Musculoskeletal

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1

The nurse is caring for an elderly pt with a fractured femur. The nurse recognizes that which of the following is an early sign of fat embolism?

  1. chest pain and dyspnea
  2. increased respirations, pulse and temp
  3. altered mental status
  4. petechiae

altered mental status

2

The clinic nurse counsels a client c/o low back pain. Which of the following statements made by the ct would require a f/u by the nurse.

  1. "I work full time as a checker at the grocery store."
  2. "I sleep on a firm mattress."
  3. "I walk for 30 min each day."
  4. "I sleep on my side with my knees and hips flexed."

"I work full time as a checker at the grocery store."

3

During an acute flare up of gouty arthritis, the nurse would expect the affected foot to appear...

  1. pale
  2. red
  3. mottled
  4. cyanotic

red

4

The nurse assesses a pt with osteoarthritis. The nurse expects to observe which of the following s/s?

  1. pain on abduction of the hips, waddling gait
  2. fever, rash and nodules over bony prominences
  3. swollen, reddened, painful joint w/limitation of motion
  4. stiffness of the hips, knees, vertebrae, and fingers

fever, rash and nodules over body prominences

5

The nurse cares for a pt in balanced, suspention traction. The pt c/o pain in the effected extremity, and the nurse admin. a prescribed medication. An hour later the pt states that they are not having any relief from the pain. Which action should the nurse take first?

  1. contact the physician
  2. offer the pt a back rub
  3. assess the level of the pt's pain
  4. perform a neurovascular assessment

perform a neurovascular assessment

6

The nurse cares for a pt after a right BKA. The nurse is MOST concerned with which of the following?

  1. the pt periodically naps
  2. the pt c/o a throbbing HA
  3. the pt c/o persistent pain at the operative site
  4. the nurse palpates a pulse above the operative site.

the pt c/o persistent pain at the operative site

7

The nurse cares for a pt w/degenerative joint disease after a total hip replacement. The nurse should intervene if which is observed?

  1. the pt uses an incentive spirometer every 2 hrs
  2. the pt is positioned with a pillow between the legs
  3. the pt's heels are lying on the bed w/toes pointed upward
  4. the pt moves slowly when getting out of bed

the pt's heels are lying on the bed w/toes pointed upward

8

The nurse cares for a pt in Buck's Traction. It is MOST important for the nurse to take what action?

  1. encourage pt to limit body movements
  2. allow wts to hang freely at all times.
  3. remove wts immediatly when pt c/o discomfort
  4. give pain meds regularly

allow wts to hang freely at all times

9

The nurse makes a home care visit to a ct w/osteoarthritis. She would further assess which statement made by the spouse.

  1. "I can tell that my husband has been worrying because he is wringing his hands."
  2. "Last night, he carried a big bowl of vegetables to the table using both hands."
  3. "My husband bends at the knees when he picks up papers off of the floor."
  4. "My husband only uses a small pillow under his head when he sleeps at night."

"I can tell that my husband has been worrying because he is wringing his hands."

10

Prednisone 2mg QD is prescribed for a client w/RA. What important points should the nurse include when teaching the client about this medication?

  1. the healthcare provider will increase the dose until there is complete relief of sx.
  2. the dosage of prednisone must be increased and decreased gradually.
  3. some people experience incontinence as a side effect of this medication.
  4. prednisone is a dangerous medication and must be carefully monitored

the dosage of prednisone must be increased and decreased gradually

11

The nurse prepares discharge teaching for a pt w/a fx'd femure in a cast. The pt asks how to keep the muscles of the leg strong while in the cast. What is the BEST response by the nurse?

  1. "It is important to perform active ROM every day w/your left leg."
  2. "I'll teach your mother to perform active assistive ROM exercises."
  3. "Perform left leg lifts w/a 2 lb wt attached to your ankle."
  4. "I'll teach you how to do isometric exercises."

"I'll teach you how to do isometric exercises."

12

The nurse is caring for a pt w/osteoarthritis. The physician orders celecoxib (Celebrex). The nurse is concerned about which of the following statements?

  1. "I am allergic to aspirin."
  2. "I should take this medication w/food."
  3. "This medication will reduce joint discomfort."
  4. "I will contact the physician if I have any wt gain."

"I am allergic to aspirin."

13

The nurse cares for a client with a newly applied plaster cast to the lower extremity. Which action should be taken by the nurse?

  1. set up a fan to blow on the cast and turn the pt freq.
  2. rest the casted leg on the mattress and avoid handling it until it has dried
  3. elevate the leg on pillows and leave it open to air.
  4. cover the cast lightly with a sheet and remove it freq.

elevate the leg on pillows and leave it open to air

14

The nurse performs a home care visit for a client w/a fx'd right femur, and assess the client's safety while using crutches. The nurse should intervene is which of the following is observed.

  1. When standing, the crutch tips are placed 6in in front and 6 in to the side of each foot.
  2. The ct ambulated using a 3 pt gait.
  3. When going down steps, the ct stands on the unaffected leg, and transfers both crutches in the hand opposite the unaffected leg.
  4. Before sitting in a chair, the ct stands on the unaffected leg and transfers both crutches in the hand opposite the unaffected leg

Before sitting in a chair, the ct stands on the unaffected leg and transfers both crutches in the hand opposite the unaffected leg

15

Which of the following nursing interventions is MOST appropriate for a pt Dx w/RA?

  1. provide support of flexed joints with pillows and pads
  2. position the pt on the abdomen several times a day
  3. massage the inflammed joints alternately w/oil and alcohol
  4. assist the pt w/heat application and ROM exercises

assist the pt w/heat application and ROM exercises

16

A client is evaluated in the clinic for RA. Which of the following finding should assume the highest priority for the nurse when assessing and planning the client's care?

  1. SQ nodules on the right and left forearms
  2. slight contracture of the right wrist
  3. mild erythema of finger joints
  4. bruised area about 3 mm in diameter on right forearm

slight contracture of the right wrist

17

3 hrs after arriving at the orthopedic unit, a pt c/o of a hot feeling under the cast. Which action should the nurse take FIRST.

  1. instruct the pt to lie still since the cast is newly applied
  2. check the circulation in the casted extremity and change the pt's position
  3. check the pt's temp and check for other signs on infx
  4. medicate the pt for pain and notify the physician of the c/o

check the circulation in the casted extremity and change the pt's position

18

A nurse returns to the parking lot after getting groceries and witnesses a car vs pedestrian accident. As the nurse approaches the pedestrian, they call out, "I think my leg is broken!" Which action should the nurse take FIRST.

  1. ask the client to move the ankle and foot on the affected side
  2. inspect the client for evidence of bleeding
  3. cut away the client's pant leg on the affected side
  4. immobilize the affected leg

cut away the client's pant leg on the affected side

19

A pt asks the nurse, "What is the difference b/t RA and osteoarthritis?" Which response is best?

  1. RA is progressive and OA is not
  2. RA is often treated w/surgery and OA is not
  3. RA is systemic and OA is not
  4. There is very little clinical difference between the two.

RA is systemic and OA is not

20

When teaching a pt with a BKA to care for the residual limb at home, the nurse should advise the pt to do which of the following?

  1. apply cream daily to the residual limb
  2. cover the residual limb with a nylon sock
  3. keep the residual limb elevated
  4. expose the residual limb to air

expose the residual limb to air

21

The nurse in the out patient clinic is measuring the ht of an older woman. She is surprised that she is one inch shorter than she used to be. Which of the following statements by the nurse is BEST?

  1. you have degenerative joint disease of the knees and that will cause your ht to decrease.
  2. you have lost ht because you have bursitis of the left shoulder.
  3. you are shorter as a result of Paget's disease
  4. maybe it is because you were Dx w/juvenile RA

you are shorter as a result of Paget's disease

22

The nurse cares for a pt 8 days after an open reduction and internal fixation of the right hip. The nurse should intervene if which is observed?

  1. the pt ate only half of their breakfast
  2. the pt is not wearing elastic stockings
  3. the pt transfers from the bed to bedside commode with assistance
  4. the pt requires pain medication 3X/day

the pt is not wearing elastic stockings

23

Aspirin is prescribed to a client, it should be given with what liquid?

  1. a glass of milk
  2. a glass of orange juice
  3. a glass of diet soda
  4. a small amount of water

a glass of milk

24

Total hip arthroplasty is scheduled for a client w/degenerative joint disease of the left femoral head. It is MOST important for the nurse to place the ct's left leg in which of the following positions?

  1. abducted with toes pointed upward
  2. elevated on 2 pillows w/knees flexed
  3. elevated on several pillows with the ankle abducted
  4. adducted with the ankle joint hyperextended

abducted with toes pointed upward

25

A pt with type I diabetes is scheduled for a right BKA d/t gangrenous toe. The pt wants to know why the amputation is so extensive. The nurse's response should be based on which of the following?

  1. A BKA ensures enough skin to form a flap over the stump
  2. A BKA results in better circulation and healing
  3. A BKA facilitates earliest prosthesis training
  4. A BKA significantly reduces edema of the residual limb

A BKA results in better circulation and healing

26

The nurse cares for a client w/an amputation w/an immediate prosthetic fitting. The nurse should include which of the following in the ct's plan of care.

  1. assess drainage from Penrose drains
  2. observe dressing for s/s of excessive bleeding
  3. elevate the residual limb for no less than 40 hrs
  4. provide cast care on the affected extremity

provide cast care on the affected extremity

27

The nurse prepares the pt for a total hip replacement. Which of the following observations by the nurse necessitates contacting the physician.

  1. the pt's Hgb is 15 g/dL
  2. the pt c/o burning w/urination
  3. the pt c/o periodic heart burn
  4. the pt's platelet count is 250,000/mm3

the pt c/o burning w/urination

28

An elderly female pt undergoes an open reduction and internal fixation (ORIF) of the left femoral head after a fx. Which action by the nurse is BEST.

  1. offer the pt a low-residue diet
  2. turn the pt to the unoperated side
  3. instruct the pt to exercise the arms
  4. encourage the pt to cough and deep breath q2h

encourage the pt to cough and deep breath q2h

29

The nurse in the outpt clinic is teaching a client receiving probenecid (Benemid). What is MOST important for the nurse to relay to the pt?

  1. drink 6-8 glasses of water each day
  2. take the medication on an empty stomach
  3. you may take ASA for minor pain
  4. you are permitted to drink wine w/dinner

drink 6-8 glasses of water each day

30

The nurse evaluates care given to a pt after a left BKA. The nurse should intervene if she observes this

  1. a tourniquet is placed in the pt's bedside table
  2. the pt lies on his stomach several times per day
  3. the nurse uses a transfer belt when pt transfers from bed to chair
  4. the pt sits on a chair freq. for short periods of time

a tourniquet is placed in the pt's bedside table


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