Davis Ch 11: Musculoskeletal Comprehensive Exam

Question 1

The 50-year-old female client is being evaluated for osteoporosis. Which data should the nurse assess? Select all that apply.

1. Family history of osteoporosis.
2. Estrogen or androgen deficit.
3. Exposure to secondhand smoke. 4. Level and amount of exercise.
4. Alcohol intake.

Answer 1

ANS: 1, 2, 4, 5

1. Clients are more prone to have osteoporosis if there is a genetic predisposition.
2. Clients who are deficient in either estrogen or androgen are at risk for osteoporosis.
3. Clients who smoke are more at risk for osteoporosis. Research does not show a correlation between osteoporosis and secondhand smoke.
4. Regular, weight-bearing exercise promotes healthy bones.
5. Clients who consume alcohol and have diets low in calcium are at a higher risk for osteoporosis.

Question 2

Which intervention should the nurse include for a client diagnosed with carpal tunnel syndrome?

1. Teach hyperextension exercises to increase flexibility.
2. Monitor safety during occupational hazards.
3. Prepare for the insertions of pins or screws.
4. Monitor dressing and drain after the fasciotomy.

Answer 2

ANS: 2

1. Treatment for carpal tunnel syndrome does not include hyperextension of the wrist.
2. The nurse should monitor for potential injuries resulting from the alterations in motor, sensory, and autonomic function of the first three digits of the hand and palmar surface of the fourth.
3. Surgery may be needed to release the compression of the medial nerve, but pins and screws are used to hold the position.
4. Fasciotomy refers to the surgical excision of strips of connective tissue. This is not applicable in clients with carpal tunnel syndrome.

Question 3

Which staff nurse should the charge nurse assign to the client recovering from a repair of the hallux valgus?

1. A new graduate nurse.
2. An experienced nurse.
3. A nurse practitioner.
4. An unlicensed assistive personnel.

Answer 3

ANS: 1

1. A new graduate is the best choice for this client. The client’s surgery (correction of a hammer toe) is not a high-risk procedure but requires assessment and pain management.
2. This client does not need a more experienced nurse.
3. A nurse practitioner does not need to be assigned to this client.
4. The UAP is not assigned the responsibility of managing the care of a client; the UAP

Question 4

The client is scheduled for a computed tomography (CT) scan. Which question is most important for the nurse to ask before the procedure?

1. “On a scale of 1 to 10, how do you rate your pain?”
2. “Do you feel uncomfortable in enclosed spaces?”
3. “Are you allergic to seafood or iodine?”
4. “Have you signed a permit for this procedure?”

Answer 4

ANS: 3

1. The assessment of the pain is important so the client will be able to tolerate the procedure. Pain is not a life-threatening problem but is a quality-of-care issue.
2. This is an appropriate question for a client having a closed MRI, not a CT scan.
3. This is the most important information the nurse should obtain. Any client who is allergic to seafood cannot be injected with the iodine-based contrast. This contrast could cause an allergic response endangering the client’s life.
4. The general consent for admission to the hospital covers this procedure. A separate informed consent is not required.

Question 5

Two unlicensed assistive personnel (UAP) are using the transfer board to move the client from the bed to the wheelchair. Which action should the nursing take?

1. Take no action because this is the correct procedure for transferring a client.
2. Instruct the UAPs not to use a transfer board when moving the client.
3. Tell the UAPs to use the bed scale sling to move the client to the chair.
4. Request the UAPs to stop and come to the nurse’s station immediately.

Answer 5

ANS: 1

1. The UAPs are transferring the client correctly and safely, so no action should be taken. The UAPs are adhering to the Patient Care Safety Standards by using approved equipment.
2. The nurse should encourage the use of appropriate equipment designed to protect the client and the staff from injury.
3. The bed scale sling is inappropriate to use when moving the client from the bed to a wheelchair.
4. There is no reason for the nurse to stop the UAPs since the task is being performed correctly.

Question 6

Which priority intervention should the day surgery nurse implement for a client who has had right knee arthroscopy?

1. Encourage the client to perform range-of- motion exercises.
2. Monitor the amount and color of the urine.
3. Check the client’s pulses distally and assess the toes.
4. Monitor the client’s vital signs.

Answer 6

ANS: 3

1. The nurse should not encourage range of motion until the surgeon gives permission for flexion of the knee.
2. Urinary output is important postoperatively, but monitoring it is not priority over a neurovascular assessment.
3. Neurovascular assessment is priority because this surgery has two to three small incisions in the knee area. The nurse needs to make sure circulation is getting past the surgical site.
4. Vital signs should be assessed, but the priority is to maintain the neurovascular status of the limb.

Question 7

The client is prescribed Fosamax, a bisphosphonate. Which information should the nurse teach?

1. Take this medication with a full glass of water.
2. Take with breakfast to prevent gastrointestinal upset.
3. Use sunscreen to prevent sensitivity to sunlight.
4. This medication increases calcium reabsorption.

Answer 7

ANS: 1

1. The client needs to take this medication with a full glass of water and remain upright for at least 30 minutes to reduce the risk of esophagitis.
2. This medication should be taken before breakfast on an empty stomach.
3. This medication does not cause photosensitivity.
4. This medication decreases calcium reabsorption by decreasing the activity of osteoclasts.

Question 8

The school nurse is completing spinal screenings. Which data require a referral to an HCP?

1. 1. Bilateral arm lengthening while bending over at the waist.
2. A deformity which resolves when the head is raised.
3. Equal spacing of the arms and body at the waist.
4. A right arm lower than the left while bending over at the waist.

Answer 8

ANS: 4

1. These are normal data and do not require intervention.
2. If the screener suspects the client has scoliosis while the client is bending over, the screener asks the client to raise the head. An abnormality caused by scoliosis will not resolve.
3. This indicates a normal occurrence and does not need to be referred.
4. Unequal arm length may indicate scoliosis, and further assessment is needed by an HCP.

Question 9

The clinic nurse assesses a client with complaints of pain and numbness in the left hand and fingers. Which question should the nurse ask the client?

1. 1. “Do you smoke or use any type of tobacco products?”
2. “Do you have to wear gloves when you are out in the cold?”
3. “Do you do repetitive movements with your left fingers?”
4. “Do you have tremors or involuntary movements of your hand?”

Answer 9

ANS: 3

1. Assessing for smoking is evaluation for Raynaud’s disease.
2. Exposure to cold is appropriate to assess for Raynaud’s disease.
3. Repetitive movements are appropriate to assess for carpal tunnel syndrome. Clients with this disorder experience pain and numbness.
4. Tremors or involuntary movements could indicate Parkinson’s disease.

Question 10

Which statement by the client prescribed calcitonin, a thyroid hormone, indicates to the nurse the teaching has been effective?

1. “I should administer the mediation in a different nostril each day.”
2. “I need to drink a lot of water when I take my medicine.”
3. “I have to dilute the medication with vitamin D before I take it.”
4. “This medication will help the calcium leave my bones.”

Answer 10

ANS: 1

1. This medication is administered intranasally. Alternating nostrils will decrease the risk of nasal irritation.
2. This intervention should be implemented for Fosamax, a bisphosphonate, not calcitonin, thyroid hormone.
3. Clients do not dilute their medication. Vitamin D is not used as a diluent for medication.
4. Calcium should be retained in the bone to maintain bone strength; medications are not administered to encourage loss from the bone.

Question 11

The client diagnosed with rule-out osteosarcoma asks the nurse, “Why am I having a bone scan?” Which statement is the nurse’s best response?

1. “You seem anxious. Tell me about your anxieties.”
2. “Why are you concerned? Your HCP ordered it.”
3. “I’ll have the radiologist come back to explain it again.”
4. “A bone scan looks for cancer or infection inside the bones.”

Answer 11

ANS: 4

1. This is a therapeutic technique, but the client is asking for information. When a client seeks information, the nurse should give information first. Discussion of feelings should follow.
2. This nontherapeutic technique blocks communication between the client and the nurse. The nurse should avoid a response with the word “why,” which asks the client to explain or justify feelings to the nurse.
3. When the client requests information, the nurse needs to provide accurate information, not pass the buck.
4. This statement answers the client’s question.

Question 12

The client is scheduled for a magnetic resonance imaging (MRI) scan. Which intervention should the nurse delegate to the unlicensed assistive personnel (UAP)?

1. Prepare the client by removing all metal objects.
2. Inject the contrast into the intravenous site.
3. Administer a sedative to the client to decrease anxiety.
4. Explain why the client cannot have any breakfast.

Answer 12

ANS: 1

1. Metal objects such as jewelry and zippers can interfere with the magnetic imaging and pose a danger to the client as a result of the magnetic properties of the equipment. This intervention can be delegated to the UAP.
2. Injection of contrast is given in the radiology department.
3. UAPs are unable to administer medications in hospitals.
4. The nurse cannot delegate teaching to a UAP.

Question 13

A client sustained a fractured femur in a motor- vehicle accident. Which data require immediate intervention by the nurse? Select all that apply.

1. The client requests pain medication to sleep.
2. The client has eupnea and normal sinus rhythm.
3. The client has petechiae over the neck and chest.
4. The client has a high arterial oxygen level.
5. The client has yellow globules floating in the urine.

Answer 13

ANS: 3, 5

1. The client requesting something for sleep is expected and does not require notifying the HCP.
2. Normal respirations and heart rate do not require notifying the HCP.
3. Petechiae are macular, red–purple pinpoint bleeding under the skin. The appearance of petechiae is a classic sign of fat embolism syndrome.
4. The arterial oxygen level would be low, not elevated. This sign does not warrant immediate intervention.
5. Yellow globules in the urine are fat globules released from the bone as it breaks. This should be reported immediately.

Question 14

The nurse is caring for the client diagnosed with fat embolism syndrome. Which HCP order should the nurse question?

1. Maintain heparin to achieve a therapeutic level.
2. Initiate and monitor intravenous fluids.
3. Keep the O2 saturation higher than 93%.
4. Administer an intravenous loop diuretic

Answer 14

ANS: 4

1. The HCP should prescribe heparin to treat a fat embolism.
2. The client should be hydrated to prevent platelet aggregation.
3. The nurse should monitor oxygen levels and administer oxygen as needed to prevent further complications.
4. The nurse should question this order. This will decrease the client’s hydration and may result in further embolism.

Question 15

The client is postoperative open reduction and internal fixation (ORIF) of a fractured femoral neck. Which long-term goal should the nurse identify for the client?

1. The client will maintain vital signs within normal limits.
2. The client will have a decrease in muscle spasms in the affected leg.
3. The client will have no signs or symptoms of infection.
4. The client will be able to ambulate down to the nurse’s station.

Answer 15

ANS: 4

1. Vital signs remaining stable is a short-term goal, not a long-term goal.
2. This is an expected short-term outcome for a preoperative client with a fractured femoral neck.
3. No signs/symptoms of infection is a short-term goal for the nurse to identify in the hospital.
4. The discharge goal or long-term goal for this client is to return the client to ambulatory status.

Question 16

The nurse is preparing to administer subcutaneous Lovenox, a low molecular weight heparin. Which intervention should the nurse implement?

1. Monitor the client’s serum aPTT.
2. Encourage oral and intravenous fluids.
3. Do not eat foods high in vitamin K.
4. Administer in the anterolateral upper abdomen.

Answer 16

ANS: 4

1. An aPTT is used to determine therapeutic levels of unfractionated heparin. Laboratory studies such as aPTT are not monitored when administering subcutaneous Lovenox, a low molecular weight heparin. A therapeutic level will not be achieved as a result of a short half-life.
2. Oral fluids do not need to be increased because of this medication.
3. Vitamin K is the antidote for warfarin (Coumadin), an oral anticoagulant. It does not affect Lovenox.
4. Administering the medication in the prescribed areas, the “love handles,” ensures safety and decreases the risk of abdominal trauma.

Question 17

Which intervention should the nurse implement for a client with a fractured hip in Buck’s traction?

1. Assess the insertion sites for signs and symptoms of infection.
2. Monitor for drainage or odor from under the plaster covering the pins.
3. Check the condition of the skin beneath the Velcro boot frequently.
4. Take weights off for one (1) hour every eight (8) hours and as needed.

Answer 17

ANS: 3

1. Skeletal traction has a pin, screws, tongs, or wires inserted into the bone. There is no insertion site in skin traction.
2. Plaster traction is a combination of skeletal traction using pins and a plaster brace to maintain alignment of any deformities.
3. In Buck’s traction, a Velcro boot is used to attach the ropes to weights to maintain alignment. Skin covered by the boot can become irritated and break down.
4. Buck’s traction is applied preoperatively to prevent muscle spasms and maintain alignment, and the weights should not be removed unless assessing for skin breakdown.

Question 18

The nurse is caring for a client in a hip spica cast. Which intervention should the nurse include in the plan of care?

1. Assess the client’s popliteal pulses every shift.
2. Elevate the leg on pillows and apply ice packs.
3. Teach the client how to ambulate with a tripod walker.
4. Assess the client for distention and vomiting.

Answer 18

ANS: 4

1. The client’s popliteal pulse will be under the cast and cannot be assessed by the nurse; circulation is assessed by the 6 Ps of the neurovascular assessment.
2. Elevation should be used with an arm cast or leg cast, but this is not possible with a spica cast.
3. Clients with spica casts will not be able to ambulate because the cast covers the entire lower half of the body.
4. The nurse should assess the client for signs and symptoms of cast syndrome—vomiting after meals, epigastric pain, and abdominal distention. This is caused by a partial bowel obstruction from compression and can lead to complete obstruction. The client may still have bowel sounds present with this syndrome.

Question 19

The nurse is discharge teaching for a client with a short leg cast. Which statement indicates the client understands the discharge
teaching?

1. “I need to keep my leg elevated on two pillows for the first 24 hours.”
2. “I must wear my sequential compression device all the time.”
3. “I can remove the cast for one (1) hour so I can take a shower.”
4. “I will be able to walk on my cast and not have to use crutches.”

Answer 19

ANS: 1

1. This is a correct intervention. The leg should be elevated for at least the first 24 hours. If edema is present, the client needs to keep it elevated longer.
2. Sequential compression devices work to prevent deep vein thrombosis and the client does not wear one of these at home.
3. The client will not be able to remove the cast for any reason. The cast must be cut off.
4. Clients with casts can only ambulate if they have a walking cast or boot. This information is not in the stem of the question.

Question 20

Which psychosocial problem should the nurse identify for a client with an external fixator device?

1. Ineffective coping.
2. Alteration in body image.
3. Grieving.
4. Impaired communication.

Answer 20

ANS: 2

1. The client problem of ineffective coping is usually not indicated for a client with an external fixator device, unless the stem provides more information about the client.
2. Many clients with an external fixator have alterations in body image because the large, bulky frame makes dressing difficult and because of scarring which occurs from the trauma and treatment. The length of healing is prolonged, so returning to the client’s normal routine is delayed.
3. The client problem of grieving is usually not indicated for a client with an external fixator device, unless the stem of the question provides more information about the client.
4. The client problem of impaired communication is usually not indicated for a client with an external fixator device, unless the stem provides more information about the client.

Question 21

A client recovering from a total hip replacement has developed a deep vein thrombosis. The health-care provider has ordered a continuous infusion of heparin, an anticoagulant, to infuse at 1,200 units per hour. The bag comes with 20,000 units of heparin in 500 mL of 0.9% normal saline. At what rate should the nurse set the pump? ______

Answer 21

30 mL/hr.
Divide the amount of heparin by the volume of fluid to get the concentration: 20,000 units ÷ 500 mL = 40 units of heparin per 1 mL

Question 22

The nurse is caring for a client with a left fractured humerus. Which data warrant intervention by the nurse?

1. Capillary refill time is less than three (3) seconds.
2. Pain is not relieved by the patient-controlled analgesia.
3. Left fingers are edematous and the left hand is purple.
4. Warm and dry skin on left fingers distal to the elastic bandage.

Answer 22

ANS: 2

1. This is a normal assessment finding and does not require immediate action.
2. Unrelieved pain should warrant intervention by the nurse. Pain may indicate a complication or the need for pain medication, but either way it warrants intervention.
3. Edema and a hematoma as a result of the injury are expected and do not warrant intervention by the nurse.
4. The fingers distal to the Ace bandage indicate adequate circulation and require no intervention.

Question 23

The client with a long arm cast is complaining of unrelenting severe pain and feeling as if the fingers are asleep. Which complication should the nurse suspect the client is experiencing?

1. Fat embolism.
2. Compartment syndrome.
3. Pressure ulcer under the cast.
4. Surgical incision infection.

Answer 23

ANS: 2

1. These are not signs/symptoms of a fat embolism.
2. These are the classic signs/symptoms of compartment syndrome.
3. Clients in casts rarely develop pressure ulcers and usually they are not painful.
4. Hot spots on the cast usually indicate an infection of the surgical incision under the cast.

Question 24

The elderly client is admitted to the hospital for severe back pain. Which data should the nurse assess first during the admission assessment?

1. The client’s use of herbs.
2. The client’s current pain level.
3. The client’s sexual orientation.
4. The client’s ability to care for self.

Answer 24

ANS: 2

1. This is a question the admitting nurse asks all clients, but it is not the most important.
2. Pain assessment and management are the most important issues if the client is breathing and has circulation. Lack of pain management decreases the attention of the client during the admission process. Pain is called the fifth vital sign.
3. Sexual practices are included in the admission forms, but they are not as important as pain management.
4. Assessing the client’s ability to perform activities of daily living and self-care is important to prepare this client for discharge, which begins on admission, but this is not the most important at this time.

Question 25

Which information should the nurse teach the client regarding sports injuries?

1. Apply heat intermittently for the first 48 hours.
2. An injury is not serious if the extremity can be moved.
3. Only return to the health-care provider if the foot becomes cold.
4. Keep the injury immobilized and elevated for 24 to 48 hours.

Answer 25

ANS: 4

1. Ice should be applied intermittently for the first 48 hours. Heat can be used later in the recovery process.
2. Severe injury can be present even with some range of motion.
3. The client needs to return if the injury does not improve and if the foot gets cold.
4. The leg should be iced, elevated, and immobilized for 48 hours.

Question 26

The emergency department nurse is caring for a client with a compound fracture of the right ulna. Which interventions should the nurse implement? List in order of priority.

1. Apply a sterile, normal saline–soaked gauze to the arm.
2. Send the client to radiology for an x-ray of the arm.
3. Assess the fingers of the client’s right hand.
4. Stabilize the arm at the wrist and the elbow.
5. Administer a tetanus toxoid injection.

Answer 26

The order should be 4, 1, 3, 2, 5.

4. The nurse first should stabilize the arm to prevent further injury.
5. A compound fracture is one in which the bone protrudes through the skin.
6. The nurse should apply sterile, saline-soaked gauze to protect the area from the intrusion of bacteria. The nurse should assess the client’s circulation to the part distal to the injury. This is done after the first two interventions because life-threatening complications could occur if stabilization and protection from infection are not addressed first
7. An x-ray will be needed to determine the extent of the injury.
8. A tetanus toxoid injection should be administered, but this can be done last.

Question 27

The emergency department nurse is caring for a 6-year-old child with a fractured forearm and suspects the injury is the result of abuse. Which x-ray would confirm the suspicions for the nurse?

Answer 27

ANS: 2

1. A compound fracture is a fracture where the bone protrudes through the skin; it is also called an open fracture, and the nurse would not suspect child abuse based on only the type of fracture.
2. A spiral fracture is a fracture that involves twisting around the shaft of the bone, such as when an adult twists the arm of a child. The nurse should suspect child abuse.
3. An oblique fracture is a fracture that re- mains contained and does not break the skin. There are many reasons the child could have this type of fracture other than child abuse.
4. A greenstick fracture is a fracture in which one side of the bone is broken and the other side is bent. There are many reasons other than child abuse that could account for this type of fracture.