Musculoskeletal (Level 1)

The nurse in the hospital emergency department is assessing a client with an open leg fracture. The nurse should inquire about the last time the client had which done? a. Tuberculin test b. Tetanus vaccine c. Chest radiograph d. Physical examination

Correct answer: B With an open fracture, the client is at risk for the development of osteomyelitis, gas gangrene, and tetanus. The nurse assesses for the date of the last tetanus immunization to ensure that the client has tetanus prophylaxis. The remaining options are unrelated to the current situation identified in the question

The client is taking methotrexate for severe rheumatoid arthritis. The nurse instructs the client that it will be necessary to monitor: a. Serum glucose b. Serum electrolytes c. Complete blood cell count with differential and platelet count d. Sedimentation rate

Correct answer: C This client should be monitored for blood dyscrasias, evidenced by decreased platelet count and white blood cell count with changes in the CBC differential.Elevated serum electrolytes, glucose, and sedimentation rates are not side effects of this drug

A client with a 4-day-old lumbar vertebral fracture is experiencing muscle spasms. Which are interventions to aid the client in relieving the spasm? Select all that apply. a. Ice b. Heat c. Analgesics d. Muscle relaxers e. Intermittent traction

Correct answers: B, C, D, E Heat, analgesics, muscle relaxers, and traction all may be used to relieve the pain of muscle spasm in the client with a vertebral fracture. Ice is applied to a painful site only for the first 48 to 72 hours (depending on the health care provider's preference) after an injury. Application of ice to the spine of a client could be uncomfortable and could result in feelings of being chilled

The nurse has reviewed activity restrictions with a client who is being discharged after insertion of a femoral head prosthetic system. What statement by the client will help the nurse determine that the client understands the material presented? a. Use a raised toilet seat b. Bend carefully to put on socks and shoes c. Sit in chairs without arms for better mobility d. Exercise the leg past the point of 90-degree flexion

Correct answer: A The client who has had an insertion of a femoral head prosthesis should use a raised toilet seat. The client should avoid putting on his or her own socks and shoes for 8 weeks after surgery because it would force the leg into acute flexion. The client should sit in chairs that have arms to provide assistance in rising from the sitting position. The client also should maintain the leg in a neutral, straight position when lying, sitting, or walking. The leg should not be adducted, internally rotated, or flexed more than 90 degrees

A client is admitted to the nursing unit after a left below-the-knee amputation after a crush injury to the foot and lower leg. The client tells the nurse, "I think I'm going crazy. I can feel my left foot itching." How should the nurse interpret this client statement? a. A normal response that indicates the presence of phantom limb pain b. A normal response that indicates the presence of phantom limb sensation c. An abnormal response that indicates that the client in is denial about limb loss d. An abnormal response that indicates that the client needs more psychological support

Correct answer: B Phantom limb sensations are felt in the area of the amputated limb. These sensations can include itching, warmth, and cold. The sensations are caused by intact peripheral nerves in the area of the amputation. Whenever possible, the client should be prepared for these sensations. The client also may feel painful sensations in the amputated limb, called phantom limb pain. The origin of the pain is less well understood, but the client should be prepared for this, too, whenever possible

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? a. Anemia b. Fractures c. Infection d. Muscle sprains

Correct answer: B The client is most at risk for fractures as a result of osteoporosis. Although other complications can occur, fracture is the greatest concern. Anemia and infection can occur with bone marrow disorders, and muscle sprains are unrelated to osteoporosis

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? a. Fever and chills b. Dyspnea and chest pain c. External rotation of right leg d. Pallor, paresthesia, and pulselessness

Correct answer: B The signs of fat embolism are associated with alterations in respiratory status or neurological status. Dyspnea, petechiae, and chest pain are signs of fat embolism. External rotation of the leg is indicative of the hip fracture itself. Fever and chills indicate signs of infection, and pallor, paresthesia, and pulselessness indicate signs of severe circulatory impairment

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? a. Age of onset is generally 65 years of age or older b. Complaints of pain that is more severe after activity c. Systemic symptoms such as fatigue, anorexia, and weight loss d. Joint pain is asymmetric and associated with past injuries to the joint

Correct answer: C In clients diagnosed with RA, systemic symptoms such as fatigue, anorexia, weight loss, and nonspecific aching and stiffness may appear before joint manifestations. RA is characterized by chronic joint pain of variable intensity, which is more severe on rising in the morning. The age of onset for RA is most commonly between 30 and 50 years of age. Complaints of pain that is more severe after activity and asymmetrical joint pain associated with past injuries to the joint are more commonly seen in osteoarthritis

A nurse is discussing the differences between skeletal and skin traction with a newly licensed nurse. Which of the following statements by the newly licensed nurse indicates understanding? a. "Skeletal traction has less risk for infection than skin traction." b. "Clients with skin traction have more mobility than those with skeletal traction." c. "Skeletal traction is more appropriate than skin traction for reducing a fracture." d. "Clients with skin traction have more discomfort than those with skeletal traction."

Correct answer: C Skeletal traction is invasive and therefore creates a greater risk for infection. Skeletal traction with balanced suspension provides the client with greater mobility than skin traction. Skeletal traction allows for reduction and alignment of a fracture. Skin traction decreases muscle spasms commonly associated with a fracture. Skeletal traction is invasive and therefore increases the risk for discomfort. Skin traction is used to treat muscle spasms and musculoskeletal discomfort

A client with a short-leg plaster cast complains of an intense itching under the cast. The nurse provides instructions to the client regarding relief measures for the itching. Which client statement indicates an understanding of appropriate measures to relieve the itching? a. "I can use a blunt object such as a ruler to scratch the area" b. "I can trickle small amount of water down inside the cast" c. "I need to obtain assistance when placing an objective into the cast for the itching" d. "I can use a hairdryer on the low setting and allow the cool air to blow into the cast"

Correct answer: D Itching is a common complaint of clients with casts. Objects should not be put inside a cast because of the risk of scratching the skin, thereby providing a point of entry for bacteria. A plaster cast can break down when wet. Therefore, the best way to relieve itching is with a forceful injection of air inside the cast

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? a. Carrots b. Tapioca c. Chocolate d. Chicken liver

Correct answer: D Liver and other organ meats should be omitted from the diet of a client who has gout because of their high purine content. Purines are a form of protein. The food items identified in the other options contain negligible amounts of purines and may be consumed freely by the client with gout

The nurse is conducting health screening for osteoporosis. Which client is at greatest risk of developing this disorder? a. A 25-year-old woman who runs b. A 36-year-old man who has asthma c. A 70-year-old man who consumes excess alcohol d. A sedentary 65-year-old woman who smokes cigarettes

Correct answer: D Risk factors for osteoporosis include female gender, being postmenopausal, advanced age, a low-calcium diet, excessive alcohol intake, being sedentary, and smoking cigarettes. Long-term use of corticosteroids, anticonvulsants, and/or furosemide also increases the risk

The nurse is creating a plan of care for a client scheduled for a left total hip arthroplasty. Which interventions should the nurse include in the plan to prevent complications of the surgery? Select all that apply. a. Keep the leg slightly abducted b. Teach leg exercises to the client c. Use aseptic technique for wound care d. Prevent hip flexion beyond 90 degrees e. Keep the client's knees flexed whenever possible f. Massage the legs daily to increase circulation and venous return

Correct answers: A, B, C, D A total hip arthroplasty (THA) is also known as a total hip replacement (THR). Postoperative complications can include dislocation, infection, venous thromboembolism, hypotension, bleeding, and infection. To prevent dislocation, the nurse needs to position the client correctly with the leg slightly abducted and prevent hip flexion beyond 90 degrees. Signs of dislocation such as acute pain, rotation, and extremity shortening needs to be reported immediately to the surgeon. To prevent infection the nurse needs to perform thorough handwashing and use aseptic technique for wound care and emptying of drains. To prevent venous thromboembolism, the client would wear elastic stockings and/or a sequential compression device per agency policy and surgeon prescription. The nurse would encourage fluid intake and teach the client leg exercises to promote circulation. Legs are not massaged; in addition, knee flexion is avoided for a prolonged period of time because these actions promote venous stasis and thromboembolism. The nurse would monitor vital signs at least every 4 hours and observe the client for bleeding. Any signs of complications are reported immediately to the surgeon

The nurse has given activity guidelines to a client with chronic low back pain. The nurse determines that the client understands the instructions if the client states to do which activities? Select all that apply. a. Lying prone b. Sitting using a lumbar roll or pillow c. Standing with one foot on a step or stool d. Lying on the site, with knees and hips straight e. Lift objects that need to be carried above elbow level f. Lean forward to reach objectives, keeping the legs and knees straight

Correct answers: B, C The client should avoid positions or activities that place strain on the lower back. The client should not sleep on the abdomen (prone) or on the side if the hips and knees are straight. It may be helpful for the client to stand with a foot elevated on a stool or to sit using a form of lumbar support. The client should not lean forward without bending the knees, stand in one position for long periods, or lift anything above elbow level

The nurse is caring for a client after the application of a plaster cast for a fractured left radius. The nurse should suspect impairment with the neurovascular status of the client's casted extremity if which findings are noted? Select all that apply. a. Capillary refill less than 3 seconds b. Pulses present and with swollen, pink fingers c. Client report of severe, deep, unrelenting pain d. Client report of pain as nurse assesses finger movement e. Client report of numbness/tingling sensation in the fingers

Correct answers: C, D, E The pressure in compartment syndrome, if unrelieved, will cause permanent damage to nerve and muscle tissue distal to the pressure. Circulatory damage may result in necrosis. Nerve and muscle damage may result in permanent contractures, deformity of the extremity, and functional impairment. Normal capillary refill time is 3 seconds or less. Pink appearance and a pulse indicate adequate blood flow; swelling is expected after a fracture. Client report of severe, deep, unrelenting pain; client report of numbness and tingling sensation; and client report of pain as the nurse assesses finger movement are indicative of development of compartment syndrome

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. a. Elevated white blood cell count b. A decreased sedimentation rate c. Joint pain that diminishes after rest d. Elevated antinuclear antibody levels e. Joint pain that intensifies with activity

Correct answers: C, E The stiffness and joint pain that occur in osteoarthritis diminish after rest and intensify with activity. No specific laboratory findings are useful in diagnosing osteoarthritis. The client may have a normal or slightly elevated sedimentation rate. Morning stiffness lasting longer than 30 minutes occurs in rheumatoid arthritis. Elevated white blood cell counts, platelet counts, and antinuclear antibody levels occur in rheumatoid arthritis

A client is seen in the health care provider's office for complaints of wrist pain. A diagnosis of carpal tunnel syndrome is made. In explaining this disorder to the client, the nurse states that it is caused by compression of which nerve? a. Median b. Peroneal c. Trigeminal Spinal accessory

Correct answer: A Carpal tunnel syndrome is caused by excessive pressure on the median nerve as a result of injury, overuse, or disease. The peroneal nerve is in the leg. Trigeminal neuropathy results in facial pain, also known as tic douloureux. The spinal accessory nerve is a motor nerve impacting shoulder function

A nurse is reviewing risk factors for osteoporosis with a group of nursing students. The nurse should include that which of the following types of medication therapy is a risk factor for osteoporosis? a. Thyroid hormones b. Anticoagulants c. NSAIDs d. Cardiac glycosides

Correct answer: A Long-term use of a synthetic thyroid hormone, such as levothyroxine, can accelerate bone loss. Anticoagulants can cause bleeding, but do not cause bone loss.NSAIDs can cause bleeding, but do not cause bone loss. Cardiac glycosides can cause hypotension and dysrhythmias, but do not cause bone loss

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? a. Yogurt b. Turkey c. Shellfish Spaghetti

Correct answer: A The major dietary source of calcium is from dairy products including milk, yogurt, and a variety of cheeses. Calcium also can be added to certain products such as orange juice, which are then advertised as being fortified with calcium. Calcium supplements also are available and recommended for persons with typically low calcium intake. Turkey, shellfish, and spaghetti are not high-calcium products

The nurse is caring for a client who had surgery to repair a fractured left-sided hip using a posterior approach. In implementing hip precautions, which action should the nurse teach the client to avoid? a. Crossing legs at the ankle b. Using an elevated toilet seat c. Placing a pillow between the legs d. Keeping the legs abducted from the midline

Correct answer: A Following surgery to repair a fractured hip using a posterior approach, client education should include the following: avoiding crossing the legs at the ankle or the knee, using an elevated toilet seat, placing a pillow between the legs while lying down for the first 6 weeks, keeping the legs abducted from the midline, and keeping the hip in a neutral position at all times

The nurse is obtaining a health history from a client and is assessing for risk factors associated with osteoporosis. The nurse would be most concerned if which data were obtained? Select all that apply. a. The client report that she doesn't exercise much at all b. The client reports that she smokes a few cigarettes a day c. The client report that she is taking phenytoin to treat a seizure disorder d. The client reports that she consumes calcium and vitamin foods and supplements daily e. The client reports that she takes a daily low dose of prednisone to treat a chronic respiratory condition

Correct answer: A, B, C, E Risk factors associated with osteoporosis include a sedentary lifestyle, cigarette smoking, excessive alcohol consumption, chronic illness, and long-term use of anticonvulsants and furosemide. Another risk factor associated with osteoporosis includes a diet that is deficient in calcium. Options 1, 2, 3, and 5 are risk factors associated with osteoporosis

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? a. A large skeletal frame b. A diet low in vitamin D c. Low thyroid hormone levels d. A high dietary intake of calcium

Correct answer: B Some of the risk factors related to osteoporosis in females are a small skeletal frame and elevated thyroid hormone. Low dietary intake of calcium and vitamin D also constitutes a risk factor for osteoporosis

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. a. Use night lights b. Remove scatter rugs c. Use staircase railing d. Remove wall-to-wall carpeting e. Place hand rails in the bathroom

Correct answers: A, B, C, E a. Home modifications to reduce the risk for falls include using railings on all staircases, providing ample lighting, removing scatter rugs, and placing hand rails in the bathroom. Removing wall-to-wall carpeting is not necessary as long as it is in good condition.

The nurse is gathering subjective and objective data from a client with a diagnosis of suspected rheumatoid arthritis (RA). The nurse would expect to note which early signs and symptoms of RA? Select all that apply. a. Fatigue b. Weight gain c. Restlessness d. Morning stiffness Pain with movement only

Correct answers: A, D Early signs and symptoms of RA include fatigue, weight loss, fever, malaise, morning stiffness, pain at rest and with movement, and complaints of night pain. The involved joints appear edematous

Which tests can be used to diagnose gout? Select all that apply. a. Renal ultrasound b. Serum uric acid level c. Bone marrow biopsy d. Urinalysis with culture e. Synovial fluid aspiration f. 24-hour urine uric acid level

Correct answers: B, E, F Diagnostic tests for gout include serum uric acid level and 24-hour urine uric acid level, as well as synovial fluid aspiration and x-ray of the affected areas. Renal ultrasound, bone marrow biopsy, and urinalysis with culture are not specifically associated with gout; they test for a variety of other conditions

A nurse is assessing a client who reports numbness and pain in his right palm, index finger, and middle finger. The client reports working with a keyboard most of the time while at work. The nurse suspects carpal tunnel syndrome. Which of the following tests should the nurse request that the client perform? a. Hold the right arm straight. b. Hold the wrist at a 90-degree flexion. c. Flex the right arm at the elbow. d. Extend the right arm upward.

Correct answer: B Carpal tunnel syndrome is the compression of the median nerve at the wrist. The condition is common in people who perform repetitive motions of the hand and wrist, such as typing. Tapping over the median nerve at the wrist may cause pain to shoot from the wrist to the hand, and bending the wrist at a 90-degree flexion will usually result in numbness, tingling, or weakness

The nurse is performing a neurovascular assessment on a client with a cast on the left lower leg. The nurse notes the presence of edema in the foot below the cast. The nurse should make which interpretation about this finding? a. Arterial insufficiency b. Impaired venous return c. Impaired arterial circulation d. The presence of an infection

Correct answer: B Edema in the extremity indicates impaired venous return. Signs of impaired arterial circulation in the limb include coolness and pallor of the skin and a diminished arterial pulse. Signs of infection under a cast area would include odor or purulent drainage from the cast and the presence of "hot spots," which are areas of the cast that feel warmer to the touch than the rest of the cast

The nurse is caring for a client with a diagnosis of gout. Which laboratory value would the nurse expect to note in the client? a. Calcium level of 9.0 b. Uric acid level of 9.0 c. Potassium level of 4.1 mEq/L Phosphorous level of 3.1 mg/dL

Correct answer: B In addition to the presence of clinical manifestations, gout is diagnosed by the presence of persistent hyperuricemia, with a uric acid level higher than 8 mg/dL (0.48 mmol/L); a normal value for a male ranges from 4.0 to 8.5 mg/dL (0.24 to 0.51 mmol/L) and for a female, from 2.7 to 7.3 mg/dL (0.16 to 0.43 mmol/L). Options 1, 3, and 4 indicate normal laboratory values. In addition, the presence of uric acid in an aspirated sample of synovial fluid confirms the diagnosis

A nurse is teaching a client at high risk for osteoporosis about dietary measures she can take to increase her calcium level. Which of the following foods should the nurse advise the client to increase in her diet? a. Carrots b. Broccoli c. Cabbage d. Potatoes

Correct answer: B One medium-size carrot only contains about 14 mg of calcium, making it a poor dietary source of calcium. Broccoli is high in calcium. Most vegetables contain considerably less calcium, except for kale, collard greens with stems, and turnip greens, which are also good sources of calcium. One cup of cabbage only contains about 44 mg of calcium, making it a poor dietary source of calcium. One medium-size potato only contains about 14 mg of calcium, making it a poor dietary source of calcium

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? a. Allows bony healing to begin before surgery and involves pins and screws b. Provides rigid immobilization of the fracture site and involves pulleys and wheels c. Lengthens the fractured leg to prevent severing of blood vessels and involves pins and screws d. Provides comfort by reducing muscle spasms, provides fracture immobilization, and involves pulleys and wheels

Correct answer: D 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. Traction does not allow for bony healing to begin or provide rigid immobilization. Traction does not lengthen the leg for the purpose of preventing blood vessel severance. This type of traction involves pulleys and wheels, not pins and screws