Musculoskeletal

Question 1

An orthopedic nurse is providing education to a younger adult who sustained an ankle injury while playing sports. The client states, “This is the second time I have done this. I didn’t have problems until I bought new shoes.” Based on the client statement, which response by the nurse is appropriate?
A. “You should think about giving up sports to prevent injuries.”
B. “You could try wearing a boot while playing sports.”
C. “You need to take anti-inflammatory medications before playing sports.”
D. “You should wear high-top shoes when playing sports.”

Answer 1

D. “You should wear high-top shoes when playing sports.”

High-top shoes provide additional support to the ankles, where low-top shoes allow more ankle movement. While high-top shoes will not prevent ankle injuries, clients are less likely to sustain injuries while wearing them.

Question 2

A nurse is caring for four clients on high-risk fall precautions. Based on their risk factors, which client is at the highest risk for sustaining a hip fracture due to a fall?
A. A 78-year-old female with a history of vitamin D deficiency
B. An 81-year-old male with a history of skin cancer
C. A 36-year-old male client with a history of alcohol abuse
D. A 62-year-old female with a history of urinary incontinence

Answer 2

A. A 78-year-old female with a history of vitamin D deficiency

Question 3

The nurse is analyzing results of an X-ray performed on a client suspected of having rheumatoid arthritis (RA). Which result supports this diagnosis?
A. Increased bone density around the joints
B. Soft tissue swelling
C. “Honeycomb” appearance of bones
D. Widening of the joint space

Answer 3

B. Soft tissue swelling

In clients diagnosed with RA, imaging studies, such as X-ray, can reveal soft tissue swelling around the affected joint. This occurs due to the cytokines released in the pannus causing an inflammatory response.

Question 4

The nurse is performing an assessment on a client diagnosed with RA. Which client statement indicates to the nurse that the client is experiencing a complication that needs to be reported to the provider immediately?
A. “I developed soreness in my groin, which I didn’t have when I was first diagnosed.”
B. “When I first wake up in the morning, the pain in my hands is excruciating.”
C. “I feel so tired that sometimes it makes me not want to eat.”
D. “I have a new tingling sensation which radiates down into my legs.”

Answer 4

D. “I have a new tingling sensation which radiates down into my legs.”

A complication of RA is when joint destruction affects the C1-C2 joint, which is the only synovial joint in the spine. This can cause quadriplegia and is not an expected assessment finding. This should be reported to the provider immediately.

Question 5

The nurse is preparing to assess a client with chronic gout. Which finding should the nurse correlate with a long-term complication of gout?
A. Decreased peripheral blood flow
B. Skin ulceration
C. Tophi
D. Osteomyelitis

Answer 5

C. Tophi

Chronic gout can eventually lead to permanent deposits of urate crystals, called tophi, along with the bones just beneath the skin.

Question 6

The nurse is creating a plan of care for a client with a fracture. Which nursing diagnosis(es) should the nurse include? Select all that apply.
A. Ineffective cardiac tissue perfusion
B. Risk for shock
C. Risk for impaired neurovascular dysfunction
D. Acute pain
E. Failure to thrive

Answer 6

B. Risk for shock
C. Risk for impaired neurovascular dysfunction
D. Acute pain

Question 7

The nurse is preparing an interdisciplinary plan of care for a client with compartment syndrome. Which is an appropriate task to delegate to a healthcare assistant?
A. Perform a neurovascular assessment
B. Obtain a compartment pressure measurement
C. Prepare the client for a fasciotomy
D. Measure the urine output

Answer 7

D. Measure the urine output

Question 8

The emergency department nurse is caring for a client with a second-degree ankle sprain sustained after falling off a ladder. Which intervention(s) should the nurse implement for this client? All apply, expect?
A. Place a heat pack on the extremity
B. Assess bilateral pedal pulses
C. Apply an immobilizing splint
D. Elevate the injured ankle
E. Administer ibuprofen 800 mg by mouth

Answer 8

A. Place a heat pack on the extremity

Question 9

A client with a fractured right tibia has suspected acute compartment syndrome. After the cast has been removed, which assessment finding(s) indicate to the nurse that the intervention has been effective? Select all that apply.
A. Numbness of the extremity
B. Pain 2/10 on a 10-point scale
C. Bilateral 3+ pedal pulses
D. Capillary refill of 4 seconds on the affected extremity
E. +1 edema in the lower affected extremity

Answer 9

B. Pain 2/10 on a 10-point scale
C. Bilateral 3+ pedal pulses

Question 10

The nurse is reviewing the diagnostic results for a client suspected of having a tibia fracture. Which result helps to confirm a diagnosis of a fracture?
A. The ultrasound reveals decreased bone mass and strength.
B. The white blood cell (WBC) count is 5,000/mm3.
C. The calcium is 9.5 mg/dL and vitamin D is 35 ng/mL.
D. The X-ray reveals a break in continuity of the bone shaft.

Answer 10

D. The X-ray reveals a break in continuity of the bone shaft.

Question 11

The nurse is discussing the causes of rheumatoid arthritis (RA) with a newly diagnosed client. The client asks the nurse, “Why is this happening to me? I don’t understand what triggered this.” Which response by the nurse is appropriate?
A. “RA has a direct correlation to repetitive knuckle cracking and hand injuries, such as ones associated with boxing.”
B. “RA occurs after an exposure to a specific antigen, causing the body to release histamine, which leads to smooth muscle contraction, vessel dilation, and constriction of the bronchioles.”
C. “Although the exact cause is unknown, RA is thought to be triggered by an interaction between genetic and environmental factors.”
D. “The cause of RA is due to a genetic mutation in the filaggrin gene and tends to run in families.”

Answer 11

C. “Although the exact cause is unknown, RA is thought to be triggered by an interaction between genetic and environmental factors.”

Question 12

The nurse caring for a client with a casted closed fracture is performing an assessment. Which finding(s) should the nurse communicate to the primary healthcare provider? Select all that apply.
A. Capillary refill greater than 5 seconds on affected limb
B. Warm, pink skin on the affected extremity
C. Oral temperature of 37.8° C (100°F) and odor coming from the cast
D. Digit movement on the affected extremity
The nurse caring for a client with a casted closed fracture is performing an assessment. Which finding(s) should the nurse communicate to the primary healthcare provider?
E. Increased swelling and pain in the extremity with a cast

Answer 12

A. Capillary refill greater than 5 seconds on affected limb
C. Oral temperature of 37.8° C (100°F) and odor coming from the cast
E. Increased swelling and pain in the extremity with a cast

Question 13

Which information should the nurse document when assessing the six P’s of a client at risk for compartment syndrome? Select all that apply.
A. Paralysis
B. Palpation
C. Percussion
D. Pallor
E. Poikilothermia
F. Paresthesia

Answer 13

A. Paralysis
D. Pallor
E. Poikilothermia
F. Paresthesia

Question 14

A client underwent an internal fixation to repair a right hip fracture three days ago. Today, the nurse caring for the client observes a dusky right foot and a thready pedal pulse. What is the best action by the nurse?
A. Raise the head of the bed to 90 degrees
B. Recommended installation of a trapeze bar in the client’s room
C. Obtain an order for a broad-spectrum antibiotic
D. Notify the surgeon immediately

Answer 14

D. Notify the surgeon immediately

After the surgical intervention of a hip fracture, clients are at risk for neurovascular compromise. A dusky extremity indicates a lack of perfusion to the affected area. This is an emergency, and the surgeon should be notified right away. The client requires urgent intervention to save the affected limb from ischemia.

Question 15

A client who sustained an ankle sprain asks the nurse about complications they may experience. Which response(s) by the nurse are appropriate? Select all that apply.
A. “Long-term complications include a neutral foot position, intact ankle dorsiflexion, and foot necrosis.”
B. “You could develop osteoarthritis, foot drop, and severe bleeding as short-term complications.”
C. “You may have stiffness, impaired range of motion, and instability of the ankle long-term.”
D. “Short-term complications can include nerve injuries, vascular injuries, or compartment syndrome.”
E. “A long-term complication is rheumatoid arthritis (RA) and a short-term complication is Dupuytren’s contractures.”

Answer 15

C. “You may have stiffness, impaired range of motion, and instability of the ankle long-term.”
D. “Short-term complications can include nerve injuries, vascular injuries, or compartment syndrome.”

Question 16

A client is scheduled to receive 60 mg of baclofen by mouth for treatment of multiple sclerosis (MS). The client is lethargic, drowsy, and difficult to arouse. Which action by the nurse is most appropriate?
A. Decrease the dose and administer the medication
B. Withhold the medication and alert the healthcare provider
C. Administer the medication as ordered
D. Hold the medication until the client is more alert

Answer 16

B. Withhold the medication and alert the healthcare provider

Skeletal muscle relaxants, such as baclofen, can cause dizziness and drowsiness. The medication should not be administered if clients have an altered level of consciousness or are unable to be easily aroused. In this situation, the nurse should withhold the medication and alert the healthcare provider.

Question 17

The nurse performing an assessment on a client with an ankle sprain asks the client to point the toes of the affected foot to the ceiling and then down to the floor. How should the nurse document this action in the medical record?
A. Dorsiflexion and plantar flexion intact
B. Positive internal and external rotation
C. Absent supination and pronation
D. Abduction and adduction present

Answer 17

A. Dorsiflexion and plantar flexion intact

Question 18

The student nurse is creating a plan of care for a client newly diagnosed with rheumatoid arthritis (RA). Which nursing diagnosis has the highest priority?
A. Readiness for enhanced coping related to a new diagnosis
B. Chronic pain related to joint inflammation
C. Activity intolerance related to chronic pain and fatigue
D. Imbalanced nutrition: less than body requirements related to lack of appetite

Answer 18

D. Imbalanced nutrition: less than body requirements related to lack of appetite

Question 19

The nurse preceptor is assisting a newly graduated nurse to develop a plan of care for a client with a closed fracture. Which statement made by the newly graduated nurse should the nurse preceptor question?
A. “I’ll notify the orthopaedic surgeon if the client experiences complications.”
B. “I can ask the nursing assistant to obtain the client’s vital signs.”
C. “I will include the physical therapist in this client’s plan of care.”
D. “The wound care nurse will be consulted for this client.”

Answer 19

D. “The wound care nurse will be consulted for this client.”

Question 20

The assistive personnel (AP) is caring for an elderly female client diagnosed with rheumatoid arthritis (RA). The AP communicates the interactions with the client to the nurse. Which report by the AP requires immediate attention by the nurse?
A. The client reports symptoms of acid reflux despite having taken several antacid pills.
B. The client only consumes 10% of their breakfast tray due to fatigue
C. The client reports “numbness and tingling in bilateral hands.”
D. The client states, “I can’t even look at my hands, these bumps make them hideous!”

Answer 20

A. The client reports symptoms of acid reflux despite having taken several antacid pills.

Question 21

Which statement should the nurse include when discussing the pathological process of acute compartment syndrome with a client?
A. “Increased pressure occurs in an enclosed compartment.”
B. “Damage to the muscles causes a decreased blood flow.”
C. “The elasticity of the fascia is decreased from the pressure.”
D. “The increased pressure of blood flow damages the vessels.”

Answer 21

A. “Increased pressure occurs in an enclosed compartment.”

Question 22

The nurse caring for a client with an ankle fracture is evaluating the effectiveness of treatment. Which objective assessment finding indicates that the treatment has been successful?
A. 9/10 pain rating in affected extremity
B. Report of numbness and tingling
C. Blue-tinged toes on the affected limb
D. Bilateral pedal pulses of 3+

Answer 22

D. Bilateral pedal pulses of 3+

Question 23

An orthopedic nurse is discussing ankle sprains with a group of nursing students. Which statement made by a student identifies a common cause of ankle sprains?
A. “Sprains can occur when the ankle twists awkwardly during exercise, falling, or playing sports.”
B. “Sprains occur when bone spurs develop in the joints, causing inflammation to the ligaments.”
C. “Anaemia affects bone metabolism in the body, softening the bones which leads to sprains.”
D. “An excess of calcium deposits in the ankle causes the muscles to weaken, leading to a sprain.”

Answer 23

A. “Sprains can occur when the ankle twists awkwardly during exercise, falling, or playing sports.”

Question 24

Which client is at most risk for acute compartment syndrome?
A. A client with a second-degree burn on the anterior forearm
B. A client with a comminuted femur fracture
C. A client who has received a unit of packed red blood cells
D. A client with an L-1 vertebral stress fracture

Answer 24

B. A client with a comminuted femur fracture

Question 25

The nurse is preparing a client for testing to confirm the diagnosis of gout. Which test should the nurse prepare the client for?
A. Erythrocyte sedimentation rate (ESR)
B. Blood urate level
C. X-ray
D. Arthrocentesis

Answer 25

D. Arthrocentesis

Question 26

The nurse is discussing the effectiveness of treatment for a client diagnosed with rheumatoid arthritis (RA) prescribed hydroxychloroquine. Which client statement indicates that treatment needs to be re-evaluated?
A. “I feel so nauseous when I take my medication.”
B. “I have these bumps on my hands and they won’t go away!”
C. “I can’t even drive a car anymore because my wrists hurt too much.”
D. “I’ve taken this pill for 5 weeks now and I only feel slightly better.”

Answer 26

C. “I can’t even drive a car anymore because my wrists hurt too much.”

This statement indicates that the treatment with hydroxychloroquine is not effective.