NCLEX 10000 Musculoskeletal Disorders

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

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

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

Risk for injury related to altered mobility

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

Throughout the first 3 weeks after a client has had a C7 spinal cord injury, the nurse should particularly assess the client for which findings? Select all that apply.

• tachycardia • rapid respirations • bladder incontinence

A client reports having pain in the casted left arm that is unrelieved by pain medication. The nurse assesses the arm and notes that the fingers are swollen and difficult to separate. What should the nurse do first?

Call the health care provider (HCP) to report swelling and pain.

A client is suspected of having carpal tunnel syndrome. The nurse assesses for Tinel's sign. Identify the area where the nurse would percuss in an attempt to elicit Tinel's sign.

Carpal tunnel syndrome is compression of the median nerve in the wrist that supplies feeling and movement to parts of the hand. Tinel's sign may be used to help identify carpal tunnel syndrome. It is elicited by percussing lightly over the median nerve, located on the inner aspect of the wrist. If the client reports tingling, numbness, and pain, the test is considered positive.

A nurse is assessing a client who recently experienced a stroke. The client has a left facial droop, hemiparesis of the upper left extremity, and diplopia. Which nursing intervention is most appropriate for this client?

Consistently place client care items in the same location.

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."

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."

A client suspected of having systemic lupus erythematosus (SLE) is being scheduled for testing. She asks which of the tests ordered will determine if she is positive for the disorder. Which statement by the nurse is most accurate?

"The diagnosis won't be based on the findings of a single test but by combining all data found."

A client undergoes total hip replacement. After surgery, the client questions why he must go to a rehabilitation center because he has family who can care for him. Which response by the nurse is best?

"The rehabilitation staff can evaluate your progress and make sure that you exercise without risking injury."

The nurse assigns an unlicensed assistive personnel (UAP) to care for a client who has a newly applied long-leg plaster cast. What should the nurse tell the UAP about proper care of the cast while it is drying?

"Turn the client every 2 hours to promote even drying of the cast."

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

After knee arthroplasty, the client has a sequential compression device (SCD). What should the nurse do?

Discontinue the SCD when the client is ambulatory.

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

A client is admitted to undergo lumbar laminectomy for treatment of a herniated disk. Which action should the nurse take first to promote comfort preoperatively?

Help the client assume a more comfortable position.

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.

The nurse is providing discharge teaching for a client being discharged after a cast application for a fractured tibia. Teaching has been effective when the client states he/she will notify the physician for which of the following?

Pallor, coolness, and parasthesias of the toes

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

Risk for infection related to effects of trauma

The 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.

Ibuprofen is prescribed for a client with osteoarthritis. Which instruction about ibuprofen should the nurse include in the client's teaching plan?

Take with food or antacids.

Which intervention would be least appropriate for a client who is in a double hip spica cast?

advising the client to eat large amounts of cheese

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

Which nursing measure will likely decrease the risk of a surgical wound infection in a client with an internal fixation and hip pinning?

changing the surgical dressings using sterile technique

A child is to receive IV antibiotics for osteomyelitis. Before the initial dose of antibiotics can be given, the nurse confirms that a blood sample for which test has been drawn?

culture

A client with a fracture develops compartment syndrome. Which sign should alert the nurse to impending organ failure?

dark, scanty urine

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:

fat embolism syndrome.

When using crutches, the nurse should instruct the client to bear weight primarily on the:

hands

A woman of African descent is admitted to the hospital after sustaining a hip fracture. She is 5 feet, 4 inches (163 cm) tall and weighs 96 lb (44 kg). She has five children. She reports that she "just stepped forward and fell." The results of her bone density tests indicate she has osteoporosis. Which is the greatest risk factor for osteoporosis for this woman?

her weight

A 30-year-old client hospitalized with a fractured femur, which is being treated with skeletal traction, has not had a bowel movement for 2 days. The nurse should:

increase the client's fluid intake to 3,000 mL/day.

A client scheduled for hip replacement surgery wishes to receive his own blood for the upcoming surgery. The nurse should:

notify the surgeon's office.

A client has a pin inserted to stabilize a fractured femur. Which clinical sign at the pin site would alert the nurse to infection?

pain

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:

shorter than the leg on the unaffected side.

After a laminectomy, the client states, "The doctor said that I can do anything I want to." Which activity that the client intends to do indicates the need for further teaching?

sweeping the front porch

The nurse should instruct a family living in a rural area where the drinking water is not fluoridated to use which dietary means of obtaining a significant amount of fluoride?

tea

Health promotion activities to reduce the incidence of osteoporosis include

teaching women to maintain adequate calcium intake.

When admitting a client with a fractured extremity, the nurse should first assess:

the area distal to the fracture.

A 14-year-old has just had a plaster cast placed on his lower left leg. To provide safe cast care, the nurse should

use only the palms of the hand when handling the cast.

The nurse is teaching the client to administer enoxaparin following a total hip replacement. What should the nurse instruct the client to do? Select all that apply.

• Avoid all aspirin-containing medications. • Report promptly any difficulty breathing, rash, or itching. • Notify the health care provider (HCP) of unusual bruising. • Wear or carry medical identification.

A client with osteoarthritis will undergo an arthrocentesis on a painful, edematous knee. What directives should be included in the nursing plan of care? Select all that apply.

• Explain the procedure. • Assess the site for bleeding. • Offer pain medication.

A nurse is assigned a client with an acute exacerbation of rheumatoid arthritis (RA). Which medical facts about RA are essential in developing a plan of care? Select all that apply.

• The client experiences stiff, swollen joints bilaterally. • Erythrocyte sedimentation rate (ESR) is elevated, and x-rays show erosions and decalcification of involved joints. • Inflamed cartilage triggers complement activation, which stimulates the release of additional inflammatory mediators.

A client with end-stage dementia is admitted to the orthopedic unit after undergoing internal fixation of the right hip. How should the nurse manage the client's postoperative pain?

Administer analgesics around the clock.

A nurse is admitting a client scheduled for a laminectomy of the L1 and L2 vertebrae. Indicate where the nurse assesses the surgical incision following completion of the procedure.

In a laminectomy, one or more of the bony laminae that cover the vertebrae are removed. The incision for the surgery is at the site of the vertebrae. There are five lumbar vertebrae that are numbered from top to bottom. L5 is the closest to the sacrum. Count up from the sacrum to locate L1 and L2.

Which is a priority nursing goal for a client with rheumatoid arthritis? The client will:

demonstrate use of adaptive equipment.

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

Applying knee splints

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

Assessing for sensation in the legs

A 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

A nurse is caring for five clients on the orthopedic unit with the help of a nursing assistant. Which task may the nurse delegate to the nursing assistant?

Assisting a client to the bathroom and recording the output in the medical record

Which information should the nurse include when performing discharge teaching with a client who had an anterolateral approach for a total hip replacement? Select all that apply.

• Avoid turning the toes or knee outward. • Use an elevated toilet seat and shower chair. • Do not extend the operative leg backwards.

A nurse is preparing discharge instructions for an above-the-knee amputation client. Which instructions would be a priority for home care? Select all that apply.

• Avoid exposing the skin around the residual limb to excessive perspiration. • Be sure to perform the prescribed exercises. • Rub the residual limb with a dry washcloth for 4 minutes three times daily if the limb is sensitive to touch.