NCLEX: Musculoskeletal

A client is being discharged after application of a plaster leg cast. The nurse determines that the client understands proper care of the cast if the client makes which statement?

"I need to avoid getting the cast wet."

A client has just had a cast removed and the underlying skin is yellow-brown and crusted. The nurse determines that further instructions are needed about skin care if the client makes which statement?

"I need to scrub the skin vigorously with soap and water."

The nurse is caring for a client admitted with fat embolism syndrome (FES). Which are some of the early manifestations of this syndrome? Select all that apply.

Dyspnea

A client is complaining of skin irritation from the edges of a cast applied the previous day. The nurse would plan for which intervention?

Petaling the cast edges with edhesive tape

A client returns to the nursing unit after an above-knee amputation of the right leg. In which position would the nurse place the client?

With the foot of the bed elevated

A client has a fiberglass (nonplaster) cast applied to the lower leg. The client asks the nurse when he will be able to walk on the cast. How would the nurse correctly respond to this question?

Within 20 to 30 minutes of application

The nurse is giving the client with a left leg cast crutch-walking instructions using the three-point gait. The client is allowed to touch down the affected leg. How would the nurse teach the client to use the crutches?

Crutches and the left leg, then advance the right leg

The nurse is discharging a client with a diagnosis of gout. Which best practice guidelines would the nurse teach the client? Select all that apply.

Drink plenty of fluids, avoid taking diuretics, avoid excessive physical or emotional stress.

The nurse has reinforced client instructions regarding crutch safety. Which comment by the client would indicate a need for further teaching?

"Crutch tips will not slip, even when wet."

Which statement by the client who has received home care instruction following an arthroscopy of the knee indicates a need for further teaching?

"I can apply heat to my knee if it becomes uncomfortable."

A transcutaneous electrical nerve stimulation (TENS) is prescribed for a client with pain, and the nurse provides information to the client about the TENS unit. Which client statements indicate the need for further teaching? Select all that apply.

"The unit should be turned off if I begin to feel pins and needles.", "Needles are inserted in the subcutaneous tissue to stimulate the nerve."

The nurse is teaching a male client with osteomalacia about this disorder. Which comment by the client indicates a need for further teaching?

"This condition is primarily due to my lack of calcium and testosterone."

The nurse is caring for a client who was just admitted with a diagnosis of fractured right femur. What are some of the acute complications the nurse needs to assess for? Select all that apply.

Crush syndrome, fat embolism syndrome, acute compartment syndrome, hemorrhage and hypovolemic shock

The nurse is caring for a client with osteoarthritis. The nurse collects data, knowing that which is a sign/symptom associated with this disorder?

Dull aching pain in the affected joints

The nurse is caring for a client with a fractured tibia and fibula. Eight hours after a long leg cast was applied, the client began to report an increase in pain level even after administration of the prescribed dose of opioid analgesic. Which is the initial nursing action?

Check the neurovascular status of the toes on the casted leg.

The nurse is caring for a client being treated for fat embolus after multiple fractures. Which data indicate to the nurse a favorable resolution of the fat embolus?

Clear chest x-ray

The nurse is planning to reinforce instructions to the client about how to stand on crutches. In the instructions, the nurse would plan to tell the client to place the crutches in which position?

8 inches to the front and side of the client's toes

A client is complaining of pain underneath a cast in the area of a bony prominence. Which would the nurse anticipate?

A window will be cut in the cast

A client who has had a total knee replacement tells the nurse that there is pain with extension of the knee. Which action would the nurse implement?

Administer an analgesic

The nurse is providing care for a client following a bone biopsy. Which action by the nurse is unnecessary in the care of this client?

Administering intramuscular opioid analgesics

The nurse is caring for a client who has had a spinal fusion with insertion of hardware. The nurse would be especially concerned with which finding?

An oral temperature of 101F orally

The nurse in the emergency department is caring for a client with a fractured arm. The nurse understands that which item is least likely needed before reduction of the fracture in the casting room?

Anesthesia Consent

The nurse has a prescription to get the client out of bed to a chair on the first postoperative day after total knee replacement. The nurse plans to do which to protect the knee joint?

Apply a knee immobilizer before getting the client up, and elevate the client's surgical leg while sitting.

A client is treated in the primary health care provider's office for a sprained ankle. Before sending the client home, the nurse plans to reinforce instructions to the client about which item to avoid in the next 24 hours?

Applying a heating pad

A client in skeletal leg traction with an overbed frame is not allowed to turn from side to side. Which action by the nurse would be most useful in trying to provide good skin care to the client?

Asking the client to pull up on a trapeze to lift the hips off the bed

During admission data collection the nurse asks the client to run the heel of one foot down the lower anterior surface of the other leg. The nurse notices rhythmic tremors of the leg being tested and concludes that the client has interference in which area?

Balance and coordination

A client has undergone fasciotomy to treat compartment syndrome of the leg. Which type of wound care would the nurse anticipate will be prescribed for the fasciotomy site?

Moist, sterile saline dressings

The nurse is evaluating a client in skeletal traction. When evaluating the pin sites, the nurse would be most concerned with which finding?

Thick, yellow drainage from the pin sites

The home care nurse is caring for a client who had a below-the-knee amputation of the right leg. What are some teaching points the nurse gives to the client and family? Select all that apply.

Use a shrinker stocking or sock to cover the wrapped stump, begin residual limb care when sutures or staples are removed, after the limb is healed, it is cleaned each day with the rest of the body during bathing with soap and water.

A client with arthritis of the hands and fingers is having difficulty using a metered-dose inhaler (MDI). The nurse suggests asking the primary health care provider for which prescription?

Use of a spacer

The nurse is discharging a client who had conventional open back surgery. Which comment by the client indicates a need for further teaching?

"I'll be careful not to lift anything heavier than 20 pounds."

The nurse has reinforced instructions to the client returning home after arthroscopy of the knee. The nurse determines that the client understands the instructions if the client makes which statement?

"I'll report fever or site inflammation to the primary health care provider."

The nurse has given a client instructions on how to do active range-of-motion exercises on her contracted right hand. The nurse determines that the client understands the rationale for this procedure when the client makes which statement?

"I'm doing these exercises so I can begin to fasten my buttons and dress myself again."

The clinic nurse is teaching a client who has just been diagnosed with osteoporosis about nutritional therapy. Which comment by the client indicates a need for further teaching?

"I'm glad I can still drink as much coffee as I want."

The nurse has reinforced instructions with the client with a nonplaster (fiberglass) leg cast about cast care at home. The nurse determines that the client needs further teaching if the client makes which statement?

"If the cast gets wet. I can dry it with a hair dryer turned to the warmest setting."

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." How does the nurse correctly interpret the client's statement?

"It is a normal response and indicates the presence of phantom limb sensation."

A client with possible rib fracture has never had a chest x-ray. The nurse would tell the client which statement about the procedure?

"It is necessary to remove jewelry and any other metal objects."

The nurse is teaching a client about crutch walking. Which comment by the client indicates a need for further teaching?

"My crutches must rest up underneath my arm for extra support."

The nurse is caring for a client with osteoporosis who is being discharged with instructions to take calcium with vitamin D. Which instructions would the nurse give the client about taking this medication? Select all that apply.

"Take a third of the daily dose at bedtime.", "increase fluid intake, unless medically contraindicated.", "Take the medication with 6 to 8 ounces of water to help dissolve it."

A client with a left arm fracture exhibits loss of sensation in the left fingers, pallor, slow refill, and diminished left radial pulse. The licensed practical nurse (LPN) would take which action?

Notify the registered nurse

A client with skeletal traction applied to the right leg complains to the nurse about severe right leg pain in spite of being medicated with a prescribed analgesic. Which action would the nurse take?

Notify the registered nurse

The nurse stops at the scene of an automobile accident to assist a victim. The victim complains of severe leg pain, is unable to get out of the automobile, and is frightened. Which is the appropriate nursing action?

Stay with the victim.

The nurse is caring for a client who has skeletal traction applied to the left leg. The client complains of severe left leg pain. The nurse checks the client's alignment in bed and notes that proper alignment is maintained. Which action would the nurse take next?

Notify the registered nurse

A client with a herniated intervertebral lumbar disk complains of a knifelike, stabbing pain in the lower back, as well as pain radiating into the right buttock. The nurse interprets that the sharp, stabbing pain is probably a result of which reason?

Muscle spasm in the area of the herniated disk

A client is complaining of low back pain with radiation down the left posterior thigh. The nurse continues to collect data from the client to see if the pain is worsened or aggravated with which action?

Bending or lifting

The nurse is caring for a client who has developed compartment syndrome from a severely fractured arm. The client asks the nurse how this can happen. How would the nurse explain compartment syndrome?

Bleeding and swelling cause increased pressure in an area that cannot expand.

The nurse is caring for a client with diabetes mellitus who is scheduled to have a right below-knee amputation. The nurse assesses which factors that can put this client at risk for amputation? Select all that apply.

Bony Deformity, Limited joint mobility, Peripheral neuropathy, peripheral vascular disease, History of skin ulcers or previous amputation

The nurse is evaluating goal achievement for a client in traction with impaired physical mobility. The nurse determines that the client has not successfully met all of the goals formulated if which outcome is noted?

Bowel movement every 5 days

The nurse is caring for a client who has had skeletal traction applied to the left leg. The client is complaining of severe left leg pain. Which action would the nurse take first?

Check the client's alignment in bed

A client has several fractures of the lower leg and has been placed in an external fixation device. The client is upset about the appearance of the leg, which is very edematous. The nurse determines that the client is experiencing which problem?

Concerns about body image

The nurse is assigned to care for a client with multiple traumas 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 would perform which intervention?

Elevate the leg on pillows continuously for 24 to 48 hours.

The nurse is caring for a client with a fresh application of a plaster leg cast. The nurse would plan to prevent the development of compartment syndrome by which action?

Elevating the limb and applying ice to the affected leg

The nurse is caring for a client who had a total knee replacement and was put on a continuous passive motion (CPM) machine in the postanesthesia care unit (PACU). What are some of the actions the nurse needs to monitor to operate this machine? Select all that apply.

Ensure that the machine is well padded, assess the client's response to the machine, turn off the machine while the client is having a meal in bed, make sure that the joint being moved is properly positioned on the machine.

The nurse is caring for a client who has had an open reduction with internal fixation (ORIF) with a posterior approach. The client has been prescribed hip precautions. The nurse plans to implement which activities in the care of the client? Select all that apply.

Ensure the client doesn't sit or stand for long periods of time, ensure the client doesn't cross the legs past the midline of the body, ensure the client uses assistive/adaptive devices with activities of daily living.

The nurse is assessing a client recently diagnosed with rheumatoid arthritis. Besides joint inflammation, what are some early systemic sign/symptoms of this disease that the nurse expects to assess? Select all that apply.

Fatigue, weakness, paresthesias

The nurse is caring for a client diagnosed with Paget's disease. The nurse plans care knowing that this condition usually affects which bones? Select all that apply.

Femur, skull, tibia, vertebrae

The nurse has provided instructions to a 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 further teaching if the client verbalizes which action should be done?

Get out of bed by sitting straight up and swinging the legs over the side of the bed.

A client has just undergone spinal fusion after suffering a herniated lumbar disk. The nurse would avoid which action to maintain client safety after this procedure?

Having the client use an overhead trapeze

A nursing instructor asks a nursing student about the risk factors associated with osteoporosis. The instructor determines that the student needs further teaching if the student states that which is an associated risk factor?

High-calcium diet consumption

The nurse witnesses a client sustain a fall and suspects that the client's leg may be fractured. Which action is the priority?

Immobilize the leg before moving the client

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 which condition?

Impaired tissue perfusion

The nurse has a prescription to place a client with a herniated lumbar intervertebral disk on bed rest to minimize the pain. The nurse plans to put the bed in which position?

In semi-Fowler's position with the knee gatch slightly raised

The nurse is caring for a comatose client at risk for fat embolism because of a fractured femur and pelvis sustained in a fall. Which finding does the nurse identify as early signs/symptoms of possible fat embolism?

Increased heart rate and adventitious breath sounds

The nurse is caring for a client with a diagnosis of osteoarthritis. Which actions would be least helpful for the client?

Increasingly vigorous and high-impact exercise

A client has Buck's extension traction applied to the right leg. The nurse would plan which intervention to prevent complications of the device?

Inspecting the skin on the right leg at least once every 8 hours

The nurse is preparing a list of cast care instructions for a client who just had a plaster cast applied to his right forearm. Which instructions would the nurse include on the list? Select all that apply.

Keep the cast and extremity elevated, the cast needs to be kept clean and dry, allow the wet cast 24 to 72 hours to dry.

The nurse is assisting in caring for a client who has sustained a nasal fracture. The nurse monitors for which priority finding specifically related to this injury?

Leakage of clear fluid from the nose

A client with right-sided weakness needs to learn how to use a cane. How would the nurse teach the client to position the cane?

Left hand, and 6 inches lateral to the left foot.

A client has had skeletal traction applied to the right leg and has an overhead trapeze available for use. The nurse would monitor which area as a high-risk area for pressure and breakdown?

Left heel

The nurse is planning to teach a client with a left arm cast about measures to keep the left shoulder from becoming stiff. Which suggestion would the nurse include in the teaching plan?

Lift the left arm up over the head

The nurse is discussing primary prevention measures to clients regarding osteoporosis. The nurse plans to tell the clients that which is a primary prevention measure?

Maintaining body weight at or above minimum recommended levels

The nurse is caring for a client who was admitted to the hospital with a fractured right femur sustained from a fall 5 hours ago. The client's plan of care includes interventions related to monitoring for signs/symptoms of fat embolism. The nurse provides appropriate care by performing which action?

Monitoring for signs of dyspnea

The 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 performed which action?

Moves the cane when the right leg is moved

A client with a left arm fracture complains of severe, diffuse pain that is unrelieved with pain medication. Based on these findings the nurse would take which action?

Notify the registered nurse

The nurse has provided instructions to a client in an arm cast about the signs/symptoms of compartment syndrome. The nurse determines that the client understands the information if the client states to report which early symptom of compartment syndrome?

Numbness and tingling in the fingers

An elderly client is brought to the emergency department via ambulance after sustaining a fall. An x-ray indicates that the client sustained a femoral neck fracture. The nurse is collecting data from the client and knows that which disease processes increase the older adult's risk for hip fractures? Select all that apply.

Osteoporosis, foot disorders, bony metastases, changes in cardiac function

Which data would indicate a potential complication associated with age-related changes in the musculoskeletal system?

Overall sclerotic lesions

The nurse is caring for a client with Paget's disease. The nurse knows that when serum calcium levels are lowered, what hormone secretion increases to release calcium to the blood?

Parathyroid Hormone (PTH)

A client has undergone total hip replacement of the right hip, which was damaged by osteoarthritis. Which action would be included in the postoperative plan of care?

Partial weight bearing on the operative leg is usually permitted 72 hours postoperatively; check surgeon's prescription.

The 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 teaching if the nurse observes the client doing which activity?

Performing active range of motion (ROM) to the right ankle and knee

The nurse is caring for a client who has a cast applied to the left lower leg. On data collection, the nurse notes the presence of skin irritation from the edges of a cast. Which nursing intervention is appropriate?

Petal the cast edges with adhesive tape

The nurse is repositioning a client who has returned to the nursing unit following internal fixation of a fractured right hip. How would the nurse plan to position the client?

Pillow to keep the right leg abducted during turning.

The nurse is preparing a plan of care for a client in skeletal leg traction with an overbed frame. Which nursing intervention would be included in the plan of care to assist the client with positioning in bed?

Place a trapeze on the bed to provide a means for the client to lift the hips off the bed.

The nurse is caring for a client who sustained multiple fractures in a motor vehicle accident 12 hours ago. The client develops severe dyspnea, tachycardia, and mental confusion, and the nurse suspects fat embolism. Which is the nurse's initial action?

Place the client in a Fowler's position.

The nurse is reinforcing 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?

Pork

The nurse is checking the casted extremity of a client. The nurse would check for which sign indicative of infection?

Presence of a "hot spot" on the cast

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 has which primary function?

Provides comfort by reducing muscle spasms and provides fracture immbolization

The nurse is caring for a client who had an above-the-knee amputation 2 days ago. The residual limb was wrapped with an elastic compression bandage that has fallen off. The nurse would immediately perform which action?

Rewrap the residual limb with an elastic compression bandage

The nurse is evaluating the pin sites of a client in skeletal traction. The nurse would be least concerned with which finding?

Serous Drainage

A client is fearful about having an arm cast removed. Which action by the nurse would be the most helpful?

Showing the client the cast cutter and explaining how it works

A client has been placed in Buck's extension traction. Which technique provided by the nurse will provide countertraction?

Slightly elevating the foot of the bed

The 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 perform which action?

Stay with the person and encourage the person to remain still

The nurse is monitoring a confused older client admitted to the hospital with a hip fracture. Which issues could place the client at increased risk for disturbed thought processes? Select all that apply.

Stress from the fracture, eyeglasses left at home, unfamiliar hospital setting, side effects of medications.

A client who is learning to use a cane is afraid it will slip with ambulation, causing a fall. What would the nurse tell the client to provide greater reassurance?

The cane has a flared tip with concentric rings to provide stability.

The nurse is teaching a client how to walk with a cane. Which information would the nurse include? Select all that apply.

The cane should create no more than 30 degrees of flexion of the elbow

A client has been taught to use a walker to aid in mobility following internal fixation of a hip fracture. The nurse determines that the client is using the walker incorrectly if which action is noted?

The client holds the walker using the handgrips

The nurse reinforces cast application instructions to a client who is going to have a plaster cast applied. The nurse determines that the client needs further teaching if the client makes which statement about the casting?

The client may bear weight on the cast in 30 mintues

The nurse is caring for a client with a long bone fracture who is at risk for fat embolism. The nurse specifically monitors for the early signs of this complication by checking which criteria? Select all that apply.

The client's mental status, the client's respiratory function.

The nurse is preparing to reinforce instructions to a client regarding how to safely use crutches. Before initiating the teaching, the nurse collects data on the client. Which priority data would be included?

The client's vital signs, muscle strength, and previous activity level

The nurse is planning to reinforce instructions to the client about proper use of a thoracolumbosacral orthosis (TLSO) after spinal fusion with instrumentation. The nurse plans to include which teaching points in discussion with the client?

The device is applied before getting out of bed in the morning