Musculoskeletal Practice Exam

A patient with a right- above-the- knee amputation asks you why he has phantom limb pain. What is your best response? A) Phantom limb pain is not explained or predicted by any one theory B) Phantom limb pain occurs because your body thinks your leg is still present C) Phantom limb pain will not interfere with your activities of daily living D) Phantom limb pain is not real, but is remembered pain

B) Phantom limb pain occurs because your body thinks your leg is still present

The nurse is evaluating the pin sites of a client in skeletal traction. The nurse would be least concerned with which finding? A) Inflammation B) Serous drainage C) Pain at a pin site D) Purulent drainage

B) Serous drainage

A patient has a fracture femur. Which finding would you instruct the UAP to report immediately? A) The patient reports pain B) The patient appears confused C) The patient's blood pressure is 236/88 mm Hg D) The patient voided using a bed pan

B) The patient appears confused

A nurse is preparing discharge instructions for an above-the-knee amputation client. Which instructions would be a priority for home care? Select all that apply A) Massage the residual limb in a motion away from the suture line B) Avoid using heat application to ease pain C) Immediately report twitching, spasms, or phantom limb pain D) Avoid exposing the skin around the residual limb to exercise perspiration E) Be sure to perform the prescribed exercises F) Rub the residual limb with a dry washcloth for 4 minutes three times daily if the limb is sensitive to touch

D) Avoid exposing the skin around the residual limb to exercise perspiration E) Be sure to perform the prescribed exercises F) Rub the residual limb with a dry washcloth for 4 minutes three times daily if the limb is sensitive to touch

A client has developed a fat embolus. Which treatments would the nurse anticipate? A) Antibiotics, IV fluids, steroids, and oxygen B) Theophylline, morphine, oxygen, and IV fluids C) Morphine, oxygen, IV fluids, steroids D) Albuterol, oxygen, IV fluids, steroids

A) Antibiotics, IV fluids, steroids, and oxygen

The nurse is caring for a client being treated for fat embolus after multiple fractures. Which data would the nurse evaluate as the most favorable indication of resolution of the fat embolus? A) Clear mentation B) Minimal dyspnea C) Oxygen saturation of 85% D) Arterial oxygen level of 78 mmHg

A) Clear mentation

The nurse is performing an admission assessment on a client with osteoarthritis. Which clinical manifestations would the nurse anticipate in this client? A) Joint pain following exercise that is relieved by rest B) Symmetrical swelling of the joints in both hands C) Morning stiffness that lasts longer than 30 minutes D) Elevated body temperature

A) Joint pain following exercise that is relieved by rest

A nurse is caring for a client diagnosed with a fracture. The health care provider has ordered a diet high in protein for the client. The nurse explains to the client that a high-protein diet is ordered because protein A) promotes gluconeogenesis B) has anti-inflammatory properties C) promote cell growth and bone union D) decreases pain medication requirements

C) promote cell growth and bone union

The nurse is obtaining a health history from a client who has been taking ibuprofen. What priority questions should the nurse ask this client? Select all that apply A) How often do you take this medication? B) Have you had any difficulty breathing? C) Do you monitor your blood pressure regularly? D) Have you ever had tarry, black stools? E) Have you ever vomited blood?

A) How often do you take this medication? B) Have you had any difficulty breathing? D) Have you ever had tarry, black stools? E) Have you ever vomited blood?

The community health nurse found a client lying in the snow. The client was unable to move her right leg because of a fracture. Which action should the nurse take first? A) Immobilize the fracture in its present position B) Elevate the leg on whatever is available C) Realign the fracture ends D) Reduce the fracture

A) Immobilize the fracture in its present position

The nurse is teaching a client about the risk factors for developing osteoporosis. What is the most important information for the nurse to include? Select all that apply A) Inadequate dietary intake of calcium B) Blood pressure mediations C) Family history D) Smoking E) Oral hypoglycemic

A) Inadequate dietary intake of calcium C) Family history D) Smoking

A 70 year old female client who reports back pain is diagnosed with osteoporosis. The nurse is aware that this client is most at risk for A) Acute pain B) Fracture C) Compartment syndrome D) Paralysis

B) Fracture

Which position would be best for a client following surgical repair of the hip? A) Prone B) Adduction C) Abduction D) Sublaxated

C) Abduction

The nursing diagnosis for a patient with a fracture of the right ankle is impaired physical mobility. As a charge nurse, you observe a newly-graduated RN perform all of these interventions. For which action should you intervene? A) Encouraging the patient to go from a lying to a standing position B) Administering pain medication before the patient begins exercises C) Explaining to the patient and family the purpose of the exercise program D) Reminding the patient about the correct use of crutches

A) Encouraging the patient to go from a lying to a standing position

Which cast care instructions should the nurse provide to a client who just had a plaster cast applied to the right forearm? Select all that apply A) Keep the cast clean and dry B) Allow the cast 24 to 72 hours to dry C) Keep the cast and extremity elevated D) Expect tingling and numbness in the extremity E) Use a hair dryer set on warm to hot setting to dry the cast F) Use a soft padded object that will fit under the cast to scratch the skin under the cast

A) Keep the cast clean and dry B) Allow the cast 24 to 72 hours to dry C) Keep the cast and extremity elevated

A 76 year old woman, with a history of osteoporosis is 24 hours postoperative for a total right hip replacement. What is the priority nursing action for this client? A) Managing pain B) Ambulating 50 feet C) Caring for the surgical wound D) Promoting nutrition

A) Managing paoin

During assessment of a patient with fractures of the medial ulna and radius, you all find all of these data. Which assessment findings should you report to the health care provider immediately? A) The patient reports pressure and pain B) The cast is in place and is dry and intact C) The skin is pink and warm to the touch D) The patient can move all the fingers and the thumb

A) The patient reports pressure and pain

The nurse is teaching a client, diagnosed with degenerative joint disease, about the condition. The nurse recognizes that teaching had been effective when the client states A) it is non-inflammatory joint disease B) it is an immune-mediated joint disease C) it is a joint inflammation after a viral infection D) it is a joint inflammation related to systemic infection

A) it is non-inflammatory joint disease

A nurse is admitting a client who is experiencing new signs and symptoms of paresthesia. What is the most appropriate question for the nurse to ask the client? A) Have you had any changes in range of motion B) Do you have any numbness and tingling C) Do you have any pain and blanching D) How long have you had a fever and chills

B) Do you have any numbness and tingling

Which clinical manifestation would lead the nurse to suspect that the client has a dislocation of the left hip? A) Pain relieved with pressure B) Pain in the inguinal area, and an abnormal gait C) Internal rotation of the knee, abduction of the leg D) Pain in the hip, the thigh appears longer than the unaffected leg

B) Pain in the inguinal area, and an abnormal gait

Which nursing intervention would be appropriate for a client in traction? A) Add and remove weights as the client wants B) Assess the pin sites every shift as needed C) Make sure the knots in the rope catch on the pulley D) Give range of motion to all joints, including those immediately proximal and distal to the fracture, every shift

B) Assess the pin sites every shift as needed

A nurse is performing a neurovascular assessment. What should the nurse include in this assessment? A) Orientation, movement, pulses, and warmth B) Capillary refill, movement, pulses, and warmth C) Orientation, pupillary responses, temperature and pulses D) Respiratory pattern, orientation, pulses and temperature

B) Capillary refill, movement, pulses, and warmth

A nurse is assigned to a client with an acute exacerbation of rheumatoid arthritis. Which medical facts about RA are essential in developing a plan of care? Select all that apply A) Onset is acute and unusually occurs between ages 20 and 40 B) The client experiences stiff, swollen joints bilaterally C) The client may not exercise once the disease is diagnosed D) Erythrocyte sedimentation rate is elevated, and x-rays show erosions and decalcification of involved joints E) Inflamed cartilage triggers complement activation, which stimulates the release of additional inflammatory mediators F) The first line-treatment is gold salts and methotrexate

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

A nurse is putting groceries in the car when an elderly client falls off a curb. The nurse assesses the client and has a bystander call for an ambulance. Which assessment findings provide data of a suspected right hip fracture? Select all that apply A) The right leg is longer than the left leg B) The right leg is shorter than the left leg C) The right leg is abducted D) The right leg is adducted E) The right leg is externally rotated F) The right leg is internally rotated

B) The right leg is shorter than the left leg D) The right leg is adducted E) The right leg is externally rotated

A nurse is caring for a client with skeletal traction to the right leg. The client reports severe right leg pain. Which action should the nurse perform first? A) Perform pin care B) Notify the health care provider C) Check the client's alignment in bed D) Remove the weights from traction

C) Check the client's alignment in bed

A nurse is caring for a client with a femoral shaft fracture. Which assessment finding would warrant an immediate intervention by a nurse? A) Decreased urine output B) Constipation C) Hemorrhage D) Pain

C) Hemorrhage

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 elevates the limb, applies an ice bag, and administers and analgesic, with little relief. Which problem may be causing this pain? A) Infection under the cast B) The anxiety of the client C) Impaired tissue perfusion D) The recent occurrence of the fracture

C) Impaired tissue perfusion

A client asks the nurse what is the difference between osteoarthritis (OA) and rheumatoid arthritis (RA)? What is the nurse's most appropriate response? A) OA is gender specific, RA is not B) OA is a systemic disease, RA is localized C) OA is a localized disease, RA is systemic D) OA has dislocations and subluxations, RA does not

C) OA is a localized disease, RA is systemic

The nurse is assessing the casted extremity of a client. Which sign is indicative of infection? A) Dependent edema B) Diminished distal pulse C) Presence of a "hot spot" on the cast D) Coolness and pallor of the extremity

C) Presence of a "hot spot" on the cast

A nurse is assisting the health care provider with the application of a cast. Which nursing interventions would be included in the immediate cast care? A) Rest the cast on the bedside table B) Dispose of the plaster water in the sink C) Support the cast with the palms of the hands D) Wait until the cast dries before cleaning the surrounding skin

C) Support the cast with the palms of the hands

A patient with a fractured fibula is receiving skeletal traction and has skeletal pins in place. What would you instruct the UAP to report immediately? A) The patient wants to change position in bed B) There is a small amount if clear fluid at the pin sites C) The traction weights are resting on the floor D) The patient reports pain and muscle spasms

C) The traction weights are resting on the floor

The nurse has given instructions to a client returning home after knee arthroscopy. Which statement by the client indicates that the instructions are understood? A) I can resume regular exercise tomorrow B) I can't eat food for the remainder of the day C) I need to stay off the leg entirely for the rest of the day D) I need to report a fever or site inflammation to my health care provider

D) I need to report a fever or site inflammation to my health care provider

A client asks the nurse why a cold pack should be applied to a sprained ankle. What is the nurse's best response? A) It decreases pain and increases circulation B) It numbs the nerves and dilates the blood vessels C) It promotes circulation and reduces muscle spasm D) It constricts local blood vessels and decreases swelling

D) It constricts local blood vessels and decreases swelling

A client has been treated with antibiotics for osteomyelitis. The treatment has not been effective. Which intervention would be the most appropriate for this client? A) Bone grafts B) Hyperbaric oxygen therapy C) Amputation of the extremity D) Debridement of necrotic tissue

D) Debridement of necrotic tissue

A client asks the nurse for information about osteoarthritis. What is the most appropriate information for the nurse to include? A) Osteoarthritis is rarely debilitating B) Osteoarthritis is a rare form of arthritis C) Osteoarthritis afflicts people over the age of 60 D) Osteoarthritis is the most common form of arthritis

D) Osteoarthritis is the most common form of arthritis

The nurse is aware that elevating a casted limb will prevent swelling. How should the nurse elevate a casted limb? A) Place the limb with the cast close to the body B) Place the limb with the cast at the level of the heart C) Place the limb with the cast below the level of the heart D) Place the limb with the cast above the level of the heart

D) Place the limb with the cast above the level of the heart

A client with a hip fracture asks the nurse why Buck's (extension) traction is being applied before surgery. The nurse provides a response based on which purpose of Buck's traction? A) Allows bony healing to being before surgery B) Provides rigid immobilization of the fracture site C) Lengthens the fractured leg to prevent severing of blood vessels D) Provides comfort by reducing muscle spasms and provides fracture immobilization

D) Provides comfort by reducing muscle spasms and provides fracture immobilization

Which symptoms are indicative of a fracture? A) Tingling, coolness, and loss of pulses B) Loss of sensation, redness, and coolness C) Coolness, redness, and pain at the site of injury D) Redness, warmth, and pain at the site of injury

D) Redness, warmth, and pain at the site of injury

The nurse is caring for a client who had an above-knee amputation 2 days ago. The residual limb was wrapped with an elastic compression bandage, which has come off. Which immediate action should the nurse take? A) Apply ice to the site B) Call the health care provider C) Apply a dry sterile dressing and elevate it one pillow D) Rewrap the residual limb with an elastic compression bandage

D) Rewrap the residual limb with an elastic compression bandage

A client with diabetes mellitus has had a right below-the-knee amputation. Given the client's history of diabetes mellitus, which should the nurse specifically observe in the postoperative period? A) Hemorrhage B) Edema of the residual limb C) Slight redness of the incision D) Separation of the wound edges

D) Separation of the wound edges

Which statement best explains an open reduction of a fractured femur? A) Traction will be used B) A cast will be applied C) Crutches will be used after surgery D) Some form of screw, plate, nail, or wire is usually used to maintain alignment

D) Some form of screw, plate, nail, or wire is usually used to maintain alignment

The emergency room nurse is caring for a 20 year old female client who reports severe pain in her upper right arm. The nurse suspects domestic abuse. Which X-ray finding would indicate the need for additional investigation? A) Longitudinal fracture B) Transverse fracture C) Oblique fracture D) Spiral fracture

D) Spiral fracture

A nurse is performing a neurovascular assessment on a client admitted with a fractured right femur. The nurse notices that the pulses are not palpable. What is the nurse's most important action? A) Alert the charge nurse immediately B) Reassess the pulses again in one hour C) Notify the health care provider immediately D) Verify the clinical findings with a doppler ultrasonography

D) Verify the clinical findings with a doppler ultrasonography