STUDYGUIDE OF MUSCULOSKELETAL DISORDERS

STUDYGUIDE OF
MUSCULOSKELETAL DISORDERS

• NCLEX REVIEW QUESTIONS FROM ROSDAHL

1. A client is diagnosed with an oblique fracture to the ulna. A cast is applied to the client’s arm to immobilize the fractured area. What assessment would indicate complications of pressure due to immobilization? : lack of distal pulsation in the affected arm.
2. A nurse is caring for an elderly client who has undergone hip replacement surgery. What measures must the nurse employ when caring for the client. :Turn the client every ½ hours from the unaffected side to the back , support the client with pillows or sandbags and trichinae rolls , avoid elevating the head of the bed when the client is on her back.
3. A young client is diagnosed with the dislocation of the hip joint after a motorcycle accident. The dislocation segment is repositioned and stabilized with traction. What measures must the nurse employ when caring for a client with traction? : Encourage the client to frequently position the ankles in a neutral position.
4. An adult client who has undergone spinal fusion surgery is put in a body cast. The client complains of frequent abdominal pains and a bloated feeling. What considerations must the nurse employ when caring for a client in a body cast? :report the symptoms to the healthcare provider
5. What type of traction would be used for a 2-year old client with a fracture of the femur? : Bryant’s traction
6. Which of the following statements is true about a client with malignant bone tumor? : malignant bone tumors can lead to pathologic fractures.
7. A young child with the cast on his fractured arm visits with the healthcare facility with complaints of pain that is unrelieved by medications and aggravated by passive stretching of the arm. The clients also exhibits signs and symptoms of swelling, tightness, and parenthesia of the affected extremity. What do these symptoms indicate?: compartment syndrome
8. An adult female client diagnosed with scleroderma comes to the healthcare facility with complaints of joint pains. What consideration must the nurse employ when caring for a client with scleroderma? : instruct the client to avoid smoking and exposure to heat.
9. What considerations must the nurse employ when caring for a client with ankylosing spondylitis ? Teach the client to refrain from lying on her side.
10. A 45 year old client diagnosed with sciatica undergoes lumbar decompression surgery to relieve the pressure over the nerve. A thoracic - lumbar -sacral orthosis brace is applied to the client to support his back. What consideration must the nurse employ when caring for the client? : smooth all wrinkles over the skin before applying the brace
11. Which of the folowing statements by the client with gout indicates that the cleint has understood patient teaching? : ‘’I need to limit drinking alcohol.’’
12. Which of the following should be included in a preventive teaching plan of osteoporosis? : increased calcium and vitamin D in the diet.
13. Which of the following findings in a client who has a hip replacement would require immediate nursing intervention? : legs are crossed
14. Which of the following statements made by a client leads the nurse to realize that further teaching is necessary to salicylates? : I should expect small amounts of blood in my stools.
15. A client with casted left arm complains of increased pain at the site. The client was last medicated 1 hour ago with Demerol 100 milligrams IM. The nurse notes that the fingers are swollen and pressing on the cast. The arm is elevated, and the client is unable to separate the fingers on the casted arm. The priority nursing action would be : call the physician and report findings

• NCLEX REVIEW QUESTIONS FROM LINTON

1. Chapter 41, 42, 43
2. The joints between the bones of the skull are classified as : SYNARTHROSES
3. Age related changes in a connective tissue include the following : loss of cartilage elasticity
4. A patient who has gout calls the clinic to report having flank pain and blood in the urine. You should: recognize signs and symptoms of urinary stones, and notify the physician immediately.
5. A continuous passive motion machine (CPM) has been ordered for a patient after a total joint replacement . The primary purpose of CPM machine is to :prevent scar tissue formation
6. One week after total hi replacement surgery, a patient complains of sudden severe pain in the affected hip and inability to bear weight on that leg. You should suspect: prosthesis dislocation
7. Common nursing diagnoses for a patient with rheumatoid arthritis( RA) include of the following: activity intolerance related to fatigue
8. What is the recommended daily calcium intake for a patient who is postmenopausal and not taking hormone replacement therapy? : 1500 mg
9. When probenecid (Benemid) is prescribed for a patient with gout, a patient teaching should include which of the following pieces of advice? : drink at least eight 8-ounce glasses of fluid each day to prevent urinary stones.
10. Which statement should be included in the teaching plan for a patient with progressive systemic sclerosis ( PSS/scleroderma) : remain upright for 1-2 hours after meals.
11. A disorder in which the eyes, mouth and vagina become dry because of the obstructed secretory ducts is: Sjogren’s syndrome
12. A pt is brought to the ER with an injury to his arm that was incurred in a fall. A bone end protrudes from his forearm. The surrounding skin is bruised and swollen. Exposed muscle tissue is also swollen. The patient has normal sensation in his fingers. His injury is best described as: grade II complete open fracture
13. During which stage of bone healing do the ends of the broken bone begins to knit: Stage IV
14. A pt with the femoral fracture suddenly complains that he cannot catch the breath. His pulse is 106, respirations 30. You notice a measles- like rash on his neck and chest. You should suspect : fat embolism
15. Methods used to stimulate bone growth include the following: electric stimulation
16. A pt is being discharged with a plaster of Paris cast on her arm. Patient teaching should include the flowing: notify the physician if the fingers become discolored.
17. Crutches are properly fitted when the : crutch pad is 3 to 4 fingers breaths from the axilla.
18. The main advantage of surgery over traction for older patients with hip fracture is: surgery allows earlier mobilization, which results in fewer complications.
19. The most common cause of Colles’ fracture is: using an outstretched hand to break a fall
20. The diet for a patient with a serious fracture should include the following: increased protein and calcium to build new bone
21. A grafting sound heard when fractured bone ends rub together is called: Crepitus
22. The most common cause of lower extremity amputation is : vascular disease
23. Smoking is contraindicated after replantation because nicotine: causes vasoconstriction
24. In which situation when an open amputation be most likely: an accident victim with a crushing injury
25. A patient complains that her amputated foot itches and feels hot? This represents which of the following? Phantom limb sensation
26. In the early postoperative period, the greatest danger to the patient who had an amputation is : Hemorrhage
27. A compression dressing or a cast is applied after amputation to : shape the residual limb
28. Measures to prevent contractures in a residual limb after lower extremity amputation include the following: guide the patient thought active range of motion exercises.
29. Patient teaching related to care of a residual limb and prosthesis should include which of the following statements? Clean, rinse, and dry the prosthetic socket every day.
30. The best way to preserve an amputated body part for possible replantaion is to : seal the part in a plastic bag and put in ice water
31. When you examine a patient’s replanted hand, it is slightly bluish, swollen, and warm. These findings indicate: venous congestion

• NCLEX REVIEW QUESTIONS FROM DAVIS

1. A 49 year old woman was admitted to a physical rehabilitation unit 2 weeks before surgery for a below-the-knee amputation on her right leg. She asks, why do I have to keep wrapping my stump? The nurses best response is : you will have to shrink and shape the residual limb to fit the prosthesis.
2. After a below-the-knee amputation, a client states please tell me I’m not crazy because it still feels like my right foot is still there. The nurses best response is : you are experiencing phantom limb sensation which is normal.
3. In caring for a residual limb after a below-the-knee amputation, the nurse knows that which of the following statements by the clients indicates a need for further teaching? I should: apply lotion or alcohol to the stump
4. A 17 year old girl was injured in a car accident. She now has paraplegia secondary to a T11 spinal cord injury. The nurse identifies the four divisions of spinal column are: cervical, thoracic, lumbar sacral.
5. The nurse assess for which of the following symptoms in a T11 spinal cord injury? Loss of movements in the upper extremities
6. Your client is being discharged and has been instructed how to lift objects to avoid lower back strain. Which of the following statements made by the client is correct? I must: maintain alignment of the head, neck, and back while lifting.
7. A 33 year old client recently had an inguinal hernia repair. The nurse modifies postoperative care from the given most general surgery clients as follows: the client should not cough.
8. A 23 year old client received multiple superficial; injuries in a motorcycle accident. The nurse in the emergency room will: administer a tetanus injection as prescribed
9. A 44 year old male client recently had a lumbosacral laminectomy to repair a herniated nucleus pulpous. The nurse would: log-roll the client when changing his position his position in bed.
10. After a thyroidectomy, a client develops spasms of the hands and feet accompanied by muscle twitching. The nurse identifies these symptoms as sign of : Hypocalcaemia
11. A client has sustained a head injury from a motor vehicle accident. The nurse would assess for which of the following early signs of increasing ICP ? : lethargy and changing levels of consciousness
12. The nurse is planning a bowel program for a client with multiple sclerosis. This would include: a high fiber diet
13. A client in traction for a fractured femur. Which of the following statements indicates understanding of the nurses instructions? : the weights must hang freely at all times.
14. A 42 year old client returned from the operating room 2 hours ago after having a lumbar disentomb. The nurse would: turn the client every 2 hours by log rolling him.
15. A 53 year old client is scheduled for an arteriogram to elevate a femoral-distal bypass in the right leg. In order to protect the kidneys from the effects of the iodine - based contrast medium to be used, the nurse should? : check for allergies to the contrast medium.
16. When assessing cleints over 65 years old the nurse would correctly identify which of the flowing as the most chronic condition in older Americans: Arthritis
17. The nurse teaching a group of older people about early signs of aging. Which of the following occur in the early stages of aging? : osteoarthritis changes in the cervical spine, difficulty staying up at night and working the next day, difficulty reading fine print without glasses.
18. A 65-year old client has been taking several aspirins daily for her arthritis. It would be most important for the nurse to observe: GI hemorrhage, decreased neural function
19. A 68 year old client has bilateral : incomplete question pg 544
20. A 38 year old woman was hospitalized with a medical diagnosis of cholecystitis. The nurse would expect the history of her present illness include intolerance to which of the following nutrients? : FAT
21. The preoperative teaching for prevention of postoperative complications includes leg exercises. The nurse teaches leg exercises preoperative to gallbladder surgery to help prevent: stasis and clot formation
22. A 68 year old client had bilateral total knee replacement under general anesthesia. The surgical procedure lasted 4 hours. Preoperatively the client received instruction on deep -breathing exercises to increase lung ventilation and gas exchange postoperatively. The post surgical nurse observes correct technique when the client is able to : take a slow, deep breath through the nose, hold it, exhale, and cough deeply from the chest.
23. On the morning of the second day after surgery, data collections reveals pains, tenderness, and swelling in the clients’ left calf. She has not taken the as-needed pain meds ordered for her since the previous day. The nurses next action should to be: immobilize her leg and have her maintain bed rest until the physician examines her leg.
24. A 78 year old man has been admitted for total joint replacement of his fractures right hip. In conjenction with the hip surgery, the physican orders aspirin 325 mg every day.The nurse is aware that this medication is probably ordered for which of the folowing effects? Anticoagulant
25. For effective traction, a 9year old boy must be maintained in appropriate position. The nurse is aware that his buttock must be: elevated and clear of the bed.
26. A pt with gout is discharged from the hospital. Which of the following might best describe the dietary regimen on discharge from the hospital: potatoes, milk, increased fluids.
27. A nursing diagnosis for a client with gout is alteration in comfort as a result of pain, related to the disease process. when talking about what the client can do to provide comfort and relieve pain, the client gives the following measures. Which one indicates a need for further teaching? Apply pressure to the affected joint as ordered
28. When planning care for a client with gout, the nurse identifies the major goal of drug therapy in arthritis and related conditions as: reducing inflammation of joints
29. In teaching a client about the care of leg brace, the nurse should emphasize : the need to inspect skin daily and to expect some minor irritations.
30. A 28 year-old client was injured in a motorcycle accident. The right leg was amputated above the knee. The nurse explains that a temporary prosthesis will be fitted to the leg. The most important use for a temporary prosthesis immediately after surgery is that it: allows the client to stand with aid within a few days.
31. A client is learning to use crutches for the first time when planning care for the client , which of the following is most important? Carefully assessing the clients’ activity level.
32. To prepare for a client for crutch walking, it would be most important for the nurse to: Initiate muscle strengthening exercises for arms and shoulders.
33. When a client receives a permanent prosthesis, the nurse should teach the client to : inspect the prosthesis daily for loose or worn parts.
34. A 12 year old boy is in a leg cast for a fractures femur. The most important nursing intervention is to: palpate the pedal pulse.
35. A 72 year old client is leaving rehabilitation still requires assistance with walking. The physician order her to relocate to a center that will permit daily assistance in walking. Concerned about leaving her husband , who is in poor health, she tells the nurse that she would rather give up walking than leave her husband. The nurses’ response is: I understand that staying with your husband is more important than walking.
36. A mother has her 12 year old daughter in the arthritis clinic. The physician prescribes naproxen ( Naprosyn)-the first dose 500 mg, then 250 mg every 8 hours- for signs and complains of inflamed joints and pain. The mother asks how long it will take for the naproxen to be effective. Which of the following is the most accurate response by the nurse? Therapeutic effects may bit be noticed for 3-4 weeks.
37. The nurse is applying an elastic bandage to the sprained ankle of a client in an outpatient clinic. The nurse leaves the toes exposed to : check for circulation and sensation of the extremity.
38. When positioning a postoperative client who has had a total hip replacement, the nurse is careful to keep the operative leg: abducted
39. The nurse is to apply an Ace bandage to sprained ankle. The nurse would wrap it beginning at the DISTAL aspect.
40. A 9 year old child has a short leg cast for a fractures ankle. Instructions to the child and mother on discharge from the ER include: avoid lifting the cast with the finger tips.
41. A 22 year old client just had a leg cast applied. Wich symptom would be of most concern to the nurse? Loss of sensation in the toes
42. A 35 year old client is hospitalized with a fractures right femur. Which of the following blood pressures would be considered within the normal range for him: 124/80 mm Hg
43. A 45 year old auto accident victim has fractures of both arms. The client is in bilateral ( both sides) casts from the shoulders to the hands. Appropriate sites to take the client’s pulse include: carotid or femoral
44. When teaching healthcare to an older client with osteoporosis, the nurse would: instruct the client to eat foods rich in calcium and to increase physical activity.
45. The best source of dietary calcium to recommend to a pregnant client is: MILK
46. Medications used to treatment of rheumatoid arthritis include: anti-inflammatory agents
47. A clients will be ambulatory on the first day after surgery. The primary benefits of early ambulation are: to facilitate the normal functioning of all body organs and systems, and reduce the danger of potential postoperative complications.
48. A 44 year old paranoid client is admitted for corrective orthopedic surgery. He refuses oral medication saying that the nurse is trying ti poison him. The nurse would: given him the choice of taking it orally or IM.
49. A 45 year old client had just had electroconvulsive therapy. The nurse would: reorient the client to time and place
50. A 12 year old client needs a leg operation. Who should sign the consent form?: let the parents decide
51. A 45 year old client is scheduled for knee surgery. Because he does not like the hospital food , his wife brings food from home. He is on the regular diet. The nurses best response is to: allow the client to eat the food.
52. A 42 year old laminectomy client is discharged home. He tells the nurse that he still has pain and is going to see an acupuncturist when he gets home. What is the nurses best response? Be sure to tell your physician that you are seeing an acupuncturist, and to br sure to tell the acupuncturist that you have had a laminectomy.
53. A 45 year old client on crutches is demonstrating her crutch walking for the nurse. The nurse knows that she is using the crutches correctly if: places her weight on the palms of her hands.
54. A 33 year old client is recovering from an endoscopy before giving fluids, the most important assessment is determining : bowel sounds
55. A 30 year old woman fractures her tibia and several metatarsal bones during a fall while she was jogging. A cast was applied extending from the knee to the toes. The nurse makes frequent observations of which of the following: color, temp, and sensation in the toes.
56. Which of the following statements would indicate that the parent of a child with a newly applied cast needs further instructions? I should use my fingertips to handle the cast.
57. An 80 year old was being discharged after a below the knee amputation. He told the nurse that his wife has AD. Which action should the nurse take: notify physician to obtain home health consult.
58. An 87 year old client is scheduled for an above the knee amputation ( AKA). To best prepare the client for postoperative therapy the nurse would: teach crutch walking.
59. A 79 year old client with osteoarthritis is scheduled to have an arthroplasty ( joint replacement) surgery to the right hip. The client has been active since retirement and is in good health. In the preoperative teaching, the nurse instructs the client that the physician will most likely begin ambulation on the third postoperative joint replacement is : prolonged inactivity in an older adult increases the chance of venous thrombosis.
60. Preoperative instructions to arthroplasty clients include hip precautions measures. The nurse correctly instructs the client : do not bend to put on your shoes; use a long shoe horn.
61. A 75 year old client is admitted with gangrene of the right leg. The physician discuss the need for an AKA of the extremity. The initial approach by the nurse flowing the discussion is: spend time with the client and allow him to verbalize feelings.
62. During a home health visit, the nurse observes that a clients AKA wound was completely healed 1 month postoperative. The nurse most appropriate action by the nurse following the observation is: provide strengthening exercises to all limbs.