Musculoskeletal Prep U

Answer KeyQuestion 1:(see full question)

A client is scheduled for a laminectomy to repair a herniated intervertebral disk. When developing the postoperative care plan, the nurse should include which action?

You selected: Turning the client from side to side, using the logroll techniqueCorrect

Explanation: To avoid twisting the spine or hips when turning a client onto the side, the nurse should use the lo...(

Question 2:(see full question)

A nurse is caring for an elderly female client with osteoporosis. When teaching the client, the nurse should include information about which major complication?

You selected: Bone fractureCorrect

Explanation: Bone fracture is a major complication of osteoporosis; it results when loss of calcium and phosphate...(


The client with a fractured tibia has been taking methocarbamol (Robaxin). Which of the following indicate that the drug is having the intended effect?

You selected: Relief of muscle spasms.Correct

Explanation: Methocarbamol is a muscle relaxant and acts primarily to relieve muscle spasms. It has no effect on ...(


Which of the following nursing measures is most useful in preventing the development of osteoporosis in a client who is immobilized?

You selected: Beginning weight-bearing activities as soon as possible.Correct

Explanation: In order to prevent disuse osteoporosis, it is important to implement weight-bearing activities as s...(


A client comes to the emergency department complaining of pain in the right leg. When obtaining the history, the nurse learns that the client has a history of obesity and hypertension. Based on this information the nurse anticipates the client having which musculoskeletal disorder?

You selected: Degenerative joint diseaseCorrect

Explanation: Obesity predisposes the client to degenerative joint disease. Obesity isn't a predisposing factor fo...(


Two days after surgery to amputate his left lower leg, a client states that he has pain in the missing extremity. Which action by the nurse is most appropriate?

You selected: Administer medication, as ordered, for the reported discomfort.Correct

Explanation: The sensation of pain and discomfort in an amputated extremity is known as phantom pain. Phantom pai...(more)


A nurse is caring for a client who complains of lower back pain. Which instruction should the nurse give to the client to prevent back injury?

You selected: "Stand close to the object you're lifting."Correct

Explanation: Standing close to an object when lifting moves the body's center of gravity closer to the object, al...(


When developing a care plan for a client newly diagnosed with scleroderma, which nursing diagnosis has the highest priority?

You selected: Impaired skin integrityCorrect

Explanation: Impaired skin integrity is a concern for the client with scleroderma in its earlier stages. Meticulo...(


A client is admitted with acute osteomyelitis that developed after an open fracture of the right femur. When planning this client's care, the nurse should anticipate which measure?

You selected: Administering large doses of I.V. antibiotics as orderedCorrect

Explanation: Treatment of acute osteomyelitis includes large doses of I.V. antibiotics (after blood cultures iden...(


A client asks the nurse what the difference is between osteoarthritis (OA) and rheumatoid arthritis (RA). Which response is correct?

You selected: "OA is a noninflammatory joint disease. RA is characterized by inflamed, swollen joints."Correct

Explanation: OA is a degenerative arthritis, characterized by the loss of cartilage on the articular surfaces of ...(


A client reports having pain in the casted left arm that is unrelieved by pain medication. The nurse assesses the arm and notes that the fingers are swollen and difficult to separate. Which action is

You selected: Elevate the arm on two pillows and reassess in 30 minutes.IncorrectCorrect response: Call the physician to report swelling and pain.

Explanation: The most appropriate action is to report the swelling, loss of mobility, and unrelieved pain to the ...(


When the client who has had a hip replacement is lying on the side, the nurse should place pillows or an abductor splint between the legs to prevent:

You selected: Adduction of the hip joint.Correct

Explanation: After hip replacement surgery, the client should be positioned on the nonoperative side with pillows...(


A client has been diagnosed with degenerative joint disease (osteoarthritis) of the left hip. Which of the following factors in the client’s history would most likely increase the joint symptoms of osteoarthritis?

You selected: Obesity.Correct

Explanation: Osteoarthritis most commonly results from “wear and tear"---excessive and prolonged mechanical str...(


Which information should the nurse include when performing discharge teaching with a client who had an anterolateral approach for a total hip replacement? Select all that apply.

You selected: • Do not extend the operative leg backwards.• Avoid turning the toes or knee outward.• Use an elevated toilet seat and shower chair.

CorrectExplanation: A client who has had a total hip replacement via an anterolateral approach has almost the opposite p...(


A client has sustained a right tibial fracture and has just had a cast applied. Which instruction should the nurse provide in his cast care?

You selected: "Keep your right leg elevated above heart level."Correct

Explanation: The nurse should instruct the client to elevate the leg to promote venous return and prevent edema. ...(


A client is recovering from an attack of gout. Client teaching should include the need to lose weight because:

You selected: weight loss will reduce uric acid levels and reduce stress on joints.Correct

Explanation: Weight loss will reduce uric acid levels and reduce stress on joints. Weight loss won't reduce purin...(


A client takes prednisone for an acute exacerbation of rheumatoid arthritis. Which of the following statements indicates the client understands how to take the prednisone?

You selected: "It is best if I take this medication with some food.”Correct

Explanation: Prednisone is a gastrointestinal irritant that is best taken with food. The client should not abrupt...(


The nurse assigns a nursing assistant to the care of a client who has just returned from surgery for repair of a fractured right wrist and application of an arm cast. The nurse should stress to the assistant the importance of reporting which of the following assessments immediately?

You selected: The client is feeling heat from the plaster cast.IncorrectCorrect response: Client cannot move the fingers on the right hand.

Explanation: The assistant should be told to report immediately to the nurse any sign that the client cannot move...(


A client who had a total hip replacement 4 days ago is worried about dislocation of the prosthesis. The nurse should respond by saying which of the following?

You selected: "Activities that tend to cause adduction of the hip tend to cause dislocation, so try to avoid them."Correct

Explanation: Dislocation precautions include: avoid extremes of internal rotation, adduction, and 90-degree flexi...(


Which of the following is the priority for a client with a fractured femur who is in traction?

You selected: Prevent effects of immobility while in traction.


A client with osteoarthritis tells the nurse she is concerned that the disease will prevent her from doing her chores. Which suggestion should the nurse offer?

You selected: "Pace yourself and rest frequently, especially after activities."Correct

Explanation: A client with osteoarthritis must adapt to this chronic and disabling disease, which causes deterior...(


Following a total hip replacement, the nurse should position the client in which of the following ways?

You selected: Keep the extremity in slight abduction using an abduction splint or pillows placed between the thighs.Correct

Explanation: After total hip replacement, proper positioning by the nurse prevents dislocation of the prosthesis....(


To protect a client’s skin under a back brace, the nurse should:

You selected: Have the client wear a thin cotton shirt under the back brace.Correct

Explanation: Having the client wear a thin cotton shirt under a back brace helps to protect the skin and to keep ...(

Question 4: A nurse is managing the care of a client with osteoarthritis. Appropriate treatment strategies for osteoarthritis include:

(see full question)

You selected: administration of nonsteroidal anti-inflammatory drugs (NSAIDs) and initiation of an exercise program.Correct

Explanation: NSAIDs are routinely used for anti-inflammatory and analgesic effects. NSAIDs reduce inflammation, w...(


In preparation for total knee surgery, a 200-lb client with osteoarthritis must lose weight. Which of the following exercises should the nurse recommend as best if the client has no contraindications?

You selected: Aquatic exercise.Correct

Explanation: When combined with a weight loss program, aquatic exercise would be best because it cushions the joi...(


Which of the following instructions regarding body mechanics would be most appropriate for helping a client to avoid back injury?

You selected: Avoid prolonged sitting and standing.Correct

Explanation: Prolonged sitting and standing should be avoided because they strain the lower back. Pushing objects...(


A client is experiencing an acute exacerbation of rheumatoid arthritis. What should the nursing priority be?

You selected: Administering ordered analgesics and monitoring their effectsCorrect

Explanation: An acute exacerbation of rheumatoid arthritis can be very painful, and the nurse should make pain ma...(


The nurse has instructed the client about the correct positioning of the leg and hip following hip replacement surgery. Which of the following statements indicates that the client has understood these instructions?

You selected: ”I should avoid bending over to tie my shoes.”Correct

Explanation: Acute flexion and adduction of the hip should be avoided after hip replacement surgery. The client m...(


During a scoliosis screening in a college health center, a student asks the public health nurse about the consequences of untreated scoliosis. The nurse indentifies one of the direct complications as:

You selected: impingement on pulmonary function.Correct

Explanation: As untreated scoliosis progresses, the thoracic spinal curvature can impinge on the lungs and affect...(


A client with arterial insufficiency undergoes below-knee amputation of the right leg. Which action should the nurse include in

the postoperative care plan?You selected: Elevating the stump for the first 24 hoursCorrect

Explanation: Stump elevation for the first 24 hours after surgery helps reduce edema and pain by increasing venou...(


The nurse is planning an educational program about the prevention of osteoporosis for a group of women at the local community center. Which of the following preventive measures would be appropriate for the nurse to include in the teaching plan?

You selected: Encouraging weight-bearing exercise on a regular basis.Correct

Explanation: Exercise, especially weight-bearing exercise such as walking or jogging, is recommended on a regular...(


A diet plan is developed for a client with gouty arthritis. The nurse should advise the client to limit his intake of:

You selected: organ meats.Correct

Explanation: Gouty arthritis is a disorder of purine metabolism. High-purine foods include organ meats, anchovies...(


A nurse suspects that a client with a recent fracture has compartment syndrome. Assessment findings may include:

You selected: inability to perform passive movement and pain with active movement.IncorrectCorrect response: inability to perform active movement and pain with passive movement.

Explanation: With compartment syndrome, the client can't perform active movement, and pain occurs with passive mo...(more)


A client is hospitalized for open reduction of a fractured femur. During the postoperative assessment, the nurse notes that the client is restless and she observes petechiae on the client's chest. Which nursing action is indicated first?

You selected: Contact the physician.IncorrectCorrect response: Administer oxygen.

Explanation: The client is demonstrating clinical manifestations consistent with a fatty embolus. Administering o...(


A client has a tibial fracture that required casting. Approximately 5 hours later, the client has increasing pain distal to the left tibial fracture despite the morphine injection administered 30 minutes previously. Which of the following should be the nurse's next assessment?

You selected: Presence of a distal pulse.

CorrectExplanation: The nurse should assess the client's ability to move her toes and for the presence of distal pulses,...(


The client returns from surgery for a below-the-knee amputation with the residual limb covered with dressings and a woven elastic bandage. At first, the bandage was dry. Now, 30 minutes later, the nurse notices a small amount of bloody drainage. The nurse should first?

You selected: Mark the area of drainage.Correct

Explanation: The nurse should mark the bloody drainage and observe it again in 10 minutes to assess if the bleedi...(


What would be the most important nursing intervention in caring for the client’s residual limb during the first 24 hours after amputation of the left leg?

You selected: Elevating the residual limb on a pillow.Correct

Explanation: Elevating the residual limb on a pillow for the first 24 hours after surgery helps prevent edema and...(


Which nursing intervention is essential in caring for a client with compartment syndrome?

You selected: Removing all external sources of pressure, such as clothing and jewelryCorrect

Explanation: Nursing measures should include removing all clothing, jewelry, and external forms of pressure (such...(


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

You selected: The area distal to the fracture.Correct

Explanation: The nursing assessment is first focused on the region distal to the fracture for neurovascular injur...(


After a laminectomy, the client states, "The physician said that I can do anything I want to." Which of the following client-stated activities indicates the need for further teaching?

You selected: Sweeping the front porch.Correct

Explanation: Sweeping causes a twisting motion, which should be avoided because twisting can cause undue stress o...(more)


When using crutches, the nurse should instruct the client to bear weight

You selected: Hands.Correct

Explanation: The proper use of crutches requires supporting the body weight primarily on the hands. Improper use ...(


A nurse suspects that a client with a recent fracture has compartment syndrome. Assessment findings may include:

You selected: inability to perform active movement and pain with passive movement.Correct

Explanation: With compartment syndrome, the client can't perform active movement, and pain occurs with passive mo...(more)


Which statement by a staff nurse on the orthopedic floor indicates the need for further staff education?

You selected: "Bleeding is a complication associated with the continuous passive motion device."IncorrectCorrect response: "The client is receiving physical therapy twice per day, so he doesn't need a continuous passive motion device."

Explanation: Further staff education is needed when the nurse states that the continuous passive motion device is...(


A client diagnosed with arthritis doesn't want to take medications. Physical therapy and occupational therapy have been consulted for nonpharmacologic measures to control pain. What might physical and occupational therapy include in the care plan to help control this client's pain?

You selected: AcupunctureIncorrectCorrect response: An exercise routine that includes range-of-motion (ROM) exercises

Explanation: Physical and occupational therapy will most likely develop an exercise routine that includes ROM exe...(


During a routine physical examination on a 75-year-old female client, a nurse notes that the client is 5 feet, 3/8 inches (1.6 m) tall. The client states, "How is that possible? I was always 5 feet and 1/2? (1.7 m) tall." Which statement is the best response by the nurse?

You selected: "After menopause, the body's bone density declines, resulting in a gradual loss of height."Correct

Explanation: The nurse should tell the client that after menopause, the loss of estrogen leads to a loss in bone ...(


The nurse is teaching a client with osteoporosis about taking alendronate sodium (Fosamax). The nurse emphasizes that the client is to take the medication:

You selected: With a full glass of water and remain upright for 30 minutes.Correct

Explanation: Clients are instructed to take Fosamax on arising, 30 minutes before eating, with a full glass of wa...(


The client who had an open femoral fracture was discharged to the home and developed fever, night sweats, chills, restlessness, and restrictive movement of the fractured leg. Which of the following reflects the findings?

You selected: Osteomyelitis.Correct

Explanation: Fever, night sweats, chills, restlessness, and restrictive movement of the fractured leg are clinica...(


A nurse is teaching a female client about preventing osteoporosis. Which teaching point is correct?

You selected: The recommended daily allowance of calcium may be found in a wide variety of foods.Correct

Explanation: Premenopausal women require 1,000 mg of calcium per day. Postmenopausal women require 1,500 mg per d...(more)


A nurse is caring for a client placed in traction to treat a fractured femur. Which nursing intervention has the highest priority?

You selected: Assessing the extremity for neurovascular integrityCorrect

Explanation: Although all measures are correct, assessing neurovascular integrity takes priority because a decrea...(


A client undergoes a total hip replacement. Which statement made by the client indicates to the nurse that the client requires further teaching?

You selected: "I don't know if I'll be able to get off that low toilet seat at home by myself."Correct

Explanation: The client requires additonal teaching if he is concerned about using a low toilet seat. To prevent ...(


A client with rheumatoid arthritis has increasing fatigue and is unable to manage all of the usual activities. Which of the following nursing interventions is most appropriate?

You selected: Encourage the client to alternate periods of rest and activity throughout the day.Correct

Explanation: The client with rheumatoid arthritis should be encouraged to alternate periods of activity and rest ...(


A 14-year-old has just had a plaster cast placed on his lower left leg. To provide safe cast care, the nurse should?

You selected: Use only the palms of the hand when handling the cast.

CorrectExplanation: The wet plaster cast should be handled using only the palms of the hands to prevent indentations of ...(


A client who has had an above-the-knee amputation develops a dime-sized bright red spot on the dressing after 45 minutes in the postanesthesia recovery unit. The nurse should:

You selected: Draw a mark around the site.Correct

Explanation: The priority action is to draw a mark around the site of bleeding to determine the rate of bleeding....(


A nurse is caring for a client who underwent a total hip replacement. What should the nurse and other caregivers do to prevent dislocation of the new prosthesis?

You selected: Prevent internal rotation of the affected leg.Correct

Explanation: The nurse and other caregivers should prevent internal rotation of the affected leg. However, extern...(


A client has a leg immobilized in traction. Which of the following activities demonstrated by the client indicate that the client understands actions to take to prevent muscle atrophy?

You selected: The client performs isometric exercises to the affected extremity three times per day.Correct

Explanation: Isometric contractions increase the tension within a muscle but do not produce movement. Repeated is...(


A 30-year-old client, hospitalized with a fractured femur being treated with skeletal traction, has not had a bowel movement for 2 days. Which of the following interventions is most appropriate at this time?

You selected: Increase the client's fluid intake to 3,000 ml/day.Correct

Explanation: Increasing the client's fluid intake to 3,000 ml/day, unless contraindicated, is the most appropriate...(


A female client is at risk for developing osteoporosis. Which action will reduce the client's risk?

You selected: Initiating weight-bearing exercise routinesCorrect

Explanation: Performing weight-bearing exercise increases bone health. A sedentary lifestyle increases the risk o...(


To reduce the incidence of complications in a client in traction, which intervention should be included in the care plan?

You selected: Remove the weights during linen changes.Incorrect

Correct response: Increase fiber intake.Explanation: Immobility increases the incidence of constipation. Increasing fiber intake will reduce GI complicat...(


Two days after being placed in a cast for a fractured femur, the client suddenly has chest pain and dyspnea. The client is confused and has an elevated temperature. The nurse should assess the client for:

You selected: Fat embolism syndrome.Correct

Explanation: Clients with fractures of the long bones such as the femur are particularly susceptible to fat embol...(


A client reports having pain in the casted left arm that is unrelieved by pain medication. The nurse assesses the arm and notes that the fingers are swollen and difficult to separate. Which action is

You selected: Call the physician to report swelling and pain.Correct

Explanation: The most appropriate action is to report the swelling, loss of mobility, and unrelieved pain to the ...(


Which nursing diagnosis takes highest priority for a client with a compound fracture?

You selected: Risk for infection related to effects of traumaCorrect

Explanation: A compound fracture involves an opening in the skin at the fracture site. Because the skin is the bo...(


A client is scheduled to undergo an open reduction internal fixation of the right femur. The night before surgery, the nurse administers zolpidem (Ambien) as ordered. Which statement about zolpidem is correct?

You selected: The nurse should administer the drug immediately before bedtime.Correct

Explanation: The nurse should administer zolpidem immediately before bedtime because the onset of action is rapid...(


A client has the leg immobilized in a long leg cast. Which of the following assessments indicates the early beginning of circulatory impairment?

You selected: Tingling of toes.Correct

Explanation: Tingling and numbness of the toes would be the earliest indication of circulatory impairment. Inabil...(


A client is scheduled for a laminectomy to repair a herniated intervertebral disk. When developing the postoperative care plan, the nurse should include which action?

You selected: Turning the client from side to side, using the logroll techniqueCorrect

Explanation: To avoid twisting the spine or hips when turning a client onto the side, the nurse should use the lo...(


A client undergoes hip-pinning surgery to treat an intertrochanteric fracture of the right hip. The nurse should include which intervention in the postoperative care plan?

You selected: Keeping a pillow between the client's legs at all timesCorrect

Explanation: After hip pinning, the client must keep the affected leg abducted at all times; placing a pillow bet...(


Which findings best correlate with a diagnosis of osteoarthritis?

You selected: Joint stiffness that decreases with activityCorrect

Explanation: A characteristic feature of osteoarthritis (degenerative joint disease) is joint stiffness that decr...(


After a right total knee replacement, the client’s right leg is placed in a continuous passive motion (CPM) machine. Nursing responsibilities when caring for a client with this apparatus should include which of the following?

You selected: Maintaining proper positioning of the leg on the CPM machine.Correct

Explanation: The nurse must frequently evaluate the positioning of the client’s leg, the range-of-motion settin...(


Which statement by the client with rheumatoid arthritis would indicate the need for additional teaching to safely receive the maximum benefit of aspirin therapy?

You selected: ”I try to take aspirin only on days when the pain seems particularly bad.”Correct

Explanation: Aspirin therapy in rheumatoid arthritis involves continuous ongoing administration to establish and ...(


After a car accident, a client is admitted to an acute care facility with multiple traumatic injuries, including a fractured pelvis. For 24 to 48 hours after the accident, the nurse must monitor the client closely for which potential complication of a fractured pelvis?

You selected: Fat embolismCorrect

Explanation: Fat embolism is a relatively rare but life-threatening complication of pelvis and long-bone fracture...(


A physician orders chlorzoxazone (Paraflex), 500 mg P.O. t.i.d for a client. The nurse knows that chlorzoxazone, a centrally acting skeletal muscle relaxant, is commonly used to treat:

You selected: severe muscle spasm.Correct

Explanation: Chlorzoxazone is used to treat acute, painful musculoskeletal conditions or severe muscle spasm. Cen...(


To protect a client’s skin under a back brace, the nurse should:

You selected: Have the client wear a thin cotton shirt under the back brace.Correct

Explanation: Having the client wear a thin cotton shirt under a back brace helps to protect the skin and to keep ...(


Which statement by a staff nurse on the orthopedic floor indicates the need for further staff education?

You selected: "The client is receiving physical therapy twice per day, so he doesn't need a continuous passive motion device."Correct

Explanation: Further staff education is needed when the nurse states that the continuous passive motion device is...(


A client is admitted to the hospital with a diagnosis of a right hip fracture. The client has right hip pain and cannot move the right leg. The nurse should further assess the right leg to determine if the leg is:

You selected: Shorter than the leg on the unaffected side.Correct

Explanation: After a hip fracture, the leg on the affected side is characteristically shorter than the unaffected...(


Which of the following indicates that a client with a fracture of the right femur may be developing a fat embolus?

You selected: Acute respiratory distress syndrome.Correct

Explanation: Fat emboli usually result in symptoms of acute respiratory distress syndrome, such as apprehension, ...(


A nurse is assessing a client with possible osteoarthritis. The most significant risk factor for primary osteoarthritis is:

You selected: age.Correct

Explanation: Age is the most significant risk factor for developing primary osteoarthritis. Development of primar...(


A nurse is assessing a client for neurologic impairment after a total hip replacement. Which of the following would indicate impairment in the affected extremity?

You selected: Inability to moveCorrect

Explanation: Being unable to move the affected leg suggests neurologic impairment. A decrease in the distal pulse...(


The client with a fractured tibia has been taking methocarbamol (Robaxin). Which of the following indicate that the drug is having the intended effect?

You selected: Relief of muscle spasms.Correct

Explanation: Methocarbamol is a muscle relaxant and acts primarily to relieve muscle spasms. It has no effect on ...(


A client diagnosed with arthritis doesn't want to take medications. Physical therapy and occupational therapy have been consulted for nonpharmacologic measures to control pain. What might physical and occupational therapy include in the care plan to help control this client's pain?

You selected: An exercise routine that includes range-of-motion (ROM) exercisesCorrect

Explanation: Physical and occupational therapy will most likely develop an exercise routine that includes ROM exe...(


A client comes to the emergency department complaining of pain in the right leg. When obtaining the history, the nurse learns that the client has a history of obesity and hypertension. Based on this information the nurse anticipates the client having which musculoskeletal disorder?

You selected: Degenerative joint diseaseCorrect

Explanation: Obesity predisposes the client to degenerative joint disease. Obesity isn't a predisposing factor fo...(


The nurse should plan to use an abduction pillow (or splint) after a total hip replacement to:

You selected: Prevent dislocation of the prosthesis.Correct

Explanation: After a total hip replacement, it is important to maintain the hip in a state of abduction to preven...(

Musculoskeletal Prep U

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