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Flashcards in Musculoskeletal Deck (150)
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The female client diagnosed with osteoporosis tells the nurse that she is going to
perform swim aerobics for 30 minutes every day. Which response would be most
appropriate by the nurse?
1. Praise the client for committing to do this activity.
2. Explain that walking 30 minutes a day is a better activity.
3. Encourage the client to swim every other day instead of daily.
4. Discuss that sedentary activities help prevent osteoporosis.

2. Weight-bearing activity, such as walking, is
beneficial in preventing or slowing bone
loss. The mechanical force of weight-bearing
exercises promotes bone growth.


The client newly diagnosed with osteoporosis is prescribed calcitonin by nasal spray.
Which assessment data would indicate an adverse effect of the medication?
1. The client complains of nausea and vomiting.
2. The client is drinking two (2) glasses of milk a day.
3. The client has a runny nose and nasal itching.
4. The client has had numerous episodes of nosebleeds.

4. Nosebleeds are adverse effects and should be reported to the client's HCP.


The nurse is teaching a class to pregnant teenagers. Which information is most important
when discussing ways to prevent osteoporosis?
1. Take at least 1200 mg of calcium supplements a day.
2. Eat foods low in calcium and high in phosphorus.
3. Osteoporosis does not occur until around age 50 years.
4. Remain as active as possible until the baby is born.

1. The National Institutes of Health recommend a daily calcium intake of 1200 to 1500 mg per day for adolescents, young adults, and pregnant and lactating women.


The 84-year-old client is a resident in a long-term care facility. Which intervention
should be implemented to help prevent complications secondary to osteoporosis?
1. Keep the bed in the high position.
2. Perform passive range-of-motion exercises.
3. Turn the client every two (2) hours.
4. Provide nighttime lights in the room.

4. Nighttime lights will help prevent the client from falling; fractures are the number one complication of osteoporosis.


The client is taking calcium carbonate (Tums) to help prevent further development of
osteoporosis. Which teaching should the nurse implement?
1. Encourage the client to take Tums with at least eight (8) ounces of water.
2. Teach the client to take Tums with the breakfast meal only.
3. Instruct the client to take Tums 30 to 60 minutes before a meal.
4. Discuss the need to get a monthly serum calcium level.

3. Free hydrochloric acid is needed for calcium absorption; therefore, Tums should be taken on an empty stomach.


The client must take three (3) grams of calcium supplement a day. The medication
comes in 500 mg/tablets. How many tablets will the client need to take daily?_______

Six (6) tablets. 1000 mg is equal to one (1) gram.
Therefore three (3) grams is equal to 3000 mg. If
one (1) tablet is 500 mg, the client will need six (6)
tablets to get the total amount of calcium needed
3000 ÷ 500  6


The nurse instructs the client with a right BKA to lie on the stomach for at least 30
minutes a day. The client asks the nurse, “Why do I need to lie on my stomach?”
Which statement would be the most appropriate statement by the nurse?
1. “This position will help your lungs expand better.”
2. “Lying on your stomach will help prevent contractures.”
3. “Many times this will help decrease pain in the limb.”
4. “The position will take pressure off your backside.”

2. The prone position will help stretch the
hamstring muscle, which will help prevent
flexion contractures that may lead to problems
when fitting the client for a prosthesis.


The recovery room nurse is caring for a client that has just had a left BKA. Which
intervention should the nurse implement?
1. Assess the client’s surgical dressing every two (2) hours.
2. Do not allow the client to see the residual limb.
3. Keep a large tourniquet at the client’s bedside.
4. Perform passive range-of-motion exercises to the right leg.

3. The large tourniquet can be used if the
residual limb begins to hemorrhage either
internally or externally.


The 62-year-old client diagnosed with Type 2 diabetes who has a gangrenous right toe
is being admitted for a BKA amputation. Which nursing intervention should the nurse
1. Assess the client’s nutritional status.
2. Refer the client to an occupational therapist.
3. Determine if the client is allergic to IVP dye.
4. Start a 22-gauge Angiocath in the right arm.

1. For wound healing, a balanced diet with adequate protein and vitamins is essential, along with meals appropriate for Type 2 diabetes.


The male nurse is helping his friend cut wood with an electric saw. His friend cut two
fingers of his left hand off with the saw. Which action should the nurse implement
1. Wrap the left hand with towels and apply pressure.
2. Instruct the neighbor to hold his hand above his head.
3. Apply pressure to the radial artery of the left hand.
4. Go into the neighbor’s house and call 911.

3. Applying direct pressure to the artery above the amputated parts will help decrease the bleeding immediately and is the first intervention the nurse should implement. Then the nurse should instruct the client to hold the hand above the head, apply towels, and call 911.


A person’s right thumb was accidentally severed with an axe. The amputated right
thumb was recovered. Which action would preserve the thumb so that it could possibly
be reattached in surgery?
1. Place the right thumb directly on some ice.
2. Put the right thumb in a glass of warm water.
3. Wrap the thumb in a clean piece of material.
4. Secure the thumb in a plastic bag and place on ice.

4. Placing the thumb in a plastic bag will protect
it and then placing the plastic bag on ice
will help preserve the thumb so that it may
be reconnected in surgery. Do not place the
amputated part directly on ice because this
will cause necrosis of viable tissue.


The Jewish client with peripheral vascular disease is scheduled for a left AKA. Which
question would be most important for the operating room nurse to ask the client?
1. “Have you made any special arrangements for your amputated limb?”
2. “What types of food would you like to eat while you’re in the hospital?”
3. “Would like the rabbi to visit you while you are in the recovery room?”
4. “Will you start checking your other foot at least once a day for cuts?”

1. The Jewish faith believes that all body parts
must be buried together. Therefore many
synagogues will keep amputated limbs until
death occurs.


The client is three (3) hours postoperative left AKA. The client tells the nurse, “My
left foot is killing me. Please do something.” Which intervention should the nurse
1. Explain to the client that his left leg has been amputated.
2. Medicate the client with a narcotic analgesic immediately.
3. Instruct the client on how to perform biofeedback exercises.
4. Place the client’s residual limb in the dependent position.

2. Phantom pain is caused by severing the
peripheral nerves. The pain is real to the
client, and the nurse needs to medicate the
client immediately.


The nurse is caring for a client with a right below the knee amputation. There is a large
amount of bright red blood on the client’s residual limb dressing. Which intervention
should the nurse implement first?
1. Notify the client’s surgeon immediately.
2. Assess the client’s blood pressure and pulse.
3. Reinforce the dressing with additional dressing.
4. Check the client’s last hemoglobin and hematocrit level.

2. Determining if the client is hemorrhaging
would be the first intervention. The nurse
should check for signs of hypovolemic
shock, decreased BP, and increased pulse.


The nurse is caring for clients on a surgical unit. Which nursing task would be most
appropriate for the nurse to delegate to an unlicensed nursing assistant?
1. Help the client with a 2-day postop amputation put on the prosthesis.
2. Request the assistant double-check a unit of blood that is being hung.
3. Change the surgical dressing on the client with a Syme amputation.
4. Ask the assistant to take the client to the physical therapy department.

4. The nursing assistant could take a client to another department in the hospital.


The client with a right AKA is being taught how to toughen the residual limb. Which
intervention should the nurse implement?
1. Instruct the client to push the residual limb against a pillow.
2. Demonstrate how to apply an elastic bandage around the residual limb.
3. Encourage the client to apply vitamin B12 to the surgical incision.
4. Teach the client to elevate the residual limb at least three times a day.

1. Applying pressure to the end of the residual limb will help toughen the limb. Gradually pushing the residual limb against harder and harder surfaces is done in preparation for prosthesis training.


The 27-year-old client has a right above-the-elbow amputation secondary to a boating
accident. Which statement by the rehabilitation nurse indicates the client has accepted
the amputation?
1. “I am going to sue the guy that hit my boat.”
2. “The therapist is going to help me get retrained for another job.”
3. “I decided not to get a prosthesis. I don’t think I need it.”
4. “My wife is so worried about me and I wish she wouldn’t.”

2. Looking toward the future and problem solving indicate that the client is accepting the loss.


The 32-year old male client with a traumatic left AKA is being discharged from the
rehabilitation department. Which discharge instructions should be included in the
teaching? Select all that apply.
1. Report any pain that is not relieved with analgesics.
2. Eat a well-balanced diet and increase protein intake.
3. Be sure to attend all outpatient rehabilitation appointments.
4. Encourage the client to attend a support group for amputations.
5. Stay at home as much as possible for the first couple of months.

1. Pain not relieved with analgesics could
indicate complications or could be phantom
2. A well-balanced diet promotes wound healing,
especially a diet high in protein.
3. The client must keep appointments in outpatient
rehabilitation to continue to improve
physically and emotionally.
4. A support group may help the client adjust
to life with an amputation.


The client is taken to the emergency department with an injury to the left arm. Which
action should the nurse take first?
1. Assess the nail beds for capillary refill time.
2. Remove the client’s clothing from the arm.
3. Call radiology for a STAT x-ray of the extremity.
4. Prepare the client for the application of a cast.

1. The nurse should assess the nail beds for
the capillary refill time. A prolonged time
(greater than three [3] seconds) indicates
impaired circulation to the extremity.


The nurse is preparing the plan of care for the client with an open fracture of the right
arm. Which problem has the highest priority?
1. Anger related to the inability to perform ADLs.
2. Sleep disturbances related to loss of work.
3. Infection related to exposed tissue.
4. Altered body image related to scarring.

3. The definition of an open fracture is a bone
that has penetrated the skin. The highestpriority
problem is infection because the
skin is the barrier that keeps bacteria from
entering the surrounding tissue.


Which interventions should the nurse implement for the client diagnosed with an open
fracture of the left ankle? Select all that apply.
1. Apply an immobilizer snugly to prevent edema.
2. Apply an ice pack for 10 minutes and remove for 20 minutes.
3. Place the extremity in the dependent position to allow drainage.
4. Obtain an x-ray of the ankle after applying the immobilizer.
5. Administer tetanus, 0.5 mL intramuscularly, in the deltoid.

2. Ice packs should be applied ten (10) minutes
on and twenty (20) minutes off. This
allows for vasoconstriction and decreases
edema. Ice is a nonpharmacological pain
management technique.

5. Any time trauma occurs, tetanus should be
considered. In an open fracture, this is an
appropriate treatment.


When assessing a client with a fractured left tibia and fibula, which data should the
nurse report to the health-care provider immediately?
1. Localized edema and discoloration occurring hours after the injury.
2. Generalized weakness and increasing sensitivity to touch.
3. Capillary refill time of nine (9) seconds and increasing pain.
4. Pain relieved after taking four (4) mg hydromorphone, a narcotic analgesic.

3. The normal capillary refill time (CRT) is less than 3 seconds. A prolonged refill time and increasing pain indicate circulation impairment. This needs to be reported before compartment syndrome occurs.


The unlicensed nursing assistant (NA) notifies the nurse of the vital signs of a 28-yearold
male client admitted the previous day with a fractured femur. The NA reports a
temperature of 101F; pulse 115; respiratory rate 28; copious amounts of thick, white
sputum; and “globs” floating in the urinal. What intervention should the nurse implement
1. Assess the client for dyspnea, breath sounds, and altered mental status.
2. Draw blood for arterial blood gases and order a portable chest x-ray.
3. Call the health-care provider for an order to administer an antibiotic.
4. Instruct the assistant to encourage the client to deep breathe.

1. The nurse should assess the client for signs
of hypoxia from a fat embolism. The symptoms
listed in this question indicate a fat
embolism. Dyspnea, adventitious breath
sounds, and confusion indicate hypoxia.
Young males are more likely to suffer from
a fat embolism, especially from fractured


During the morning assessment, the nurse determines that the 80-year-old client
admitted with a fractured right femoral neck is confused. Which action should the
nurse implement first?
1. Check for a positive Homans’ sign.
2. Encourage the client to take deep breaths and cough.
3. Assess the left pedal pulse.
4. Monitor the client’s Buck’s traction.

2. Encouraging the client to take deep breaths
and cough would aid in the exchange of
gases. Mental changes are early signs of
hypoxia in the elderly client.


The client admitted with a diagnosis of a fractured hip is complaining of severe pain.
Which pain management technique would be best for the nurse to implement for this
1. Adjust the patient-controlled analgesia (PCA) machine for a lower dose.
2. Ensure that the weights of the Buck’s traction are off the floor and hang freely.
3. Raise the head of the bed to 45 degrees and the foot to 15 degrees.
4. Turn the client to the affected leg using pillows to support the other leg.

2. Weights from traction should be off the
floor and hanging freely. Buck’s traction is
used to reduce muscle spasms preoperatively
in clients who have fractured hips.


When preparing the discharge teaching for the 12-year-old with a fractured humerus,
which information should the nurse include regarding cast care?
1. Keep the arm at heart level.
2. Handle the cast with the tips of the fingers only.
3. Apply an ice pack to any area that itches.
4. Foul smells are expected occurrences.

3. Applying ice packs to the cast will relieve
itching and nothing should be placed down
a cast to scratch. Skin becomes fragile
inside the cast and is torn easily. Alteration
in the skin’s integrity can become infected.


Which statement by the client diagnosed with a fractured ulna would indicate that the
nurse needs to do further teaching?
1. “I need to eat a high-protein diet to ensure healing.”
2. “I need to wiggle my fingers every hour to increase circulation.”
3. “I need to take my pain medication before my pain is too bad.”
4. “I need to keep this immobilizer on when lying down only.”

4. The immobilizer should be kept on at all times. This indicates that the client does not understand the teaching and needs the nurse to provide more instruction.


When preparing the nursing care plan for a client with a fractured lower extremity,
which would be the most appropriate treatment outcome for the nurse to include?
1. The client will maintain function of the leg.
2. The client will ambulate with assistance.
3. The client will be turned every two (2) hours.
4. The client will have no infection.

1. The expected outcome for a client with a fracture is maintaining the function of the extremity.


While caring for a client diagnosed with a fracture of the right distal humerus, what
data would the nurse assess that would indicate a complication? Select all that apply.
1. Numbness and mottled cyanosis.
2. Paresthesia and paralysis.
3. Proximal pulses and point tenderness.
4. Coldness of the extremity and crepitus.
5. Palpable radial pulse and functional movement.

1. The nurse should assess for numbness and
mottled cyanosis, which might indicate
nerve damage.
2. The presence of paresthesia and paralysis
indicate impaired circulation.
4. Coldness indicates decreased blood supply.
Crepitus indicates air in subcutaneous
tissue and is not expected.


An 88-year-old client is admitted to the orthopedic floor with the diagnosis of fractured
pelvis. What intervention should the nurse implement first?
1. Insert an indwelling catheter.
2. Administer a Fleet’s enema.
3. Assess abdomen for bowel sounds.
4. Apply Buck’s traction.

3. Assessing the bowel sounds should be the
first intervention to determine if an ileus
has occurred. This is a common complication
of a fractured pelvis.