Musculoskeletal NCLEX

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."

The nurse is reinforcing discharge instructions for a client who underwent left total knee replacement (TKR) with insertion of a metal prosthesis. Which statement by the client indicates the need for further teaching?

"I don't need to be worried if the shape of my knee changes."

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."

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 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 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 is diagnosed with gout. Which foods should the nurse instruct the client to avoid?

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

(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.

The nurse prepares to care for a client with inflamed joints and plans to use which item to maintain proper positioning for rest of the inflamed joints? 1. Large pillows 2. Footboards 3. Small pillows 4. Soft mattress

3. Small pillows

An older client with advanced Alzheimer's disease is placed in balanced suspension traction, and the health care provider expects to internally fixate the client's femur in 1 week. Based on this information, the nurse determines that the first priority relates to addressing which of the following nursing diagnoses? 1. Risk for constipation 2. Risk for activity intolerance 3. Impaired tissue integrity 4. Disturbed thought processes

1. Risk for constipation

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.

A client with type 1 diabetes mellitus has had a left above-the-knee amputation. The nurse carefully inspects the residual limb for which of the following complications because of the history of diabetes? 1. Separation of wound edges 2. Pain 3. Edema of the stump 4. Hemorrhage

1. Separation of wound edges

A 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. The appropriate nursing action is to: Submit 1. Stay with the victim. 2. Assist the victim out of the automobile. 3. Leave the victim to call an ambulance. 4. Tell the victim to keep moving the leg to maintain circulation.

1. Stay with the victim.

A nurse is caring for a client who had a total knee replacement. Postoperatively, the nurse monitors for which highest priority item? 1. Calf pain 2. Heel breakdown 3. Bladder distention 4. Extremity shortening

1. Calf pain

A nurse is caring for a client following total hip replacement who has a Hemovac wound suction drain in place. At the end of the 8-hour shift, the nurse empties 45 mL of drainage from the wound-suction device. Based on this amount of drainage, which action is appropriate? 1. Document the findings. 2. Place the leg in a flat position. 3. Check the client's blood pressure. 4. Immediately notify the health care provider.

1. Document the findings.

Which of the following interventions would be contraindicated in the postprocedure care of the client following a bone biopsy of the left arm? 1. Place the left arm in a dependent position for 24 hours. 2. Monitor vital signs every 4 hours. 3. Monitor site for swelling, bleeding, hematoma. 4. Administer oral analgesics as needed.

1. Place the left arm in a dependent position for 24 hours.

A client has sustained multiple fractures in the left leg and is in skeletal traction. The nurse has obtained an overhead trapeze for the client's use to aid in bed mobility. The nurse would pay particular attention to monitoring for which of the following high-risk areas for pressure and breakdown? 1. Right heel 2. Left heel 3. Scapulae 4. Back of the head

1. Right heel

A nurse has reviewed activity restrictions with a client who is being discharged following hip surgery and insertion of a femoral head prosthesis. The nurse determines that the client understands the material presented if the client states that it is acceptable to: 1. Use a raised toilet seat. 2. Bend carefully to put on socks and shoes. 3. Sit in chairs without arms for better mobility. 4. Exercise the leg past the point of 90-degree flexion.

1. Use a raised toilet seat. Rationale: The client who has had an insertion of a femoral head prosthesis should use a raised toilet seat. The client should also 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. The client should sit in chairs that have arms so there will be assistance when the client is ready to rise from the sitting position. The client should avoid putting on own socks and shoes for 8 weeks after surgery because it would force the leg into acute flexion. (POSSIBLE MISTAKE ON EXAM)

A nurse is caring for an older client with a diagnosis of osteoarthritis. Which of the following would be least helpful for the client? Submit 1. Gentle regular exercise 2. Increasingly vigorous and high-impact exercise 3. A warm bath or shower early in the day 4. An individualized program of pain medication administration

2. Increasingly vigorous and high-impact exercise

A client being measured for crutches asks the nurse why the crutches cannot rest up underneath the arm for extra support. The nurse's response is based on the understanding that this could result in: 1. A fall and further injury 2. Injury to the brachial plexus nerves 3. Skin breakdown in the area of the axilla 4. Impaired range of motion while the client ambulates

2. Injury to the brachial plexus nerves

A client has had skeletal traction applied to the right leg and has an overhead trapeze available for use. The nurse should monitor which of the following as a high-risk area for pressure and breakdown? 1. Scapulae 2. Left heel 3. Right heel 4. Back of the head

2. Left heel

A nurse is preparing a client scheduled for a bone marrow aspiration, and the client asks the nurse whether the procedure will be painful. The nurse should make which response to the client? 1. "No, it is not painful." 2. "A local anesthetic will be given." 3. "You will receive general anesthesia." 4. "You will be heavily medicated before the procedure."

2. "A local anesthetic will be given."

A client has just had a cast removed and the underlying skin is yellow-brown and crusted. The nurse determines that further skin care instructions are required when the client states: 1. "I will soak the skin and then wash it gently." 2. "I need to scrub the skin vigorously with soap and water." 3. "I need to apply an emollient lotion to enhance softening." 4. "I need to use a sunscreen on the skin if it's exposed for a period of time."

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

A client with possible rib fracture has never had a chest x-ray. The nurse would plan to tell the client which of the following items about the procedure? 1. "The x-ray stimulates a small amount of pain." 2. "It is necessary to remove jewelry and any other metal objects." 3. "The client will be asked to breathe in and out during the x-ray." 4. "The x-ray technologist will stand next to the client during the x-ray."

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

A nurse is planning to teach the client with a left arm cast about measures to keep the left shoulder from becoming stiff. Which suggestion should the nurse include in the teaching plan? 1. "Use a sling on the left arm." 2. "Lift the left arm up over the head." 3. "Lift the right arm up over the head." 4. "Make a fist with the hand of the casted arm."

2. "Lift the left arm up over the head." Rationale: Immobility and the weight of a casted arm may cause the shoulder above an arm fracture to become stiff. The shoulder of a casted arm should be lifted over the head periodically as a preventive measure. The use of slings further immobilizes the shoulder and may be contraindicated. Making fists with the left hand provides isometric exercise to maintain muscle strength. Range of motion of the affected fingers is also a useful general measure. Lifting the right arm is of no particular value.

A nurse is planning to provide instructions to the client about how to stand on crutches. In the 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 to the 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. 8 inches to the front and side of the client's toes Rationale: The classic tripod position is taught to the client before giving instructions on gait. The crutches are placed anywhere from 6 to 10 inches in front and to the side of the client, depending on the client's body size. This provides a wide enough base of support to the client and improves balance.

A nurse is caring for a client diagnosed with Paget's disease. The nurse understands that this condition usually affects which bones? 1. Anterior rib cage and sternum 2. Axial skeleton including vertebrae 3. Bones of hands and feet 4. Shoulder and humerus

2. Axial skeleton including vertebrae

A nurse is providing postprocedure instructions to a client returning home after arthroscopy of the shoulder. The nurse would encourage the client to: 1. Not eat or drink anything until the following morning. 2. Report to the health care provider the development of fever or redness and heat at the site. 3. Keep the shoulder completely immobilized for the rest of the day. 4. Resume regular full activity the following day.

2. Report to the health care provider the development of fever or redness and heat at the site.

A client has a newly fractured fibula that is plaster casted in the emergency department. Because the client will need to use crutches, the nurse plans to teach the client which crutch-walking gait before discharge? 1. Four-point alternate gait 2. Three-point gait 3. Two-point gait 4. Swing-through gait

2. Three-point gait

A nurse is collecting data from a client who is being seen in the health care clinic. The client is complaining of unrelieved back pain that has persisted over the past 3 months. The nurse determines that which of the following harmful effects can occur as a result of uncontrolled muscle pain? 1. Anorexia 2. Weakness 3. Weight loss 4. Hypertension

2. Weakness

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

24 hours.

A client with a fractured femur is placed in skeletal traction. The nurse should do which to monitor for nerve injury? 1. Check the blood pressure. 2. Check the pin sites for drainage. 3. Check the neurovascular status of the affected extremity. 4. Monitor the client's ability to perform active range of motion to the affected extremity.

3. Check the neurovascular status of the affected extremity.

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

Which statement by the client who has received home care instruction following an arthroscopy of the knee indicates a need for further education? 1. "I should elevate my knee while sitting." 2. "I should avoid excessive use of the joint for several days." 3. "I can apply heat to my knee if it becomes uncomfortable." 4. "I should return to the health care provider in about 7 days for followup."

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

A postoperative client received a spinal anesthetic during the repair of a right hip fracture. The client has not experienced pain because the anesthetic has not yet worn off. The nurse will monitor the client closely for pain and provide the client with which instruction? 1. "I will be bringing your pain medication at ten o'clock PM." 2. "You will not feel pain because of the spinal anesthesia." 3. "You will need to let me know when you start to get feeling back in your legs." 4. "You will not be able to take pain medication until you have been up to the bathroom."

3. "You will need to let me know when you start to get feeling back in your legs."

A nurse is preparing to collect data from a client who has sustained a pelvic fracture following a motor vehicle accident. The nurse reviews the health care provider's (HCP) prescriptions and notes that the HCP has prescribed a pelvic (skin) sling. The nurse prepares to place the client in which device? Refer to figure. 1. 1 2. 2 3. 3 4. 4

3. 3

A client who has had a total knee replacement tells the nurse that there is pain with extension of the knee. The nurse should: 1. Put the client's knee through full passive range of motion. 2. Immobilize the knee temporarily. 3. Administer an analgesic. 4. Notify the health care provider immediately.

3. Administer an analgesic.

A nurse is talking to a client who underwent a below-the-knee amputation 2 days earlier. The client says to the nurse, "I hate looking at this; I feel that I'm not even myself anymore." The nurse understands that the client is experiencing which problem? 1. Self-care deficit 2. Ineffective coping 3. Disturbed body image 4. Ineffective health maintenance

3. Disturbed body image

A 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. The initial nursing action is to: 1. Contact the health care provider. 2. Elevate the casted leg. 3. Administer another dose of pain medication. 4. Check the neurovascular status of the toes on the casted leg.

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

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

age

A nurse is providing discharge instructions to a client following surgical treatment for carpal tunnel syndrome. Which statement by the client would indicate a need for further instruction? 1. "I should elevate my arm to reduce the swelling." 2. "I should use a sling to limit movement and keep my arm elevated." 3. "I should return to the health care provider in about ten days to have the sutures removed." 4. "I should perform pronation and supination exercises of my wrist starting twenty-four hours after surgery."

4. "I should perform pronation and supination exercises of my wrist starting twenty-four hours after surgery."

A nurse is assisting in preparing a client for discharge to home. Daily cold therapy has been prescribed for the client, and the nurse provides instructions about this treatment. Which statement by the client indicates adequate understanding of cold therapy treatment? 1. "I need to apply the cold pack for at least 60 minutes." 2. "I should check my pulse before using the ice on my joints." 3. "I can lie on the ice by placing it between the bed and my body." 4. "I should wrap the frozen ice pack in a warm towel to help adjust to the cold."

4. "I should wrap the frozen ice pack in a warm towel to help adjust to the cold."

A 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 instruction if the client makes which statement? 1. "I should avoid walking on wet, slippery floors." 2. "I'm not supposed to scratch the skin underneath the cast." 3. "It's all right to wipe dirt off the top of the cast with a damp cloth." 4. "If the cast gets wet, I can dry it with a hair dryer turned to the warmest setting."

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

A client who is scheduled for surgery and who is to be placed in skeletal traction says to the nurse, "I'm not sure if I want to have this skeletal traction or if the skin traction would be best to stabilize my fracture." Based on the client's statement, the nurse should make which response to the client? 1. "Your fracture is very unstable. You will die if you don't have this surgery performed." 2. "There is no reason to be concerned. I have seen lots of these procedures." 3. "Skeletal traction is much more effective than skin traction in your situation." 4. "You have concerns about skeletal versus skin traction for your type of fracture?"

4. "You have concerns about skeletal versus skin traction for your type of fracture?"

This morning a client sustained a right proximal fibula and tibia fracture that was casted in a long leg plaster cast. During evening rounds, the nurse notes that the right lower extremity capillary refill is greater than 3 seconds and the toes are edematous and dusky. The client states that the pain medication is not working anymore and that the right foot feels like it is asleep. The nurse analyzes the data and determines that the client's symptoms are indicative of: 1. Fat embolism 2. Volkmann's thrombosis 3. Venous thrombosis 4. Compartment syndrome

4. Compartment syndrome

A nurse is caring for a client following a total hip replacement. The client has been diagnosed with iron deficiency anemia. The nurse instructs the client to increase intake of which of the following foods? 1. Milk and yogurt 2. Potatoes and carrots 3. Apples and mangos 4. Lean beef and chicken liver

4. Lean beef and chicken liver

A health care provider has given a prescription for dietary iron supplements to the client with osteoporosis who has an iron deficiency anemia. The nurse suggests that the client do which of the following to enhance compliance with therapy? 1. Decrease fluid intake. 2. Decrease dietary fiber. 3. Chew the tablet thoroughly. 4. Take the medication following a meal.

4. Take the medication following a meal.

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

Acetylcholine

A client is experiencing an acute exacerbation of bursitis. The nurse encourages the client to avoid which least likely helpful measure until the current episode is resolved?

Active intermittent range of motion

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

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

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

The nurse is teaching a client about foods in the diet that could minimize the risk of osteoporosis. The nurse should encourage the client to increase intake of which food?

Cheese

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

Colchicine

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.

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

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 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

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.

A client has just had skeletal traction applied following insertion of pins. The nurse should place highest priority on performing which action?

Ensuring that the weights on the traction setup are hanging free

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.

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%

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

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?

Greenstick Fracture

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

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

Impaired physical mobility

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

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

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 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

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

Joint stiffness that decreases with activity

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.

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

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 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

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

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

No further increase in bone length occurs.

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 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.

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 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

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.

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

Risk for infection related to effects of trauma

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

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.

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.

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.

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

Type and crossmatch

The nurse is reinforcing instructions to the client with a below-the-knee amputation (BKA) with regard to measures to protect the residual limb. The nurse should be sure to include which point in discussions with the client?

Use a mirror to inspect all areas of the residual limb.

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 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 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.

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.

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.

Elderly clients who fall are most at risk for:

pelvic fracture

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.

A nurse is caring for the client who is going to have an arthrogram using a contrast medium. Which of the following data collected by the nurse would be of highest priority? 1. Allergy to iodine or shellfish 2. Whether the client needs to void before the procedure 3. Ability of the client to remain still during the procedure 4. Whether the client has any remaining questions about the procedure

1. Allergy to iodine or shellfish

A nurse in the emergency department is caring for a client with a fractured arm. The nurse understands that which item is not necessary before reduction of the fracture in the casting room? 1. Anesthesia consent 2. Consent for the procedure 3. Administration of an analgesic 4. Explanation of the procedure to the client

1. Anesthesia consent

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 to: 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. Avoid getting the cast wet.

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. Elevating the limb and applying ice to the affected leg

A 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 should the nurse include on the list? Select all that apply. 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. 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.

A client with right-sided weakness needs to learn how to use a cane. The nurse plans to teach the client to position the cane by holding it with the: 1. Left hand, and 6 inches lateral to the left foot 2. Right hand, and 6 inches lateral to the right foot 3. Left hand, and placing the cane in front of the left foot 4. Right hand, and placing the cane in front of the right foot

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

A 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 of fat embolism. The nurse provides appropriate care by: 1. Monitoring for signs of dyspnea 2. Monitoring the client's temperature regularly 3. Maintaining external rotation of the right leg 4. Educating the client to report paresthesia of the right lower leg

1. Monitoring for signs of dyspnea

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: 1. Muscle spasm in the area of the herniated disk 2. Pressure on the spinal cord 3. Pressure on the spinal nerve root 4. Excess cerebrospinal fluid production in the area

1. Muscle spasm in the area of the herniated disk

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. Pork

A client who has experienced a brain attack (stroke) has partial hemiplegia of the left leg. The straight-leg cane formerly used by the client is not sufficient any longer. The nurse determines that the client could benefit from the somewhat greater support and stability provided by a: 1. Quad cane 2. Wheelchair 3. Wooden crutch 4. Lofstrand crutch

1. Quad cane

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 normal response and indicates the presence of phantom limb sensation

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 window cut in the cast

A client has had surgery to repair a fractured left hip. The nurse plans to use which of the following important items when repositioning the client from side to side in the bed? 1. Bed pillow 2. Abductor splint 3. Adductor splint 4. Overhead trapeze

2. Abductor splint

A nurse is caring for a client who has had spinal fusion with insertion of hardware. The nurse should be especially concerned with which of the following findings? 1. Complaints of discomfort during repositioning 2. An oral temperature of 101° F orally 3. Old bloody drainage outlined on the surgical dressing 4. Discomfort during coughing and deep breathing exercises

2. An oral temperature of 101° F orally

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? 1. Having another nurse tilt the client to the side 2. Asking the client to pull up on a trapeze to lift the hips off the bed 3. Pushing down on the mattress of the bed while administering care 4. Asking the client to lift up by digging into the mattress with the unaffected leg

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

During admission data collection, a 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 the area of: 1. Muscle strength and flexibility 2. Balance and coordination 3. Bowel and bladder control 4. Sensation and reflexes

2. Balance and coordination

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 by: 1. Bedrest 2. Bending or lifting 3. Ibuprofen (Motrin) 4. Application of heat

2. Bending or lifting

A 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. The nurse's response is based on the understanding that: 1. A bone fragment has injured the nerve supply in the area. 2. Bleeding and swelling cause increased pressure in an area that cannot expand. 3. An injured artery causes impaired arterial perfusion through the compartment. 4. The fascia expands with injury, causing pressure on underlying nerves and muscles.

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

A client with a 4-day-old lumbar vertebral fracture is experiencing muscle spasms. The nurse avoids using which of the following in an effort to relieve the spasm? 1. Heat 2. Cold 3. Analgesics 4. Prescribed intermittent traction

2. Cold

A nurse is repositioning the client who has returned to the nursing unit following internal fixation of a fractured right hip. The nurse plans to use a: 1. Trochanter roll to prevent abduction while turning 2. Pillow to keep the right leg abducted during turning 3. Pillow to keep the right leg adducted during turning 4. Trochanter roll to prevent external rotation while turning

2. Pillow to keep the right leg abducted during turning

A nurse is caring for a client following the application of a plaster cast because of a fractured left radius. The nurse monitors the neurovascular status of the client's casted extremity because: 1. The skin under the cast is at high risk for infection. 2. Compartment syndrome may lead to irreversible nerve and muscle tissue injury. 3. Alterations in the neurovascular status of the fingers may be early signs of fat embolism. 4. The client is at high risk of neurovascular compromise until the cast is completely dry.

2. Compartment syndrome may lead to irreversible nerve and muscle tissue injury.

A 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 of the following in the care of the client? Select all that apply. 1. Ensure the client doesn't bend the hips beyond 120 degrees. 2. Ensure the client doesn't sit or stand for long periods of time. 3. Ensure the client engages in rigorous exercise to maintain strength. 4. Ensure the client doesn't cross the legs past the midline of the body. 5. Ensure the client uses assistive/adaptive devices with activities of daily living.

2. Ensure the client doesn't sit or stand for long periods of time. 4. Ensure the client doesn't cross the legs past the midline of the body. 5. Ensure the client uses assistive/adaptive devices with activities of daily living.

A nurse is monitoring a confused older client admitted to the hospital with a hip fracture. Which of the following data obtained by the nurse could place the client at increased risk for disturbed thought processes? 1. Relatives at the bedside 2. Eyeglasses left at home 3. Familiar hospital setting 4. Hearing aid available and in working order

2. Eyeglasses left at home

A nurse has a prescription to place a client with a herniated lumbar intervertebral disk on bedrest to minimize the pain. The nurse plans to put the bed: 1. In high-Fowler's position with the foot of the bed flat 2. In semi-Fowler's position with the knee gatch slightly raised 3. In semi-Fowler's position with the foot of the bed flat 4. Flat with the knee gatch raised

2. In semi-Fowler's position with the knee gatch slightly raised Rationale: Clients with low back pain are often more comfortable when placed in semi-Fowler's position with the knee gatch slightly raised or with pillows under the knees. The bed is placed in semi-Fowler's position with the knee gatch raised sufficiently to flex the knees. This relaxes the muscles of the lower back and relieves pressure on the spinal nerve root. Keeping the foot of the bed flat will enhance extension of the spine. Option 4 stretches the lower back.

A nurse is caring for a client with a long bone fracture who is at risk for fat embolism. The nurse specifically monitors for the earliest signs of this complication by checking the client's: Select all that apply. 1. Renal system 2. Mental status 3. Mobility status 4. Respiratory function 5. Cardiovascular system

2. Mental status 4. Respiratory function

A client has undergone fasciotomy to treat compartment syndrome of the leg. The nurse should anticipate that which type of wound care will be prescribed for the fasciotomy site? 1. Dry, sterile dressings 2. Moist, sterile saline dressings 3. Hydrocolloid dressings 4. Half-strength povidone-iodine (Betadine) dressings

2. Moist, sterile saline dressings

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 the 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. Moves the cane when the right leg is moved Rationale: The cane is held on the stronger side to minimize stress on the affected extremity and provide a wide base of support. The cane is held 6 inches lateral to the fifth great toe. The cane is moved forward with the affected leg. The client leans on the cane for added support while the stronger side swings through.

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 an 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. Notify the registered nurse.

Which data would indicate a potential complication associated with age-related changes in the musculoskeletal system? 1. Decrease in height 2. Overall sclerotic lesions 3. Diminished lean body mass 4. Changes in structural bone tissue

2. Overall sclerotic lesions Rationale: Sclerotic lesions occur as bone resorption increases and results in replacement of original bone with fibrous material. This condition occurs in Paget's disease, an age-related disorder. Options 1, 3, and 4 identify normal age-related changes in the musculoskeletal system.

A client has just undergone spinal fusion after suffering a herniated lumbar disk. The nurse should avoid which of the following to maintain client safety after this procedure? 1. Head of bed flat 2. Overhead trapeze 3. Pillows under the length of the legs 4. Logrolling technique for repositioning

2. Overhead trapeze Rationale: Following spinal fusion, the head of the bed is generally kept in a flat position. The client is logrolled from side to side as prescribed. Pillows may be placed under the entire length of the legs by surgeon preference to relieve tension on the lower back. The use of an overhead trapeze is contraindicated because its use could promote twisting of the spine after surgery.

A client has undergone total hip replacement of the right hip, which was damaged by osteoarthritis. Which of the following should be included in the postoperative plan of care? 1. Assist the client to keep her legs as close together as possible. 2. Partial weight bearing on the operative leg is usually permitted 72 hours postoperatively. 3. Remind the client to use a handrail if she is lowering her hips into a 120-degree flexion. 4. Ensure the client receives her daily tablet of enoxaparin (Lovenox).

2. Partial weight bearing on the operative leg is usually permitted 72 hours postoperatively.

A 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. Petaling the cast edges with adhesive tape

A 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. The initial action of the nurse is to: 1. Place the client in a supine position. 2. Place the client in a Fowler's position. 3. Perform a neurological assessment. 4. Reassess the vital signs.

2. Place the client in a Fowler's position. Rationale: Clients with fractures are at risk for fat embolism. If the nurse suspects fat embolism, the nurse should place the client in a sitting (Fowler's) position to relieve dyspnea. Supplemental oxygen is indicated to reduce the signs of hypoxia. The health care provider needs to be notified. A neurological assessment needs to be performed, but this would not be the initial nursing action. Vital signs will need to be taken, but this action may delay initial and required interventions.

A 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 immediately: 1. Calls the health care provider 2. Rewraps the residual limb with an elastic compression bandage 3. Applies ice to the site 4. Applies a dry sterile dressing and elevates it on one pillow

2. Rewraps the residual limb with an elastic compression bandage

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 a pin site 4. Purulent drainage

2. Serous drainage

A client who has had spinal fusion and insertion of hardware is extremely concerned about the perceived lengthy rehabilitation period. The client expresses concerns about finances and the ability to return to work. The nurse understands that the client's needs could best be addressed by referral to the: 1. Surgeon 2. Social worker 3. Physical therapist 4. Clinical nurse specialist

2. Social worker

A nurse has given the client instructions regarding crutch safety. The nurse determines that the client needs reinforcement of the instructions if the client states: 1. That use of someone else's crutches is a bad idea 2. That crutch tips will not slip, even when wet 3. That he or she needs to have spare crutches and tips available 4. That crutch tips should be inspected periodically for wear

2. That crutch tips will not slip, even when wet

A 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 of the following teaching points in discussion with the client? 1. The brace should be applied directly next to the skin. 2. The device is applied before getting out of bed in the morning. 3. The Velcro closures should be fairly loose to avoid constriction. 4. Areas of skin redness at the edges of the brace indicate a good, snug fit.

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

A nurse is caring for a client with a diagnosis of gout. Which laboratory value would the nurse expect to note in the client? 1. Calcium level of 9 mg/dL 2. Uric acid level of 8 mg/dL 3. A uric acid level of 5 mg/dL 4. Phosphorus level of 3 mg/dL

2. Uric acid level of 8 mg/dL

A nurse is providing care of the client following a bone biopsy. Which action by the nurse is unnecessary in the care of this client? 1. Elevating the limb for 24 hours 2. Monitoring vital signs every 4 hours 3. Administering intramuscular opioid analgesics 4. Monitoring the site for swelling, bleeding, hematoma

3. Administering intramuscular opioid analgesics

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 the client: 1. Holds the walker using the handgrips 2. Leans forward slightly when advancing the walker 3. Advances the walker with reciprocal motion 4. Supports body weight on the hands while advancing the weaker leg

3. Advances the walker with reciprocal motion Rationale: The client should use the walker by placing the hands on the handgrips for stability. The client lifts the walker to advance it and leans forward slightly while moving it. The client walks into the walker, supporting the body weight on the hands while moving the weaker leg. A disadvantage of the walker is that it does not allow for reciprocal walking motion. If the client were to try to use reciprocal motion with a walker, the walker would advance forward one side at a time as the client walks, thus the client would not be supporting the weaker leg with the walker during ambulation.

A client is treated in the health care provider's office after a fall, which sprained an 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. Application of a heating pad

A client who has had a right total knee replacement asks the nurse how long the right leg must be kept in the continuous passive motion (CPM) machine. The nurse's response is based on the understanding that the device should be used: 1. Every other hour for 60 minutes 2. For 30 minutes out of every hour 3. As much as the client can tolerate 4. For 3 hours at a time, followed by 1 hour of rest

3. As much as the client can tolerate

A nurse is caring for the client who has had skeletal traction applied to the left leg. The client is complaining of severe left leg pain. Which action should the nurse take first? 1. Provide pin care. 2. Call the health care provider (HCP). 3. Check the client's alignment in bed. 4. Medicate the client with an analgesic.

3. Check the client's alignment in bed.

A nurse is caring for a client being treated for fat embolus after multiple fractures. Which of the following data indicates to the nurse favorable resolution of the fat embolus? 1. Arterial oxygen level of 78 mm Hg 2. Minimal dyspnea 3. Clear chest x-ray 4. Oxygen saturation 85%

3. Clear chest x-ray

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? 1. Feelings of isolation 2. Inability to tolerate activity 3. Concerns about appearance 4. Inability to physically move about

3. Concerns about appearance

A nurse is giving the client with a left leg cast crutch-walking instructions using the three-point gait. The client is allowed touch-down of the affected leg. The nurse tells the client to advance the: 1. Crutches and then both legs simultaneously 2. Crutches and the right leg, then advance the left leg 3. Crutches and the left leg, then advance the right leg 4. Left leg and right crutch, then right leg and left crutch

3. Crutches and the left leg, then advance the right leg Rationale: A three-point gait requires good balance and arm strength. The crutches are advanced with the affected leg, and then the unaffected leg is moved forward. Option 4 describes a two-point gait. Option 1 describes a swing-to gait. Option 2 describes the three-point gait used for a right leg problem.

A client seeks treatment in the emergency department for a lower leg injury. There is visible deformity to the lower aspect of the leg, and the injured leg appears shorter than the other. The area is painful, swollen, and beginning to become ecchymotic. The nurse interprets that this client has experienced a: 1. Strain 2. Sprain 3. Fracture 4. Contusion

3. Fracture

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. High-calcium diet consumption

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. 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: 1.Infection under the cast 2.The anxiety of the client 3.Impaired tissue perfusion 4.The newness of the fracture

3. Impaired tissue perfusion

A nurse is caring for a comatose client at risk for fat embolism because of a fractured femur and pelvis sustained in a fall. Which of the following findings does the nurse identify as early signs of possible fat embolism? 1. Increased heart rate and increased oxygen saturation 2. Decreased heart rate and decreased respiratory rate 3. Increased heart rate and adventitious breath sounds 4. Decreased heart rate and increased restlessness

3. Increased heart rate and adventitious breath sounds

A client has Buck's extension traction applied to the right leg. The nurse should plan which intervention to prevent complications of the device? 1. Giving pin care once a shift 2. Massaging the skin of the right leg with lotion every 8 hours 3. Inspecting the skin on the right leg at least once every 8 hours 4. Releasing the weights on the right leg for range-of-motion exercises daily

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

A client with a left arm fracture complains of severe, diffuse pain that is unrelieved with pain medication. On further data collection, the nurse notes that the client experiences more pain during passive motion of the left arm as compared with active motion. Based on these findings, the nurse should take which action? 1. Check to see whether it is time for more pain medication. 2. Encourage the client to continue with active range-of-motion exercises to the left arm. 3. Notify the registered nurse. 4. Reassess the client in 30 minutes.

3. 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 should the nurse take? 1. Remove some of the traction weights. 2. Provide pin care. 3. Notify the registered nurse. 4. Find out when the next dose of the prescribed analgesic can be given.

3. Notify the registered nurse.

A nurse is caring for the 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 should the nurse take next? 1. Medicate the client. 2. Provide pin care. 3. Notify the registered nurse. 4. Remove 2 pounds of weight from the traction.

3. Notify the registered nurse.

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. Presence of a "hot spot" on the cast

An 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 should anticipate which of the following on inspection of the client's leg? 1. Lengthening, adduction, and external rotation 2. Shortening, abduction, and internal rotation 3. Shortening, adduction, and external rotation 4. Lengthening, abduction, and internal rotation

3. Shortening, adduction, and external rotation

A client has been placed in Buck's extension traction. The nurse can provide for countertraction by: 1. Using a footboard 2. Providing an overhead trapeze 3. Slightly elevating the foot of the bed 4. Slightly elevating the head of the bed

3. Slightly elevating the foot of the bed

A nurse provides cast application instructions to a client who is going to have a plaster cast applied. The nurse determines that the client needs further instruction if the client states that: 1. The cast will give off heat as it dries. 2. The cast edges may be trimmed with a cast knife. 3. The client may bear weight on the cast in 30 minutes. 4. A stockinette will be placed over the leg area to be casted.

3. The client may bear weight on the cast in 30 minutes.

A nurse is preparing to teach a client how to safely use crutches. Before initiating the teaching the nurse collects data on the client. The priority data would include which of the following? 1. The client's fear related to the use of the crutches 2. The client's understanding of the need for increased mobility 3. The client's vital signs, muscle strength, and previous activity level of the client 4. The client's feelings about the restricted mobility

3. The client's vital signs, muscle strength, and previous activity level of the client

A nurse is teaching a client who is to have a gallium scan about the procedure. The nurse should include which of the following items as part of the instructions? 1. The client must stand erect during the filming. 2. The procedure takes about 15 minutes to perform. 3. The gallium will be injected intravenously 2 to 3 hours before the procedure. 4. The client should remain on bedrest for the remainder of the day after the scan.

3. The gallium will be injected intravenously 2 to 3 hours before the procedure.

A 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 of the following to protect the knee joint? 1. Obtain a walker to minimize weight bearing by the client on the affected leg. 2. Apply an Ace wrap around the dressing and put ice on the knee while sitting. 3. Lift the client to the bedside chair, leaving the continuous passive motion (CPM) machine in place. 4. Apply a knee immobilizer before getting the client up, and elevate the client's surgical leg while sitting.

4. Apply a knee immobilizer before getting the client up, and elevate the client's surgical leg while sitting. Rationale: The nurse assists the client to get out of bed on the first postoperative day after putting a knee immobilizer on the affected joint for stability. The surgeon prescribes the weight-bearing limits on the affected leg. The leg is elevated while the client is sitting in the chair to minimize edema.

A nurse is caring for a client diagnosed with Paget's disease. The nurse plans care, knowing that this condition usually affects which bones? 1. Shoulder and humerus 2. Bones of the hands and feet 3. Anterior rib cage and sternum 4. Axial skeleton including the vertebrae

4. Axial skeleton including the vertebrae Rationale: Paget's disease usually affects the axial skeleton, especially the vertebrae and skull. Besides the vertebrae and skull, the pelvis, femur, and tibia are other common sites of the disease. Skull involvement and deformed facial bones frequently occur.

A 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 of the following outcomes was noted? 1. Equal calf measurements bilaterally 2. Active range of motion (ROM) of uninvolved joints 3. Intact skin surfaces 4. Bowel movement every 5 days

4. Bowel movement every 5 days

A client has had a bone scan procedure. The nurse determines that the client understands the elements of follow-up care if the client states that he or she will: 1. Report any feelings of nausea or flushing. 2. Eat only small meals for the remainder of the day. 3. Ambulate at least three times before the end of the day. 4. Drink plenty of water for a day or two following the procedure.

4. Drink plenty of water for a day or two following the procedure. Rationale: There are no special restrictions following a bone scan. The client is encouraged to drink large amounts of water for 24 to 48 hours to flush the radioisotope from the system. The minimal amount of radioactivity of the isotope poses no hazards to the client or staff.

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? Submit 1. Morning stiffness 2. Positive rheumatoid factor 3. An elevated sedimentation rate 4. Dull aching pain in the affected joints

4. Dull aching pain in the affected joints

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

A 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 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 the legs over the side of the bed.

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

A nurse is providing care to a client with this type of cast. (Refer to figure.) The nurse documents that the client has a: 1. Short leg cast 2. Long leg cast 3. Body jacket cast 4. Hip spica cast

4. Hip spica cast

A nurse is collecting physical data of the musculoskeletal system on an assigned client. The nurse should document the presence of which of the following as a normal finding? 1. Presence of fasciculations 2. Atrophy on the client's dominant side 3. Atrophy on the client's nondominant side 4. Hypertrophy on the client's dominant side

4. Hypertrophy on the client's dominant side Rationale: Hypertrophy, or increased muscle size on the client's dominant side of up to 1 cm, is considered normal. Atrophy on either side is considered an abnormal finding. Fasciculations are fine muscle twitches that are not normally present.

A nurse is discussing primary prevention measures to clients regarding osteoporosis. The nurse plans to tell the clients that which of the following is a primary prevention measure? 1. Applying nonskid strips on areas that get wet 2. Selecting shoes that have firm nonskid soles 3. Installing telephones in several rooms of the house 4. Maintaining body weight at or above minimum recommended levels

4. Maintaining body weight at or above minimum recommended levels

A nurse has provided instructions to a client in an arm cast about the signs and 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? 1. Pain that is relieved only by an opioid analgesic 2. Pain that increases when the arm is dependent 3. Cold, bluish fingers 4. Numbness and tingling in the fingers

4. Numbness and tingling in the fingers

A nurse is caring for a client with osteoarthritis. The nurse monitors the client, knowing that which of the following is a clinical manifestation associated with the disorder? 1. An elevated platelet count 2. Symmetrical joint discomfort 3. Elevated antinuclear antibody levels 4. Pain that increases with activity and is relieved by rest

4. Pain that increases with activity and is relieved by rest

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 and extending the feet 3. Doing quadriceps-setting and gluteal-setting exercises 4. Performing active range of motion (ROM) to the right ankle and knee

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

A nurse is caring for a client who has a cast applied to the left lower leg. On data collection of the client, the nurse notes the presence of skin irritation from the edges of a cast. Which nursing intervention is appropriate? 1. Massage the skin at the edges of the cast. 2. Contact the health care provider. 3. Place a small face cloth in the cast around the edges of the cast. 4. Petal the cast edges with adhesive tape.

4. Petal the cast edges with adhesive tape.

A nurse is preparing a plan of care for a client in skeletal leg traction with an overbed frame. Which nursing intervention should be included in the plan of care to best assist the client with positioning in bed? 1. Encourage the client to pull up by pushing with the unaffected leg on the bed mattress. 2. Use the assistance of four nurses to reposition the client. 3. Place a draw sheet under the client for pulling the client up in bed. 4. Place a trapeze on the bed to provide a means for the client to lift the hips off the bed.

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

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. Provides comfort by reducing muscle spasms and provides fracture immobilization Rationale: Buck's extension traction is a type of skin traction often applied after hip fracture, before the fracture is reduced in surgery. It reduces muscle spasms and helps immobilize the fracture. It does not lengthen the leg for the purpose of preventing blood vessel severance. It also does not allow for bony healing to begin.

A nurse has provided instructions to the client returning home after arthroscopy of the knee. The nurse determines that the client understands the instructions if the client states that he or she will: 1. Resume regular exercise the following day. 2. Stay off of 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 health care provider.

4. Report fever or site inflammation to the health care provider.

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. Separation of wound edges

A client is fearful about having an arm cast removed. Which of the following actions by the nurse would be the most helpful? 1. Telling the client that the saw makes a frightening noise 2. Reassuring the client that no one has had an arm lacerated yet 3. Stating that the hot cutting blades cause burns only very rarely 4. Showing the client the cast cutter and explaining how it works

4. Showing the client the cast cutter and explaining how it works

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. Stay with the person and encourage the person to remain still.

A client has slight weakness in the right leg. Based on this information, the nurse determines that the client would benefit most from the use of a: 1. Walker 2. Wooden crutch 3. Lofstrand crutch 4. Straight-leg cane

4. Straight-leg cane

A client who is learning to use a cane is afraid it will slip with ambulation, causing a fall. The nurse provides the client with the greatest reassurance by telling the client that: 1. Canes prevent falls, not cause them. 2. The physical therapist will determine if the cane is inadequate. 3. The cane would help to break a fall, even if the client does slip. 4. The cane has a flared tip with concentric rings to provide stability.

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

A nurse plans dietary measures for a client with osteomalacia, knowing that the client is deficient in which of the following? 1. Vitamin A 2. Vitamin B 3. Vitamin C 4. Vitamin D

4. Vitamin D

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. The nurse replies that the client will be able to bear weight on the cast: 1. In 24 hours 2. In 48 hours 3. In approximately 8 hours 4. Within 20 to 30 minutes of application

4. Within 20 to 30 minutes of application

A nurse is caring for a client who had a below-the-knee amputation of the right leg and has a cast on the residual limb. The client calls the nurse and reports that the cast fell off. The nurse immediately: 1. Replaces the cast with a new one 2. Contacts the surgeon 3. Documents the findings 4. Wraps the residual limb with an elastic compression bandage

4. Wraps the residual limb with an elastic compression bandage