cord injury. The client is experiencing blurred vision and has a blood pressure of 204/102 mm Hg. What should the nurse do first?
Check the client's bladder for distention.
The school nurse is planning an educational session to prevent injuries in children with juvenile arthritis. Which information should the nurse include in the teaching?
Schedule the completion of daily range-of-motion exercises to support joint mobility.
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?
Eat a diet high in protein and vitamins C and D.
The nurse is counseling a client with osteoporosis about dietary choices to slow bone loss. What foods should the nurse teach the client to avoid?
Foods and beverages high in caffeine
The nurse is going to lunch and is conducting a "hand-off of care" to the charge nurse. Which information should the nurse communicate to the charge nurse during the hand-off of care communication?
Give the charge nurse information about what care should be given while the nurse is at lunch.
A client complains that they experience pain and numbness in the fingers when typing on a computer keyboard. Which action will help the nurse assess for Phalen's sign?
Having the client hold both wrists in acute flexion with the dorsal surfaces touching for 60 seconds
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?
Send the client on the bed with extra help to stabilize the traction.
When developing a care plan for a client newly diagnosed with scleroderma, which nursing diagnosis has the highest priority?
Impaired skin integrity
A client with a history of osteoarthritis is admitted to the rehabilitation unit after hospitalization for a hip fracture. Which plan by the multidisciplinary team best optimizes client outcomes?
Including the client in developing a care plan that works toward meeting discharge goals
The nurse is planning care for a client recovering from total hip replacement surgery. Which intervention should the nurse add to the client's plan of care?
Instruct the client not to lean forward at the waist when sitting up in a chair.
A client was undergoing conservative treatment for a herniated nucleus pulposus, at L5 - S1, which was diagnosed by magnetic resonance imaging. Because of increasing neurological symptoms, the client undergoes lumbar laminectomy. The nurse should take which step during the immediate postoperative period?
Logroll the client from side to side.
A client is being discharged following an open reduction and internal fixation of the left ankle and is to wear a non-weight-bearing cast for 2 weeks. What should the nurse teach the client to do when using crutches?
Maintain two to three finger widths between the axillary fold and underarm piece grip.
The 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?
Mark the area of drainage.
A client with a broken ulna reports having pain in the casted arm that is unrelieved by pain medication. The nurse assesses the arm and notes that the fingers are swollen and difficult to separate. After reviewing the health care provider's prescriptions, what should the nurse do first?
Notify the health care provider (HCP) about the swelling and pain.
A client arrives via ambulance with a suspected pelvic fracture from a motor vehicle collision. The client's vital signs are: blood pressure 85/50 mm Hg, heart rate 120 beats/min, respiratory rate 22 breaths/min, and an oxygen saturation of 98% on room air. The client is afebrile. The health care provider has written several prescriptions. What is the nurse's priority action?
Obtain STAT hemoglobin and group and match.
A nurse is caring for a client who underwent a total hip replacement. What should the nurse and other caregivers do to prevent dislocation of the new prosthesis?
Prevent internal rotation of the affected leg.
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?
Take NSAIDs with food.
A client's left leg is in skeletal traction with a Thomas leg splint and Pearson attachment. Which intervention should the nurse include in this client's care plan?
Teach the client how to prevent problems caused by immobility.
A client with an extracapsular hip fracture is scheduled for surgical internal fixation with the insertion of a pin. What can the nurse tell the client about the reason for this type of treatment for the fracture?
The client can be mobilized sooner.
A nurse is caring for a client who's experiencing septic arthritis. This client has a history of immunosuppressive therapy and the client's immune system is currently depressed. Which assignment is the most appropriate for the nurse caring for this client?
The nurse is caring for this client on the intensive care unit.
A client with arterial insufficiency undergoes below-knee amputation of the right leg. Which action should the nurse include in the postoperative care plan?
elevating the stump for the first 24 hours
A nurse is teaching a female client about preventing osteoporosis. Which teaching point is correct?
The recommended daily allowance of calcium may be found in a wide variety of foods.
Unlicensed assistive personnel (UAP) are helping a client who had knee surgery 2 days ago get into bed. As the nurse makes rounds, which information requires the nurse to intervene?
The side rails on the head and foot of the bed are in the up position.
The nurse is planning an educational program about the prevention of osteoporosis for a group of women. Which preventive measure should the nurse include in the teaching plan?
encouraging weight-bearing exercise on a regular basis
After a car accident, a client is admitted to an acute care facility with multiple traumatic injuries, including a fractured pelvis. For 24 to 48 hours after the accident, the nurse must monitor the client closely for which potential complication of a fractured pelvis?
fat embolism
Two days after being placed in a cast for a fractured femur, the client suddenly has chest pain and dyspnea. The client is confused and has an elevated temperature. The nurse should assess the client for which health problem?
fat embolism syndrome
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?
Thoracic
The nurse has been assigned to provide care for a group of clients. Each of the clients has called out to the nurses' station requesting assistance. Which client should the nurse see first?
a 32-year-old male who had a plaster cast applied to his leg 2 hours ago and reports that the cast feels as if it is getting tighter
The nurse is planning care for a group of clients who have had a total hip replacement. Of the clients listed below, who is at the highest risk for infection and should be assessed first?
a 74-year-old who has periodontal disease with periodontitis
The nurse is advising a client who underwent femoral head prosthesis placement on the type of chair to sit in during the first 6 to 8 weeks after surgery. Which chair would be the correct type to recommend?
a high-backed chair with armrests
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?
abduction
The nurse is teaching a postmenopausal client about strategies to prevent the development of osteoporosis. On which topic should the nurse focus as primary prevention for the disorder?
increasing calcium and vitamin D in the diet
A female client is at risk for developing osteoporosis. Which action will reduce the client's risk?
initiating weight-bearing exercise routines
Which findings best correlate with a diagnosis of osteoarthritis?
joint stiffness that decreases with activity
A client undergoes hip-pinning surgery to treat an intertrochanteric fracture of the right hip. The nurse should include which intervention in the postoperative care plan?
keeping a pillow between the client's legs at all times
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?
24 hours after the surgery
A client with acute osteomyelitis is to receive parenteral penicillin for 4 to 6 weeks. Before administering the first dose, the nurse asks the client about known drug allergies. An allergy to which antibiotic or antibiotic class necessitates cautious use of penicillin?
cephalosporins
A client asks the nurse what the difference is between osteoarthritis (OA) and rheumatoid arthritis (RA). Which response is correct?
"OA is a noninflammatory joint disease. RA is characterized by inflamed, swollen joints."
X-rays reveal a leg fracture in a client who was brought to the emergency department after falling on ice. After a cast is applied and allowed to dry, the nurse teaches the client how to use crutches. Which instruction should the nurse provide about climbing stairs?
"Place the unaffected leg on the first step, followed by the crutches and the injured leg, which should move together."
A client with rheumatoid arthritis is taking high doses of nonsteroidal anti-inflammatory medications. What should the nurse teach the client about taking these medications?
"Take prescribed medication with food to lessen the likelihood of an upset stomach."
Which statement by a staff nurse on the orthopedic floor indicates the need for further staff education?
"The client is receiving physical therapy twice per day, so they don't need a continuous passive motion device."
A client recovering from lumbar surgery is fitted for a contour splint. What should the nurse explain to the client about this device?
"The splint immobilizes the body part in a functional position."
A client with an amputation is learning how to apply a prosthetic limb. Which statement(s) made by the client indicates an increased risk for skin impairment? Select all that apply.
-"I can clean and inspect the skin of my amputated leg weekly." -"I will make sure the padding is all placed in the front of the stump." -"I can wear a cotton garment with seams over the stump."
The nurse is providing information to the parents of a child newly diagnosed with juvenile arthritis. Which statements by the parents indicate understanding of the teaching? Select all that apply.
-"I help my child perform daily range-of-motion exercises." -"I give my child NSAIDs three times a day." -"I apply heat pads to the joints when my child is having pain."
A client is diagnosed with osteoporosis. Which statements would the nurse include when teaching the client about the disease? Select all that apply.
-Osteoporosis is common in females after menopause. -Osteoporosis is a degenerative disease characterized by a decrease in bone density. -Osteoporosis can cause pain and injury.
A nurse is putting groceries in the car when an older adult client falls off of a curb. The nurse assesses the client and has a bystander call for an ambulance. Which assessment findings provide data of a suspected right hip fracture? Select all that apply.
-The right leg is shorter than the left leg. -The right leg is adducted. -The right leg is externally rotated.
A nurse is teaching a client with osteomalacia how to take ordered vitamin D supplements. Which adverse effects should the nurse instruct the client to report?
GI upset and metallic taste
A client has a C7 spinal cord injury. Which would be the most important nursing intervention during the acute stage of the injury?
Maintain a patent airway.
The nurse is positioning a client who has had a total hip replacement. Which is the intended outcome of using an abduction pillow (or splint)?
Prevent dislocation of the prosthesis.
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?
acute respiratory distress syndrome
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?
a small amount of yellow drainage at the left pin insertion site
When the client who has had a hip replacement is lying on the side, the nurse should place pillows or an abductor splint between the legs to prevent:
adduction of the hip joint.
A nurse is teaching a client with a long leg cast how to use crutches properly while descending a staircase. The nurse should tell the client to transfer body weight to the unaffected leg, and then
advance both crutches.
A nurse is assessing a client with possible osteoarthritis. The most significant risk factor for primary osteoarthritis is
age
What is the most important assessment for the nurse to make when assessing peripheral pulses on a client who is post limb fracture?
amplitude and symmetry of both extremities
The nurse is assessing a client who had a total hip replacement yesterday for potential complications. Which complication has the greatest likelihood of occurring?
deep vein thrombosis (DVT)
The nurse administers a preoperative intramuscular medication at the ventrogluteal site. Into which muscle should the nurse inject the medication?
gluteus minimus
The nurse is teaching a client about using crutches. On which part of the body should the nurse instruct the client to support the body weight?
hands
A client who has skeletal traction to stabilize a fractured femur has not had a bowel movement for 2 days. The nurse should:
increase the client's fluid intake to 3,000 mL/day.
When assessing an older adult as a candidate for crutch walking, the nurse should take into account that for some elderly people, crutch walking is an impractical goal primarily because of decreased:
motor coordination.
A client has been diagnosed with degenerative joint disease (osteoarthritis) of the left hip. Which factor in the client's history would most likely increase the joint symptoms of osteoarthritis?
obesity
A diet plan is developed for a client with gouty arthritis. The nurse should advise the client to limit his intake of
organ meats.
A client with Paget's disease comes to the hospital and complains of difficulty urinating. The emergency department physician consults urology. What should the nurse suspect is the most likely cause of the client's urination problem?
renal calculi
The nurse is caring for a client with a newly applied cast on the left leg for a fracture of the tibia and fibula. The client reports a sudden increase in pain throughout the calf area with numbness to the toes which appear dusky. What action should the nurse take?
request immediate assistance to cut the cast and assess the leg
Which activity should the nurse teach the client to do to strengthen the hand muscles in preparation for using crutches?
squeezing a rubber ball
The nurse is caring for an older adult male client who had an open reduction internal fixation of the right hip 24 hours ago. The client is now experiencing shortness of breath and reports having "tightness in my chest." The nurse reviews the recent lab test results. The nurse should report which lab test result to the health care provider?
troponin: 1.4 mcg/L (1.4 μg/L)
The client with an above-the-knee amputation is to be fitted with a functioning prosthesis. The nurse has been teaching the client how to care for the residual limb. Which behavior would demonstrate that the client understands proper residual limb care?
washes and dries the residual limb daily
A client is recovering from an attack of gout. Client teaching should include the need to lose weight because
weight loss will reduce uric acid levels and reduce stress on joints.
After surgery to treat a hip fracture, a client returns from the postanesthesia care unit to the medical-surgical unit. Postoperatively, how should the nurse position the client?
with the leg on the affected side abducted
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?
an exercise routine that includes range-of-motion (ROM) exercises
The nurse is admitting a client with a fractured tibia. Which area should the nurse assess first?
area distal to the fracture
A clinical nurse specialist developed clinical pathways for common orthopedic conditions. In which way should the interdisciplinary team use these pathways?
as guidelines to ensure continuity of care
What are important nursing priorities on the first postoperative day for a client who has had an open reduction and internal fixation (ORIF) after a right hip fracture?
assessing the neurovascular status in the right leg, providing pain control, encouraging position changes, and early ambulation
A nurse is caring for an elderly female client with osteoporosis. When teaching the client, the nurse should include information about which major complication?
bone fracture
A male client underwent a lumbar spinal fusion yesterday. Which nursing assessment should alert the nurse to the development of a possible complication?
clear yellowish fluid on the dressing
A client with an open femoral fracture was discharged to home and reports having a fever, night sweats, chills, restlessness, and restrictive movement of the fractured leg. The nurse should interpret these findings as the client may be experiencing which complication?
osteomyelitis
A client seeks care for lower back pain of 2 weeks duration. Which assessment finding suggests a herniated intervertebral disk?
pain radiating down the posterior thigh
The client comes to the clinic reporting activity restriction and sexual dysfunction. Tests are completed and a diagnosis of L5-S1 herniated disk impinging on the right nerve root is made by the healthcare provider. What assessment findings should the nurse expect to note?
pain radiating down the right leg
The client sustained a tibia fracture and a cast was applied. The client is reporting increasing pain when flexing toes. Which symptoms does the nurse assess as associated with compartment syndrome? Select all that apply.
paresthesia pain pulselessness
The client is being discharged today after having an above-the-knee amputation a week ago. Which complications should the nurse include in the discharge directions? Select all that apply.
-new openings in wound or skin around the wound pulling away -worsening pain not controlled by medication -skin around the stump or wound dark or turning black
A client undergoes a total hip replacement. Which statement made by the client indicates to the nurse that the client requires further teaching?
"I don't know if I'll be able to get off that low toilet seat at home by myself."
The nurse teaches the parent of a young child with Duchenne muscular dystrophy about the disease and its management. Which statement by the parent indicates successful teaching?
"My child will probably be unable to walk independently by the time they are 9 to 11 years old."
In preparation for total knee surgery, a 200-lb (90.7-kg) client with osteoarthritis must lose weight. Which exercise should the nurse recommend as best if the client has no contraindications?
aquatic exercise
A client is preparing for discharge from the emergency department after sustaining an ankle sprain. The client is instructed to avoid weight bearing on the affected leg and is given crutches. After instruction, the client demonstrates proper crutch use in the hallway. What additional information is most important to know before discharging the client?
whether the client needs to navigate stairs routinely at home
A client is brought to the emergency department after injuring their right arm in a bicycle accident. The orthopedic surgeon tells the nurse that the client has a greenstick fracture of the arm. What does this mean?
One side of the bone is broken and the other side is bent.
A client has a herniated disk in the region of the third and fourth lumbar vertebrae. Which nursing assessment finding most supports this diagnosis?
severe lower back pain
The nurse enters the room to do an initial assessment on a client with a fracture of the femoral head. What would be the expected findings on the affected limb?
shortening of the affected extremity with external rotation
A client has an intracapsular hip fracture. The nurse should conduct a focused assessment to detect which change near the fracture?
shortening of the affected leg
A client has had a total hip replacement. When assessing the client, the nurse understands that which sign most likely indicates that the hip has dislocated?
shortening of the affected leg
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?
shorter than the leg on the unaffected side
The nurse is caring for an adult with a grade III compound fracture of the right femur; the client has been placed in skeletal traction. What is the intended outcome of the traction?
Reduce and immobilize the fracture.
