Musculoskeletal

A nurse is caring for a client who is postoperative following a total knee arthroplasty and is prescribed a continuous passive motion (CPM) machine and PCA. The client tells the nurse, "I am in so much pain." Which of the following actions should the nurse take first?

Ask the client to describe the characteristics of the pain.

A patient in the ambulatory clinic is diagnosed with a muscle strain. What actions should the nurse instruct the patient to do to treat this injury? (Select all that apply.)

-Rest the limb -Elevate the limb -Apply ice to the area. -Wrap with an elastic bandage

The nurse is collecting data for a patient with osteoporosis. Which serum calcium result indicates the typical changes that occur in serum calcium levels with osteoporosis?

6.5 mg/dL

The nurse is assessing capillary refill time for a patient with a fractured tibia and fibula. Which refill time should the nurse report to the physician?

7 seconds

The nurse, who is inspecting the knee of a patient who fell and reports stiffness, hears a grating sound with knee movement. How should the nurse document this finding?

Crepitus

A nurse is an ambululatory clinic is caring for a client who has facial trauma to the nose. Which of the following actions should the nurse take first?

Determine the client's ability to take deep breaths. *ABCs

The nurse is reinforcing teaching provided to a patient with rheumatoid arthritis (RA). Which patient statement indicates understanding of the symptoms of RA?

Fatigue

A nurse is reviewing the medical record of a female client. Which of the following findings should the nurse identify as a risk factor for osteoporosis?

History of anorexia nervosa

The nurse sees a neighbor fall and fracture a leg. What should the nurse do first for the neighbor?

Immobilize the affected limb using minimal movement.

A patient has an open reduction of a radial fracture and is casted. Several hours after the operation, the patient reports a throbbing pain in the arm. What nursing action is essential for the nurse to take?

Perform neurovascular checks.

A nurse is caring for a client who had a fiberglass cast placed on her left arm several hours ago and now reports itching under the cast. Which of the following actions should the nurse plan to take?

Use a hair dryer on a cool setting to blow air into the cast.

A nurse is teaching a client who has a new prescription for alendronate for treatment of osteoporosis. Which of the following statements by the client indicates understanding of the teaching?

"I will sit upright after taking the medication." *A client taking alendronate should sit upright for 30 min after administration to prevent esophageal irritation and ulceration. Therefore, the nurse should identify this statement as indicating an understanding of the teaching.

The nurse is collecting data for a patient who is reporting pain in the right hip. Which question should the nurse ask to determine the severity of the pain?

"What number rating would you give your pain on a scale from 0 to 10?"

During a health history the nurse becomes concerned that a patient is at risk for developing osteoporosis. Which modifiable risk factors did the nurse use to come to this conclusion? (Select all that apply.)

-Cigarette smoking -Sedentary lifestyle -Low calcium intake

A patient in a motor vehicle crash has injuries to bones of the appendicular skeleton. Which bones should the nurse expect to support when caring for this patient? (Select all that apply.)

-Femur -Humerus

Th nurse is contributing to the plan of care for a patient who is scheduled for a below the knee amputation. What nursing diagnosis should be recommended for the preoperative plan of care?

Anxiety

The nurse is monitoring a patient with a casted left tibial fracture and a contusion of the thigh. The patient reports increasing pain in the left foot that has not been relieved by morphine injections. What should the nurse do?

Ensure physician is immediately notified.

The nurse observes a petechial rash and respiratory distress in a patient recovering from a fractured femur. What should these findings suggest to the nurse?

Fat embolism

A patient with a 36 hour old fractured femur is in traction and is prescribed morphine 10 mg tid PRN. The patient received a dose 3 hours ago and is now reporting a pain level of 8. The patient is stable. Which action should the nurse take?

Give pain medication as ordered.

The nurse is collecting data for a patient who is reporting pain in the left wrist. What question should the nurse use to address the region of the pain?

"Where is the pain?"

The mother of a 6 year old child is concerned that the child is not going to be tall like other family members. What should the nurse explain as influencing the growth of bone? (Select all that apply.)

-Adequate intake of Vitamin D -Production of growth hormone. -Adequate intake of vitamins A and C

A patient 48 hours after surgery for a fractured shaft is experiencing mental confusion, tachycardia, tachypnea, and dyspnea. The patient's BP is elevated and petechiae are present on the chest. After reporting the findings to the RN what should the nurse do while awaiting the physician's specific orders? (Select all that apply.)

-Administer O2 -Prepare patient for ABGs tests -Prepare patient for chest x-ray or lung scan. -Maintain bedrest and keep movement to a minimum. -Place patient in high Fowler's position or raise the HOB

The nurse is caring for a patient in traction. Which actions are appropriate when caring for this patient? (Select all that apply.)

-Allow weights to hang freely in place -Use assistance to reposition the patient in bed

A patient asks the difference between osteoarthritis and rheumatoid arthritis. What manifestations should the nurse explain are characteristic of rheumatoid arthritis? (Select all that apply.)

-Low grade fever -Autoimmune disease -Early morning stiffness -Involvement of other major organs

The nurse is caring for a patient who has had a right hip replacement. For which position is the nurse attempting to achieve when a pillow is placed between the legs during turning?

Abduction of the thighs

A nurse in the emergency department is preparing to discharge a client following a Grade II (moderate) ankle sprain. Which of the following instructions should the nurse plan to give to the client?

Apply cold compresses to the extremity intermittently.

A patient with a fractured pelvis and a left acetabular fracture is prescribed bedrest. When the patient asks to toilet, which measure would be appropriate?

Ask patient to lift straight up using a trapeze mounted above the bed and slide a bedpan underneath from the right side.

The nurse is collecting data on a patient with a crushing injury to the lower extremities. Which serum creatine kinase (CK) result should the nurse review and report to the physician?

CK-MM

A nurse in the emergency department is assessing a client who was in a motor-vehicle crash 2 days ago and sustained fractures to his tibia, ulna, and several ribs. The client is now disoriented to time and place, has a SaO2 of 87%, and the nurse notes generalized petechiae on the client's skin. Which of the following complications should the nurses suspect?

Fat embolism syndrome *The nurse should identify the triad of neurologic changes, petechial rash, and hypoxemia as findings of fat embolism syndrome. Risk factors include multiple fractures and fracture of a long bone. Male clients are also at greater risk. The manifestations occur when fat globules occlude small blood vessels.

A nurse is caring for a client who is in skeletal traction following a femur fracture. The nurse finds the clients has slid down toward the foot of the bed and the traction weight is resting on the floor. Which of the following actions should the nurse take?

Have the client use a trapeze to pull himself up while ensuring the weight hangs freely.

A patient with a neurological illness has lost the function of opposing muscle antagonists. What should the nurse expect to assess in this patient?

Inability to maintain balance.

The nurse is caring for a patient with gout. Which laboratory value should the nurse review which indicates that the treatment plan is effective?

Uric acid: 7.9 mg/dL

The nurse reinforces medication teaching provided to a patient with rheumatoid arthritis. Which medication should the patient identify as helpful to control the symptoms of the health problems?

"Ibuprofen."

A nurse is discussing the difference between rheumatoid arthritis (RA) and osteoarthritis with a newly licensed nurse. Which of the following information should the nurse include about osteoarthritis?

"Osteoarthritis can impair a joint on a single side of the body."

The nurse is contributing to the plan of care for a patient who has a bone fracture that is splintered and has shattered into numerous fragments. Which term should the nurse use to document this type of fracture?

Comminuted

The nurse is reinforcing teaching provided to a patient with gout. Which food should the patient state will be avoided that indicates teaching has been effective?

Liver

A patient is diagnosed with osteomyelitis of the right lower leg. What should the nurse expect to be prescribed for this patient's care?

Long-term antibiotic therapy

The nurse is contributing to the plan of care for a patient who has a right fractured femur. What intervention should the nurse include in the plan of care to prevent fat emboli?

Maintain immobilization of the right leg.

The nurse is caring for a patient who had a bone biopsy on the right leg. Which activity should the nurse implement?

Monitor the site of biopsy for bleeding.

The nurse checks a patient's casted right leg resting upon a pillow and finds that the cast appears too tight. What should the nurse do?

Notify the RN.

A nurse is caring for a client who has a pelvic fracture. The client reports sudden shortness of breath, stabbing chest pain, and feelings of doom. The nurse should identify that the client is experiencing which of the following complications?

Pulmonary embolus

The nurse is contributing to the plan of care for a patient who has a fractured hip and is placed in Buck's (boot) traction while awaiting surgery. What is the desired outcome for placing the patient in Buck's traction?

Relieve patient pain.

A nurse is assessing a client who is 24 hr postoperative following an above-the-elbow amputation. Which of the following findings should the nurse identify as the priority?

Report of muscle spasms

A patient is diagnosed with fractured thoracic vertebrae from a motor vehicle crash. Which other structure should the nurse suspect may have been damaged during this accident?

Ribs

The nurse finds a 2 day postoperative patient who had a right total hip replacement lying supine with crossed legs. What data should the nurse collect on this patient?

The right leg for shortening.

The nurse is contributing to the plan of care for a patient who has an upper extremity amputation. Why should the nurse keep in mind that this type of amputation can be more debilitating than a lower extremity amputation when planning care?

The upper extremity is more specialized.

The nurse is reinforcing teaching provided to a patient scheduled for an arthrocentesis. Which patient statement indicates understanding of the planned procedure?

"A needle will be used to draw off some fluid from my elbow."

A nurse is caring for a client who had a below-the-knee amputation for gangrene of the right foot. The client reports sensations of burning and crushing pain in the toes of the right foot. Which of the following statements should the nurse make?

"An anticonvulsant medication can be helpful in relieving this type of pain."

An 87 year old female with a history of osteoarthritis reports an average generalized pain score of 4 on a 0 to 10 scale while using acetaminophen PRN. Which response about this pain level should the nurse make to the patient?

"Are you satisfied with this level of pain control?"

An older adult visiting a wellness clinic reports joint stiffness in the morning. What should the nurse respond to this patient?

"As we age, the cartilage in joints gets rough, causing stiffness."

A patient with gout has been instructed on the prescribed medication allopurinol (Zyloprim). Which patient statement indicated understanding of the action of this medication?

"Blocks formation of uric acid."

The nurse is reinforcing teaching provided to a patient recovering from right total hip replacement. Which patient statement indicates a correct understanding of the teaching?

"Keep legs apart."

A patient scheduled for a magnetic resonance imaging (MRI) scan of the abdomen and pelvis asks how the machine takes a picture. What should the nurse respond to the patient?

"Magnetic fields create an image."

The nurse is reinforcing teaching provided to a patient for carpal tunnel syndrome treatment. Which patient statement indicates a correct understanding of the teaching?

"Wrist splint."

A nurse is reinforcing teaching with a client who has osteomyelitis of an open wound on his heel. Which of the following information should the nurse include?

"Your provider might prescribe a central catheter line for long-term antibiotic therapy."

The nurse is evaluating teaching provided to a patient with gout. Which patient menu selection indicates that additional teaching is required?

Sardines

A nurse is caring for a client who is 3 days postoperative following a right total hip arthroplasty. While transferring to a chair, the client cries out in pain. The nurse should assess the client for which of the following manifestations of dislocation of the hip prosthesis?

Shortening of the right leg

The nurse is gathering functional data on a patient with rheumatoid arthritis. Which of theses areas should be included?

Ability to dress

The nurse is caring for a patient with a minor rotator cuff shoulder injury. What should the nurse emphasize when reviewing care with this patient? (Select all that apply.)

-Apply ice -Rest the shoulder -Take NSAIDs as prescribed -Begin out-patient physical therapy

The nurse is collecting data for a patient's health history as part of the musculoskeletal system assessment. What should the nurse include when collecting this data? (Select all that apply.)

-Diet history -Occupation and activities -Risk factors for musculoskeletal problems -Family history of musculoskeletal problems

The nurse is assisting in the development of an educational seminar on prevention of osteoporosis for a group of community members. Which actions should the nurse suggest be included in this presentations? (Select all that apply.)

-Ensure an adequate intake of calcium each day -Participate in weight-bearing exercise every day -Wear well-supporting nonskid shoes at all times -Consider participating in resistance exercise training

The nurse is contributing to the plan of care for a patient recovering from total hip replacement. Which exercises should the nurse recommend to help prevent deep vein thrombosis (DVT) formation? (Select all that apply.)

-Foot circles -Heel pumping -Quadriceps setting -Straight leg raises

A patient recovering from a biopsy of the right femur had pain medication 1 hour ago. Which symptoms should the nurse report and closely monitor in this patient? (Select all that apply.)

-Hematoma formation -Pain reported as 7 on a 0-to-10 scale.

A patient is experiencing a tendon that is torn from a moveable bone. What should the nurse observe when collecting data on the patient's musculoskeletal system? (Select all that apply.)

-Inability to move the joint.

The nurse is admitting an 88-year old woman to an extended care facility. Which findings should the nurse consider as normal age-related changes of the patient's musculoskeletal system? (Select all that apply.)

-Limb weakness -Loss of 2 inches in height -Mild pain experiencing in the hands during the morning hours.

A patient with diabetes mellitus is scheduled for an arthroscopy of the right knee at 0800. What should be included in nursing preoperative care for this patient? (Select all that apply.)

-Maintaining NPO (nothing by mouth ) status -Obtaining blood glucose -Witnessing signature on surgical consent.

The nurse is collecting data from a patient suspected of developing a fat embolus from a fracture of the right femur. Which manifestations should the nurse expect? (Select all that apply.)

-Petechiae -Tachycardia -Mental confusion

A patient was an unrestrained passenger in a motor vehicle accident and hit the windshield. The patient's leg was also fractured. Which areas should be included in a patient's neuromuscular checks? (Select all that apply.)

-Pulses -Sensation -Movement

A nurse is reviewing the medical record of a client who has a prescription for probenecid to treat gout. The nurse should identify that which of the following medications can interact with probenecid?

Aspirin *Aspirin can decrease the effectiveness of probenecid. The nurse should caution the client to avoid interaction between probenecid and salicylate medications.

A patient is experiencing sacroiliac joint pain after falling. Which structure within the vertebral column should the nurse suspect is injured in this patient?

Sacrum

The nurse is reinforcing teaching on positioning for a patient after a right total knee replacement. Which patient statement indicated a correct understanding of the teaching?

"Supine with pillow under right knee."

The nurse is caring for a patient who is to have a needle biopsy of a tumor in the right calf. Which patient statement indicates correct understanding of the teaching?

"The biopsy will be used to determine if this is a cancerous tumor."

A patient with a casted, fractured left leg asks why the leg has to be elevated. What should the nurse respond to this patient?

"Decrease swelling."

The nurse is collecting data for a patient who is reporting pain in the left knee. What question should the nurse ask to address radiation of the pain?

"Does the pain move?"

A patient is completing instructions about complications that can occur from osteoporosis. Which complications should the patient states as evidence that teaching has been effective?

"Hip fracture."

A nurse is caring for a client who is postoperative following shoulder surgery. The client has a prescription to keep the affected arm adducted. Which of the following instructions should the nurse provide the client?

"Hold your arm against the side of your body."

The nurse is collecting data for a patient who is reporting pain in the hand joints. What question should the nurse ask to determine the quality of the pain?

"How does the pain feel?"

A nurse is reinforcing preoperative teaching with a client who is scheduled for total knee arthroplasty. Which of the following statements by the client should the nurse identify as understanding the teaching?

"I should wear elastic stockings on both of my legs."

The nurse is reinforcing teaching for a patient who has severe arthritis and is having an x-ray. Which patient statement indicates teaching has been effective?

"The table is hard and cold."

The nurse is caring for a patient scheduled for an arthrography. What should the nurse explain to the patient about pain expectations during the procedure?

"There is temporary pain during dye injection."

The nurse reinforces teaching on prevention of osteoporosismyelitis with a patient who has an open fracture of the right leg. Which patient statement indicates that teaching has been effective?

"Wash hands prior to touching fracture area."

A nurse is performing medication reconciliation for a newly admitted client who has rheumatoid arthritis (RA). Which of the following medications should the nurse identify as the treatment for this condition?

Celecoxib *Celecoxib is a type of NSAID, called cyclooxygenase-2 (COX-2) inhibitors, used to relieve some of the manifestations caused by RA in adults. The nurse should identify that the medication is also prescribed for osteoarthritis, spondylitis, and painful menstruation.

The nurse is reinforcing teaching for a patient who has had a total hip replacement on correct sitting positions. Which position should the nurse teach the patient to avoid?

Crossing legs

The nurse is caring for a patient who has a newly casted, fractured wrist. Data collection reveals slightly puffy fingers with good capillary refill. What should the nurse do now to prevent complications?

Elevate the cast on pillows.

The nurse is caring for a patient with a suspected bone tumor. Which serum laboratory result indicates to the nurse that this health problem is present?

Elevated alkaline phosphatase.

The daughter of an older female patient with osteoporosis asks what she can do to prevent the development of the disorder as she ages. What should the nurse suggest to the daughter?

Engage in weight-bearing exercises.

The nurse is reviewing data collected during the health history for a patient with osteoporosis. What should the nurse identify as a risk factor for osteoporosis development?

Increased caffeine intake.

A patient who has a displaced mid-shaft fracture of the left femur and is in balanced suspension skeletal traction with 35 pounds of weights is experiencing calf pain with right foot dorsiflexion. Which action should the nurse take?

Notify the RN.

A patient recovering from a bone biopsy of the left leg has pain unrelieved by morphine 5 mg intramuscularly given 1.5 hours ago. The morphine is prescribed for every 3 hours. What should the nurse do?

Notify the charge nurse.

The nurse is contributing to the plan of care for a patient with Paget's disease. Which outcome should the nurse identify as being appropriate for this patient?

Pain is relieved at a satisfactory level.

A nurse is caring for a client immediately following application of a plaster cast. The nurse should monitor for and report which of the following findings as an indication of compartment syndrome?

Paresthesias of the extremity *The nurse should identify paresthesias as a finding of compartment syndrome. Compartment syndrome involves the compression of nerves and blood vessels in an enclosed space, leading to impaired blood flow and nerve damage. Other findings include numbness, tingling, weakness, and pain that does not respond to medication.

The nurse is caring for a patient who had a closed reduction of the ulna with a cast applied. Later the patient reports left arm pain. What should the nurse do first?

Perform neurovascular check on fingers.

The nurse is caring for a patient 1 hour after a diagnostic arthroscopy of the right knee. Which activity should the nurse implement?

Straight-leg raises

A patient is suspected as having a fractured skull. When explaining this pathology to the patient, how should the nurse describe the joints between the cranial bones?

Sutures

The nurse is reinforcing teaching provided to a patient who is postmenopausal, has lost 2 inches of height, and has osteoporosis. Which patient statement indicates correct understanding of the purpose of calcium supplements?

To decrease bone loss

A nurse is assessing a client who is 48 hr postoperative following open reduction and internal fixation of a fractured tibia. Which the following findings should the nurse report to the provider?

Toes are cold to the touch