Musculoskeletal Examination (Practice Mode)- Www.Rnpedia.Com

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Questions and Answers

1.

A client is 1 day postoperative after a total hip replacement. The client should be placed in which of the following position?
- A.
  
  Supine
- B.
  
  Semi Fowler's
- C.
  
  Orthopneic
- D.
  
  Trendelenburg
Correct Answer
B. Semi Fowler's

Explanation
After a total hip replacement, the client should be placed in a semi Fowler's position. This position allows for proper alignment of the hip joint and reduces the risk of dislocation. It also promotes optimal lung expansion and prevents complications such as pneumonia. The semi Fowler's position involves elevating the head of the bed to a 30-45 degree angle, with the knees slightly flexed. This position provides comfort and stability for the client while facilitating postoperative recovery.

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2.

A client who has had a plaster of Paris cast applied to his forearm is receiving pain medication. To detect early manifestations of compartment syndrome, which of these assessments should the nurse make?
- A.
  
  Observe the color of the fingers
- B.
  
  Palpate the radial pulse under the cast
- C.
  
  Check the cast for odor and drainage
- D.
  
  Evaluate the response to analgesics
Correct Answer
D. Evaluate the response to analgesics

Explanation
To detect early manifestations of compartment syndrome, the nurse should evaluate the client's response to analgesics. Compartment syndrome is a condition where increased pressure within a confined space, such as a cast, can cause tissue damage. Pain is a common symptom of compartment syndrome, and assessing the client's response to analgesics can help determine if the pain is adequately controlled. If the pain persists or worsens despite pain medication, it may indicate the development of compartment syndrome and further assessment and intervention are needed. Observing the color of the fingers, palpating the radial pulse, and checking the cast for odor and drainage are important assessments but do not specifically address compartment syndrome.

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3.

After a computer tomography scan with intravenous contrast medium, a client returns to the unit complaining of shortness of breath and itching. The nurse should be prepared to treat the client for:
- A.
  
  An anaphylactic reaction to the dye
- B.
  
  Inflammation from the extravasation of fluid during injection.
- C.
  
  Fluid overload from the volume of the infusions
- D.
  
  A normal reaction to the stress of the diagnostic procedure
Correct Answer
A. An anapHylactic reaction to the dye

Explanation
After a computer tomography scan with intravenous contrast medium, if a client returns to the unit complaining of shortness of breath and itching, it indicates an anaphylactic reaction to the dye. Anaphylactic reactions occur when the body's immune system overreacts to a substance, in this case, the contrast dye. Symptoms such as shortness of breath and itching are common signs of an allergic reaction. Prompt treatment is necessary to prevent further complications.

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4.

While caring for a client with a newly applied plaster of Paris cast, the nurse makes note of all the following conditions. Which assessment finding requires immedite notification of the physician?
- A.
  
  Moderate pain, as reported by the client
- B.
  
  Report, by client, the heat is being felt under the cast
- C.
  
  Presence of slight edema of the toes of the casted foot
- D.
  
  Onset of paralysis in the toes of the casted foot
Correct Answer
D. Onset of paralysis in the toes of the casted foot

Explanation
The onset of paralysis in the toes of the casted foot requires immediate notification of the physician because it may indicate nerve compression or damage. This could be a serious complication that needs prompt medical attention to prevent further damage or complications.

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5.

Which of these nursing actions will best promote independence for the client in skeletal traction?
- A.
  
  Instruct the client to call for an analgesic before pain becomes severe.
- B.
  
  Provide an overhead trapeze for client use
- C.
  
  Encourage leg exercise within the limits of traction
- D.
  
  Provide skin care to prevent skin breakdown.
Correct Answer
B. Provide an overhead trapeze for client use

Explanation
Providing an overhead trapeze for client use will best promote independence for the client in skeletal traction. This allows the client to move and reposition themselves without assistance, which promotes autonomy and independence. It also helps to prevent complications such as pressure ulcers and muscle atrophy that can result from prolonged immobility.

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6.

A client presents in the emergency department after falling from a roof. A fracture of the femoral neck is suspected. Which of these assessments best support this diagnosis.
- A.
  
  The client reports pain in the affected leg
- B.
  
  A large hematoma is visible in the affected extremity
- C.
  
  The affected extremity is shortenend, adducted, and extremely rotated
- D.
  
  The affected extremity is edematous
Correct Answer
C. The affected extremity is shortenend, adducted, and extremely rotated

Explanation
The presentation of the affected extremity being shortened, adducted, and extremely rotated is consistent with a fracture of the femoral neck. This specific combination of findings is known as the classic presentation of a hip fracture.

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7.

The nurse is caring for a client with compound fracture of the tibia and fibula. Skeletal traction is applied. Which of these priorities should the nurse include in the care plan?
- A.
  
  Order a trapeze to increase the client's ambulation
- B.
  
  Maintain the client in a flat, supine position at all times.
- C.
  
  Provide pin care at least every hour
- D.
  
  Remove traction weights for 20 minutes every two hours.
Correct Answer
C. Provide pin care at least every hour

Explanation
The correct answer is to provide pin care at least every hour. Compound fractures can increase the risk of infection due to the open wound. Pin care is necessary to prevent infection and promote healing. By providing pin care at least every hour, the nurse can ensure that the client's wound is clean and free from infection. This is a priority in the care plan to prevent complications and promote the client's recovery.

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8.

To prevent foot drop in a client with Buck's traction, the nurse should:
- A.
  
  Place pillows under the client's heels.
- B.
  
  Tuck the sheets into the foot of the bed
- C.
  
  Teach the client isometric exercises
- D.
  
  Ensure proper body positioning.
Correct Answer
D. Ensure proper body positioning.

Explanation
To prevent foot drop in a client with Buck's traction, ensuring proper body positioning is essential. Proper body positioning helps maintain alignment and prevents the foot from dropping. This can include techniques such as using pillows to support the client's heels, tucking the sheets into the foot of the bed to prevent sliding, and teaching the client isometric exercises to strengthen the muscles. However, the most important factor is ensuring that the client's body is positioned correctly to avoid foot drop.

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9.

Which nursing intervention is appropriate for a client with skeletal traction?
- A.
  
  Pin care
- B.
  
  Prone positionin
- C.
  
  Intermittent weight
- D.
  
  5lb weight limit
Correct Answer
A. Pin care

Explanation
Pin care is an appropriate nursing intervention for a client with skeletal traction. Skeletal traction involves the use of pins or wires inserted into the bone to align and immobilize fractures. These pins can increase the risk of infection, so proper pin care is essential to prevent complications. This includes cleaning the pin site regularly, monitoring for signs of infection, and ensuring proper hygiene. Prone positioning, intermittent weight, and weight limits are not specific interventions for skeletal traction.

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10.

In order for Buck's traction applied to the right leg to be effective, the client should be placed in which position?
- A.
  
  Supine
- B.
  
  Prone
- C.
  
  Sim's
- D.
  
  Lithotomy
Correct Answer
A. Supine

Explanation
Buck's traction is a type of traction used to immobilize and align fractures in the lower extremities. In order for it to be effective, the client should be placed in a supine position. This position allows for proper alignment of the leg and prevents any unnecessary movement or displacement of the fracture. Placing the client in a prone, Sim's, or lithotomy position would not provide the necessary support and alignment required for Buck's traction.

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11.

An elderly client has sustained intertrochanteric fracture of the hip and has just returned from surgery where a nail plate was inserted for internal fixation. The client has been instructed that she should not flex her hip. The best explanation of why this movement would be harmful is:
- A.
  
  It will be very painful for the client
- B.
  
  The soft tissue around the site will be damaged
- C.
  
  Displacement can occur with flexion
- D.
  
  It will pull the hip out of alignment
Correct Answer
C. Displacement can occur with flexion

Explanation
Flexing the hip after an intertrochanteric fracture and nail plate insertion can cause displacement of the fracture site. This movement puts stress on the healing bone and can lead to malalignment or further damage to the fracture. It is important for the client to avoid flexing the hip to ensure proper healing and prevent complications.

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12.

When the client is lying supine, the nurse will prevent external rotation of the lower extremity by using a:
- A.
  
  Trochanter roll by the knee
- B.
  
  Sandbag to the lateral calf
- C.
  
  Trochanter roll to the thigh
- D.
  
  Footboard
Correct Answer
C. Trochanter roll to the thigh

Explanation
When a client is lying supine, a trochanter roll to the thigh can be used to prevent external rotation of the lower extremity. This is because the trochanter roll provides support to the hip and prevents the leg from rotating outward. By placing the trochanter roll to the thigh, the nurse ensures that the client's leg remains in a neutral position and minimizes the risk of external rotation.

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13.

A client has just returned from surgery after having his left leg amputated below the knee. Physician's orders include elevation of the foot of the bed for 24 hours. The nurse observes that the nursing assistant has placed a pillow under the client's amputated limb. The nursing action is to:
- A.
  
  Leave the pillow as his stump is elevated
- B.
  
  Remove the pillow and elevate the foot of the bed
- C.
  
  Leave the pillow and elevate the foot of the bed
- D.
  
  Check with the physician and clarify the orders
Correct Answer
B. Remove the pillow and elevate the foot of the bed

Explanation
The correct answer is to remove the pillow and elevate the foot of the bed. Placing a pillow under the client's amputated limb is not appropriate because it does not provide proper elevation. Elevation of the foot of the bed is necessary to promote circulation and reduce swelling in the remaining part of the leg. Therefore, the nurse should remove the pillow and follow the physician's orders by elevating the foot of the bed.

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14.

A client has sustained a fracture of the femur and balanced skeletal traction with a Thomas splint has been applied. To prevent pressure points from occurring around the top of the splint, the most important intervention is to:
- A.
  
  Protect the skin with lotion
- B.
  
  Keep the client pulled up in bed
- C.
  
  Pad the top of the splint with washcloths
- D.
  
  Provide a footplate in the bed
Correct Answer
C. Pad the top of the splint with washcloths

Explanation
To prevent pressure points from occurring around the top of the splint, padding the top of the splint with washcloths is the most important intervention. This helps to distribute the pressure more evenly and reduce the risk of skin breakdown or pressure ulcers. Lotion may be used to moisturize the skin, but it does not directly address the issue of pressure points. Keeping the client pulled up in bed or providing a footplate in the bed may help with overall positioning and comfort, but they do not specifically address the prevention of pressure points around the top of the splint.

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15.

The major rationale for the use of acetylsalicylic acid (aspirin) in the treatment of rheumatoid arthritis is to:
- A.
  
  Reduce fever
- B.
  
  Reduce the inflammation of the joints
- C.
  
  Assist the client's range of motion activities without pain
- D.
  
  Prevent extension of the disease process
Correct Answer
B. Reduce the inflammation of the joints

Explanation
Aspirin is commonly used in the treatment of rheumatoid arthritis because it helps to reduce the inflammation of the joints. Rheumatoid arthritis is an autoimmune disease that causes chronic inflammation in the joints, leading to pain, stiffness, and swelling. Aspirin is a nonsteroidal anti-inflammatory drug (NSAID) that works by inhibiting the production of prostaglandins, which are responsible for inflammation. By reducing inflammation, aspirin can help alleviate the symptoms of rheumatoid arthritis and improve joint function. It does not directly reduce fever, assist with range of motion activities, or prevent the progression of the disease.

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16.

Following an amputation, the advantage to the client for an immediate prosthesis fitting is:
- A.
  
  Ability to ambulate sooner
- B.
  
  Less change of phantom limb sensation
- C.
  
  Dressing changes are not necessar
- D.
  
  Better fit of the prosthesis
Correct Answer
A. Ability to ambulate sooner

Explanation
Following an amputation, an immediate prosthesis fitting allows the client to start walking or ambulating sooner. This is advantageous as it promotes early mobility and independence, which can have positive effects on the client's physical and psychological well-being. By providing support and stability, the prosthesis enables the client to regain their ability to walk and perform daily activities more quickly. This can also contribute to a faster recovery and rehabilitation process.

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17.

One method of assessing for sign of circulatory impairment in a client with a fractured femur is to ask the client to:
- A.
  
  Cough and deep breathe
- B.
  
  Turn himself in bed
- C.
  
  Perform biceps exercise
- D.
  
  Wiggle his toes
Correct Answer
D. Wiggle his toes

Explanation
Wiggling toes is a method of assessing for circulatory impairment in a client with a fractured femur because it tests the client's ability to move the muscles in their lower extremities. If the client is unable to wiggle their toes, it may indicate a lack of blood flow to the area, which could be a sign of circulatory impairment. This test helps to identify potential issues with blood circulation and allows for early intervention to prevent further complications.

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18.

The morning of the second postoperative day following hip surgery for a fractured right hip, the nurse will ambulate the client. The first intervention is to:
- A.
  
  Get the client up in a chair after dangling at the bedside.
- B.
  
  Use a walker for balance when getting the client out of bed
- C.
  
  Have the client put minimal weight on the affected side when getting up
- D.
  
  Practice getting the client out of bed by having her slightly flex her hips
Correct Answer
D. Practice getting the client out of bed by having her slightly flex her hips

Explanation
The correct answer is to practice getting the client out of bed by having her slightly flex her hips. This intervention is important because it helps the client gradually adjust to the movement and minimize the risk of complications such as dislocation or further injury to the hip. By slightly flexing the hips, the client can engage the muscles and joints in a controlled manner, allowing for a safer and more comfortable transition from bed to standing position.

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19.

A young client is in the hospital with his left leg in Buck's traction. The team leader asks the nurse to place a footplate on the affected side at the bottom of the bed. The purpose of this action is to:
- A.
  
  Anchor the traction
- B.
  
  Prevent footdrop
- C.
  
  Keep the client from sliding down in bed
- D.
  
  Prevent pressure areas on the foot
Correct Answer
B. Prevent footdrop

Explanation
Placing a footplate on the affected side at the bottom of the bed helps to prevent footdrop. Footdrop is a condition where the muscles and tendons in the foot become weak or paralyzed, causing the foot to hang downward. By placing a footplate, it provides support and helps to maintain the foot in a neutral position, preventing the foot from dropping and reducing the risk of developing footdrop.

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20.

When evaluating all forms of traction, the nurse knows the direction of pull is controlled by the:
- A.
  
  Client's position
- B.
  
  Rope/pulley system
- C.
  
  Amount of weight
- D.
  
  Point of friction
Correct Answer
B. Rope/pulley system

Explanation
The nurse knows that the direction of pull is controlled by the rope/pulley system. This is because the rope/pulley system is responsible for transmitting the force applied to the traction apparatus, determining the direction in which the force is exerted. The client's position, amount of weight, and point of friction may affect the overall effectiveness and comfort of the traction, but they do not control the direction of pull.

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21.

When a client has cervical halter traction to immobilize the cervical spine counteraction is provided by:
- A.
  
  Elevating the foot of the bed
- B.
  
  Elevating the head of the bed
- C.
  
  Application of the pelvic girdle
- D.
  
  Lowering the head of the bed
Correct Answer
B. Elevating the head of the bed

Explanation
When a client has cervical halter traction to immobilize the cervical spine, counteraction is provided by elevating the head of the bed. This is because elevating the head of the bed helps to maintain proper alignment and reduce the pull of the traction on the cervical spine. It helps to create a counteracting force that prevents excessive traction and promotes stability in the cervical spine. Elevating the foot of the bed, application of the pelvic girdle, or lowering the head of the bed would not provide the necessary counteraction and may compromise the effectiveness of the traction.

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22.

After falling down the basement steps in his house, a client is brought to the emergency room. His physician confirms that his leg is fractured. Following application of a leg cast, the nurse will first check the client's toes for:
- A.
  
  Increase in the temperature
- B.
  
  Change in co
- C.
  
  Edema
- D.
  
  Movemen
Correct Answer
B. Change in co

Explanation
After a leg fracture, it is important to check for changes in color and temperature of the toes. This is because a change in color, such as pallor or cyanosis, can indicate poor blood circulation to the toes. Similarly, a change in temperature, such as coldness or warmth, can also indicate compromised blood flow. These signs are important to monitor as they can indicate potential complications, such as compartment syndrome or arterial occlusion.

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23.

A 23 year old female client was in an automobile accident and is now a paraplegic. She is on an intermittent urinary catheterization program and diet as tolerated. The nurse's priority assessment should be to observe for:
- A.
  
  Urinary retentio
- B.
  
  Bladder distentio
- C.
  
  Weight gain
- D.
  
  Bower evacuati
Correct Answer
B. Bladder distentio

Explanation
The nurse's priority assessment should be to observe for bladder distention. This is because the client is on an intermittent urinary catheterization program, which means that they may be at risk for urinary retention. Bladder distention can occur if the client's bladder is not being adequately emptied, which can lead to discomfort, pain, and potential complications such as urinary tract infections. Therefore, it is important for the nurse to closely monitor the client's bladder for any signs of distention and address it promptly to prevent any further complications.

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24.

A female client with rheumatoid arthritis has been on aspirin grain TID and prednisone 10mg BID for the last two years. The most important assessment question for the nurse to ask related to the client's drug therapy is whether she has
- A.
  
  Headache
- B.
  
  Tarry stool
- C.
  
  Blurred vision
- D.
  
  Decreased appeti
Correct Answer
B. Tarry stool

Explanation
The most important assessment question for the nurse to ask related to the client's drug therapy is whether she has tarry stool. This is because both aspirin and prednisone can cause gastrointestinal bleeding, which can manifest as tarry stool. It is crucial for the nurse to assess for this symptom as it may indicate a serious adverse effect of the medications and prompt further intervention. Headache, blurred vision, and decreased appetite are also important to assess, but tarry stool is the most pertinent in this case.

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25.

A 7 year old boy with a fractured leg tells the nurse that he is bored. An appropriate intervention would be to
- A.
  
  Read a story and act out the
- B.
  
  Watch a puppet show
- C.
  
  Watch televisi
- D.
  
  Listen to the radio
Correct Answer
C. Watch televisi

Explanation
An appropriate intervention for a 7-year-old boy with a fractured leg who is bored would be to watch television. This activity can help distract the child from the pain and boredom, providing entertainment and stimulation. It can also help pass the time and provide a source of enjoyment while the child is unable to engage in physical activities due to the leg fracture.

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26.

On a visit to the clinic, a client reports the onset of early symptoms of rheumatoid arthritis. Which of the following would be the nurse most likely to asses
- A.
  
  Limited motion of joint
- B.
  
  Deformed joints of the han
- C.
  
  Early morning stiffnes
- D.
  
  Rheumatoid nodule
Correct Answer
C. Early morning stiffnes

Explanation
Early morning stiffness is a common symptom of rheumatoid arthritis. It is characterized by stiffness and difficulty moving the joints, especially in the morning or after periods of inactivity. This symptom is often one of the first signs of rheumatoid arthritis and can be a key indicator for diagnosis. Assessing for early morning stiffness would help the nurse determine if the client is experiencing symptoms consistent with rheumatoid arthritis.

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27.

After teaching the client about risk factors for rheumatoid arthritis, which of the following, if stated by the client as a risk factor, would indicate to the nurse that the client needs additional teaching?
- A.
  
  History of Epstein-Barr virus infection
- B.
  
  Female ge
- C.
  
  Adults between the ages 60 to 75 years
- D.
  
  Positive testing for human leukocyte antigen (HLA) DR4 allele
Correct Answer
C. Adults between the ages 60 to 75 years

Explanation
Rheumatoid arthritis typically affects adults between the ages of 30 and 60, so if the client states that being between the ages of 60 to 75 is a risk factor, it would indicate a need for additional teaching as this is not a correct risk factor for rheumatoid arthritis.

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28.

When developing the teaching plan for the client with rheumatoid arthritis to promote rest, which of the following would the nurse expect to instruct the client to avoid during the rest periods?
- A.
  
  Proper body alignment
- B.
  
  Elevating the part
- C.
  
  Prone lying positions
- D.
  
  Positions of flexio
Correct Answer
C. Prone lying positions

Explanation
The nurse would expect to instruct the client with rheumatoid arthritis to avoid prone lying positions during rest periods. Prone lying positions can put pressure on the joints and may cause discomfort or pain for individuals with rheumatoid arthritis. It is important to maintain proper body alignment and elevate the affected parts during rest to reduce strain on the joints. Positions of flexion may also be beneficial in promoting rest and reducing pain in individuals with rheumatoid arthritis.

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29.

After teaching the client with severe rheumatoid arthritis about the newly prescribed medication methothrexate (Rheumatrex 0), which of the following statements indicates the need for further teaching?
- A.
  
  "I will take my vitamins while I am on this drug"
- B.
  
  "I must not drink any alcohol while I'm taking this drug"
- C.
  
  I should brush my teeth after every meal"
- D.
  
  "I will continue taking my birth control pills"
Correct Answer
D. "I will continue taking my birth control pills"

Explanation
The statement "I will continue taking my birth control pills" indicates the need for further teaching because methotrexate can cause birth defects and should not be taken during pregnancy. Therefore, it is important for the client to use an alternative form of contraception while taking this medication.

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30.

When completing the history and physical examination of a client diagnosed with osteoarthritis, which of the following would the nurse assess?
- A.
  
  Anemia
- B.
  
  Osteoporosis
- C.
  
  Weight loss
- D.
  
  Local joint pain
Correct Answer
D. Local joint pain

Explanation
When completing the history and physical examination of a client diagnosed with osteoarthritis, the nurse would assess for local joint pain. Osteoarthritis is a degenerative joint disease that primarily affects the cartilage in the joints, leading to pain, stiffness, and limited mobility. Assessing for local joint pain is important in determining the extent and severity of the client's osteoarthritis and developing an appropriate care plan. Anemia, osteoporosis, and weight loss are not specific manifestations of osteoarthritis and would not be the primary focus of assessment in this case.

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31.

At which of the following times would the nurse instruct the client to take ibuprofen (Motrin), prescribed for left hip pain secondary to osteoarthritis, to minimize gastric mucosal irritation?
- A.
  
  At bedtime
- B.
  
  On arising
- C.
  
  Immediately after meal
- D.
  
  On an empty stomach
Correct Answer
C. Immediately after meal

Explanation
Taking ibuprofen immediately after a meal helps to minimize gastric mucosal irritation because the food in the stomach acts as a buffer and helps to protect the stomach lining from the potential irritation caused by the medication. By taking it after a meal, the medication is more likely to be absorbed into the bloodstream without causing as much irritation to the stomach.

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32.

When preparing a teaching plan for the client with osteoarthritis who is taking celecoxib (Celebrex), the nurse expects to explain that the major advantage of celecoxib over diclofenac (Voltaren), is that the celecoxib is likely to produce which of the following?
- A.
  
  Hepatotoxicity
- B.
  
  Renal toxicity
- C.
  
  Gastrointestinal bleedin
- D.
  
  Nausea and vomitin
Correct Answer
C. Gastrointestinal bleedin

Explanation
Celecoxib (Celebrex) is a selective COX-2 inhibitor, while diclofenac (Voltaren) is a non-selective COX inhibitor. The major advantage of celecoxib over diclofenac is that celecoxib is less likely to produce gastrointestinal bleeding. This is because COX-2 inhibitors specifically target the enzyme responsible for inflammation, while sparing the COX-1 enzyme that protects the stomach lining. In contrast, non-selective COX inhibitors like diclofenac inhibit both COX-1 and COX-2 enzymes, increasing the risk of gastrointestinal bleeding. Therefore, the nurse would explain that celecoxib is less likely to cause gastrointestinal bleeding compared to diclofenac.

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33.

After surgery and insertion of a total joint prosthesis, a client develops severe sudden pain and an inability to move the extremity. The nurse interprets these findings as indicating which of the following?
- A.
  
  A developing infection
- B.
  
  Bleeding in the operative si
- C.
  
  Joint dislocati
- D.
  
  Glue seepage into soft tissu
Correct Answer
C. Joint dislocati

Explanation
After surgery and insertion of a total joint prosthesis, severe sudden pain and an inability to move the extremity indicate joint dislocation. This occurs when the artificial joint becomes displaced from its normal position, causing pain and loss of function. It is important to address this immediately to prevent further complications and restore joint stability.

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34.

Which of the following would the nurse assess in a client with an intracapsular hip fracture?
- A.
  
  Internal rotatio
- B.
  
  Muscle flaccidity
- C.
  
  Shortening of the affected le
- D.
  
  Absence of pain the fracture ar
Correct Answer
C. Shortening of the affected le

Explanation
In a client with an intracapsular hip fracture, the nurse would assess for shortening of the affected leg. This is because an intracapsular hip fracture occurs within the joint capsule of the hip, and can cause the leg to appear shorter due to displacement of the fractured bone. Assessing for shortening of the affected leg is important in diagnosing and managing the fracture.

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35.

Which of the following would be inappropriate to include when preparing a client for magnetic resonance imaging (MRI) to evaluate a rupture disc?
- A.
  
  Informing the client that the procedure is painless
- B.
  
  Taking a thorough history of past surgeries
- C.
  
  Checking for previous complaints of claustropphobia
- D.
  
  Starting an intravenous line at keep-open rate
Correct Answer
D. Starting an intravenous line at keep-open rate

Explanation
Starting an intravenous line at keep-open rate would be inappropriate to include when preparing a client for magnetic resonance imaging (MRI) to evaluate a rupture disc. This is because an IV line is not typically required for a routine MRI procedure and is not necessary specifically for evaluating a rupture disc. The other options, such as informing the client that the procedure is painless, taking a thorough history of past surgeries, and checking for previous complaints of claustrophobia, are all important steps in preparing a client for an MRI.

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36.

Which of the following actions would be a priority for a client who has been in the postanesthesia care unit (PACU) for 45 minutes after an above the knee amputation and develops a dime size bright red spot on the ace bondage above the amputation site?
- A.
  
  Elevate the stump
- B.
  
  Reinforcing the dressing
- C.
  
  Calling the surge
- D.
  
  Drawing a mark around the si
Correct Answer
D. Drawing a mark around the si

Explanation
Drawing a mark around the site would be a priority for the client who has been in the PACU for 45 minutes after an above the knee amputation and develops a dime size bright red spot on the ace bondage above the amputation site. This action is important because it allows the healthcare team to monitor the progression of the red spot and assess for any further changes or worsening of the condition. It also helps in determining the appropriate course of treatment or intervention if needed.

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37.

A client in the PACU with a left below the knee amputation complains of pain in her left big toe. Which of the following would the nurse do first?
- A.
  
  Tell the client it is impossible to feel the pain
- B.
  
  Show the client that the toes are not there
- C.
  
  Explain to the client that the pain is real
- D.
  
  Give the client the prescribed narcotic analgesic
Correct Answer
D. Give the client the prescribed narcotic analgesic

Explanation
The nurse would first give the client the prescribed narcotic analgesic because the client is experiencing pain and it is important to provide relief. The nurse would not tell the client that it is impossible to feel the pain or show the client that the toes are not there, as these actions would invalidate the client's pain and may cause distress. Additionally, explaining to the client that the pain is real may be helpful, but providing immediate pain relief takes priority.

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38.

The client with an above the knee amputation is to use crutches until the prosthesis is being adjusted. In which of the following exercises would the nurse instruct the client to best prepare him for using crutches?
- A.
  
  Abdominal exercises
- B.
  
  Isometric shoulder exercises
- C.
  
  Quadriceps setting exercise
- D.
  
  Triceps stretching exercises
Correct Answer
D. Triceps stretching exercises

Explanation
Triceps stretching exercises would be the best choice to prepare the client for using crutches. Using crutches requires upper body strength and stability, particularly in the arms and shoulders. Triceps stretching exercises specifically target the muscles in the back of the upper arm, which are important for supporting the weight and movement involved in using crutches. Strengthening and stretching the triceps muscles will help the client to better support themselves and maintain balance while using crutches.

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39.

The client with an above the knee amputation is to use crutches until the prosthesis is properly lifted. When teaching the client about using the crutches, the nurse instructs the client to support her weight primarily on which of the following body areas?
- A.
  
  Axillae
- B.
  
  Elbows
- C.
  
  Upper arms
- D.
  
  Hand
Correct Answer
D. Hand

Explanation
The nurse instructs the client to support her weight primarily on the hand when using crutches. This is because the hand is the most stable and strongest area to bear weight, providing better balance and support while walking with crutches. Supporting weight on the axillae can cause nerve damage and discomfort, while supporting weight on the elbows or upper arms may lead to muscle strain and fatigue. Therefore, the hand is the most appropriate body area to support weight while using crutches.

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40.

Three hours ago a client was thrown from a car into a ditch, and he is now admitted to the ED in a stable condition with vital signs within normal limits, alert and oriented with good coloring and an open fracture of the right tibia. When assessing the client, the nurse would be especially alert for signs and symptoms of which of the following?
- A.
  
  Hemorrhage
- B.
  
  Infection
- C.
  
  Deformity
- D.
  
  Shock
Correct Answer
A. Hemorrhage

Explanation
The nurse would be especially alert for signs and symptoms of hemorrhage because the client was thrown from a car and has an open fracture of the right tibia. Hemorrhage is a potential complication of trauma and open fractures can lead to significant bleeding. It is important for the nurse to monitor the client closely for any signs of bleeding such as excessive blood loss, rapid heart rate, low blood pressure, and pale skin. Prompt recognition and management of hemorrhage are crucial to prevent further complications and ensure the client's well-being.

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41.

The client with a fractured tibia has been taking methocarbamol (Robaxin), when teaching the client about this drug, which of the following would the nurse include as the drug's primary effect?
- A.
  
  Killing of microorganism
- B.
  
  Reduction in itching
- C.
  
  Relief of muscle spasms
- D.
  
  Decrease in nervousness
Correct Answer
C. Relief of muscle spasms

Explanation
The nurse would include relief of muscle spasms as the primary effect of methocarbamol (Robaxin). Methocarbamol is a muscle relaxant that works by blocking nerve impulses (or pain sensations) that are sent to the brain. It helps to relieve muscle spasms and reduce muscle stiffness, allowing for improved mobility and comfort.

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42.

A client who has been taking carisoprodol (Soma) at home for a fractured arm is admitted with a blood pressure of 80/50 mmHg, a pulse rate of 115bpm, and respirations of 8 breaths/minute and shallow, the nurse interprets these finding as indicating which of the following?
- A.
  
  Expected common side effects
- B.
  
  Hypersensitivity reactions
- C.
  
  Possible habituating effects
- D.
  
  Hemorrhage from GI irritation
Correct Answer
A. Expected common side effects

Explanation
The client's low blood pressure, increased heart rate, and shallow respirations are common side effects of carisoprodol (Soma). These side effects are expected and can be attributed to the medication's muscle relaxant properties.

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43.

When admitting a client with a fractured extremity, the nurse would focus the assessment on which of the following fi
- A.
  
  The area proximal to the fract
- B.
  
  The actual fracture sit
- C.
  
  The area distal to the fracture
- D.
  
  The opposite extremity for baseline comparison
Correct Answer
C. The area distal to the fracture

Explanation
When admitting a client with a fractured extremity, the nurse would focus the assessment on the area distal to the fracture. This is because assessing the area distal to the fracture helps to determine the circulation, sensation, and movement of the affected extremity. It allows the nurse to monitor for any signs of compromised blood flow or nerve damage. By assessing the area distal to the fracture, the nurse can identify any potential complications and provide appropriate interventions to promote healing and prevent further damage.

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44.

A client with fracture develops compartment syndrome. When caring for the client, the nurse would be alert for which of the following signs of possible organ failure
- A.
  
  Rales
- B.
  
  Jaundic
- C.
  
  Generalized edem
- D.
  
  Dark, scanty urine
Correct Answer
D. Dark, scanty urine

Explanation
Dark, scanty urine is a sign of possible organ failure in a client with compartment syndrome. Compartment syndrome occurs when increased pressure within a muscle compartment impairs blood flow and tissue perfusion. This can lead to ischemia and damage to the kidneys, resulting in decreased urine output and the presence of dark, scanty urine. It is important for the nurse to be alert to this sign as it indicates potential kidney dysfunction and the need for immediate intervention to prevent further organ damage. Rales, jaundice, and generalized edema are not specifically associated with compartment syndrome or organ failure in this context.

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45.

Which of the following would lead the nurse to suspect that a client with a fracture of the right femur may be developing a fat embolus?
- A.
  
  Acute respiratory distress syndrome
- B.
  
  Migraine like headaches
- C.
  
  Numbness in the right leg
- D.
  
  Muscle spasms in the right thigh
Correct Answer
A. Acute respiratory distress syndrome

Explanation
The nurse would suspect that a client with a fracture of the right femur may be developing a fat embolus if they are experiencing acute respiratory distress syndrome. Fat embolism syndrome occurs when fat particles from the bone marrow enter the bloodstream and travel to the lungs, causing respiratory distress. This can lead to symptoms such as shortness of breath, rapid breathing, chest pain, and low oxygen levels. Therefore, the presence of acute respiratory distress syndrome in this client would be a red flag for a potential fat embolus.

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46.

The client who had an open femoral fracture was discharged to her home, where she developed, fever, night sweats, chills, restlessness and restrictive movement of the fractured leg. The nurse interprets these finding as indicating which of the following?
- A.
  
  Pulmonary emboli
- B.
  
  Osteomyelitis
- C.
  
  Fat emboli
- D.
  
  Urinary tract infection
Correct Answer
B. Osteomyelitis

Explanation
Based on the symptoms described, the client's fever, night sweats, chills, restlessness, and restrictive movement of the fractured leg indicate the possibility of an infection in the bone, known as osteomyelitis. This condition can occur as a complication of an open fracture, where bacteria can enter the bone and cause an infection. Pulmonary emboli, fat emboli, and urinary tract infections would typically present with different symptoms and would not explain the specific symptoms mentioned in the scenario.

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47.

When antibiotics are not producing the desired outcome for a client with osteomyelitis, the nurse interprets this as suggesting the occurrence of which of the following as most likely?
- A.
  
  Formation of scar tissue interfering with absorption
- B.
  
  Development of pus leading to ischemia
- C.
  
  Production of bacterial growth by avascular tissue
- D.
  
  Antibiotics not being instilled directly into the bone
Correct Answer
C. Production of bacterial growth by avascular tissue

Explanation
The nurse interprets the lack of desired outcome from antibiotics as suggesting the production of bacterial growth by avascular tissue as the most likely occurrence. In osteomyelitis, the infection affects the bone and surrounding tissue. Avascular tissue refers to the areas with poor blood supply, which can create an environment conducive to bacterial growth and make it difficult for antibiotics to reach and eliminate the infection effectively. Therefore, the presence of bacterial growth in avascular tissue can hinder the effectiveness of antibiotics and result in an unsatisfactory outcome.

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48.

Which of the following would the nurse use as the best method to assess for the development of deep vein thrombosis in a client with a spinal cord injury?
- A.
  
  Homan's sign
- B.
  
  Pain
- C.
  
  Tenderness
- D.
  
  Leg girth
Correct Answer
A. Homan's sign

Explanation
Homan's sign is the best method to assess for the development of deep vein thrombosis in a client with a spinal cord injury. This test involves dorsiflexing the client's foot while the knee is slightly flexed, and if the client experiences pain in the calf, it could indicate the presence of a blood clot. Pain, tenderness, and leg girth are not specific enough to accurately assess for deep vein thrombosis in this population.

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49.

The nurse is caring for the client who is going to have an arthogram using a contrast medium. Which of the following assessments by the nurse are of highest priority?
- A.
  
  Allergy to iodine or shellfish
- B.
  
  Ability of the client to remain still during the procedure
- C.
  
  Whether the client has any remaining questions about the procedur
- D.
  
  Whether the client wishes to void before the procedure
Correct Answer
A. Allergy to iodine or shellfish

Explanation
The highest priority assessment for the nurse is to determine if the client has any allergies to iodine or shellfish. This is because the contrast medium used in an arthrogram typically contains iodine, and if the client is allergic, it could lead to a severe allergic reaction or anaphylaxis. It is crucial for the nurse to identify any potential allergies before the procedure to ensure the client's safety and prevent any adverse reactions.

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50.

The client immobilized skeletal leg traction complains of being bored and restless. Based on these complaints, the nurse formulates which of the following nursing diagnoses for this client?
- A.
  
  Divertional activity defic
- B.
  
  Powerlessness
- C.
  
  Self care deficit
- D.
  
  Impaired physical mobility
Correct Answer
A. Divertional activity defic

Explanation
The client in skeletal leg traction is complaining of being bored and restless, indicating a lack of diversional activity. This suggests that the client may be experiencing divertional activity deficit, which refers to a decreased ability to engage in activities that provide enjoyment, interest, and relaxation. This nursing diagnosis is appropriate in this situation as the client's immobilization may limit their ability to participate in usual activities, leading to feelings of boredom and restlessness.

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May 17, 2012

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Musculoskeletal Examination (Practice Mode)- Www.Rnpedia.Com

A client is 1 day postoperative after a total hip replacement. The client should be placed in which of the following position?

A client who has had a plaster of Paris cast applied to his forearm is receiving pain medication. To detect early manifestations of compartment syndrome, which of these assessments should the nurse make?

After a computer tomography scan with intravenous contrast medium, a client returns to the unit complaining of shortness of breath and itching. The nurse should be prepared to treat the client for:

While caring for a client with a newly applied plaster of Paris cast, the nurse makes note of all the following conditions. Which assessment finding requires immedite notification of the physician?

Which of these nursing actions will best promote independence for the client in skeletal traction?

A client presents in the emergency department after falling from a roof. A fracture of the femoral neck is suspected. Which of these assessments best support this diagnosis.

The nurse is caring for a client with compound fracture of the tibia and fibula. Skeletal traction is applied. Which of these priorities should the nurse include in the care plan?

To prevent foot drop in a client with Buck's traction, the nurse should:

Which nursing intervention is appropriate for a client with skeletal traction?

In order for Buck's traction applied to the right leg to be effective, the client should be placed in which position?

An elderly client has sustained intertrochanteric fracture of the hip and has just returned from surgery where a nail plate was inserted for internal fixation. The client has been instructed that she should not flex her hip. The best explanation of why this movement would be harmful is:

When the client is lying supine, the nurse will prevent external rotation of the lower extremity by using a:

A client has just returned from surgery after having his left leg amputated below the knee. Physician's orders include elevation of the foot of the bed for 24 hours. The nurse observes that the nursing assistant has placed a pillow under the client's amputated limb. The nursing action is to:

A client has sustained a fracture of the femur and balanced skeletal traction with a Thomas splint has been applied. To prevent pressure points from occurring around the top of the splint, the most important intervention is to:

The major rationale for the use of acetylsalicylic acid (aspirin) in the treatment of rheumatoid arthritis is to:

Following an amputation, the advantage to the client for an immediate prosthesis fitting is:

One method of assessing for sign of circulatory impairment in a client with a fractured femur is to ask the client to:

The morning of the second postoperative day following hip surgery for a fractured right hip, the nurse will ambulate the client. The first intervention is to:

A young client is in the hospital with his left leg in Buck's traction. The team leader asks the nurse to place a footplate on the affected side at the bottom of the bed. The purpose of this action is to:

When evaluating all forms of traction, the nurse knows the direction of pull is controlled by the:

When a client has cervical halter traction to immobilize the cervical spine counteraction is provided by:

After falling down the basement steps in his house, a client is brought to the emergency room. His physician confirms that his leg is fractured. Following application of a leg cast, the nurse will first check the client's toes for:

A 23 year old female client was in an automobile accident and is now a paraplegic. She is on an intermittent urinary catheterization program and diet as tolerated. The nurse's priority assessment should be to observe for:

A female client with rheumatoid arthritis has been on aspirin grain TID and prednisone 10mg BID for the last two years. The most important assessment question for the nurse to ask related to the client's drug therapy is whether she has

A 7 year old boy with a fractured leg tells the nurse that he is bored. An appropriate intervention would be to

On a visit to the clinic, a client reports the onset of early symptoms of rheumatoid arthritis. Which of the following would be the nurse most likely to asses

After teaching the client about risk factors for rheumatoid arthritis, which of the following, if stated by the client as a risk factor, would indicate to the nurse that the client needs additional teaching?

When developing the teaching plan for the client with rheumatoid arthritis to promote rest, which of the following would the nurse expect to instruct the client to avoid during the rest periods?

After teaching the client with severe rheumatoid arthritis about the newly prescribed medication methothrexate (Rheumatrex 0), which of the following statements indicates the need for further teaching?

When completing the history and physical examination of a client diagnosed with osteoarthritis, which of the following would the nurse assess?

At which of the following times would the nurse instruct the client to take ibuprofen (Motrin), prescribed for left hip pain secondary to osteoarthritis, to minimize gastric mucosal irritation?

When preparing a teaching plan for the client with osteoarthritis who is taking celecoxib (Celebrex), the nurse expects to explain that the major advantage of celecoxib over diclofenac (Voltaren), is that the celecoxib is likely to produce which of the following?

After surgery and insertion of a total joint prosthesis, a client develops severe sudden pain and an inability to move the extremity. The nurse interprets these findings as indicating which of the following?

Which of the following would the nurse assess in a client with an intracapsular hip fracture?

Which of the following would be inappropriate to include when preparing a client for magnetic resonance imaging (MRI) to evaluate a rupture disc?

Which of the following actions would be a priority for a client who has been in the postanesthesia care unit (PACU) for 45 minutes after an above the knee amputation and develops a dime size bright red spot on the ace bondage above the amputation site?

A client in the PACU with a left below the knee amputation complains of pain in her left big toe. Which of the following would the nurse do first?

The client with an above the knee amputation is to use crutches until the prosthesis is being adjusted. In which of the following exercises would the nurse instruct the client to best prepare him for using crutches?

The client with an above the knee amputation is to use crutches until the prosthesis is properly lifted. When teaching the client about using the crutches, the nurse instructs the client to support her weight primarily on which of the following body areas?

The client with a fractured tibia has been taking methocarbamol (Robaxin), when teaching the client about this drug, which of the following would the nurse include as the drug's primary effect?

A client who has been taking carisoprodol (Soma) at home for a fractured arm is admitted with a blood pressure of 80/50 mmHg, a pulse rate of 115bpm, and respirations of 8 breaths/minute and shallow, the nurse interprets these finding as indicating which of the following?

When admitting a client with a fractured extremity, the nurse would focus the assessment on which of the following fi

A client with fracture develops compartment syndrome. When caring for the client, the nurse would be alert for which of the following signs of possible organ failure

Which of the following would lead the nurse to suspect that a client with a fracture of the right femur may be developing a fat embolus?

The client who had an open femoral fracture was discharged to her home, where she developed, fever, night sweats, chills, restlessness and restrictive movement of the fractured leg. The nurse interprets these finding as indicating which of the following?

When antibiotics are not producing the desired outcome for a client with osteomyelitis, the nurse interprets this as suggesting the occurrence of which of the following as most likely?

Which of the following would the nurse use as the best method to assess for the development of deep vein thrombosis in a client with a spinal cord injury?

The nurse is caring for the client who is going to have an arthogram using a contrast medium. Which of the following assessments by the nurse are of highest priority?

The client immobilized skeletal leg traction complains of being bored and restless. Based on these complaints, the nurse formulates which of the following nursing diagnoses for this client?