Musculoskeletal Flashcards
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.”
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.
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
A. A 78-year-old female with a history of vitamin D deficiency
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
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.
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.”
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.
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
C. Tophi
Chronic gout can eventually lead to permanent deposits of urate crystals, called tophi, along with the bones just beneath the skin.
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
B. Risk for shock
C. Risk for impaired neurovascular dysfunction
D. Acute pain
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
D. Measure the urine output
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
A. Place a heat pack on the extremity
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
B. Pain 2/10 on a 10-point scale
C. Bilateral 3+ pedal pulses
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.
D. The X-ray reveals a break in continuity of the bone shaft.
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.”
C. “Although the exact cause is unknown, RA is thought to be triggered by an interaction between genetic and environmental factors.”
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
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
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
A. Paralysis
D. Pallor
E. Poikilothermia
F. Paresthesia
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
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.
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.”
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.”
