Musculoskeletal NCLEX review ?'s
Terms in this set (81)
The charge nurse in the hospital-based day surgery center is making client assignments for the staff. Which client is most appropriate to assign to a nurse who has floated from the general surgical unit?
Older adult who has undergone arthroscopic surgery of the shoulder under local anesthesia. Correct: Arthroscopic surgery and local anesthesia have low complication rates and could be monitored by the float nurse, who would be expected to know how to assess neurovascular status
The ambulatory surgery postanesthesia care unit (PACU) nurse has just received report about clients who had arthroscopic surgery. Which client will the nurse plan to assess first?
Middle-aged adult client who returned to the PACU 25 minutes ago after left knee arthroscopic surgery under epidural anesthesia. Correct: After epidural anesthesia, frequent assessments for the return of sensation and movement of the leg will be important. This client is at greatest risk for complications and should be assessed first.
The nurse is completing an admission assessment on a client scheduled for arthroscopic knee surgery. Which information will be most essential for the nurse to report to the health care provider?
Warm, red, and swollen knee. Correct: Swelling, heat, and redness may indicate infection in the knee joint, which would indicate a need to cancel the procedure.
The nurse is reviewing the medication history for a client scheduled for a left total hip replacement. The nurse plans to contact the physician if the client is taking which medication?
Prednisone (Deltasone) to treat asthma. Correct: Long-term steroid use is strongly associated with osteoporosis and will increase the risk for poor wound healing and prolonged recovery after the hip replacement.
A diabetic older adult client who had arthroscopic surgery on the right knee the previous day has a red, swollen, and painful right knee. The nurse anticipates that the physician will request which medication?
Levofloxacin (Levaquin) Correct: The client's symptoms indicate a possible right knee infection. The first action will be to start antibiotic therapy, especially because the client is diabetic and is at greater risk for infection.
When assessing a female client, the nurse learns that the client has several risk factors for osteoporosis. Which risk factor will be the priority for client teaching?
Low calcium intake
Correct: The client's calcium intake is the only risk factor that the client can change. The nurse will discuss the other risk factors as contributing to osteoporosis, but the teaching will focus on ways to increase calcium intake.
Which client information is most essential for the nurse to report to the physician before a client with knee pain undergoes magnetic resonance imaging (MRI)?
The client has a permanent pacemaker.
Correct: Having a permanent pacemaker is a contraindication for MRI because metallic implants are present within the client.
Which aspect of a musculoskeletal assessment will the physical therapist and the nurse plan to collaborate on?
The need for ambulatory devices
Correct: The nurse and the physical therapist assess and collaborate on the need for ambulatory devices.
Which diagnostic test requires the nurse to know whether the client is allergic to iodine-based contrast?
Computed tomography (CT)
Correct: A CT scan creates three-dimensional images and may be done with iodine-based contrast.
The client is suspected of having muscular dystrophy (MD). For which laboratory test does the nurse anticipate seeing an abnormal result?
Moderately elevated aspartate aminotransferase (AST)
Correct: The AST level is moderately elevated (three to five times normal) in certain musculoskeletal diseases, such as MD.
The client is scheduled to undergo closed magnetic resonance imaging (MRI) without contrast medium. Which information does the nurse give to the client before the test?
"All jewelry and clothing with zippers or metal fasteners must be removed."
Correct: The client must remove all metal objects on clothing and all jewelry before undergoing MRI.
The client recently has had an amputation of the right hand. Which statement by the client, who was right-handed, indicates that he or she is coping effectively?
"I can learn to write with my left hand."
Correct: This statement indicates that the client is coping effectively by planning to adapt to the loss of the right hand.
The client experiencing kyphosis appears withdrawn and does not initiate any conversation with the nurse when medications are given each day. Which statement by the nurse is most supportive of this client?
"How do you feel about the pain in your spine? I am here if you want to talk."
Correct: This is an open-ended question that allows the client to discuss her or his feelings and gives support to the client. It also informs the client that the nurse is available to listen.
The nursing student is studying the skeletal system. Which statement indicates to the nursing instructor that the student understands a normal physiologic function of the skeletal system?
"Hematopoiesis occurs in the red marrow, which is where blood cells are produced."
Correct: Hematopoiesis is the production of blood cells in the red marrow.
The nurse understands that care of the older adult may be affected by which physiologic change in the musculoskeletal system?
Decreased range of motion (ROM)
Correct: Decreased ROM occurs in the older adult. The client may need assistance with self-care skills.
The nurse is conducting a musculoskeletal history in the older adult client who requires a caregiver to perform all activities of daily living. Which level of functioning does the nurse record in the client's history using Gordon's Functional Health Patterns?
Level IV-is dependent and does not participate
Correct: Level IV indicates that the client is dependent and does not participate in activities of daily living such as dressing himself.
The nurse plans to use which tool to measure joint range of motion (ROM)?
Correct: A goniometer provides an exact measurement of flexion and extension or joint ROM.
The 65-year-old female client has chronic hip pain and muscle atrophy from an arthritic disorder. Which musculoskeletal assessment finding does the nurse expect to see in the client?
Correct: This client would have a combination of antalgic gait and lurch. The client with chronic hip pain and muscle atrophy from arthritic disorders would likely have a lurch in the gait.
The nurse is using Lovett's scale to grade a client's muscle strength. The client is able to complete range of motion (ROM) with gravity eliminated. Which grade will the nurse document in this client's record?
2. Correct: Two indicates poor: can complete range of motion with gravity eliminated.
The nurse is caring for an older adult client diagnosed with osteomalacia. The nurse anticipates that the physician will request which medication?
Correct: Osteomalacia is loss of bone related to vitamin D deficiency. The major treatment for osteomalacia is vitamin D in an active form such as ergocalciferol (calciferol).
An older adult client is discharged from the hospital for treatment of osteoporosis. What will the nurse include in client teaching related to the client's home safety?
Keep walkways free of clutter.
Correct: Walkways in the home must be clear of clutter and obstacles to help prevent falls.
The nurse plans to refer a client diagnosed with osteoporosis to which community resource?
Hospital support group
Correct: Large hospitals often have osteoporosis specialty clinics and support groups for clients with osteoporosis.
The nurse is assessing a client with Ewing's sarcoma. Which finding will the nurse expect to observe?
Correct: Ewing's sarcoma is a malignant tumor, and the client may experience systemic manifestations including leukocytosis, anemia, and low-grade fever.
Which nursing intervention helps to prevent the incidence of osteomyelitis for a client receiving hemodialysis?
Instructing the client to brush teeth after every meal
Correct: Proper dental hygiene helps prevent periodontal infection, which can be a causative factor in osteomyelitis of the facial bone.
The nurse is teaching a client newly diagnosed with osteoporosis about dietary and lifestyle interventions to decrease risk factors for osteoporosis. Which is the best way to decrease the risk for osteoporosis?
Walk for 30 minutes three times a week.
Correct: Walking for 30 minutes three to five times a week is the single most effective exercise for osteoporosis prevention. Walking is a safe way to promote weight-bearing and muscle strength.
The nurse is taking the history of an adult female client. Which factor places the client at risk for osteoporosis?
Working at a desk and playing the piano for a hobby
Correct: Sedentary lifestyle and prolonged immobility produce rapid bone loss.
A mother is a carrier of muscular dystrophy (MD) and has a daughter. The client asks the nurse what the daughter's genetic risk is for having MD. What is the nurse's best response?
"There is a 50% chance that your daughter may carry the gene."
Correct: MD is an X-linked recessive disorder. The daughter of a mother who is a carrier has a 50% chance of carrying the gene.
The nurse is assessing a client with osteomalacia. Which findings will the nurse expect to observe? Select all that apply.
Hypophosphatemia. Correct: Osteomalacia is loss of bone related to vitamin D deficiency, which can lead to bone softening and inadequate deposits of calcium and phosphorus in the bone matrix; this may cause hypophosphatemia.
Looser's lines or zones. Correct: Looser's lines or zones (radiolucent bands) represent stress fractures and are a classic diagnostic finding of osteomalacia.
Unsteady gait. Correct: Muscle weakness in the lower extremities may cause waddling and an unsteady gait.
The nurse is caring for a client with bone cancer of the right hip who has undergone radical resection of the tumor and has received a prosthetic implant. Which client statement indicates effective coping after the procedure?
"Physical therapy and counseling will help me adjust to my prosthesis."
Correct: This statement illustrates effective coping and acceptance.
The client with bone cancer is scheduled for a right upper extremity amputation. Which statement by the client's spouse indicates an effective coping strategy?
"I'll have to find ways to help my spouse focus on positive aspects of his or her body."
Correct: This statement illustrates that the spouse is coping with the change in the client's body image in a positive way.
The nurse is caring for a client with prostate cancer who has bone metastasis. The nurse anticipates that the physician will prescribe which medication?
Correct: Pamidronate (Aredia) is a bisphosphonate that is available intravenously and is approved for bone metastasis from the breast, lung, and prostate. Pamidronate protects bones and prevents fractures.
The nursing instructor asks a nursing student to identify risk factors that are shared by clients who have osteoporosis or osteomalacia. Which statement by the student is correct?
"High alcohol intake is a risk factor for both conditions."
Correct: High alcohol intake is a risk factor for both osteoporosis and osteomalacia.
The nurse admits a client diagnosed with Paget's disease. The nurse anticipates that the client will have which condition?
Enlarged thick skull
Correct: An enlarged thick skull is a feature of Paget's disease.
Which finding will the nurse expect to observe for a client with suspected common chronic osteomyelitis?
Ulceration of the skin
Correct: Ulceration of the skin is a feature of chronic osteomyelitis.
The client has had a sequestrectomy of the right fibula for osteomyelitis 1 day ago. Which assessment finding requires the nurse to immediately contact the surgeon?
Paresis of right lower extremity
Correct: Paresis indicates a neurovascular compromise that must be reported immediately to the surgeon.
Which is problem for the older adult client diagnosed with bone cancer?
Potential for injury related to weakness and drug therapy
Correct: Older adult clients are more likely to fall and injure themselves because of weakness and the medications that they are prescribed, especially analgesics.
The nurse suspects that a client may have plantar fasciitis if the client has which finding?
Severe pain in the arch of the foot, especially when getting out of bed. Correct: This is a description of plantar fascia.
What is the primary role of the nurse when caring for the adult client with muscular dystrophy (MD)?
Supportive care. Correct: Management of the client with MD is supportive and involves the entire health care team.
Which nursing action will the nurse on the orthopedic unit plan to delegate to unlicensed assistive personnel (UAP)?
Check the vital signs for a client who was admitted after a total knee replacement 3 hours ago.
Correct: Vital sign assessment is a skill that is within the role of the UAP.
The nurse anticipates providing collaborative care for a client with a traumatic amputation of the right hand with which health care team members?
Correct: An occupational therapist will help to enable the client to become more independent in performing activities of daily living.
Correct: A physical therapist will help to enable the client to become more independent in performing activities of daily living.
Correct: An amputation can be traumatic to the client; loss of a body part should not be underestimated because the client may experience an altered self-concept. Counseling support should be made available to the client..
The nurse plans to refer a client with an amputation and the client's family to which community resource?
Amputee Coalition of America (ACA)
Correct: The ACA is an available resource for clients with amputations and supports them and their families.
The client is brought to the emergency department (ED) via ambulance after a motor vehicle accident. What condition will the nurse assess for first?
Correct: The client is first assessed for respiratory distress, and any oxygen interventions are instituted accordingly.
The client has a grade III compound fracture of the right tibia. To prevent infection, which intervention will the nurse implement?
Using strict aseptic technique when cleaning the site
Correct: Using aseptic technique is the best way to prevent infection.
The nurse is instructing a local community group about ways to reduce the risk for musculoskeletal injury. What information will the nurse include in the teaching plan?
Wear helmets when riding a motorcycle.
Correct: Those who ride motorcycles or bicycles should wear helmets to prevent head injury.
The older adult client has had a right open reduction internal fixation (ORIF) of a fractured hip. Which intervention will the nurse implement for this client?
Keep the client's heels off the bed at all times.
Correct: Because the client is an older adult and is more at risk for skin breakdown because of impaired circulation and sensation, the client's heels must be kept off the bed at all times to avoid constant pressure on this sensitive area.
The client is recovering from an above-knee amputation resulting from peripheral vascular disease. Which statement indicates that the client is coping well after the procedure?
"It will take me some time to get used to this."
Correct: This statement indicates that the client is expressing acceptance and effective coping.
Which intervention will the nurse suggest to a client with a leg amputation to help cope with loss of the limb?
Talking with an amputee close to the client's age who has had the same type of amputation
Correct: Meeting with someone of a comparable age who has gone through a similar experience will help the client cope better with his or her own situation.
The client with a fracture asks the nurse about the difference between a compound fracture and a simple fracture. Which statement by the nurse is correct?
"Compound fracture, grade I, involves minimal skin damage."
Correct: A grade I compound fracture involves minimal damage to the skin.
Which statement indicates to the nursing instructor that the nursing student understands the normal healing process of bone after a fracture?
"A hematoma forms at the site of the fracture."
Correct: In stage 1, within 24 to 72 hours after a fracture, a hematoma forms at the site of the fracture because bone is extremely vascular. This then prompts the formation of fibrocartilage, providing the foundation for bone healing.
Which typical clinical manifestation does the nurse expect to observe for a client with a right tibial fracture?
Crepitation of extremity
Correct: On assessment, crepitation (a continuous grating sound created by bone fragments) may be heard when the affected extremity is moved.
The client's left arm is placed in a plaster cast. Which assessment will the nurse perform before the client is discharged?
Assess that the cast is dry.
Correct: The cast must be dry and free of cracking and crumbling.
The client is in skeletal traction. Which nursing intervention ensures proper care of this client?
Inspect the skin at least every 8 hours.
Correct: Inspect the skin every 8 hours for signs of irritation, inflammation, or actual skin breakdown.
An older adult client has multiple tibia and fibula fractures of the left lower extremity after a motor vehicle accident. Which pain medication does the nurse anticipate will be requested for this client?
Correct Patient-controlled analgesia (PCA) with morphine
Correct: Morphine is an opioid narcotic analgesic; given through PCA, it is the most appropriate mode of pain management for this type of acute pain associated with multiple injuries.
A rock climber has sustained an open fracture of the right tibia after a 20-foot fall. The nurse plans to assess the client for which potential complications?
Acute compartment syndrome (ACS)
Fat embolism syndrome (FES)
Correct: Acute compartment syndrome (ACS) is a serious condition in which increased pressure within one or more compartments reduces circulation to the area.
Correct: A fat embolus is a serious complication in which fat globules are released from yellow bone marrow in the bloodstream within 12 to 48 hours after the injury. FES usually results from long bone fracture or fracture repair but is occasionally seen in clients who have received a total joint replacement.
Correct: Bone infection, or osteomyelitis, is most common in open fractures.
The nurse prepares to perform a neurovascular assessment on the client with closed multiple fractures of the right humerus. Which technique will the nurse use?
Assess sensation of the right upper extremity.
Correct: Assessing sensation of the right upper extremity is part of a focused neurovascular assessment for the client with multiple fractures of the right humerus.
The client has sustained a fracture of the left tibia. The extremity is immobilized using an external fixation device. Which postoperative instruction will the nurse plan to include in this client's teaching plan?
Use pain medication as prescribed to control pain.
Correct: The client should be taught the correct use of prescribed pain medication to control pain adequately.
The client has undergone an elective below-knee amputation of the right leg as a result of severe peripheral vascular disease. In postoperative care teaching, the nurse instructs the client to notify the health care provider if which change occurs?
Observation of a large amount of serosanguineous or bloody drainage
Correct: A large amount of serosanguineous or bloody drainage may indicate hemorrhage or, if an incision is present, that the incision has opened. This requires immediate attention.
The client has sustained a rotator cuff tear while playing baseball. The nurse anticipates that the client will receive which immediate conservative treatment?
Sling for the affected arm
Correct: The conservative treatment for this client is to place the injured arm in a sling or immobilizer.
The nurse admits an older adult client who sustained a left hip fracture and is in considerable pain. The nurse anticipates that the client will be placed in which type of traction?
Correct: Buck's traction may be applied before surgery to help decrease pain associated with muscle spasm.
A client is admitted to the emergency department after a motorcycle accident with a compound fracture of the left femur. Which action will be most essential for the nurse to take first?
Check the dorsalis pedis pulses.
Correct: The first action should be to assess the circulatory status of the leg because the client is at risk for acute compartment syndrome (ACS), which can begin as early as 6 to 8 hours after an injury. Severe tissue damage can also occur if neurovascular status is compromised.
Which information about a client who was admitted with pelvic and bilateral femoral fractures after being crushed by a tractor is most important for the nurse to report to the physician?
Serum potassium level is 7 mEq/L.
Correct: The elevated potassium level may indicate that the client has rhabdomyolysis and acute tubular necrosis caused by the crush injury. Further assessment and treatment are needed immediately to prevent further renal damage or cardiac dysrhythmias.
The nurse is developing a teaching plan for a client diagnosed with osteoarthritis (OA). The nurse plans to include which instructions in the teaching plan?
Wear supportive shoes.
Correct: Wearing supportive shoes will help to prevent falls and damage to foot joints, especially metatarsal joints.
Assessment findings reveal that the older adult client with severe osteoarthritis of the left hip can no longer perform ADLs and has had several falls in the home over the past month. The nurse plans to refer the client to which community resource?
Home health care agency
Correct: Home health care referrals can order a nurse to evaluate the home situation and notify the health care provider of any in-home needs, such as an aide, a physical therapist, or a social worker.
The nurse understands that the client's genetic susceptibility to osteoarthritis is most likely caused by which genetic changes?
Interleukin-1 (IL-1) promotes cartilage breakdown by releasing and activating destructive enzymes.
Correct: Interleukin-1, a cytokine, may promote cartilage breakdown by releasing and activating destructive enzymes.
The client diagnosed with rheumatoid arthritis (RA) is started on methotrexate (Rheumatrex). Which statement made by the client indicates to the nurse that further teaching is needed regarding drug therapy?
"Rheumatrex should be taken at mealtimes."
Correct: Rheumatrex should be taken 1 hour before or 2 hours after a meal; this statement indicates the client needs further teaching.
Which instructions for joint protection will the nurse recommend for the client with a connective tissue disease? Select all that apply.
Use long-handled devices, such as a reacher.
Use adaptive devices such as Velcro closures.
Both help to protect joints.
The home health nurse conducts a community presentation on Lyme disease for the residents of an assisted-living facility. Which statement from the audience indicates to the home health nurse that further instruction is needed?
Correct "I will gently remove the tick with tissue and then burn it to prevent the spread of the disease."
Correct: Burning a tick could spread infection. Flushing it down the toilet is the recommended disposal method; this statement indicates that further instruction is needed.
The client who recently has had a total hip arthroplasty is preparing for discharge from the hospital. Which information is most important for the nurse to provide to the client and caregiver?
Correct Avoid using a straight razor.
Correct: The client will be on anticoagulants for 4 to 6 weeks at home and should avoid any injury to the skin, including when shaving.
The nurse is caring for an older adult client diagnosed with osteoarthritis. Which client statement indicates to the nurse that the client is using effective coping strategies?
"The bus is coming to pick me up from the senior center three times a week so I can play cards."
Correct: Participation in diversional activities is a way to cope with daily stressors of osteoarthritis and shows good use of available resources for support.
The nurse is caring for a middle-aged client diagnosed with rheumatoid arthritis. Which client statement requires further assessment for unproductive coping strategies?
Correct "My husband is getting used to having sexual intercourse only once a month."
Correct: This could indicate negative body image or depression. Additional open-ended questions by the nurse are required.
The nurse is teaching the client about the difference between rheumatoid arthritis (RA) and osteoarthritis (OA). Which statement by the client indicates a need for further teaching?
Correct "The disease pattern of RA is usually unilateral and is seen in a single joint, whereas OA is usually bilateral and symmetric, and is noted in multiple joints."
Correct: OA is unilateral and usually affects a single joint, whereas RA is bilateral and affects multiple joints; this statement is incorrect, so it indicates that the client needs further teaching.
The nurse is reviewing laboratory results for the client with symptoms of rheumatoid arthritis (RA)? Which laboratory finding indicates to the nurse that the client may have rheumatoid arthritis?
Correct Positive total antinuclear antibody (ANA)
Correct: Elevation of total ANA is common in systemic lupus erythematosus (SLE), systemic sclerosis (SSc), and RA.
The nurse is caring for a postoperative client with a total joint arthroplasty. What actions will the nurse take to prevent venous thromboembolism (VTE) postoperatively?
CorrectApply elastic stockings.
Correct: Support stockings provide compression, which helps to prevent VTE.
Correct: Anticoagulants help to prevent VTE because they inhibit the formation of blood clots.
Before administering prednisone IV push to the middle-aged adult with rheumatoid arthritis (RA), the nurse notes that the client's random Accu-Chek is 139. Which action is most important for the nurse to take?
Correct Administer the prescribed prednisone on schedule.
Correct: For this client, giving the medication per schedule is essential in treating the disease. The Accu-Chek value will be monitored regularly because the client is receiving prednisone.
Before administering low-molecular weight heparin (LMWH) to the older adult client after total knee arthroplasty, the nurse notes that the client's platelet count is 50,000/mm3. What action is most important for the nurse to take?
Correct Notify the health care provider of the platelet count.
Correct: If the platelet count falls below 20,000/mm3, spontaneous bleeding could occur. Notifying the health care provider before the LMWH is given is essential.
Which factor indicates to the nurse the only similarity between discoid lupus erythematosus (DLE) and systemic lupus erythematosus (SLE)?
Correct Disfiguring and embarrassing rash
Correct: Skin lesions are common to SLE and DLE.
The client diagnosed with exacerbation of systemic sclerosis (SSc) asks the nurse why a foot board and a bed cradle have been placed on the bed. The nurse explains that the foot board and the bed cradle are used for what purpose?
To promote comfort from Raynaud's phenomenon
Correct: Acute pain occurs during Raynaud's phenomenon (the first symptom that occurs with SSc), and avoiding pressure from bed linens is a comfort measure.
In teaching the client with acute secondary gout, which instruction about preventing recurrence is most important for the nurse to include?
Correct "Weight Watchers has healthy meal plans."
Correct: Crash diets and obesity are causes of secondary gout. Avoiding crash diets and keeping fit will prevent recurrence.
The nurse assesses a client diagnosed with Sjögren's syndrome. The nurse anticipates that the client will have which common condition?
Correct Dry eyes
Correct: Clients with Sjögren's syndrome experience dry eyes (keratoconjunctivitis [KCS]).
Which statement indicates to the nurse that the client with fibromyalgia syndrome is using a complementary therapy to help relieve symptoms?
Correct "Focusing on the slow stretching movements and my breathing in tai chi helps me relax."
Correct: Tai chi is an alternative or complementary therapy that focuses on slow and gentle stretching movements and breathing.
The nurse is reviewing the medication history for a client diagnosed with rheumatoid arthritis who has been ordered to start sulfasalazine (Azulfidine) therapy? The nurse plans to contact the health care provider if the client has which condition?
Correct: Sulfasalazine (Azulfidine) contains sulfa and is contraindicated in clients with sulfa allergies.