Musculoskeletal

The nurse provides discharge teaching to a client who had total hip replacement 4 days ago. Which client statement indicates that additional teaching is necessary? 1. "I will concentrate on leaning forward as I carefully sit down in a chair." 2. "I will do my leg raises and quadriceps and buttock isometric exercises 2-3 times a day." 3. "I will use the sock puller that the therapist gave me when I get dressed." 4. "My child got me a riser for the toilet seat at home. I hope my feet reach the floor!"

1

The office nurse for an orthopedic health care provider receives 4 telephone messages. Which client does the nurse call back first? 1. Client who had a left total knee replacement 7 days ago and reports cramping pain in the left calf 2. Client with a fractured wrist who reports severe itching under a cast that was applied 3 days ago 3. Client with an ankle sprain who is using crutches and reports tingling in the forearm and fingers 4. Client with an intact anterior cruciate ligament injury who reports tightness in the knee unrelieved with ice

1

The registered nurse (RN) on an orthopedic unit is orienting a new graduate nurse (GN) assigned to a client with a fractured hip and in Buck's traction. The RN intervenes when the GN performs which action? 1. Elevates the head of the bed 45 degrees 2. Holds the weight while the client is repositioned up in bed 3. Loosens the Velcro straps when the client reports that the boot is too tight 4. Provides the client with a fracture pan for elimination needs

1

The emergency department nurse assesses an elderly client who was just admitted with a fractured hip after a fall. Which assessment findings would the nurse most likelyexpect? Select all that apply. 1. Ecchymosis over the thigh and hip 2. Groin and hip pain with weight bearing 3. Internal rotation of the affected extremity 4. Muscle spasm around the affected area 5. Shortening of the affected extremity

1,2,4,5

The nurse is teaching a client recently diagnosed with rheumatoid arthritis (RA) about home care and management of symptoms. What should the nurse encourage the client to do at home? Select all that apply. 1. Allow for periods of rest in the afternoon 2. Avoid using ice on painful joints 3. Perform range-of-motion exercises daily 4. Place a pillow under the knees at night before sleeping 5. Use moist heat packs to relax stiff joints as needed

1,3,5

The nurse plans discharge teaching for a client newly diagnosed with polycythemia vera. Which actions will the nurse include in the teaching plan? Select all that apply. 1. Elevate the legs and feet when sitting 2. Increase dietary intake of foods rich in iron 3. Increase fluid intake during exercise and hot weather 4. Increase water temperature to reduce post-bath itching 5. Report swelling or tenderness in the legs

1,3,5

A client with advanced osteoarthritis (OA) is admitted for right total knee arthroplasty. Which characteristic manifestations does the nurse expect to assess in this client? Select all that apply. 1. Crepitus with joint movement 2. Low-grade temperature 3. Morning stiffness lasting several hours 4. Pain exacerbated by weight-bearing activities 5. Positive serum rheumatoid factor

1,4

The nurse completes the preoperative assessment for a client scheduled for a total knee replacement today. Which information should the nurse report to the health care provider (HCP) as soon as possible before the surgery? 1. Has allergy to strawberries 2. Is experiencing burning on urination starting yesterday 3. Rates knee pain as a 9 on a 0-10 scale 4. Stopped taking celecoxib 7 days ago

2

An elderly client with osteoporosis falls onto an out-stretched hand and injures the wrist. The client has severe wrist edema, deformity, and pain rated a 10 on a pain scale of 0-10. What should be the nurse's first action? 1. Administer analgesia 2. Apply an ice pack to the wrist 3. Assess capillary refill and sensation 4. Elevate the wrist above heart level

3

The health care provider suspects a rotator cuff injury in a client who is an avid tennis player. The nurse would most likely assess which of the following? 1. Complete stiffness of the shoulder joint 2. Paresthesia over the first 3½ fingers 3. Shoulder pain with arm abduction 4. Tenderness over the lateral epicondyle

3

The nurse is caring for a client who is 12 hours postoperative total hip replacement. Which nursing intervention is appropriate to help prevent dislocation of the hip prosthesis? 1. Instructing the client to cross the legs only at the ankles 2. Maintaining the head of the bed at ≥45-60 degrees 3. Placing an abductor pillow between the legs when turning the client 4. Turning the client to the affected side to alleviate lateral muscle pulling

3

The nurse is caring for a client with a fractured femur. Which nursing intervention is most effective in helping reduce the risk for fat emboli? 1. Administering prophylactic enoxaparin as prescribed 2. Frequent use of incentive spirometry 3. Minimizing movement of the fractured extremity 4. Use of an intermittent pneumatic compression device

3

The nurse provides care for a client diagnosed with polycythemia vera. Which statement by the client would require immediate follow-up? 1. "I am trying to find makeup to cover my unattractive and ruddy facial complexion." 2. "I take a baby aspirin to relieve my occasional headaches." 3. "My leg has been sore. I suppose I need to elevate it more often when I am sitting." 4. "My skin itches so severely that no lotion or cream seems to help."

3

The nurse is caring for an adolescent client who just had placement of an external fixation device for long-term stabilization of a fractured tibia. Which interventions are appropriate to include in the client's plan of care? Select all that apply. 1. Check the pins every 4 hours and if these are loose, turn the bolt clockwise to tighten 2. Maintain bed rest until the device is removed 3. Notify the health care provider (HCP) immediately if drainage or increased pain occurs at the pin sites 4. Perform neurovascular checks every 2-4 hours for 24 hours 5. Perform pin care with 1/2-strength hydrogen peroxide and normal saline solution (NSS) every 4 hours

3,4,5

A client comes to the emergency department after being assaulted. Imaging studies show a simple fracture of the mandible. The nurse assesses edema of the face and jaw, drooling, and bleeding in the mouth; the client rates pain as a 9 out of 10. What is the priority nursing intervention? 1. Administer nasal oxygen at 3 L/min 2. Administer opioids for pain 3. Apply ice pack to face for 20 minutes each hour 4. Suction the mouth and oropharynx

4

A client is diagnosed with carpal tunnel syndrome (CTS). Teaching for this client is primarily focused on which of the following? 1. No caffeine and smoking 2. Repetitive hand exercises 3. Use of elastic compression 4. Use of hand splint

4

A client with a mandibular fracture who has the upper and lower teeth wired together begins to choke on excessive oral secretions. What is the nurse's immediate action? 1. Cut the wires 2. Elevate the head of the bed 3. Notify the health care provider 4. Suction the mouth and oropharynx

4

A nurse in the emergency department has 4 orthopedic clients to see. Which client should be assessed first? 1. A child who sustained a closed, incomplete ulnar fracture while playing sports 2. A client with metastatic breast cancer who has a hip fracture and is in Buck traction 3. A client with multiple myeloma who has a rib fracture and reports pain with deep breaths 4. A client with severe pain and deformity of the shoulder due to blocking a basketball shot

4

A nurse is caring for a client diagnosed with rheumatoid arthritis (RA). Which assessment finding does the nurse expect to assess? 1. Asymmetrical pain in the large weight bearing joints 2. Low back pain and stiffness that is worse in the morning 3. Pain, swelling, and redness of the great toe 4. Symmetrical pain and swelling in the small joints of the hands

4

A nurse cares for a frail, elderly client with osteoporosis in a nursing home. Which interventions are appropriate to include in the client's care plan to help prevent a hip fracture? Select all that apply. 1. Calcium supplements 2. Encourage bed rest 3. Use of full bed rails during the night 4. Vitamin D supplements 5. Weight-bearing exercises

1,4,5

The health care provider (HCP) suspects a fat embolism syndrome (FES) in a client who has had multiple long bone fractures. Which findings does the nurse expect to assess to support this diagnosis? Select all that apply. 1. Confusion and restlessness 2. Increasing pain despite the opioid analgesia 3. Paresthesia of the affected extremity 4. Petechiae over neck and chest 5. Pulse oximeter showing hypoxia

1,4,5

The nurse is caring for a 6-year-old who is postoperative open right tibial fracture reduction with cast placement. Which finding requires priority action? 1. Blood-tinged stain on the inner aspect of the cast 2. Capillary refill of 2 seconds on the affected extremity 3. Mild swelling of toes on the right foot 4. Pain of 9/10 an hour after a dose of morphine

4

A client involved in a motor vehicle collision reports severe pelvic and right heel pain. While waiting for imaging, the nurse assesses the client. Which finding should the nurse report to the health care provider immediately? 1. Distended abdomen and absent bowel sounds 2. Ecchymosis over the pelvic bones 3. Hemoglobin of 11.5 g/dL (115 g/L) and hematocrit of 34% (0.34) 4. Tenderness over the right heel

1

The nurse has provided education for a client with newly diagnosed ankylosing spondylitis. Which client statements indicate a need for further teaching? Select all that apply. 1. "I should continue strenuous exercise during flare-ups." 2. "I should do stretching activities such as swimming or racquet sports." 3. "I should quit smoking and perform breathing exercises." 4. "I will sleep on a soft mattress to help decrease my morning stiffness." 5. "I will take the prescribed ibuprofen on an empty stomach."

1,4,5

A nurse working in the office of a health care provider (HCP) must respond to client telephone messages. The nurse should return which call first? 1. Client with a left shoulder sling due to a fractured clavicle, reports nausea after taking oxycodone 2. Client with a right leg cast applied yesterday for a fractured ankle, reports tingling in the right foot 3. Client with diabetes, reports having taken the usual dose of insulin this morning and is now vomiting 4. Client with fibromyalgia who is prescribed amitriptyline for sleep, reports continued insomnia

2

A home health nurse is assessing for complications in a client who has been using crutches for 2 weeks. Assessing for which finding is most important? 1. Biceps muscle spasm 2. Forearm swelling 3. Hand and wrist weakness 4. Shoulder range of motion

3

A client with chronic rheumatoid arthritis (RA) says, "I'm upset because I can't cook dinner like I used to. My fingers are so painful and twisted that I can't open containers or take pots off the stove by myself anymore." What is the priority nursing diagnosis (ND)? 1. Chronic pain 2. Disturbed body image 3. Impaired physical mobility 4. Ineffective role performance

1

A registered nurse is precepting a new graduate nurse on the orthopedic unit. Which action by the graduate nurse requires the registered nurse to intervene? 1. Elevating a client's residual limb on a pillow 1 day after above-the-knee amputation 2. Placing an abductor pillow between a client's legs after total hip replacement 3. Positioning a client with Buck traction supine with the foot of the bed raised 4. Using pillows to raise a client's extremity following cast placement

1

The nurse is assessing a client in the outpatient clinic who has a cast on for a distal humerus fracture. Which statements made by the client would be the priority to assess further? 1. "I am having problems extending my fingers since this morning." 2. "I can't take any of the pain medicine because it makes me feel sick." 3. "I have to scratch under the cast with a nail file because of the itching." 4. "I noticed a warm spot on my cast, and a bad smell is coming from it."

1

The nurse is assigned to care for a client who had a total hip replacement an hour ago. Which of the following should the nurse assess first? 1. Amount of drainage in suction drainage device 2. Client's level of pain and last dose of pain medication 3. Proper placement of the abduction pillow 4. Urine in the catheter bag for presence of cloudiness or pus

1

A client is seen in the ambulatory care center for treatment of a second episode of acute gout. Which instructions would help prevent future exacerbations? Select all that apply. 1. Achieve and maintain a healthy weight 2. Avoid diet sodas 3. Avoid foods containing protein 4. Drink plenty of fluids 5. Limit alcohol consumption

1,4,5

The nurse is caring for a woman with obesity who is 3 days postoperative total hip joint replacement. Which laboratory value is of greatest concern and should be reported to the health care provider (HCP) immediately? 1. Blood urea nitrogen (BUN) 22 mg/dL (7.9 mmol/L) 2. Glucose 158 mg/dL (8.7 mmol/L) 3. Hematocrit 33% (0.33) and hemoglobin 11 g/dL (110 g/L) 4. White blood cell count (WBC) 16,000/mm3 (16.0 ×109/L)

4

The nurse plans teaching for an adolescent client being discharged home with a Boston brace for treatment of scoliosis. Which instruction will the nurse include in the discharge teaching plan? 1. Apply body lotion or powder under the brace to prevent skin irritation 2. Avoid any exercises that require the use of spinal muscles 3. Keep the brace on for all activities, including showering 4. Wear a cotton t-shirt under the brace at all times

4

The nurse provides discharge teaching to a client who had a total knee replacement 4 days ago. Which client statement indicates the need for additional teaching? 1. "I have to give myself shots in the belly because my spouse is afraid of needles!" 2. "I have to use a walker because I can't bear any weight on this knee yet." 3. "I will call my health care provider if I get short of breath or sore or swollen below my knee." 4. "The raised toilet seat makes it easier for me to get on and off the toilet by myself."

2

The nurse teaches a client with osteopenia, who is lactose intolerant, how to increase dietary calcium and vitamin D intake. Which lunch food is the best choice? 1. Broiled chicken breast 2. Canned sardines 3. Egg white omelet 4. Peanut butter

2

After rolling the ankle outwards when jogging, a client develops ankle pain and swelling. The health care provider diagnoses a lateral ankle sprain. Which interventions does the nurse include in the discharge instructions? Select all that apply. 1. Apply heat to reduce swelling during the first 24 hours 2. Begin an exercise rehabilitation program when the pain subsides 3. Elevate the leg above the heart level on 2 pillows 4. Flex and dorsiflex the foot to prevent stiffness during the first 24 hours 5. Take ibuprofen every 6 hours as needed 6. Wrap the ankle with an elastic compression bandage

2,3,5,6

A client with a hip fracture is placed in Buck's traction. Which nursing intervention is most important when caring for this client? 1. Keeping the extremity above the client's heart level 2. Pain assessment and analgesia use every 2 hours 3. Skin assessments every 2-4 hours 4. Turning the client, using an abduction pillow, every 2 hours

3

A client with rheumatoid arthritis (RA) tells the home health nurse, "My fatigue and stiffness are getting worse and I'm having trouble moving around, especially in the morning. What can I do?" Which intervention would be best for the client to perform first? 1. Eat a high-calorie carbohydrate breakfast immediately after awakening 2. Perform range of motion exercises before getting out of bed 3. Take a warm shower or bath immediately after getting out of bed 4. Take prescribed nonsteroidal anti-inflammatory medication on awakening

3