NCLEX 10000 Musculoskeletal Disorders
A nurse is caring for a client with a spinal cord injury. The client is experiencing blurred vision and has a blood pressure of 204/102 mm Hg. What should the nurse do first? a) Position the client on the left side. b) Check the client's bladder for distention. c) Control the environment by turning the lights off and decreasing stimulation for the client. d) Administer pain medications.
Check the client's bladder for distention. Correct Explanation: The client is experiencing autonomic dysreflexia, which is a medical emergency. The nurse should immediately evaluate the client for bladder distention and be prepared to catheterize the client.
After total hip replacement, a client is receiving epidural analgesia to relieve pain. Which action is a nursing priority for this client? a) Assessing capillary refill time b) Keeping the client flat in bed c) Changing the catheter site dressing every shift d) Assessing for sensation in the legs
Assessing for sensation in the legs Correct Explanation: For epidural analgesia, a catheter is placed outside the dura mater in the epidural space. Catheter displacement, which may cause spinal injury, is signaled by loss of motion and sensation in the legs. Therefore, the nurse should assess closely for sensation and ask about numbness of the leg
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? a) Diet deficient in vegetables and fruits, high intake of red meats, and increased alcohol intake b) Regular exercise, low fat intake, and recurrent trauma to the bones through increased weight-bearing activities c) Excessive sunlight exposure, adequate calcium intake, and lactose intolerance d) Heavy smoking, sedentary lifestyle, and high intake of carbonated drinks
Heavy smoking, sedentary lifestyle, and high intake of carbonated drinks Correct Explanation: Osteoporosis has been linked to heavy smoking. A sedentary lifestyle results in more osteoclastic or breakdown activity rather than bone building or osteoblastic activity. Because carbonated drinks tend to have high phosphate levels, the inverse relationship of phosphorus to calcium results in a depletion of calcium
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? a) Degenerative joint disease b) Paget's disease c) Muscular dystrophy d) Scoliosis
Degenerative joint disease Correct Explanation: Obesity predisposes the client to degenerative joint disease. Obesity isn't a predisposing factor for muscular dystrophy, scoliosis, or Paget's disease
In preparation for total knee surgery, a 200-lb (90.7 kg) client with osteoarthritis must lose weight. Which exercise should the nurse recommend as best if the client has no contraindications? a) weight lifting b) aquatic exercise c) walking d) tai chi exercise
aquatic exercise Correct Explanation: When combined with a weight loss program, aquatic exercise would be best because it cushions the joints and allows the client to burn off calories. Aquatic exercise promotes circulation, muscle toning, and lung expansion, which promote healthy preoperative conditioning.
After a person experiences a closure of the epiphyses, which statement is true? a) No further increase in bone length occurs. b) The bone increases in thickness and is remodeled. c) The bone grows in length but not thickness. d) Both bone length and thickness continue to increase.
No further increase in bone length occurs. Correct Explanation: After closure of the epiphyses, no further increase in bone length can occur. The other options are inappropriate and not related to closure of the epiphyses.
A client who had a total hip replacement 4 days ago is worried about dislocation of the prosthesis. The nurse should respond by saying: a) "Decreasing use of the abductor pillow will strengthen the muscles to prevent dislocation." b) "Do not worry. Your new hip is very strong." c) "Use of a cushioned toilet seat helps to prevent dislocation." d) "Activities that tend to cause adduction of the hip tend to cause dislocation, so try to avoid them."
"Activities that tend to cause adduction of the hip tend to cause dislocation, so try to avoid them." Correct Explanation: Dislocation precautions include: avoid extremes of internal rotation, adduction, and 90-degree flexion of affected hip for at least 4 to 6 weeks after the procedure.
During a routine physical examination on a 75-year-old female client, a nurse notes that the client is 5 feet, 3/8 inches (1.6 m) tall. The client states, "How is that possible? I was always 5 feet and 1/2 inches (1.7 m) tall." Which statement is the best response by the nurse? a) "After age 40, height may show a gradual decrease as a result of spinal compression" b) "After menopause, the body's bone density declines, resulting in a gradual loss of height." c) "The posture begins to stoop after middle age." d) "There may be some slight discrepancy between the measuring tools used."
"After menopause, the body's bone density declines, resulting in a gradual loss of height." Correct Explanation: The nurse should tell the client that after menopause, the loss of estrogen leads to a loss in bone density, resulting in a loss of height
Which discharge instruction should a nurse give a client who's had surgery to repair a hip fracture? a) "Don't flex your hip more than 30 degrees, don't cross your legs, and have someone help you put your shoes on." b) "Don't flex your hip more than 90 degrees, don't cross your legs, and have someone help you put your shoes on." c) "Don't flex your hip more than 120 degrees, don't cross your legs, and have someone help you put your shoes on." d) "Don't flex your hip more than 60 degrees, don't cross your legs, and have someone help you put your shoes on."
"Don't flex your hip more than 90 degrees, don't cross your legs, and have someone help you put your shoes on." Correct Explanation: Falls in the home cause most injuries among the elderl
After instructing a 40-year-old woman about osteoporosis after menopause, the nurse determines that the client needs further instruction when the makes which client statement? a) "Estrogen therapy at menopause can reduce the risk of osteoporosis." b) "Women who do not eat dairy products should consider calcium supplements." c) "Women of African descent are at the greatest risk for osteoporosis." d) "A standard serving of yogurt is the equivalent of one glass of milk."
"Women of African descent are at the greatest risk for osteoporosis." Correct Explanation: Small-boned, fair-skinned women of northern European descent are at the greatest risk for osteoporosis, not women of African descent.
What is the most important assessment for the nurse to make when assessing peripheral pulses on a client who is post limb fracture? a) Local temperature and visible pulsations b) Color of the skin and rhythm above the affected fracture site c) Amplitude and symmetry of both extremities d) Strong contractility and rate of only the unaffected limb
Amplitude and symmetry of both extremities Correct Explanation: Assessment of any peripheral pulse should include the characteristics of the pulse (e.g., amplitude, rhythm, and rate). The presence or lack of symmetry in the peripheral pulses must also be assessed.
Which of the following instructions regarding body mechanics would be most appropriate for helping a client to avoid back injury? a) Sit in chairs with soft cushions. b) Avoid prolonged sitting and standing. c) Pull objects rather than push them. d) Sleep on a soft mattress.
Avoid prolonged sitting and standing. Correct Explanation: Prolonged sitting and standing should be avoided because they strain the lower back.
The nurse should plan to use an abduction pillow (or splint) after a total hip replacement to: a) Prevent hip flexion. b) Decrease formation of sacral pressure ulcers. c) Increase peripheral circulation. d) Prevent dislocation of the prosthesis.
Prevent dislocation of the prosthesis. Correct Explanation: After a total hip replacement, it is important to maintain the hip in a state of abduction to prevent dislocation of the prosthesis
Which nursing diagnosis takes highest priority for a client with a compound fracture? a) Risk for infection related to effects of trauma b) Imbalanced nutrition: Less than body requirements related to immobility c) Impaired physical mobility related to trauma d) Activity intolerance related to weight-bearing limitations
Risk for infection related to effects of trauma Correct Explanation: A compound fracture involves an opening in the skin at the fracture site. Because the skin is the body's first line of defense against infection, any skin opening places the client at risk for infection.
Which of the following pieces of equipment should the nurse plan to use to help prevent external rotation of the client's right leg postoperatively? a) A high footboard. b) A metal bed cradle. c) Sandbags. d) A rubber air ring.
Sandbags. Correct Explanation: It is best to support the client's leg in its proper anatomic position and to prevent external rotation by supporting the leg with sandbags. A trochanter roll can also be used. Sandbags should be placed along the length of the thigh and lower leg.
A nurse is teaching a female client about preventing osteoporosis. Which teaching point is correct? a) To prevent fractures, the client should avoid strenuous exercise. b) Obtaining the recommended daily allowance of calcium requires taking a calcium supplement. c) Obtaining an X-ray of the bones every 3 years is recommended to detect bone loss. d) The recommended daily allowance of calcium may be found in a wide variety of foods.
The recommended daily allowance of calcium may be found in a wide variety of foods. Correct Explanation: Premenopausal women require 1,000 mg of calcium per day. Postmenopausal women require 1,500 mg per day. Clients usually can get the recommended daily requirement of calcium by eating a varied diet.
The nurse is evaluating a client in skin traction. Which of the following indicate the traction is applied for maximum effectiveness? a) The client is positioned low in the bed. b) The weights rest securely on the bed frame. c) The weights are increased by one-half pound (0.23 kg) each shift d) The ropes are in the wheel grooves of the pulleys
The ropes are in the wheel grooves of the pulleys. Correct Explanation: For the weights to maintain the therapeutic effect of the traction, they must be properly positioned, free hanging, and should be removed only in life-threatening situations. Effective traction depends on the client being positioned at the head of the bed. Sufficient weight is applied initially to overcome spasm in affected muscles. As the muscles relax, the weight may be reduced. The amount of weight used is determined by the physician and is not changed each shift.
A client is scheduled to undergo an open reduction internal fixation of the right femur. The night before surgery, the nurse administers zolpidem as ordered. Which statement about zolpidem is correct? a) The nurse shouldn't use the liquid if it becomes slightly darkened. b) The nurse should administer the drug immediately before bedtime. c) The nurse should dilute it in fruit juice to improve absorption. d) Avoid administration with grapefruit juice; it interferes with absorption.
he nurse should administer the drug immediately before bedtime. Correct Explanation: The nurse should administer zolpidem immediately before bedtime because the onset of action is rapid.
A nurse suspects that a client with a recent fracture has compartment syndrome. Assessment findings may include: a) body-wide decrease in bone mass. b) inability to perform passive movement and pain with active movement. c) inability to perform active movement and pain with passive movement. d) a growth in and around the bone tissue.
inability to perform active movement and pain with passive movement. Correct Explanation: With compartment syndrome, the client can't perform active movement, and pain occurs with passive movement.
A client who has had a total hip replacement has a dislocated hip prosthesis. The nurse should first: a) apply an ice pack to the affected hip. b) notify the orthopedic surgeon. c) position the client toward the opposite side of the hip. d) stabilize the leg with Buck's traction.
notify the orthopedic surgeon. Correct Explanation: If a prosthesis becomes dislocated, the nurse should immediately notify the surgeon. This is done so the hip can be reduced and stabilized promptly to prevent nerve damage and to maintain circulation.
When admitting a client with a fractured extremity, the nurse should first assess: a) the area distal to the fracture. b) the opposite extremity for baseline comparison. c) the area proximal to the fracture. d) the actual fracture site.
the area distal to the fracture. Correct Explanation: The nursing assessment is first focused on the region distal to the fracture for neurovascular injury or compromise. When a nerve or blood vessel is severed or obstructed at the actual fracture site, innervation to the nerve or blood flow to the vessel is disrupted below the site; therefore, the area distal to the fracture site is the area of compromised neurologic input or vascular flow and return, not the area above the fracture site or the fracture site itself
A nurse is teaching a client who was recently diagnosed with carpal tunnel syndrome. Which statement should the nurse include? a) "This condition is associated with various sports." b) "Surgery is the only sure way to manage this condition." c) "Using arm splints will prevent hyperflexion of the wrist." d) "Ergonomic changes can be incorporated into your workday to reduce stress on your wrist."
"Ergonomic changes can be incorporated into your workday to reduce stress on your wrist." Correct Explanation: Ergonomic changes, such as adjusting keyboard height, can help clients with carpal tunnel syndrome avoid hyperextension of the wrist
After the nurse teaches a client about wearing a back brace after a spinal fusion, which statement indicates effective teaching? a) "I will be sure to pad the area around my iliac crest." b) "I should wear a thin cotton undershirt under the brace." c) "I can use baby powder under the brace to absorb perspiration." d) "I will apply lotion before putting on the brace."
"I should wear a thin cotton undershirt under the brace." Correct Explanation: The client should wear a thin cotton undershirt under the brace to prevent the brace from abrading directly against the skin. The cotton material also aids in absorbing any moisture, such as perspiration, that could lead to skin irritation and breakdown.
To ensure safe postoperative care of a client after a total hip arthroplasty, which actions are most appropriate for the nurse to perform? Select all that apply. a) Teach the client not to cross their legs. b) Use a pillow under the knees to prevent hip flexion. c) Limit movements resulting in internal rotation and adduction of the affected hip. d) Reduce extension and hyperextension of the affected hip. e) Elevate the client's legs above the level of the heart.
• Limit movements resulting in internal rotation and adduction of the affected hip. • Teach the client not to cross their legs. Explanation: With a total hip replacement, correct positioning and movement is important to prevent dislocation. Dislocation after hip replacement is minimized when the client avoids movements resulting in internal rotation and adduction of the affected hip. Teaching the client not to cross their legs is important to prevent dislocation.
A client undergoes a total hip replacement. Which statement made by the client indicates to the nurse that the client requires further teaching? a) "I don't know if I'll be able to get off that low toilet seat at home by myself." b) "I need to remember not to cross my legs. It's such a habit." c) "I'll need to keep several pillows between my legs at night." d) "The occupational therapist is showing me how to use a sock puller to help me get dressed.
"I don't know if I'll be able to get off that low toilet seat at home by myself." Correct Explanation: The client requires additonal teaching if he is concerned about using a low toilet seat. To prevent hip dislocation after a total hip replacement, the client must avoid bending the hips beyond 90 degrees. The nurse should instruct the client to use assistive devices, such as a raised toilet seat, to prevent severe hip flexion.
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) Limited exercise to only bathroom privileges b) Use assistive devices when ambulation c) Use of opioid therapy for pain management d) A diet high in protein and nutrients
A diet high in protein and nutrients Explanation: It is essential for the nurse to instruct on a diet that is high in protein and nutrients to increase healing and strengthen the immune system.
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? a) The client asks the nurse to add a 5-lb (2.3-kg) weight to the traction for 30 minutes per day. b) The client adducts the affected leg every 2 hours. c) The client rolls the affected leg away from the body's midline twice per day. d) The client performs isometric exercises to the affected extremity three times per day.
The client performs isometric exercises to the affected extremity three times per day. Correct Explanation: Isometric contractions increase the tension within a muscle but do not produce movement. Repeated isometric contractions make muscles grow larger and stronger.
