NCLEX Musculoskeletal #1

A client who had a total hip replacement 2 days ago has developed an infection with a fever. The nursing diagnosis of fluid volume deficit related to diaphoresis is made. Which of the following is the most appropriate outcome? 1. The client drinks 2,000 mL of fluid per day. 2. The client understands how to manage the incision. 3. The client's bed linens are changed as needed. 4. The client's skin remains cool throughout hospitalization.

1

A client who has had a lumbar laminectomy with a spinal fusion is sitting in a chair. In which position are his feet if he is complying with his post operative instructions? 1. On the floor with the feet flat. 2. On a low footstool. 3. In any comfortable position with legs uncrossed. 4. On a high footstool so the feet are level with the chair seat.

1

A client with a hip fracture has undergone surgery for insertion of a femoral head prosthesis. Which of the following activities should the nurse instruct the client to avoid? 1. Crossing the legs while sitting down. 2. Sitting on a raised commode seat. 3. Using an abductor splint while lying on the side. 4. Rising straight from a chair to a standing position.

1

A physician orders a lengthy X-ray examination for a client with osteoarthritis. Which of the following actions by the nurse would demonstrate client advocacy? 1. Contact the X-ray department and ask the technician if the lengthy session can be divided into shorter sessions. 2. Contact the physician to determine if an alternative examination could be scheduled. 3. Provide a dose of acetaminophen (Tylenol). 4. Cancel the examination because of the hard X-ray table.

1

A postmenopausal client is scheduled for a bone-density scan. To plan for the client's test, what should the nurse communicate to the client? 1. Request that the client remove all metal objects on the day of the scan. 2. Instruct the client to consume foods and beverages with a high content of calcium for2 days before the test. 3. Inform the client that she will need to ingest 600 mg of calcium gluconate by mouth for 2 weeks before the test. 4. Tell the client that she should report any significant pain to her physician at least 2 days before the test.

1

Following a total joint replacement, which of the following complications has the greatest likelihood of occurring? 1. Deep vein thrombosis (DVT). 2. Polyuria. 3. Intussception of the bowel. 4. Wound evisceration.

1

The client diagnosed with osteoarthritis states, "My friend takes steroid pills for her rheumatoid arthritis. Why don't I take steroids for my osteoarthritis?" Which of the following is the best explanation? 1. Intra-articular corticosteroid injections are used to treat osteoarthritis. 2. Oral corticosteroids can be used in osteoarthritis. 3. A systemic effect is needed in osteoarthritis. 4. Rheumatoid arthritis and osteoarthritis are two similar diseases.

1

The client has just had a total knee replacement for severe osteoarthritis. Which of the following assessment findings should lead the nurse to suspect possible nerve damage? 1. Numbness. 2. Bleeding. 3. Dislocation. 4. Pinkness.

1

The nurse develops a teaching plan for a client scheduled for a spinal fusion. Which of the following should the nurse expect to include? 1. The client typically experiences more pain at the donor site than at the fusion site. 2. The surgeon will apply a simple gauze dress ing to the donor site. 3. Neurovascular checks are unnecessary if the fibula is the donor site. 4. The client's level of activity restriction is determined by the amount of pain.

1

The nurse is observing a client who is recovering from back strain lift a box. What should the nurse do? 1. Praise the client for using correct body mechanics. 2. Suggest to the client that she put both knees on the floor before attempting to lift the box. 3. Advise the client to bend from the waist rather than stretching her back in this position. 4. Inform the client that she should keep her back straight by squatting with both knees parallel.

1

Which of the following statements indicates that the client with osteoarthritis understands the effects of capsaicin (Zostrix) cream? 1. "I always wash my hands right after I apply the cream." 2. "After I apply the cream, I wrap my knee with an elastic bandage." 3. "I keep the cream in the cabinet above the stove in the kitchen." 4. "I also use the same cream when I get a cut or a burn."

1

A client with osteoporosis needs education about diet and ways to increase bone density. Which of the following should be included in the teaching plan? Select all that apply. 1. Maintain a diet with adequate amounts of vitamin D, as found in fortified milk and cereals. 2. Choose good calcium sources, such as figs, broccoli, and almonds. 3. Use alcohol in moderation because a moderate intake has no known negative effects. 4. Try swimming as a good exercise to maintain bone mass. 5. Avoid the use of high-fat foods, such as avocados, salad dressings, and fried foods.

1, 2, 3

The nurse is assessing a client who had a left hip replacement 36 hours ago. Which of the following indicates the prosthesis is dislocated? Select all that apply. 1. The client reported a "popping" sensation in the hip. 2. The left leg is shorter than the right leg. 3. The client has sharp pain in the groin. 4. The client cannot move his right leg. 5. The client cannot wiggle the toes on the left leg.

1, 2, 3

The nurse is preparing the discharge of a client who has had a knee replacement with a metal joint. The nurse should instruct the client about which of the following? Select all that apply. 1. Notify health care providers about the joint prior to invasive procedures. 2. Avoid use of Magnetic Resonance Imaging (MRI) scans. 3. Notify airport security that the joint may set off alarms on metal detectors. 4. Refrain from carrying items weighing more than 5 lb. 5. Limit fluid intake to 1,000 mLIday.

1, 2, 3

The nurse is assessing a client's left leg for neurovascular changes following a total left knee replacement. Which of the following are expected normal findings? Select all that apply. 1. Reduced edema of the left knee. 2. Skin warm to touch. 3. Capillary refill response. 4. Moves toes. 5. Pain absent 6. Pulse on the left leg weak than the right leg

1, 2, 3, 4

The nurse is teaching the client to administer enoxaparin (Lovenox) following a total hip arthroplasty? The nurse should instruct the client about which of the following? Select all that apply. a. Report promptly any difficulty breathing, rash, or itching. 2. Notify the health care provider of unusual bruising. 3. Avoid all aspirin-containing medications. 4. Wear or carry medical identification. 5. Expel the air bubble from the syringe before the injection. 6. Remove needle immediately after medication is injected.

1, 2, 3, 4

Which of the following statements should the nurse include in the teaching session when preparing a client for arthrocentesis? Select all that apply. 1. "A local anesthetic agent may be injected into the joint site for your comfort." 2. "A syringe and needle will be used to with draw fluid from your joint." 3. " T h e procedure, although not painful, will provide immediate relief." 4. "We'll want you to keep your joint active after the procedure to increase blood flow." 5. "You will need to wear a compression bandage for several days after the procedure."

1, 2, 5

A client is to have a total hip replacement. The preoperative plan should include which of the following? Select all that apply. 1. Administer antibiotics as prescribed to ensure therapeutic blood levels. 2. Apply leg compression device. 3. Request a trapeze be added to the bed. 4. Teach isometric exercises of quadriceps and gluteal muscles. 5. Demonstrate crutch walking with a 3-point gait. 6. Place Buck's traction on the bed.

1, 3, 4

Which information should the nurse include when performing discharge teaching with a client who had an anterolateral approach for a total hip replacement? Select all that apply. 1. Avoid turning the toes or knee outward. 2. Use an abduction pillow between the legs when in bed. 3. Use an elevated toilet seat and shower chair. 4. Do not extend the operative leg backwards. 5. Restrict motion for 2 weeks after surgery.

1, 3, 4

When preparing a client for discharge from the hospital after a total knee replacement, the nurse should include which of the following information in the discharge plan? Select all that apply. 1. Report signs of infection to health care provider. 2. Keep the affected leg and foot on the floor when sitting in a chair. 3. Remove anti-embolism stockings when sleeping. 4. The physical therapist will encourage progressive ambulation with use of assistive devices. 5. Change the dressing daily.

1, 4

A client with osteoarthritis will undergo an arthrocentesis on his painful edematous knee. What should be included in the nursing plan of care? Select all that apply. 1. Explain the procedure. 2. Administer preoperative medication 1 hour before surgery. 3. Instruct the client to immobilize the knee for 2 days after the surgery 4. Assess the site for bleeding 5. Offer pain medication

1, 4, 5

A client complaining of numbness from the back of his left buttock to the dorsum of his foot and big toe is scheduled to undergo a laminectomy. The operative consent form states, "a left lumbar laminectomy of L3-4." Which of the following should the nurse do next? 1. Have the client sign the consent form. 2. Call the surgeon. 3. Change the consent form. 4. Review the client's history.

2

A client with a ruptured intervertebral disc at L4-5 stands with a flattened spine slightly tilted forward and slightly flexed to the affected side. The nurse interprets this finding as indicating which of the following? 1. Motor changes. 2. Postural deformity. 3. Alteration of reflexes. 4. Sensory changes.

2

A male client underwent a spinal fusion yesterday. Which of the following nursing assessments should alert the nurse to the development of a possible complication? 1. Lateral rotation of the head and neck. 2. Clear yellowish fluid on the dressing. 3. Use of the standing position to void. 4. Nonproductive cough.

2

After teaching a group of clients with osteoarthritis about using regular exercise, which of the following client statements indicates effective teaching? 1. "Performing range-of-motion exercises will increase my joint mobility." 2. "Exercise helps to drive synovial fluid through the cartilage." 3. "Joint swelling should determine when to stop exercising." 4. "Exercising in the outdoors year-round pro motes joint relaxation."

2

Immediately after a lumbar laminectomy, the nurse administers ondansetron hydrochloride (Zofran) to the client as ordered. The nurse determines that the drug is effective when which of the following is controlled? 1. Muscle spasms. 2. Nausea. 3. Shivering. 4. Dry mouth.

2

The nurse is assessing a client for neurologic impairment after a total hip replacement. Which of the following would indicate impairment in the affected extremity? 1. Decreased distal pulse. 2. Inability to move. 3. Diminished capillary refill. 4. Coolness to the touch.

2

The nurse is assessing the home environment of an elderly client who is using crutches during the postoperative recovery phase after hip pinning. Which of the following would pose the greatest hazard to the client as a risk for falling at home? 1. A 4-year-old cocker spaniel. 2. Scatter rugs. 3. Snack tables. 4. Rocking chairs.

2

Which of the following positions would be most comfortable for a client with a ruptured disc at L5-S1 right? 1. Prone. 2. Supine with the legs flexed. 3. High Fowler's. 4. Right Sims.

2

A client had a posterolateral total hip replacement 2 days ago. What should the nurse include in the client's plan of care? Select all that apply. 1. When using a walker, encourage the client to point the toes inward. 2. Position a pillow between the legs to maintain abduction. 3. Allow the client to be in the supine position or in the lateral position on the unoperated side. 4. Do not allow the client to bend down to tie or slip on shoes. 5. Place ice on the incision after physical therapy.

2, 3, 4, 5

Following a total hip replacement, the nurse should do which of the following? Select all that apply. 1. With the aid of a coworker, turn the client from the supine to the prone position every 2 hours. 2. Encourage the client to use the overhead trapeze to assist with position changes. 3. For meals, elevate the head of the bed to 90 degrees. 4. Use a fracture bedpan when needed by the client. 5. When the client is in bed, prevent thromboembolism by encouraging the client to do toe-pointing exercises.

2, 4, 5

A client has an intracapsular hip fracture. The nurse should conduct a focused assessment to detect: 1. Internal rotation. 2. Muscle flaccidity. 3. Shortening of the affected leg. 4. Absence of pain in the fracture area.

3

A client who has a total hip replacement 4 days ago is worried about dislocation of the prosthesis. the nurse should respond by saying which of the following? 1. "Don't worry. Your new hip is very strong." 2. "Use of a cushioned toilet seat helps to prevent dislocation." 3. "Activities that tend to cause adduction of the hip tend to cause dislocation, so try to avoid them." 4. "Decreasing use of the abductor pillow will strengthen the muscles to prevent dislocation."

3

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 of the following responses would be best? 1. "The tube helps us to detect a wound infection early on." 2. "This way we won't have to irrigate the wound." 3. "Fluid won't be allowed to accumulate at the site." 4. "We have a way to administer antibiotics into the wound."

3

After surgery and insertion of a total joint prosthesis, a client develops severe sudden pain and an inability to move the extremity. The nurse correctly interprets these findings as indicating which of the following? 1. A developing infection. 2. Bleeding in the operative site. 3. Joint dislocation. 4. Glue seepage into soft tissue.

3

At which of the following times should the nurse instruct the client to take ibuprofen (Motrin), prescribed for left hip pain secondary to osteoarthritis, to minimize gastric mucosal irritation? 1. At bedtime. 2. On arising. 3. Immediately after a meal. 4. On an empty stomach.

3

In preparation for total knee surgery, a 200-lb client with osteoarthritis must lose weight. Which of the following exercises should the nurse recommend as best if the client has no contraindications? 1. Weight lifting. 2. Walking. 3. Aquatic exercise. 4. Tai chi exercise.

3

The nurse advises the client who has had a femoral head prosthesis placement on the type of chair to sit in during the first 6 to 8 weeks after surgery. Which would be the correct type to recommend? 1. A desk-type swivel chair. 2. A padded upholstered chair. 3. A high-backed chair with armrests. 4. A recliner with an attached footrest.

3

The nurse has established a goal with a client to improve mobility following hip replacement. Which of the following is a realistic outcome at the time of discharge from the surgical unit? 1. The client can walk throughout the entire hospital with a walker. 2. The client can walk the length of a hospital hallway with minimal pain. 3. The client has increased independence in transfers from bed to chair. 4. The client can raise the affected leg 6 inches with assistance.

3

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? 1. A 55-year-old client who is 6 feet tall and weighs 180 lb. 2. A 90-year-old who lives alone. 3. A 74-year-old who has periodontal disease with periodontitis. 4. A 75-year-old who has asthma and uses an inhaler.

3

Which of the following activities should the nurse instruct the client with low back pain to avoid? 1. Keeping light objects below the level of the elbows when lifting. 2. Leaning forward while bending the knees. 3. Exceeding the prescribed exercise program. 4. Sleeping on the side with legs flexed.

3

Which of the following exercises should the nurse advise the client to avoid after a lumbar laminectomy? 1. Knee-to-chest lifts. 2. Hip tilts. 3. Sit-ups. 4. Pelvic tilts.

3

A client in a double hip spica cast is constipated. The surgeon cuts a window into the cast. Which of the following outcomes should the nurse anticipate? 1. The window will allow the nurse to palpate the superior mesenteric artery. 2. The window will allow the surgeon to manipulate the fracture site. 3. The window will allow the nurses to reposition the client. 4. The window will provide some relief from pressure due to abdominal distention as a result of constipation.

4

A client who has had a total hip replacement has a dislocated hip prosthesis. The nurse should first? 1. Stabilize the leg with Buck's traction 2. Apply an ice pack to the affected hip. 3. Position the client toward the opposite side of the hip 4. Notify the orthopedic surgeon

4

After a laminectomy, the client states, "The physician said that I can do anything I want to." Which of the following client-stated activities indicates the need for further teaching? 1. Drying the dishes. 2. Sitting outside on firm cushions. 3. Making the bed walking from side to side. 4. Sweeping the front porch.

4

After knee arthroplasty, the client has a sequential compression device (SCD). The nurse should do which of the following? 1. Elevate the sequential compression device (SCD) on two pillows. 2. Change the settings on the SCD to make the client more comfortable. 3. Stop the SCD to remove dressings and bathe the leg. 4. Discontinue the SCD when the client is ambulatory.

4

After the nurse teaches a client about wearing a back brace after a spinal fusion, which of the following client statements indicates effective teaching? 1. "I will apply lotion before putting on the brace." 2. "I will be sure to pad the area around my iliac crest." 3. "I can use baby powder under the brace to absorb perspiration." 4. "I should wear a thin cotton undershirt under the brace."

4

Following a total hip replacement, the nurse should position the client in which of the following ways? 1. Place weights alongside of the affected extremity to keep the extremity from rotating. 2. Elevate both feet on two pillows. 3. Keep the lower extremities adducted by use of an immobilization binder around both legs. 4. Keep the extremity in slight abduction using an abduction splint or pillows placed between the thighs.

4

On the evening of surgery for total knee replacement, a client wants to get out of bed. To safely assist the client the nurse should do which of the following? 1. Encourage the client to apply full weight bearing. 2. Order a walker for the client. 3. Place a straight-backed chair at the foot of the bed. 4. Apply a knee immobilizer.

4

Prior to surgery, the nurse is instructing a client who will have a total hip replacement tomorrow. Which of the following information is most important to include in the teaching plan at this time? 1. Teaching how to prevent hip flexion. 2. Demonstrating coughing and deep-breathing techniques 3. Showing the client what an actual hip prosthesis looks like. 4. Assessing the client's fears about the procedure

4

The client with a herniated intervertebral disc scheduled for a myelogram asks the nurse about the procedure. The nurse explains that radiographs will be taken of the client's spine after an injection of which of the following? 1. Sterile water. 2. Normal saline solution. 3. Liquid nitrogen. 4. Radiopaque dye.

4

The nurse develops a plan of care for a client in the initial postoperative period following a lumbar laminectomy. Which of the following activities is contraindicated? 1. Assisting with her daily hygiene activities. 2. Lying flat in bed. 3. Walking in the hall. 4. Sitting all afternoon in her room.

4

The nurse is developing the discharge teaching plan for a client after a lumbar laminectomy L4-5 who will be returning to work in 6 weeks. Which of the following actions should the nurse encourage the client to avoid? 1. Placing one foot on a step stool during pro longed standing. 2. Sleeping on the back with support under the knees. 3. Maintaining average body weight for height. 4. Sitting whenever possible.

4

The nurse is developing the plan of care for an older adult client with a hip fracture. Which of the following chronic health problems would the nurse be least likely to assess in the client? 1. Hypertension. 2. Cardiac decompensation. 3. Pulmonary disease. 4. Multiple sclerosis.

4

When teaching a client with an extracapsular hip fracture scheduled for surgical internal fixation with the insertion of a pin, the nurse bases the teaching on the understanding that this surgical repair is the treatment of choice. Which of the following explains the reason? 1. Hemorrhage at the fracture site is prevented. 2. Neurovascular impairment risk is decreased. 3. The risk of infection at the site is lessened. 4. The client is able to be mobilized sooner.

4

Which of the following should the nurse assess when completing the history and physical examination of a client diagnosed with osteoarthritis? 1. Anemia. 2. Osteoporosis. 3. Weight loss. 4. Local joint pain.

4

Which of the following would not be appropriate to include when preparing a client for magnetic resonance imaging (MRI) to evaluate a ruptured disc? 1. Informing the client that the procedure is painless. 2. Taking a thorough history of past surgeries. 3. Checking for previous complaints of claustrophobia. 4. Starting an LV. line at keep-open rate.

4