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Musculoskeletal

Terms in this set (73)

What are some symptoms of carpal tunnel?
Tingling of hand, numbness and weakness
Another name for an open fracture is a/an ________ fracture.
compound
Open reduction internal fixation means:
The bone is realigned via incision and hardware is used
Reduction is
putting the bone ends into proper alignment
Which of the following is a type of skin traction?
Buck's extension
Care of the patient in skeletal traction includes all EXCEPT:
Monitoring skin integrity
cleansing the pin sites with chlorhexidine
interrupting the traction every four hours to perform ROM
Assisting the patient to use a fracture pan for elimination
interrupting the traction every four hours to perform ROM
After a total hip replacement, residents can not bend the hip more than
90 degrees
After a total hip replacement the hips should be kept
Abducted
Which of the following causes gout?
increase in uric acid production
underexcretion of uric acid
increased intake of foods with purines
All of the above
All of the above
What is Osteoporosis?
A medical condition causing brittle bones
A treatment for Osteoporosis is?
Apply Heat
intake of Calcium/Vitamin D
Amputation
Osteomyelitis
intake of Calcium/Vitamin D
rheumatoid arthritis
is an autoimmune disease
Common clinical findings of osteoarthritis include:
boney enlargement of joints
Osteomyelitis is...
an infection in your bones due to bacteria
a deficiency of vitamin D can result in
osteomalacia
Good sources of vitamin D are...
milk
The client with a thyroid deficiency is at risk for which of the following musculoskeletal issues?
Osteoporosis
Deep vein thrombosis
Muscular atrophy
Fasciitis
Osteoporosis
The nurse is providing care to the postmenopausal older adult. The nurse provides information on weight-bearing exercise. What is the reason for this information in regard to the musculoskeletal system?
Weight-bearing exercises decrease the effects of osteoporosis.
The nurse is the first to arrive to the side of a client's side who has fallen onto outstretched hands and is lying down holding their left arm. The nurse quickly assesses the left arm to see a swelling and an abnormal "bump" on the wrist. The priority rationale for the nurse to immediately immobilize the wrist is which of the following?
Immobilization may prevent the occurrence of osteomyelitis.
The nurse finds an older adult client on the floor after their attempt to return from the toilet to the bed. The client complains of pain to the right groin area, and the nurse notes that the right leg appears shorter and misaligned compared to the left. What is the priority intervention and for this situation?
Immobilize the extremity at the hip and console the client
The nurse witnesses a client collapsing onto the floor and hitting their head on a counter. The client is now conscious and bleeding profusely from a laceration on their head, and their left forearm is shorter, with an apparent open fracture. What is the priority intervention at this time?

Apply pressure to the head wound with a dressing
Immobilize the forearm from the wrist to the elbow
Obtain vital signs including an oxygen saturation
Complete a neurovascular assessment
Apply pressure to the head wound with a dressing
The orthopedic health-care provider (HCP) has ordered a closed reduction of an oblique fracture of the right radius bone. The client asks the nurse why they will have a splint on their arm instead of a cast. Which of the following would be the most appropriate answer?

Because there is a cut close to the fracture site, the splint will be used to monitor healing of the skin wound while immobilizing the fracture.

A pain medication and sedative will be given prior to the procedure, and the HCP will manually pull on the limb to manipulate the ends into alignment.

The cast would not maintain proper alignment for this type of fracture.

The splint is easier to clean and keeps the arm cool during the summer months.
Because there is a cut close to the fracture site, the splint will be used to monitor healing of the skin would while immobilizing the fracture
The nurse is providing care to a client with an external fixation device of the lower extremity. The client is to be discharged to home the next day and requires teaching on pin care. Which of the following statements best shows that the client understands pin care?

"I will wash the pin sites carefully with mild soap and rinse thoroughly every morning."

"I will remove the crusting around the pins with sterile cotton swabs to maintain a sterile site. "

"I will allow the pins to air dry every day and cover at night to prevent an infection."

"I will keep the dressing on the pins until I see the provider next week."
"I will remove the crusting around the pins with sterile cotton swabs to maintain a sterile site. "
The nurse is providing care to an elderly client who has sustained a hip fracture. The client asks why the surgeon recommends an open reduction internal fixation. What would be an appropriate response to the client?

Open reduction and internal fixation of the hip allows early ambulation while the bone is healing.

Open reduction and internal fixation of the hip allows the health-care provider to visualize signs of osteoporosis.

Open reduction and internal fixation of the hip is contraindicated for elderly clients due to the complexity of surgery.

Open reduction and internal fixation of the hip is less harmful to the client than an external fixture.
Open reduction and internal fixation of the hip allows early ambulation while the bone is healing.
The nurse is providing care to the 3-day status post total hip arthroplasty client. The nurse finds the client in the process of applying their own antiembolism stockings by bending over to touch their toes. Why would the nurse immediately stop the client from taking this action?

The client is not complying with the total hip precautions and may dislocate the surgical hip.

The client has narcotic pain medications in their system and may fall due to dizziness.

The client may become dizzy by doing this due to the potential for orthostatic hypotension.

The client may have decreased strength due to the extensive surgery.
The client is not complying with the total hip precautions and may dislocate the surgical hip.
The nurse is providing care to a client who sustained a traumatic amputation of their right arm via a leaf blower. The client is in otherwise excellent health, and the trauma team was able to retrieve the amputated limb for replantation. Which of the following actions by the team would facilitate a successful replantation of the limb? Select all that apply.

1.
Rinsing the dirty limb immediately.
2.
Placing the limb in a plastic bag and covering with ice.
3.
Applying a tourniquet on the stump.
4.
Applying oxygen to the client at the scene.
5.
Administering an anticoagulant to the client.
Rinsing the dirty limb immediately.
Placing the limb in a plastic bag and covering with ice.
Which of the following are interventions to prevent femoral head subluxation for the total hip arthroplasty client? Select all that apply.

Place the client supine with the head slightly elevated

Place an abduction pillow between the legs

Use aseptic technique with dressing changes

Turn the client every 2 hr

Use a bedpan while the client is on bedrest
Place the client supine with the head slightly elevated

Place an abduction pillow between the legs

Use a bedpan while the client is on bedrest
The nurse is providing care to a client who is 1 day status post above-the-knee amputation. Which of the following nursing interventions would be most appropriate at this time? Select all that apply.

Monitor temperature, inspect for redness or drainage.

Assess for gastrointestinal symptoms, such as diarrhea or constipation.

Limit the use of pillows for the residual limb to less than 24 hr.

Teach the client to perform activities of daily living prior to discharge.

Begin education on prosthesis and shrinker sock use.
Monitor temperature, inspect for redness or drainage.

Limit the use of pillows for the residual limb to less than 24 hr.
A client is to receive 120 mcg of digoxin three times/day. What is the total amount, in milligrams, of digoxin that the client will receive in one 24-hr period?
0.36
The nurse is assessing a client who has undergone an open reduction internal fixation of the right radius for complications after surgery. Which of the following techniques would be utilized to monitor for compartment syndrome?

Listen for crepitation during range of motion

Palpate for capillary refill

Observe for muscle deformities

Assess the dressing for hemorrhage
Palpate for capillary refill
The nurse is attempting to assist a client who has an external fixation device to their lower leg to transfer from bed to bedside commode. Which of the following is the most appropriate method in doing this?

When moving a limb, grasp the device and lift, raise and move the limb as needed.

When moving the limb, grasp the area above the device to gently transfer the weight while the client stands on their unaffected limb.

When moving the limb, grasp the area above and below the device to steady the weight and promote balance to the transfer.

When moving the client, let the leg dangle to the floor while proving stability with a walker for the client.
When moving a limb, grasp the device and lift, raise and move the limb as needed.
The nurse is providing care to a client who has returned to discuss their laboratory results with the health-care provider. The client had complained of a low-grade fever, general malaise, weakness, and fatigue for the past 6 mo. The lab results are as follows:
Positive RF
Antinuclear antibody test
Positive C-reactive protein
What is the suspected medical diagnosis for this client?
Rheumatoid arthritis
The nurse is assessing a client who has a musculoskeletal disorder. Which of the following would be considered subjective data pertaining to the musculoskeletal system?

Palpate all pulses below the involved area.

Identify the client's level of activity prior to the problem.

Identify any deformities or changes in the body.

Identify any difficulty breathing with exercise.

Ask the client whether they have any allergies.
Identify the client's level of activity prior to the problem.

Identify any deformities or changes in the body.
A client arrives to their health-care provider's (HCP's) office with complaints of bilateral wrist pain. The client states that they recently found employment as an assembly line factory worker. The HCP notes that the client appears fatigued and has unintentionally lost 30 lb since their last examination. The client attributes the weight loss to their new diet that includes an increase in organ meats and shellfish.The HCP then performs a synovial biopsy that reveals cloudy, dark-yellow synovial fluid. The HCP obtains the client's latest laboratory results, which reveal decreased red blood cells, increased total cholesterol, and a positive C-reactive protein.Which of those signs and symptoms are indicative for rheumatoid arthritis?Select all that apply.

Repetitive motion with new employment at factory

Weight loss

Cloudy synovial fluid

Decreased red blood cells

Positive C-reactive protein
Cloudy synovial fluid

Decreased red blood cells

Positive C-reactive protein
A middle-aged male client arrives at the family practice clinic with complaints of severe pain and swelling to his great toe. The nurse's assessment reveals a swollen, red, hot, and tender great toe. What are the medical interventions that will be the expected to diagnosis this problem?
Serum uric acid and joint fluid aspiration
Which of the following medications treat osteoporosis by increasing bone density? Select all that apply.

Prednisone

Nonsteroidal anti inflammatory drugs

Denosumab

Levothyroxine

Teriparatide
Denosumab

Teriparatide
The nurse prepares a client for a diagnostic test of the entire skeletal system. The nurse administers a sedative because the client is too restless to lie still during the required 90 min of testing. The client understands this diagnostic test will include the injection of a radioisotope. This will facilitate imaging during various intervals to reveal the location of infections or tumors such as osteosarcoma. What is this diagnostic test?

Myelography

Magnetic resonance imaging

Nuclear medicine scan

Ultrasonography
Nuclear medicine scan
A client arrives to the orthopedic office for their second hylan g-f 20 injection for their osteoarthritis. What is the purpose of this injection?
Hylan g-f 20 provides a replacement for the cushioning synovial fluid for pain control and increased flexibility.
The nurse is providing information to a client who has been diagnosed with avascular necrosis of the right femoral head. Which of the following components of the client's health history would have caused this musculoskeletal issue?

The client is a retired physical education teacher for an elementary school.

The client has a 10-yr history of steroid use for severe allergies.

The client is a thin postmenopausal vegetarian.

The client has a history of long-term use of antibiotics.
The client has a 10-yr history of steroid use for severe allergies.
The nurse is providing care to a client with a malabsorption disorder in the small intestine. The client's recent laboratory results are:
Alkaline phosphatase 75 units/L
Calcium 14.2 mg/dL
Phosphorus 1.7 mg/dL
Uric acid 6 mg/dL
What would be the suspected deficiency for this client?
Vitamin D
Which of the following are methods to prevent complications from the effects on the musculoskeletal system and aging? Select all that apply.

Weight-bearing exercises

Strength training

A diet rich in vitamins A and C

Maintenance of immunizations

Adequate and consistent intake of calcium and phosphorus
Weight-bearing exercises

Strength training

A diet rich in vitamins A and C

Adequate and consistent intake of calcium and phosphorus
The nurse's assessment of a client who has sustained an injury after jumping and twisting their ankle reveals swelling, tenderness, and minor joint deformity. The client stated that they tried to jump from a step and slipped with one foot on the ground. An x-ray reveals a fractured tibia. What type of fracture is suspected at this time?
This describes how a spiral fracture would occur.
A client reports severe, increasing pain after application of a cast to treat a left lower tibial fracture. The nurse assesses the left foot and notes sluggish capillary refill, and toes are cool to the touch. The client further states that they feel burning in their toes and sole of the affected foot. Which of the following are symptoms of compartment syndrome?

The client reports severe, increasing pain after application of a cast.

The client complains of itching under the cast.

The nurse assesses the left foot and notes sluggish capillary refill.

The client complains that the cast is heavy and awkward.

The client states that they have a tingling in their toes and distal portion of their foot.
The client reports severe, increasing pain after application of a cast.

The nurse assesses the left foot and notes sluggish capillary refill.

The client states that they have a tingling in their toes and distal portion of their foot.
The nurse is providing care to a client who is 5-days postoperative total hip arthroplasty. The client recently was diagnosed with a urinary tract infection secondary to the Foley catheter. The client complains of increased pain at the hip that is not managed with opioids. The nurse's assessment finds that the site is reddened, is warm to the touch, and has moderate swelling. What is the possible medical diagnosis for this client?
Osteomylitis
A client is to receive 1g of ceftriaxone intravenously twice per day.The available dose is 1,000 mg/50 mL bag.What is the flow rate (mL/hr) for the medication to be run over 30 min via electronic pump?
100
Which of the following conditions would be the nurse's priority assessment for a client related to the musculoskeletal system?

The client is at risk for venous pooling and deep vein thrombosis.

The client is at risk for fluid imbalance and urinary retention.

The client is at risk for constipation and diarrhea.

The client is at risk for impaired skin integrity and pressure ulcers.
Rationales
The client is at risk for venous pooling and deep vein thrombosis.
The nurse finds an older adult client on the floor after their attempt to return from the toilet to the bed. The client complains of pain to the right groin area, and the nurse notes that the right leg appears shorter and misaligned compared to the left. What is the priority intervention and for this situation?

Obtain vital signs and level of consciousness

Call the health-care provider (HCP) for an order for transport to an urgent care center

Immobilize the extremity at the hip and console the client

Assist the client to a sitting position and gather assistive personnel to transfer the client to bed
Immobilize the extremity at the hip and console the client
The nurse is providing care to an older client who sustained a right hip fracture after a motor vehicle accident. The client is now 1-day status post open reduction internal fixation of the left femur. The client becomes increasingly confused and tachypneic, and has a mild petechial rash on their arm noted during a vital signs assessment. The nurse immediately applies supplemental oxygen at 2 L/min via nasal cannula and calls the health-care provider. What is the rationale for this nursing action?
The client appears to have a fatty embolism.
The nurse is providing care to an older adult client who complains of pain and stiffness in both knees. Which of the following would be the most appropriate reason for this condition?

Obesity would increase likelihood of joint injury, especially the knees.

Muscle strength declines with age as protein synthesis decreases.

Bone density is lost with age, which increases the likelihood of fractures.

Articular cartilage wears down and becomes rough.
Articular cartilage wears down and becomes rough.
A middle-aged male client arrives at the family practice clinic with complaints of severe pain and swelling to his great toe. The nurse's assessment reveals a swollen, red, hot, and tender great toe. What are the medical interventions that will be the expected to diagnosis this problem?

Serum complete blood count and renal panel

Serum uric acid and joint fluid aspiration

X-rays of the foot and serum alkaline phosphatase

Serum calcium and thyroid stimulating hormone levels
Serum uric acid and joint fluid aspiration
Which of the following conditions would be the nurse's priority assessment for a client related to the musculoskeletal system?

The client is at risk for venous pooling and deep vein thrombosis.

The client is at risk for fluid imbalance and urinary retention.

The client is at risk for constipation and diarrhea.

The client is at risk for impaired skin integrity and pressure ulcers.
The client is at risk for venous pooling and deep vein thrombosis
The nurse is obtaining subjective data on a client pertaining to their musculoskeletal system. Why would the nurse identify the geographical location of the client's home?
The client may be at risk for vitamin D deficiency.
The nurse is teaching the client how to care for the saddle joint repair surgery. In which part of the body did the surgery occur?
The carpometacarpal of the thumb
The nurse witnesses a client that has fallen on the sidewalk and notes that there is an immediate loss of range of motion of the shoulder, and a joint deformity has occurred. The client instructs the nurse to "just pull it back into place because it hurts so much." What is the proper nursing intervention at this time?

Gently but firmly pull the shoulder until a "pop" is felt or heard

Immediately immobilize the joint, apply ice. and call for help

Immediately hyperextend the shoulder and apply ice

Keep the client comfortable until the ambulance arrives
Immediately immobilize the joint, apply ice, and call for help
An older adult client asks the nurse why it is important to take calcium and vitamin D supplements. What is the most appropriate response to the client's question?

The bone is a living part of the body and is continuously breaking down and rebuilding.

Calcium is important to prevent bone loss. If the serum calcium levels drop, the body will pull calcium from the bones into the bloodstream.

The medication that suppresses osteoclast activity also depletes serum calcium.

The intestinal flora prevents proper absorption of nutrients due to the aging process, so more is needed.
Calcium is important to prevent bone loss. If the serum calcium levels drop, the body will pull calcium from the bones into the bloodstream.
The nurse is reviewing a client's medical history. The client has chronic asthma with a longstanding history of steroid use. Which type of fracture is this client at most risk of acquiring?

Pathological

Spiral

Oblique

Stress
Pathological
The nurse is preparing to administer enoxaparin to a client. Which of the following would be the recommended method of administering?

Draw up the medication and administer intramuscularly

Draw up the medication and administer subcutaneously

Dispose of the excess amount of medication and air bubble from the prefilled syringe

Administer the medication from the prefilled syringe with no alteration
Administer the medication from the prefilled syringe with no alteration
Which of the following are signs and symptoms of carpal tunnel syndrome? Select all that apply.

Positive Homan's sign

Client work history as a factory worker

Positive Phalen test

Sluggish capillary refill

Deformity of the affected area
Client work history as a factory worker

Positive Phalen test
A client is to receive 1,000 mL of 0.9% normal saline over 8 hr.The drop factor is 10 gtt/mL.What is the drop rate for this infusion?
21
The nurse is providing care to an adult male client with a musculoskeletal disorder. The client presents with dark urine, myalgia, and muscle weakness. The client's serum laboratory results are: eatine kinase (CK) 378 units/ L
Potassium 6.3mEq
Myoglobin 114 ng/mL.
What is the suspected medical diagnosis for this client?
Rhabdomyolysis
The orthopedic office nurse is providing care to a client who has been injured in a fall onto an icy patch of sidewalk a year ago. The client states that they still cannot move their knee due to the pain and swelling. The nurse anticipates that the health-care provider will use which of the following diagnostic procedures?
Arthroscopy
The nurse is assessing a male adult client in the family practice clinic. The client complains of pain of the great toe, and the nurse notes redness, swelling, and inflammation at the joint. Prior to the appointment, the client had laboratory tests, and the reports are as follows:
Alkaline phosphatase: 140 units/L
Calcium, total: 9.1 mg/dL
Creatine kinase (CK): 196 units/L
Uric acid 18 mg/dL
What will the nurse anticipate as the medical diagnosis?
Gout
The nurse witnesses a fellow hiker on a trail fall and undergo a suspected fractured left radius. What would be the proper intervention?

Immobilize the joints above and below the suspected fracture

Attempt to reposition the bones to maintain alignment

Apply pressure on the open skin

Assess for crepitus with passive range of motion of the wrist.
Immobilize the joints above and below the suspected fracture
A client is to receive 4 mg of morphine sulfate intravenous push for severe pain every 4 hr.The available dose vial contains 10 mg in 2 mL.How many milliliters will the nurse administer? (Round to the nearest tenth of a milliliter.)
0.8
What subjective data should the nurse collect for a patient with a fractured arm? Select all that apply.

1.Inspection of skin color at injury site
2.Palpation of skin temperature
3.Occupation
4.Family history
5.Nutritional history
6.Range of motion
occupation
family history
nutritional history
The nurse asks the patient to perform which of these to check muscle strength? Select all that apply.

1.Blink.
2.Cough.
3.Push feet against nurse's hands.
4.Squeeze nurse's hands.
5.Swallow.
6.Wiggle toes.
Push feet against nurse's hands
Squeeze nure's hands
Which of these serum blood tests would the nurse review as an indicator of bone health?

1.Calcium
2.Muscle enzymes
3.Myoglobin
4.Uric acid
Calcium
What actions should the nurse take for a patient's increased pain unresponsive to analgesics after a bone biopsy? Select all that apply.

1.Administer higher analgesic dose.
2.Observe site for hematoma.
3.Perform neurovascular checks.
4.Notify the health care provider.
5.Administer aspirin.
Observe site for hematoma
Perform neurovascular checks
Notify the health care provider
The nurse evaluates the patient as understanding teaching on the purpose of a test dose of gold therapy if the patient states which of these?

1."To avoid waste of expensive gold."
2."To determine the necessary dose."
3."To determine the therapeutic response."
4."To assess for an allergic reaction."
To determine the therapeutic response
The nurse would educate the nurse's aide on the use of which of these techniques for safe patient movement? Select all that apply.

1.Apply non-skid footwear.
2.Lift up under patient's arms to reposition.
3.Use lifting device.
4.Use lift sheet.
5.Sit on bedside before standing.
6.Use walking belt.
Apply non-skid footwear
Use lifting device
Use lift sheet
sit on bedside before standing
use walking belt
The nurse is collecting data on a patient who has fallen. Which patient data would alert the nurse to a possible hip fracture? Select all that apply.

1.Crepitation
2.Deformity
3.Groin pain
4.Increased range of motion
5.Limb rotation
6.Lengthening of limb
Crepitation
Deformity
Groin pain
Lengthening of limb
The nurse would evaluate the patient who is age 60 as requiring further teaching if the patient states which of these prevents osteoporosis? Select all that apply.

1."I should avoid alcohol."
2."I should avoid smoking."
3."I should consume vitamin D 600 I U daily."
4."I should consume calcium 1,000 milligram daily."
5."I should increase my vitamin A intake."
6."I should limit weight-bearing exercise."
"I should consume 1000mG daily"
"I should increase my vitamin A intake"
"I should limit weight-bearing exercise"
True or False:
After a knee replacement, dislocation is a possible complication.
False
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