NCLEX 10000 MUSCULOSKELETAL DISORDERS
A client asks the nurse what the difference is between osteoarthritis (OA) and rheumatoid arthritis (RA). Which response is correct?
OA is a noninflammatry joint disease. RA is characterized by inflamed
A nurse is assisting a client with range-of-motion exercises. The nurse moves the client's leg out and away from the midline of the body. What movement does the nurse document?
abduction
A nurse is caring for an elderly female client with osteoporosis. When teaching the client, the nurse should include information about which major complication?
bone fracture
The nurse instructs the client with osteoporosis that food products high in calcium include:
broccoli
Which discharge instruction should a nurse give a client who's had surgery to repair a hip fracture?
dont flex your hip more than 90 degrees
To protect a client's skin under a back brace, the nurse should:
have the client wear a thin cotton shirt
The client sustained an open fracture of the femur from an automobile accident. The nurse should assess the client for which type of shock?
hypovolemic
A client takes prednisone for an acute exacerbation of rheumatoid arthritis. The nurse determines the client understands how to take the prednisone when the client says:
it is best if i take this medication with some food
After surgery and insertion of a total hip prosthesis, a client develops severe sudden pain and an inability to move the extremity. The nurse interprets these findings as indicating:
joint dislocation
A nurse is caring for a client who recently underwent a total hip replacement. The nurse should:
limit hip flexion of the clients hip when he sits
A client was diagnosed with chronic gouty arthritis 2 years ago. He has been taking sulfinpyrazone, 200 mg P.O. b.i.d. as maintenance therapy. How soon after administration of this drug does onset of action occur?
30 min
Following a total joint replacement, which complication has the greatest likelihood of occurring?
DVT
The nurse is caring for a client on a second course of antibiotics to eliminate osteomyelitis. It is most essential for the nurse to instruct on which aspect of daily care?
a diet high in protein and nutrients
To assess the joints, a nurse asks a client to perform various movements. As the client moves his arm away from the midline, the nurse evaluates his ability to perform:
abduction
A client who had a total hip replacement 4 days ago is worried about dislocation of the prosthesis. The nurse should respond by saying:
activities that tend to cause adduction of the hip tend to cause dislocation
When the client who has had a hip replacement is lying on the side, the nurse should place pillows or an abductor splint between the legs to prevent:
adduction of the hip joint
A client returns from the first session of scheduled physical therapy following total knee replacement surgery. The nurse assesses that the client's knee is swollen, slightly erythematous, and painful. The client rates the pain as 7 out of 10 and has not had any scheduled or PRN pain medication today. What should the nurse do? Select all that apply.
administer pain med elevate the leg and apply a cold pack
To prevent back injury, the nurse should instruct the client to:
avoid prolonged sitting and standing
A nurse monitors a client receiving enoxaparin 30 mg subcutaneously b.i.d after hip replacement surgery. Which adverse reaction is the client most likely to experience?
bleeding
A client reports having pain in the casted left arm that is unrelieved by pain medication. The nurse assesses the arm and notes that the fingers are swollen and difficult to separate. What should the nurse do first?
call the health care provider to report swelling and pain
A client with an extracapsular hip fracture returns to the nursing unit after internal fixation and pin insertion with a drainage tube at the incision site. Her husband asks, "Why does she have this tube inserted in her hip?" Which response would be best?
fluid will not be allowed to accumulate at the site
After a right total knee replacement, the client's right leg is placed in a continuous passive motion (CPM) machine. Nursing responsibilities when caring for a client with this apparatus should include:
maintaining proper of the leg
A client is recovering from an attack of gout. Client teaching should include the need to lose weight because:
weight loss will reduce uric acid levels and reduce stress on joints
The nurse is caring for a client admitted for pneumonia with a history of hypertension and heart failure. The client has reported at least one fall in the last 3 months. The client may ambulate with assistance, has a saline lock in place, and has demonstrated appropriate use of the call light to request assistance. Using the Morse Fall Scale (see chart), what is this client's total score and risk level?
60 high risk
Upon reporting to work and receiving report, a nurse has been assigned to provide care for three clients. Each of the clients has called out to the nurses' station requesting assistance. Which client should the nurse see first?
a 32 year old male
A nurse is managing the care of a client with osteoarthritis. Appropriate treatment strategies for osteoarthritis include:
administration of nonsterodal anti inflammatory drugs
Two days after surgery to amputate his left lower leg, a client states that he has pain in the missing extremity. Which action by the nurse is most appropriate?
admister medication, as ordered, for the reported discomfort
A nurse is caring for a client with a cast on his left arm after sustaining a fracture. Which assessment finding is most significant for this client?
fingers on the left hand are swollen and cool
Passive range-of-motion (ROM) exercises for the legs and assisted ROM exercises for the arms are part of the care regimen for a client with a spinal cord injury. Which observation by the nurse would indicate a successful outcome of this treatment?
free easy movement of the joints
A male client comes to the clinic with complaints of pain in his right great toe. The client reports that the pain is worse at night. Assessment reveals tophi. The nurse suspects the client has:
gouty arthritis
After a total hip replacement, the client tells the nurse that the pain in the operative hip has increased. Assessing the hip and leg, the nurse notes that the leg is internally rotated and shorter than the other leg and that the client has difficulty moving the leg. Based on this information, the nurse determines that the client:
has experienced a dislocation of the hip prosthesis
To protect a client's skin under a back brace, the nurse should:
have the client wear a think cotton shirt
A client has been diagnosed with osteoporosis after a bone density test and is asking what has caused it. Discussion of risk factors would include which of the following?
heavy smoking
The nurse has instructed the client about the correct positioning of the leg and hip following hip replacement surgery. Which statement indicates that the client has understood these instructions?
i should avoid bending over to tie my shoes
A client undergoes an arthroscopy at the outpatient clinic. After the procedure, the nurse provides discharge teaching. Which response by the client indicates the need for further teaching?
i should use my heating pad this evening to reduce some of the pain
To reduce the incidence of complications in a client in traction, which intervention should be included in the care plan?
increase fiber intake
A client is experiencing chronic arthritis and active range of motion is ordered. The nurse understands that the goal is to do which of the following?
increase muscle strength
The nurse is planning care with an older adult who is at risk for falling because of postural hypotension. Which intervention will be most effective in preventing falls in this client?
instruct the client to sit obtain balance dangle legs and rise slowly
Following a total hip replacement, the nurse should position the client by:
keeping the extremity in slight abduction using an abduction splint or pillows
A client was undergoing conservative treatment for a herniated nucleus pulposus, at L5 - S1, which was diagnosed by magnetic resonance imaging. Because of increasing neurological symptoms, the client undergoes lumbar laminectomy. The nurse should take which step during the immediate postoperative period?
legroom the client from side to side
A client who has been using crutches at home for 1 week reports having trouble using the crutches because the armpits hurt and the fingers tingle. The nurse should tell the client:
let me watch you ambulate
Which condition should the nurse assess when completing the history and physical examination of a client diagnosed with osteoarthritis?
local joint pain
After a right total knee replacement, the client's right leg is placed in a continuous passive motion (CPM) machine. Nursing responsibilities when caring for a client with this apparatus should include:
maintaining proper positioning of the leg on the CPM machine
When assessing a client who reports a back injury, it is critical for the nurse to question the client about:
mechanism of injury
A client with muscle weakness and an abnormal gait is being evaluated for muscular dystrophy. Which test or finding confirms muscular dystrophy?
muscle biopsy
The nurse is assessing the neurovascular status of a client's right arm, which has just had a cast applied. The nurse should notify the health care provider when which symptom occurs?
nail bed capillary refill time of 10 seconds
After a person experiences a closure of the epiphyses, which statement is true?
no further increase in bone length occurs
The client has just had a total knee replacement for severe osteoarthritis. When assessing the client, which finding should lead the nurse to suspect possible nerve damage?
numbness
A client who has had a lumbar laminectomy with a spinal fusion is sitting in a chair. Which is the correct position for this client's feet?
on the floor with the feet flat
The nurse is providing discharge teaching for a client being discharged after a cast application for a fractured tibia. Teaching has been effective when the client states he/she will notify the physician for which of the following?
pallor, coolness, and paresthesia
Elderly clients who fall are most at risk for which injuries?
pelvic fractures
The second morning after surgery for a below-the-knee amputation of the left leg, the client says, "This sounds crazy, but I feel my left toes tingling." This statement would indicate to the nurse that he is experiencing a:
phantom limb sensation
The nurse is evaluating the pin insertion site of a client's skeletal traction. Which finding indicates a complication?
pin moves slightly at insertion site
Which goal is the priority for a client with a fractured femur who is in traction at this time?
prevent effects of immpbility while in traction
Which nursing intervention is essential in caring for a client with compartment syndrome?
removing all external sources of pressure
A nurse is giving instructions to a client who's going home with a cast on his leg. Which teaching point is most critical?
reporting signs of impaired circulation
A nurse should monitor a client with a pelvic fracture receiving an opium derivative, such as morphine, for what common adverse reaction?
respiratory depression
Which nursing diagnosis is most appropriate for an elderly client with osteoarthritis?
risk for injury related to altered mobility
Which equipment should the nurse plan to use to help prevent external rotation of the client's right leg postoperatively?
sandbags
A client has a herniated disk in the region of the third and fourth lumbar vertebrae. Which nursing assessment finding most supports this diagnosis?
severe lower back pain
A physician orders chlorzoxazone, 500 mg P.O. t.i.d for a client. The nurse knows that chlorzoxazone, a centrally acting skeletal muscle relaxant, is commonly used to treat:
severe muscle spasm
On a visit to the family physician, a client is diagnosed with a bunion on the lateral side of the great toe, at the metatarsophalangeal joint. Which statement should the nurse include in the teaching session?
some bunions are congenital
Health promotion activities to reduce the incidence of osteoporosis include:
teaching women to maintain adequate calcium intake
A client who had a total hip replacement 2 days ago has developed an infection with a fever and profuse diaphoresis. The nurse establishes a goal to reduce the fluid deficit. Which outcome is the most appropriate?
the client drinks 2000mL of fluid per day
A nurse is assigned a client with an acute exacerbation of rheumatoid arthritis (RA). Which medical facts about RA are essential in developing a plan of care? Select all that apply.
the client experiences erythrocyte inflamed cartilage
A client has a leg immobilized in traction. Which observation by the nurse indicates that the client understands actions to take to prevent muscle atrophy?
the client performs isometric exercises to the affected extremity three times
The intended outcome of the use of treatment with skeletal traction for a client who has had a femoral fracture is:
to align injured bones
The nurse is caring for an older adult male who had open reduction internal fixation (ORIF) of the right hip 24 hours ago. The client is now experiencing shortness of breath and reports having "tightness in my chest." The nurse reviews the recent lab results. The nurse should report which lab results to the health care provider (HCP)?
troponin 1.4 mvg/L
A client is scheduled for a laminectomy to repair a herniated intervertebral disk. When developing the postoperative care plan, the nurse should include which action?
turning the client from side to side using the logroll
A 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 transfer body weight to the unaffected leg, and then:
advance both crutches
The nurse is teaching a client about risk factors associated with atherosclerosis and how to reduce the risk. Which risk factor is the client unable to modify?
age
A client who has suffered a compound fracture is preparing for discharge to home. During the teaching session, the client asks why he needs antibiotics for a broken bone. Which response by the nurse is most appropriate?
antibiotic therapy has been prescribed
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
A client has a fiberglass cast on the right arm. Which action should the nurse include in the care plan?
assessing movement and sensation in the fingers of the right hand
For a client with osteoporosis, the nurse should provide which dietary instruction?
eat more dairy products to increase
When assessing an older adult as a candidate for crutch walking, the nurse should take into account that for some elderly people, crutch walking is an impractical goal primarily because of decreased:
motor coordination
The initial postoperative assessment is completed on a client who had an arthroscopy of the knee. Which information is not necessary to obtain every 15 minutes during the first postoperative hour?
urine output
A client with arterial insufficiency undergoes below-knee amputation of the right leg. Which action should the nurse include in the postoperative care plan?
elevating the stump for the first 24 hours
The nurse is instructing the unlicensed assistive personnel (UAP) about how to prevent plantar flexion (footdrop) for a client on complete bed rest. The UAP should:
encourage active range of motion to unaffected extremities
A client with rheumatoid arthritis has increasing fatigue and is unable to manage all of the usual activities. The nurse should:
encourage the client to alternate periods of rest and activity throughout
After teaching a client with osteoarthritis about the importance of regular exercise, which statement indicates the client has understood the teaching?
exercise helps to drive synovial fluid through the cartilage
A client with osteoarthritis asks for information concerning activity and exercise. When assisting the client, which concept should be included?
exercising at least 1 hour after awakening allows
The nursing assessment of a client with osteomyelitis of the left great toe reveals pain with partial weight-bearing, unsteady gait, and general weakness. Based on these data, the nurse should institute which safety measure?
falls precautions
The nurse assigns an unlicensed assistive personnel (UAP) to the care of a client who has just returned from surgery for repair of a fractured right wrist and application of an arm cast. The nurse should stress to the UAP the importance of reporting:
the client cannot move the fingers on the right hand
A client suspected of having systemic lupus erythematosus (SLE) is being scheduled for testing. She asks which of the tests ordered will determine if she is positive for the disorder. Which statement by the nurse is most accurate?
the diagnosis won't be based on he findings of a single test
The media requests information from a nurse caring for a client who is a criminal. Which statement best shows the nurse's understanding of confidentiality requirements when the client is a criminal?
the nurse shouldn't provide the media with any info
What are important nursing priorities on the first postoperative day for a client who has had an open reduction and internal fixation (ORIF) after a right hip fracture?
assessing the neuromuscular status in the right leg , providing pain control
A nurse is caring for five clients on the orthopedic unit with the help of a nursing assistant. Which task may the nurse delegate to the nursing assistant?
assisting a client to the bathroom
After the application of an arm cast, the client has pain on passive stretching of the fingers, finger swelling and tightness, and loss of function. Based on these data, the nurse anticipates that the client may be developing:
compartment syndrome
A client is 4 days postoperative from a tibia fracture and has a long leg cast. The nurse is conducting initial teaching for walking with crutches. What is the most important activity for the nurse to encourage the client to do prior to discharge from the hospital?
conduct exercises in bed to strengthen the upper extremities
A client with a hip fracture has undergone surgery for insertion of a femoral head prosthesis. Which activity should the nurse instruct the client to avoid?
crossing the legs while sitting down
A public health nurse is providing an information session focusing on injury prevention for young children diagnosed with juvenile arthritis. Of the information offered below, what should be included in this session?
daily range of motion
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.
avoid be sure rub
A client is admitted to the orthopedic unit in balanced skeletal traction using a Thomas splint and Pearson attachment. The primary purpose of traction is to:
realign fracture fragments
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? Select all that apply.
avoid be sure to perform rub
The nurse is preparing to administer carbamazepine oral suspension, 150 mg by mouth. The pharmacy has dispensed carbamazepine suspension 100 mg/5 mL. How many milliliters of carbamazepine should the nurse administer to the client? Record your answer using one decimal place.
7.5
A client comes to the emergency department reporting pain in the right leg. When obtaining the history, the nurse learns that the client has a history of obesity and hypertension. Based on this information the nurse anticipates the client having which musculoskeletal disorder?
degenerative joint disease
After undergoing surgery the previous day for a total knee replacement, a client states that he doesn't feel ready to ambulate yet. What should the nurse do?
discuss the complications that the clients may experience if he doesn't
A client who recently had a stroke requires a cane to ambulate. When teaching about cane use, the nurse should explain that the reason for holding a cane on the uninvolved side is to:
distribute weight away from the involved side
A 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
What would be the most important nursing intervention in caring for the client's residual limb during the first 24 hours after amputation of the left leg?
elevate the residual limb on a pillow
Which client statement identifies a knowledge deficit about cast care?
i can pull out cast padding to scratch inside the cast
A client has a total hip replacement. Which of the following client statements indicates a need for further teaching before discharge?
i can't wait to take a tub bath when i get home
A nurse notices a client lying on the floor at the bottom of the stairs. He's alert and oriented and states that he fell down several stairs. He denies pain other than in his arm, which is swollen and appears deformed. After calling for help, what should the nurse do?
immobilize the clients are
When developing a care plan for a client newly diagnosed with scleroderma, which nursing diagnosis has the highest priority?
impaired skin integrity
A client who has skeletal traction to stabilize a fractured femur has not had a bowel movement for 2 days. The nurse should:
increase the clients fluid intake to 3000 mL/ day
A hospitalized client with a fracture of the tibia and fibula of the left leg is reporting increased pain at the site. What signs must the nurse be alert to that would indicate compromised circulation to the leg?
increased swelling of th toes and decreased distal pulses
A nurse notes that a client has kyphosis and generalized muscle atrophy. Which problem is a priority when the nurse develops a nursing plan of care?
ineffective coughing and deep breathing
A client is to have a below-the-knee amputation. Prior to surgery, the circulating nurse in the operating room should:
initiate a time out
The nurse is evaluating the outcome of therapy for a client with osteoarthritis. Which outcome indicates the goals of therapy have been met?
joint range of motion improved
A client has sustained a right tibial fracture and has just had a cast applied. Which instruction should the nurse provide in his cast care?
keep your right leg elevated above heart level
A client has a C7 spinal cord injury. Which would be the most important nursing intervention during the acute stage of the injury?
maintain a patent airway
A client is being discharged following an open reduction and internal fixation of the left ankle, and is to wear a non-weight-bearing cast for 2 weeks. What should the nurse teach the client to do when using crutches?
maintain two to three fingers widths between the axillary fold
A client is in Buck's traction after fracturing his right hip. The nurse should include which action in the care plan?
maintaining correct body alignment
Four hours after a cast has been applied for a fractured ulna, the nurse assesses that the client's fingers are pale and cool and capillary refill is delayed for 4 seconds. How should the nurse interpret these findings?
material blood supply to the fingers
The nurse is caring for a client who is 30 years of age with a fracture of the right femur and left tibia. Both legs have casts. The nurse assesses the following: respirations are 30 per minute and are rapid and shallow; presence of faint expiratory wheeze; and coughing produces thin pink sputum. The client is yelling at the nurse and wants to be released from the hospital; this is behavior unlike that previously reported. The last pain medication was administered 3 hours ago. The nurse should first:
notify HCP
A client has been diagnosed with degenerative joint disease (osteoarthritis) of the left hip. Which factor in the client's history would most likely increase the joint symptoms of osteoarthritis?
obesity
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
The nurse should closely monitor the client with an open fracture for which complication?
osteomyelitis
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
A client is in the advanced stages of osteoarthritis. Which statement best describes the pain that occurs in the advanced stage of the disease?
pain occurs with minimal activity
A nurse is performing an admission assessment on a client admitted with a pelvic fracture. Which statement by the client requires the nurse to seek more information from a legal standpoint?
sometimes my husband gets so angry with me
A nurse is caring for a client who complains of lower back pain. Which instruction should the nurse give to the client to prevent back injury?
stand close to the object you're lifting
When caring for a client with acute osteomyelitis in the right tibia, which measure is most appropriate to implement when repositioning the client's leg?
support the leg above and below the affected
When caring for a client with acute osteomyelitis in the right tibia, which measure is most appropriate to implement when repositioning the client's leg?
support the leg above and below the affected area
An older adult is being admitted to the hospital after falling from a 6- foot ladder. Which information is essential for the nurse to obtain at this time? Select all that apply.
symptoms history location activity time trauma
Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used in the treatment of musculoskeletal conditions. It is important for the nurse to remind the client to:
take NSAID with food
The client in traction for a fractured femur is having difficulty managing self-care activities. Which outcome indicates a successful completion of a goal of promoting independence for this client?
the client assists as much as possible
A nurse is teaching a female client about preventing osteoporosis. Which teaching point is correct?
the recommended daily allowance of calcium
A client undergoes total hip replacement. After surgery, the client questions why he must go to a rehabilitation center because he has family who can care for him. Which response by the nurse is best?
the rehabilitation staff can evaluate your progress
A client in a double hip spica cast is constipated. The surgeon cuts a window into the front of the cast. Which outcome is intended?
the window will provide some relief from pressure
The client with rheumatoid arthritis has been taking large doses of aspirin to relieve joint pain. The nurse should assess the client for:
tinnitus
A client is on bed rest after sustaining injuries in a car accident. Which nursing action helps prevent complications of immobility?
turning the client every 2 hours and providing a low air loss mattress
Which laboratory study is most relevant to treating a client who has sustained a pelvic fracture?
type and crossmatch
A 14-year-old has just had a plaster cast placed on his lower left leg. To provide safe cast care, the nurse should:
use only the palms of the hand when handling the cast
The nurse is assisting a client who has had a spinal fusion apply a back brace. In which order of priority should the nurse assist the client applying the brace? All options must be used.
verify have the client assist the client ask the client
The client with an above-the-knee amputation is to be fitted with a functioning prosthesis. The nurse has been teaching the client how to care for the residual limb. Which behavior would demonstrate that the client has an understanding of proper residual limb care? The client:
washes and dries the residual limb daily
A client is preparing for discharge from the emergency department after sustaining an ankle sprain. The client is instructed to avoid weight bearing on the affected leg and is given crutches. After instruction, the client demonstrates proper crutch use in the hallway. What additional information is most important to know before discharging the client?
whether the client needs to navigate stairs
The nurse is teaching a client with osteoporosis about taking alendronate sodium. The nurse emphasizes that the client is to take the medication:
with a full glass or water remain upright for 30 min
When a client is placed in balanced skeletal traction, the nurse should:
ensure that the traction weights hang freely from the bed at all times
A client seeks care for lower back pain of 2 weeks' duration. Which assessment finding suggests a herniated intervertebral disk?
pain radiating down the posterior thigh
The nurse is planning care for a group of clients who have had total hip replacement. Of the clients listed below, which is at highest risk for infection and should be assessed first?
a 74 year old who has periodontal disease
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 anticipate which measure?
administering large doses of IV antibiotics as ordered
A client has a left tibial fracture that required casting. Approximately 5 hours later, the client has increasing pain distal to the fracture despite the morphine injection administered 30 minutes previously. Which area should be the nurse's next assessment?
distal pulse
A client involved in a motor vehicle accident (MVA) has a long leg cast applied to the right leg and is reporting heel pain. The nurse would assess for which of the following as part of a focused exam? Select all that apply.
drainage at the heel site color and temp of the toes
The nurse is planning an educational program about the prevention of osteoporosis for a group of women. Which preventive measures would be appropriate for the nurse to include in the teaching plan?
encouraging weigh bearing exercise on a regular basis
A nurse is teaching a client who was recently diagnosed with carpal tunnel syndrome. Which statement should the nurse include?
ergonomic changes can be incorporated
The client returns from surgery for a below-the-knee amputation with the residual limb covered with dressings and a woven elastic bandage. At first, the bandage was dry. Now, 30 minutes later, the nurse notices a small amount of bloody drainage. The nurse should first:
mark the area of drain
The client with a fractured tibia has been taking methocarbamol. Which finding indicates that the drug is having the intended effect?
relief of muscle spasms
To assess the joints, a nurse asks a client to perform various movements. As the client moves his arm away from the midline, the nurse evaluates his ability to perform
abduction
