Musculoskeletal Disorders NCLEX 3000

A client with gangrene of the left foot is scheduled for below-knee amputation. When planning preoperative care, the nurse should assign highest priority to which nursing diagnosis?

Disturbed body image related to loss of body part

A client seeks medical attention for a ganglion. Which statement about this musculoskeletal disorder is true?

Dorsiflexion exacerbates signs and symptoms of a ganglion.

A client has sustained a right tibial fracture and has just had a cast applied. Which instruction should the nurse provide regarding cast care?

Keep your right leg elevated above heart level.

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 is giving instructions to a client who's going home with a cast on his leg. Which point is most critical?

Reporting signs of impaired circulation

Which nursing diagnosis takes highest priority for a client with a compound fracture?

Risk for infection related to effects of trauma

The nurse is developing a teaching plan for a client diagnosed with osteoarthritis. To minimize the risk of injury to the osteoarthritic client, the nurse should instruct the client to:

install safety devices in the home.

The nurse is caring for a client who recently underwent a total hip replacement. The nurse should:

instruct the client to limit hip flexion while sitting.

After a traumatic spinal cord injury, a client requires skeletal traction. When caring for this client, the nurse must:

maintain traction continuously to ensure its effectiveness.

A client with gouty arthritis is prescribed a low-purine diet. The nurse should instruct this client to avoid:

organ meats.

A client with possible osteoarthritis is having X-rays performed on both knees. X-rays of an osteoarthritic joint reveal:

osteophyte formation.

A client is hospitalized for open reduction of a fractured femur. After surgery, the nurse monitors for signs and symptoms of fat embolism, which include:

restlessness and petechiae.

A client has a herniated disk in the region of the third and fourth lumbar vertebrae. When collecting data, the nurse expects to note:

severe low back pain.

The nurse is developing a teaching plan for a client who must undergo an above-the-knee amputation of the left leg. After a leg amputation, exercise of the remaining limb:

should begin the day after surgery.

Which laboratory study is most relevant to treating a client who has sustained a pelvic fracture?

Type and crossmatch

The physician diagnoses primary osteoporosis in a client who has lost bone mass. In this metabolic disorder, the rate of bone resorption accelerates while bone formation slows. Primary osteoporosis is most common in:

elderly postmenopausal women.

The nurse is teaching a client with a T4 spinal cord injury and paralysis of the lower extremities how to transfer from the bed to a wheelchair. The nurse should instruct the client to move:

his upper body to the wheelchair first.

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?

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

For a client with osteoporosis, the nurse should provide which dietary instruction?

"Eat more dairy products to increase your calcium intake."

A client undergoes a total hip replacement. Which statement made by the client would indicate 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."

A client with osteoarthritis tells the nurse she is concerned that the disease will prevent her from doing her chores. Which suggestion should the nurse offer?

"Pace yourself and rest frequently, especially after activities."

The X-rays of a client who was brought to the emergency department after falling on ice reveal a leg fracture. 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."

(SELECT ALL THAT APPLY) A client is diagnosed with gout. Which foods should the nurse instruct the client to avoid?

(2) Liver, (3) Cod, (5) Sardines

At a health fair, a woman, age 43, with a family history of osteoporosis asks the nurse how much calcium she should consume. The nurse tells her that the recommended daily calcium intake for premenopausal women is:

1,000 to 1,200 mg.

Which of the following would the nurse identify as a neurotransmitter?

Acetylcholine

A client is admitted with acute osteomyelitis that developed after an open fracture of the right femur. When planning this client's care, the nurse should include which measure?

Administering large doses of I.V. antibiotics as prescribed

The nurse is teaching a client with a left fractured tibia how to walk with crutches. Which instruction is appropriate?

All weight should be on the hands.

The nurse is caring for a client with burns on his legs. Which nursing intervention will help prevent leg contractures?

Applying knee splints

After total hip replacement, a client is receiving epidural analgesia to relieve pain. Which of the following is a nursing priority for this client?

Assessing for sensation in the legs

A client has a Fiberglas cast on the right arm. Which action should the nurse include in the plan of care?

Assessing movement and sensation in the fingers of the right hand Explanation: The nurse should assess a casted arm every 2 hours for finger movement and sensation to make sure the cast isn't restricting circulation. To reduce the risk of skin breakdown, the nurse should leave a casted arm uncovered, which allows air to circulate through the cast pores to the skin below. Unlike a plaster cast, a Fiberglas cast dries quickly and can be handled without damage soon after application. The nurse should assess the brachial and radial pulses distal to the cast — not the pedal and posterior tibial pulses, which are found in the legs.

For a client who has had a stroke, which nursing intervention can help prevent contractures in the lower legs?

Attaching braces or splints to each foot and leg

The 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?

Avoid internal rotation of the affected leg.

The nurse monitors a client receiving enoxaparin (Lovenox), 30 mg subQ b.i.d after hip replacement surgery. Which adverse reaction is the client most likely to experience?

Bleeding

A client is diagnosed with osteoporosis. Which electrolytes are involved in the development of osteoporosis?

Calcium and phosphorous

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

When caring for a client experiencing an acute gout attack, the nurse anticipates administering which medication?

Colchicine

An X-ray of the left femur shows a fracture that extends through the midshaft of the bone and multiple splintering fragments. What is this type of fracture called?

Comminuted fracture

A 78-year-old client has a history of osteoarthritis. Which signs and symptoms would the nurse expect to find on physical assessment?

Joint pain, crepitus, Heberden's nodes

A client comes to the emergency department complaining of pain in the right leg. When obtaining his history, the nurse learns that the client was diagnosed with diabetes mellitus at age 12. The nurse knows that this disease predisposes the client to which musculoskeletal disorder?

Degenerative joint disease

Which of these findings best correlates with a diagnosis of osteoarthritis?

Joint stiffness that decreases with activity

A client with arterial insufficiency undergoes below-knee amputation of the right leg. Which action should the nurse include in the postoperative plan of care?

Elevating the stump for the first 24 hours

During a visit to a client who underwent total hip replacement surgery, the home health care nurse notes small area rugs located throughout the house. How should the nurse intervene to ensure the client's safety?

Explain to the client that small area rugs pose a danger to clients after hip replacement surgery.

While a nurse on the orthopedic floor is administering medications to her group of clients, the physical therapy department calls to inform her that two of her clients are late for their scheduled session. What should the nurse do?

First, administer scheduled medications to the clients who require physical therapy, and then have them attend therapy.

A client is treated in the emergency department for a Colles' fracture sustained during a fall. What is a Colles' fracture?

Fracture of the distal radius

The nurse is teaching a client with osteomalacia how to take prescribed vitamin D supplements. The nurse stresses the importance of taking only the prescribed amount because high doses of vitamin D can be toxic. Early signs and symptoms of vitamin D toxicity include:

GI upset and metallic taste.

A client admitted to the hospital for internal fixation of a fractured left femur is attending physical therapy to learn how to use crutches. After the session, a nurse observes improper crutch use by the client. How should the nurse intervene?

Gently remind the client of the proper technique.

A client is admitted with severe pain in the knees. Which form of arthritis is characterized by urate deposits and joint pain, usually in the feet and legs, and occurs primarily in men older than age 30?

Gouty arthritis

Which of the following is the most appropriate nursing diagnosis for a client with a strained ankle?

Impaired physical mobility

A client is scheduled for a laminectomy of L1-L2. The nurse is teaching the client about the procedure. Identify the area that the nurse explains will be involved in this client's surgery.

In laminectomy, one or more of the bony laminae that cover the vertebrae are removed. There are five lumbar vertebrae, so the nurse can count up from the sacrum to locate L1-L2. Vertebrae are numbered from top to bottom, with L5 being closest to the sacrum

Which of the following is a priority nursing diagnosis for the client with an amputated extremity?

Ineffective tissue perfusion: peripheral related to injury and amputation

During a senior citizen health screening, the nurse observes a 75-year-old female with a severely increased thoracic curve, or "humpback". What is this condition called?

Kyphosis

A client is in Buck's skin traction after fracturing his right hip. The nurse should include which action in the plan of care?

Maintaining correct body alignment

A client is admitted to the orthopedic unit with septic arthritis of the knee. The case manager should be consulted if which of the following complications occurs during hospitalization?

Mobility decreases.

A client with muscle weakness and an abnormal gait is being evaluated for muscular dystrophy. Which of the following confirms muscular dystrophy?

Muscle biopsy

After a person experiences a closure of the epiphyses, which of the following is true?

No further increase in bone length occurs.

Which cells are involved in bone resorption?

Osteoclasts

A client seeks care for low back pain of 2 weeks' duration. Which data collection finding suggests a herniated intervertebral disk?

Pain radiating down the posterior thigh

A client comes to the outpatient department with suspected carpal tunnel syndrome. When assessing the affected area, the nurse expects to find which abnormality typically associated with this syndrome?

Positive Tinel's sign

Which nursing diagnosis is most appropriate for an elderly client with osteoarthritis?

Risk for injury related to altered mobility

A client is prescribed diazepam (Valium) to treat severe skeletal muscle spasms. During this therapy, the nurse monitors the client closely for adverse reactions. Which adverse reaction is most likely to occur?

Sedation

During a scoliosis screening in a college heath center, a student asks the public health nurse about the consequences of untreated scoliosis. The nurse would be accurate by identifying one of the direct complications as:

impingement on pulmonary function.

On a visit to the family physician, a client complains of painful swelling on the lateral side of the great toe, at the metatarsophalangeal joint. After determining that the swelling is a bunion, the physician injects an intra-articular corticosteroid. The client asks the nurse what causes bunions. Which answer is correct?

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

A client is admitted to an acute care facility with osteomyelitis. Which organism usually causes this infection?

Staphylococcus aureus

A client who sustained a right lower leg fracture in a motorcycle accident has an external fixation device in place. During visiting hours, a nurse sees a friend of the client using the device to lift the client's leg off of the bed. Which action should the nurse take?

Teach the client and his friend the proper technique for lifting the leg.

A client is scheduled for a laminectomy to repair a herniated intervertebral disk. When developing the postoperative plan of care, the nurse should include which action?

Turning the client from side to side, using the logroll technique

Which information should a nurse include when consulting with a home health care agency about the nursing care and physical therapy needs of a client who will be discharged after undergoing total hip replacement surgery?

The client lives alone and will be restricted from driving for at least 6 weeks.

The nurse is teaching the client how to use a cane. Which statements is inaccurate?

The client should hold the cane on the involved side.

An elderly client fractured the neck of his femur in a fall. The nurse is using an illustration to explain to the family where the fracture occurred. Identify the area that the nurse would point out to the family as the site of the fracture.

The neck of the femur connects the round ball head of the femur to the shaft.

A client is admitted to the orthopedic unit for treatment of a fractured right femur caused by a motor vehicle crash. He is scheduled to undergo an open reduction internal-fixation of his right femur. The night before surgery, the nurse administers 250 mg of glutethimide (Doriden) as prescribed. Which statement regarding usage of glutethimide is correct?

The nurse should store the drug in a tight, light-resistant container.

The nurse is teaching a female client about preventing osteoporosis. Which of the following teaching points is correct?

The recommended daily allowance of calcium may be found in a wide variety of foods.

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 22-year-old client with an external fixation device attached to his left thigh is unable to bear weight on his left leg. He asks a nurse if he can take a shower. How should the nurse respond to the client's request?

Wrap the device with plastic and then assist the client into the shower using a wheelchair.

To assess the joints, the nurse asks a client to perform various movements. As the client moves the arm away from the midline, the nurse evaluates the ability to perform:

abduction.

The nurse is managing the care of a client with osteoarthritis. Appropriate treatment strategies for osteoarthritis include:

administration of nonsteroidal anti-inflammatory drugs (NSAIDs).

The nurse is caring for a client who complains of lower back pain. Which instructions should the nurse give the client to prevent back injury?

"Stand close to the object you're lifting."

A client who has just been diagnosed with mixed muscular dystrophy asks the nurse about the usual course of this disease. How should the nurse respond?

"You may experience progressive deterioration in all voluntary muscles."

An elderly client who is having difficulty using a walker tells the nurse, "I don't care what the doctor says; I'm not going to use that thing!" Which response by the nurse is best?

"You say that you don't like using the walker; is there any particular reason why?"

A middle-age client recovering from major back surgery must wear a back brace and walk with a cane after experiencing leg weakness. During routine care, the client tells a nurse, "I'm sorry I had this operation. Before surgery I didn't look like I had a problem, but now I do." Which response by the nurse is appropriate?

"You sound concerned about your appearance. In what way are you worse off than before?"

(SELECT ALL THAT APPLY) A nurse is teaching a class about osteoporosis. Which factors place a client at greater risk for developing this disease?

(1) Being postmenopausal, (2) Long-term use of corticosteroids, (6) Sedentary lifestyle

(SELECT ALL THAT APPLY) A client with a suspected fracture of the right hip is in the emergency department. Which data collection findings would the nurse expect to see in the client's right leg?

(2)The right leg is shorter than the left leg., (4) The right leg is adducted., (5) The right leg is externally rotated.

(SELECT ALL THAT APPLY) A client is about to undergo total hip replacement surgery. Before the surgery, the nurse conducts a preoperative teaching session with him. The nurse can tell that her teaching has been effective when the client verbalizes the importance of avoiding which actions?

(3) Internally rotating the feet, (4) Bending to pick items up from the floor

(SELECT ALL THAT APPLY) A client is preparing for discharge from the hospital after undergoing an above-the-knee amputation. Which instructions should the nurse include in the teaching plan for this client?

(4) Avoid exposing the skin around the stump to excessive perspiration.(5) Be sure to perform the prescribed exercises., (6) Rub the stump with a dry washcloth for 4 minutes three times per day if the stump is sensitive to touch.

(SELECT ALL THAT APPLY) A client who was involved in a motor vehicle accident has a fractured femur. The nurse caring for the client documents Acute pain as one of the nursing diagnoses in his care plan. Which nursing interventions are appropriate?

(5) Assess the client's perception of pain., (6) Ask the client about methods he has used previously to alleviate pain.

A client undergoes a muscle biopsy. After the procedure, the nurse must keep the biopsy site elevated for:

24 hours.

The nurse is caring for a client placed in traction to treat a fractured femur. Which nursing intervention has the highest priority?

Assessing the extremity for neurovascular integrity

The nurse is caring for an elderly female with osteoporosis. When teaching the client, the nurse should include information about which major complication of this condition?

Bone fracture

A nurse on the orthopedic floor is caring for a group of clients who are in various stages of recovery after knee replacement surgery. One client is ready for discharge. How should the nurse proceed with discharge planning?

Complete the discharge instructions for the client who is being discharged, and allow time for him to ask questions.

After sustaining injuries in a motor vehicle accident, a client spends 10 days recovering in the intensive care unit. His condition stabilizes and he's transferred to the orthopedic unit. Upon arrival at the unit, his vital signs are stable, his temperature is 100° F (37.8° C), and he has an indwelling urinary catheter in place. He is currently on bed rest and able to consume a regular diet. Which independent nursing action should the nurse include in this client's plan of care?

Encourage the client to increase his intake of fluids.

The infection control team has identified a 25% infection rate on the orthopedic floor. The nursing staff members are asked to record their care activities by recording them in a log to help identify the cause of the high infection rate. Which of the following care activities should be recorded in the activity log?

Hand washing between client contacts

The nurse is caring for a client with a cast on his left arm. Which data collection finding is most significant for this client?

Intact skin around the cast edges

Before a client undergoes arthroscopy, the nurse reviews the data collection findings for contraindications for this procedure. Which finding is a contraindication?

Joint flexion of less than 50%

A client undergoes hip-pinning surgery to treat an intertrochanteric fracture of the right hip. The nurse should include which intervention in the postoperative plan of care?

Keeping a pillow between the client's legs at all times

A client is undergoing an extensive diagnostic workup for suspected muscular dystrophy. The nurse knows that muscular dystrophy has many forms, but that one data collection finding is common to all forms. Which finding belongs in this category?

Muscle weakness

During assessment, a licensed practical nurse (LPN) notes that a client who had a total hip replacement 5 days ago has a temperature of 100.4° F (38° C) and a red, edematous incision. The dressing that was covering the incision contains yellow-green, foul-smelling drainage, and the client complains of pain at the site. How should the nurse proceed?

Notify a registered nurse (RN) coassigned to the client, apply a sterile dressing to the incision, and administer pain medication as prescribed.

A client recovering from back surgery tells a nurse that she's concerned about going home. She explains that she has many stairs to navigate and household responsibilities she must perform. How can the nurse help ease this client's concerns?

Notify the charge nurse of the client's concerns, and request a team meeting to discuss the client's discharge planning.

A nurse is caring for a client who sustained a gunshot wound to the leg during a jewelry store robbery. The client is in police custody and receiving treatment in the emergency department. A member of the media asks the nurse about the client's condition. How should the nurse respond?

Notify the nursing supervisor so she can obtain a formal statement from the physician about the client's condition for the media.

After a physician describes the surgical procedure for lumbar spinal fusion and its associated risks, the nurse provides a consent form for the client to sign. The client asks the nurse what the term "fusion" means and whether he'll lose a lot of blood during the procedure. Which action should the nurse take?

Notify the physician of the client's questions about the procedure before having the client sign the informed consent form.

A 69-year-old 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.

A client is brought to the emergency department after injuring his 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.

Four clients on an orthopedic unit are scheduled to attend physical therapy at the same time. Facility policy dictates that each client be escorted to therapy in a wheelchair or on a stretcher. When it's time for therapy, only three wheelchairs are available. One of the four clients is learning crutch-walking and is scheduled for discharge in the morning. What should the nurse do to ensure the clients' safety and timely arrival to physical therapy?

Request that a physical therapist accompany the client to therapy while he uses the crutches.

An incarcerated client is admitted to the hospital after sustaining multiple contusions and a fractured femur in an assault. After surgical repair of the femur, the client develops paralytic ileus. A nasogastric (NG) tube and cleansing enemas are prescribed. The client has a prison guard assigned to his bedside. How should a nurse proceed to implement a physician's orders?

Request that the guard remain outside the client's door during the prescribed procedures.

The 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:

advance both crutches first.

The nurse is assessing a client with possible osteoarthritis. The most significant risk factor for osteoarthritis is:

age

Elderly clients who fall are most at risk for:

pelvic fracture