Musculskeletal questions

A nurse is preparing a list of cast care instructions for a client who just had a plaster cast applied to his right forearm. Select all instructions that the nurse includes on the list. 1. Keep the cast and extremity elevated 2. The cast needs to be kept clean and dry 3. Allow the wet cast 24 to 72 hours to dry 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, 2, 3

A client is being discharged home after application of a plaster leg cast. The nurse determines that the client understands proper care of the cast if the client states that he or she will: 1. avoid getting the cast wet. 2. Cover the casted leg with warm blankets. 3. Use the fingertips to lift and move the leg. 4. Use a padded coat hanger end to scratch under the cast.

1.

A nurse is caring for a client with fresh application of a plaster leg cast. The nurse plans to prevent the development of compartment syndrome by: 1. Elevating the limb and applying ice to the affected leg 2. Elevating the limb and covering the limb with bath blankets 3. Keeping the leg horizontal and applying ice to the affected leg 4. Placing the leg in a slightly dependent position and applying ice.

1.

A nurse prepares a list of home-care instructions for the parents of a child who has a plaster cast applied to the left forearm. Choose the instructions that would be included on the list. Select all that apply. 1. Use the fingertips to lift the cast while it is drying 2. Keep small toys and sharp objects away from the cast 3. Contact the physician if the child complains of numbness or tingling in the extremity 4. Use a padded ruler or another padded object to scratch the skin under the cast if it itches. 5. Place a heating pad on the lower end of the cast and over the fingers if the fingers feel cold. 6. Elevate the extremity on pillows for the first 24 to 48 hours after casting to prevent swelling.

2, 3, 6

A 4-year-old child sustains a fall at home and is brought to the emergency department by the mother. After an x-ray, t is determined that the child has a fractured arm, and a plaster cast is applied. The nurse provides instructions to the mother regarding cast care for the child. Which statement by the other indicates the need for further instructions? 1. "The cast may feel warm as it dries." 2. "I can use lotion or powder around the cast edges to relieve itching." 3. "A small amount of white shoe polish can touch up a soiled white cast." 4. "If the cast becomes wet, a blow-ryer set on the cool setting may be used to dry it."

2.

A client is treated in the physician's office after a fall, which sprained the ankle. Radiography has ruled out fracture. Before sending the client home, the nurse would plan to teach the client about which item that is to be avoided in the next 24 hours? 1. Resting the foot 2. Application of an Ace wrap 3. Application of a heating pad 4. Elevating the ankle on a pillow while sitting or lying down

3.

A nurse is performing a neurovascular check on a child with a cast applied to the lower leg. The child complains of tingling in the toes distal to the fracture site. Which action should be taken by the nose? 1. Elevate the extremity. 2. Document the findings. 3. Notify the registered nurse (RN). 4. Ambulate the child with crutches.

3.

A nurse is assisting a physician during the examination of an infant with hip dysplasia. The physician performs the Ortolani maneuver. Which best describes the action/purpose of the Ortolani maneuver? 1. Determining the extent of range of motion 2. Checking for asymmetry on the affected side 3. Pushing the unstable femoral head out of the acetabulum 4. Reducing the dislocated femoral head back into the acetabulum

3. For Ortolani maneuver, the examiner reduces the dislocated femoral head back into the acetabulum. A positive Ortolani maneuver is a palpable clink as the femoral head moves over the acetabular ring. When performing the Barlow maneuver, the examiner pushes the unstable femoral head out of the acetabulum.

A client has sustained a closed fracture and has just had a cast applied to the affected arm. The client is complaining of intense pain. The nurse has elevated the limb, applied an ice bag, and administered an analgesic, which was ineffective in relieving the pain. The nurse interprets that this pain may be caused by: 1. Infection under the cast 2. The anxiety of the client 3. Impaired tissue perfusion 4. The newness of the fracture

3. For new closed fracture, there not yet infection. The possible causes of pain are: tissue perfusion impairment, tissue breakdown, necrosis.

The mother of a child with juvenile idiopathic arthritis calls the nurse becaue the child is experiencing a painful exacerbation of the disease. The mother asks the nurse if thechild should perform range-of-motion (ROM) exercises at this time. The nurse makes which response to the mother? 1. "Avoid all exercise during painful periods." 2. "The ROM exercises must be performed every day." 3. "Have the child perform simple isometric exercises durign this time." 4. "Administer additional pain medication before performing the ROM exercises."

3. isometric exercises do not involve joint movement. Although resting is necessary, it is important begin simple isometric or tensing exercises as soon as the client is able to. For arthritis, during painful period, hot or cold pack, or positioning the effected joint in neutral position helps to reduce the pain.

A nurse provides information to the mother of a 2-week-old infant who was diagnosed with club foot at the time of birth. which statement by the mother indicates the need for further instruction regarding this disorder? 1. "Treatment needs to be started as soon as possible." 2. "I realize my child will require follow-up care until full grown." 3. "I need to bring my child back to the clinic in 1 month for a new cast." 4. " I need to come to the clinic every week with my child for the casting."

3. long term interval follow up is required to assess for recurrence of club foot. The treatment for club foot is started as soon as possible after birth. Serial manipulation and casting are performed at least weekly. If sufficient correction is not achieved within 3 to 6 months, surgery is usually indicated.

A nurse is checking the casted extremity of a client. The nurse would check for which of the following signs and symptoms 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. other signs are signs of impaired blood circulation.

A nurse has provided instructions to the client returning home after arthroscopy of the knee. The nurse determines that the client understand the instructions if the client states that he or she will: 1. Resume regular exercise the following day. 2. Stay off the leg entirely for the rest of the day. 3. Refrain from eating food for the remainder of the day. 4. Report fever or site inflammation to the physician.

4.

A nurse has provided instructions regarding specific leg exercises for the client immobilized in right skeletal lower leg traction. The nurse determines that the client needs further instruction if the nurse observes the client: 1. Pulling up on the trapeze 2. Flexing the extending the feet 3. Doing quadriceps-setting and gluteal-settign exercises 4. Performing active range of motion (ROM) to the right ankle and knee.

4.

A nurse has provided instructions to client with a herniated lumbar disk about proper body mechanics and other items pertinent to low back care. The nurse determines that the client needs care. The nurse determines the client needs further instructions if the client verbalizes that he or she will: 1. Increase fiber and fluids in the diet 2. Bend at the knees to pick up objects 3. Strengthen the back muscles by swimming or walking 4. Get out of bed by sitting straight up and swinging legs over the side of the bed.

4.

A nurse is assigned to care for a client with multiple trauma who is admitted to the hospital. The client has a leg fracture, and a plaster cast has been applied. In positioning the casted leg, the nurse should: 1. Keep the leg in a level position. 2. Elevate the leg for 3 hours, and put it flat for 1 hour. 3. Keep the leg level for 3 hours, and elevate it for 1 hour. 4. Elevate the leg on pillows continuously for 24 to 48 hours.

4.

A nurse is one of several people who witness a vehicle hit a pedestrian at a fairly low speed on a small street. The individual is dazed and tries to get up, and the leg appears fractured. The nurse would plan to: 1. Try to manually reduce the fracture. 2. Assist the person to get up and walk to the sidewalk. 3. Leave the person for a few moments to call an ambulance. 4. Stay with the person and encourage the person to remain still.

4.

A nurse is caring for a client with osteoarthritis. The nurse collects data, knowing that which of the following is a clinical manifestation associated with the disorder? 1. morning stiffness 2. Positive rheumatoid factor 3. An elevated sedimentation rate 4. Dull aching pain in the affected joints

4. 1, 2 are rehumatoid arthritis signs.

client is complaining of skin irritation from the edges of a cast applied the previous day. The nurse should plan for which of the following actions? 1. Massaging the skin at the rim of the cast 2. Petaling the cast edges with adhesive tape 3. Using a rough file to smooth the cast edges 4. Applying lotion to the skin at the rim of the cast.

2.

A nurse is providing instructions to the parents of a child with scoliosis regarding the use of a brace. Which statement by a parent indicates the need for further instruction? 1. "I need to have my child wear a soft fabric under the brace." 2. "I will apply lotion under the brace to prevent skin breakdown." 3. "I need to encourage my child to perform the prescribed exercises." 4. " I need to avoid applying powder under the brace, because it will cake."

2. Avoid applying lotion or powder. They can become sticky and cake under the brace and cause irritation.

A nurse is evaluating the pin sites of a client in skeletal traction. The nurse would be least concerned with which finding? 1. Inflammation 2. Serous drainage 3. Pain at pin site 4. Purulent drainage

2. a small amount of drainage is expected. However, signs of infection should be reported: inflammation, purulent drainage, pain a t pine site.

A nurse is assigned to care for a child after a spinal fusion for the treatment of scoliosis. The child complains of abdominal discomfort and begins to have episodes of vomiting. On assessment, the nurse notes abdominal distention. Which action should the nurse take? 1. Administer an antiemetic. 2. Increase the intravenous fluids. 3. Notify the registered nurse (RN). 4. Place the child in a side-lying Sims' position.

3. Attention to postoperative vomiting. This could be superior mesenteric artery syndrome. After the surgical treatment of scoliosis, the complication is superior mesenteric artery syndrome, which caused by the change of position of the child's abdomen contents that result from the lengthening of the child's body. syndrom: emesis, abdominal distention (similar symptoms to intestinal obstruction or paralytic ileus).

A client with a hip fracture asks the nurse why Buck's extension traction is being applied before surgery. The nurse's response is based on the understanding that Buck's extension traction primarily: 1. Allows bony healing to begin before surgery 2. Provides rigid immobilization of the fracture site. 3. Lengthens the fractured leg to prevent severing of blood vessels 4. Provides comfort by reducing muscle spasms and provides fracture immobilization

4. Buck's extension traction is a type of skin traction applied after hip fracture, before surgery. It reduces muscle spasms and helps immobilze the fracture.

A client with diabetes mellitus has had a right below-knee amputation. The nurse would be especially vigilant in monitoring for which of the following because of the client's history of diabetes mellitus? 1. Hemorrhage 2. Edema of residual limb 3. Slight redness of incision 4. Separation of wound edges

4. DM patients are prone to infection and delayed wound healing. 1,2 are immediate postoperative complications apply to many client.

A client is admitted to the nursing unit after a left below-knee amputation following 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." The nurse interprets the client's statement to be: 1. A normal response and indicates the presence of phantom limb pain 2. A normal response, and indicates the presence of phantom limb sensation 3. An abnormal response, and indicates that the client is in denial about the limb loss 4. An abnormal response, and indicates that the client needs more psychological support

2.

A client is complaining of pain underneath a cast in the area of a bony prominence. The nurse interprets that this client may need to have 1. The cast bivalved 2. A window cut in the cast 3. The cast replaced with an air splint 4. Extra padding put over this area of the cast

2.

A client with a left arm fracture exhibits loss of sensation in the left fingers, pallor, slow refill, and diminished left radial pulse. The nurse should take which of the following actions? 1. Administer and analgesic. 2. Notify the registered nurse 3. Check the circulation again in 30 minutes 4. Provide range-of-motion exercises to the fingers of the left hand.

2.

A nurse is evaluating the client's use of a cane for left-sided weakness. The nurse would intervene and correct the client if the nurse observed that the client: 1. Holds the cane on the right side 2. Moves te cane when the right leg is moved 3. Leans on the cane when the right leg swings through 4. Keeps the cane 6 inches out to the side of the right foot

2.

A nurse is planning to provide instructions to the client about how to stand on crutches. In the written instructions, the nurse plans to tell the client to place the crutches: 1. 3 inches to the front and side of the client's toes 2. 8 inches tot he front and side of the client's toes 3. 20 inches to the front and side of the client's toes 4. 15 inches to the front and side of the client's toes

2.

A nurse is providing instructions to a client with osteoporosis regarding appropriate food items to include in the diet. The nurse tells the client that which food item would provide the least amount of calcium? 1. Pork 2. Seafood 3. Sardines 4. Plain yogurt

1.

A nurse witnesses a client sustain a fall and suspects that the client's leg may be fractured which action is the priority? 1. Take a set of vital signs. 2. Call the radiology department. 3. Immobilize the leg before moving the client. 4. Reassure the client that everything will be fine.

3.

A nursing instructor asks a nursing student about the risk factors associated with osteoporosis The instructor tells the student that she needs to read and learn about this disorder if the student states that which of the following is an associated risk factor? 1. postmenopausal age 2. Family history of osteoporosis 3. High-calcium diet consumption 4. Long-term use of corticosteroids

3.

A nurse is assigned to care for a child who is in skeletal traction. The nurse avoids which of the following when caring for the child? 1. Keeping the weights hanging freely 2. Ensuring that the ropes are in the pulleys 3. Placing the bed linens on the traction ropes 4. Ensuring that the weights are out of the child's reach.

3. Bed linens on the traction topes may disrupt the traction apparatus.

A nurse is preparing to perform a neurovascular check for tissue perfusion in the child with an arm cast. Which of the following is the priority when performing this procedure? 1. Taking the temperature 2. Taking the blood pressure 3. Checking the apical heart rate 4. Checking the peripheral pulse in the affected arm

4. assessment for tissue perfusion is performed on the fingers and toes distal to the injury or cast. It includes peripheral pulse, color, capillary refill time, warmth, motion, and sensation.