Passpoint - Musculoskeletal Disorders
The X-rays of a client who was brought to the emergency department after falling on ice reveal a leg fracture. After a cast is applied and allowed to dry, the nurse teaches the client how to use crutches. Which instruction should the nurse provide about climbing stairs?
"Place the unaffected leg on the first step, followed by the crutches and the injured leg, which should move together."
The nurse is reinforcing education for a client who recently had a cast applied. Which statement by the client indicates that the nurse's education has been effective?
"Heat is a normal sensation as a cast dries."
A client has a long leg cast applied for a tibia fracture. Which statement made by the client would indicate to the nurse that compartment syndrome may be developing?
"I am having a decrease in sensation of my toes."
A nurse reinforces a client's instructions for preventing osteoporosis. Which statement from the client indicates an understanding of the instructions?
"I can meet my daily allowance of calcium by eating a wide variety of foods."
A client has been prescribed an anti-inflammatory for osteoarthritis, and the nurse has reinforced educating the client about taking the medication. Which statement by the client indicates that the nurse's education has been effective?
"It can take up to 2 to 3 weeks for me to feel the full effects from the medication."
A client asks a nurse to explain the difference between osteoarthritis (OA) and rheumatoid arthritis (RA). Which response is correct?
"OA is a noninflammatory joint disease. RA is characterized by inflamed, swollen joints."
A client asks for information about osteoarthritis. Which statement should the nurse include when reinforcing education for the client on this condition?
"Osteoarthritis is the most common form of arthritis."
A nurse is reinforcing education for a client with a long leg cast on how to use crutches properly while descending a staircase. What step should the nurse inform the client to do first?
"Place the crutches on the first stair below you."
A client with osteoporosis uses a cane for assistance in walking. Which instruction should be reinforced when the client is using assistive devices for ambulation?
"The cane should be used on the unaffected side."
A middle-age client recovering from major back surgery must wear a back brace and walk with a cane after experiencing leg weakness. During routine care, the client tells a nurse, "I'm sorry I had this operation. Before surgery I didn't look like I had a problem, but now I do." Which response by the nurse is appropriate?
"You sound concerned about your appearance. In what way are you worse off than before?"
The health care provider has ordered for a child with an open femur fracture morphine sulfate 10 mg PO times one dose. The elixir on hand is 100 mg/5 mL. How many milliliters will the nurse administer? Record your answer using one decimal place.
0.5
A client has just had total hip replacement surgery. The client's primary care provider orders 8,000 units of heparin to be administered subcutaneously. The label on the heparin vial reads "Heparin 10,000 units/mL." How many milliliters of heparin should the nurse draw up in the syringe to administer the correct dose? Record your answer using one decimal place.
0.8
A client who's being discharged with an arm cast wants to shower at home. The nurse demonstrates how to shower without getting the cast wet. For which reason is this important?
A wet cast will weaken or decompose.
A client asks the reason for being placed in traction prior to surgery. Which response by the nurse is most appropriate?
Traction helps to prevent trauma and overcome muscle spasms.
A client who has been recently diagnosed with gout asks the nurse to explain why they need to take colchicine. What should the nurse base the response on?
Colchicine decreases inflammation.
A client is brought to the emergency department with a painful swollen ankle. Which is the nurse's most appropriate action?
Elevate the ankle.
A client with arterial insufficiency undergoes below-knee amputation of the right leg. Which action should the nurse include in the postoperative plan of care?
Elevating the stump for the first 24 hours
A 22-year-old client with an external fixation device attached to his left thigh is unable to bear weight on his left leg. He asks a nurse if he can take a shower on his third postoperative day. After a review of the physician's orders, the nurse notes an order stating, "Client may shower ten (10) days after surgery." In order to meet the client needs, what appropriate action will the nurse take?
Explain that he is not permitted to shower, but the nursing assistant can help him with a sponge bath.
A client who was casted for a recent fracture of the right ulna reports severe pain, numbness, and tingling of the right arm. What would be the nurse's most appropriate response?
Immediately report the client's symptoms.
Which of these findings best correlates with a diagnosis of osteoarthritis?
Joint stiffness that decreases with activity
A client sustained a fracture of the right tibia and has just had a cast applied. Which instruction should the nurse reinforce regarding cast care?
Keep the extremity elevated above heart level
During a senior citizen health screening, the nurse observes a 75-year-old female with a severely increased thoracic curve, or "humpback". What is this condition called?
Kyphosis
A client is admitted to the emergency department with severe lower back pain, weakness, and atrophy of leg muscles. For which diagnostic tests should the nurse prepare the client? Select all that apply.
MRI CT scan myelography
A client who fell while washing windows has a fractured right ankle that requires a cast. After assisting with the cast application, the nurse should reinforce which instructions to the client?
Move the right toes for several minutes every hour.
A client is undergoing an extensive diagnostic workup for suspected muscular dystrophy. The nurse knows that muscular dystrophy has many forms, but that one data collection finding is common to all forms. Which finding belongs in this category?
Muscle weakness
A nurse is admitting a client scheduled for a laminectomy of the L1 and L2 vertebrae. Upon returning from the surgical procedure, place an X where the nurse observes the surgical incision?
Note the placement of the X in the lower back.
After a physician describes the surgical procedure for lumbar spinal fusion and its associated risks, the nurse provides a consent form for the client to sign. The client asks the nurse what the term "fusion" means and whether he'll lose a lot of blood during the procedure. Which action should the nurse take?
Notify the physician of the client's questions about the procedure before having the client sign the informed consent form.
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 and the other side is bent.
The nurse educator is presenting an in-service on falls and notes that elderly clients are most at risk for a particular type of fracture. Which type of fracture, if identified by the nursing staff, would indicate to the educator that the in-service was effective?
Pelvic fractures
Which nursing intervention is essential in caring for a client with compartment syndrome?
Removing all external sources of pressure, such as clothing and jewelry
On a visit to the family physician, a client reports painful swelling on the lateral side of the great toe, at the metatarsophalangeal joint. After determining that the swelling is a bunion, the physician injects an intra-articular corticosteroid. The client asks the nurse what causes bunions. Which answer is correct?
Some bunions are congenital; others are caused by wearing shoes that are too short or narrow
A client calls the clinic and informs the nurse that there is a foul odor coming from the cast. What is the best response by the nurse?
Tell the client to come to the clinic immediately since the foul odor may be a sign of infection.
The nurse is reinforcing education about muscular dystrophy for the parents of a child newly diagnosed with the disease. When asked about what the disease is, what should the nurse respond?
There is progressive degeneration of muscle fibers.
A client is recovering from an attack of gout. When reinforcing education, the nurse should include the need to lose weight for which reason?
Weight loss will decrease uric acid levels and decrease stress on joints.
A client sustained a femur fracture while skiing. After the client undergoes surgery to stabilize the fracture, what does the nurse determine will assist with healing of this fracture?
formation of new bone tissue
A nurse is gathering data to determine fall risk for a client. What information is most important for the nurse collect? Select all that apply.
functional level muscular strength gait and balance visual acuity
The nurse is gathering data from a client in the late stage of osteoarthritis and asks the client to describe the pain. What description does the nurse anticipate the client will give?
grating
The nurse is caring for a client who recently underwent a total hip replacement. The nurse should:
instruct the client to limit hip flexion while sitting.
A nurse is providing nutritional information to a client with a diagnosis of gout. Which of the client's favorite foods should be limited?
liver
After a traumatic spinal cord injury, a client requires skeletal traction. When caring for this client, the nurse must:
maintain traction continuously to ensure its effectiveness.
When a child is suspected of having muscular dystrophy, a nurse should expect which muscles to be affected first?
muscles of the hip
After treatment of compartment syndrome, a client reports experiencing paresthesia. Which symptoms should the nurse monitor?
numbness and tingling
A client has just returned from the postanesthesia care unit (PACU) after undergoing internal fixation of a left femoral neck fracture. The nurse should place the client in which position?
on the client's back with two pillows between the legs
When gathering data from a child, which observation would alert the nurse that the child may be developing scoliosis?
raised right iliac crest
A client arrives in the emergency department reporting that he or she fell down the stairs and thinks broke his or her leg. What data gathered by the nurse would indicate that the client might be correct in his or her assumption?
redness, warmth, pain at the site of injury
A client in skeletal traction reports pain even though receiving an analgesic 1 hour ago. The nurse offers an alternative pain management measure. Which measure can be implemented within the nursing scope of practice?
relaxation and imagery
A client has a herniated disk in the region of the third and fourth lumbar vertebrae. When collecting data, the nurse expects to note:
severe low back pain.
The nurse is caring for a female client with osteoarthritis who is being discharge to home. Which items would the nurse reinforce the use of in order to assist the client to dress independently at home? Select all that apply.
skirts with elastic waists jackets with Velcro closures bras with front closure
A client is reporting severe pain in the right upper arm. Which x-ray finding would indicate to the nurse that further investigation is required?
spiral fracture
The health care provider has ordered sulfasalazine for a child with juvenile rheumatoid arthritis. The nurse questions the order when reading that the client has an allergy to what medication?
sulfamethoxazole-trimethoprim
A client presents with pain and warmth in his big toe and reduced urine output. The health care provider suspects gouty arthritis. The nurse can expect the health care provider to confirm this diagnosis by ordering which diagnostic tests?
synovial fluid analysis and serum uric acid level
A client with a fractured femur is in Russell's traction and asks the nurse to help with back care. Which nursing action is most appropriate?
telling the client to use the trapeze to lift his back off the bed
The nurse is caring for a child with a Harrington rod placement. Which data gathered by the nurse would be of greatest concern 2 days postoperatively?
urine output less than 30 mL/hr
A client is 2 weeks post op from knee replacement surgery and has been on warfarin therapy. The client's most recent INR blood level was 5.6. What should the nurse prepare to administer to the client?
vitamin K
The nurse is caring for a client who reports of lower back pain. Which instructions should the nurse give the client to prevent back injury?
"Stand close to the object you are lifting."
A client with skeletal fracture to the right leg reports severe right leg pain. Which action should the nurse take first?
Check the client's alignment in bed.
A client with osteoarthritis is refusing to perform independent daily care. Which approach would be most appropriate to use with this client?
Encourage the client to perform as much care as pain will allow
A client is scheduled for a laminectomy to repair a herniated intervertebral disk. When developing the postoperative plan of care, the nurse should include which action?
Turning the client from side to side, using the logroll technique
The nurse is reinforcing education on cast care for a client with a cast on the arm. How should the nurse instruct the client to place the casted limb, if there is swelling?
above the level of the heart
A client has been prescribed a diet that limits purine-rich foods. Which would the nurse teach the client to avoid eating?
anchovies, sardines, kidneys, sweetbreads, and lentils
Which information is the priority to include in the discharge plan for a client leaving the hospital in a leg cast?
cast care, neurovascular checks, and hygiene measures
A child in skeletal traction for a fracture of the right femur reports new and constant left calf pain. Also, the nurse notes that the child's left calf is 1 inch larger than the right and that he has nonpitting edema below the left knee. The nurse knows these signs are most consistent with which condition?
deep vein thrombosis (DVT)
A client with long-standing rheumatoid arthritis has frequent reports of joint pain. The plan of care should be based on the understanding that chronic pain is most effectively relieved when analgesics are administered in which way?
at regularly scheduled intervals
A child with muscular dystrophy is admitted to the hospital with reports of chest pain. The electrocardiogram showed cardiac muscle damage. Which cardiac medications does the nurse anticipate administering? Select all that apply.
benazepril enalapril metoprolol
A client is admitted with a possible diagnosis of osteomyelitis. Based on the documentation shown, which laboratory result is the priority for the nurse to report to the health care provider?
blood culture
In a child with developmental dysplasia of the hip (DDH), which position of the femur is accurate in relation to the acetabulum?
anterior
A client underwent a bipolar hip replacement after a fracture. Which interventions would help prevent deep vein thrombosis (DVT) after surgery? Select all that apply.
application of pneumatic compression boots