Unit Q-Musculoskeletal

Question 1

The nurse is caring for an older client who has kyphosis and a widened gait. For which health problems is the client at risk for?

a. Osteoporosis
b. Contracture
c. Osteopenia
d. Falls

Answer 1

ANS: D
Kyphosis is caused by bone loss and causes the client to bend forward which changes the center of gravity leading to problems with balance. Older adults who have balance issues are at risk for falls.

Question 2

The nurse is teaching assistant personnel (AP) about care of an older ambulatory adult who has osteopenia. Which statement by the AP indicates understanding of the teaching?

a. “I will tell the client to change positions frequently to prevent pressure injury.”
b. “I will remind the client to take frequent walks to strengthen bones.”
c. “I will assist the client with activities of daily living as needed.”
d. “ I will apple warm compresses to the joints to relieve pain.”

Answer 2

ANS: B
The ambulatory client who has osteopenia has experienced bone loss. Therefore, taking walks as a weight-bearing exercise helps to prevent further bone loss. The client does not have joint pain and does not need assistance or position changed because the client is ambulatory and probably independent.

Question 3

A client had an arthroscopy 1 hour ago on the left knee. The nurse finds the left lower leg to be pale and cool, with a 1+ pedal pulse. What action would the nurse perform first?

a. Assess the neurovascular status of the right leg.
b. Document the findings in the patient’s chart.
c. Elevate the left leg on at least two pillows.
d. Notify the primary health care provider immediately.

Answer 3

ANS: A
The nurse would compare findings of the two legs as these findings may be normal for the client. If a difference is observed, the nurse would then notify the primary health care provider. Documentation would occur after the nurse has all the data. Elevating the left leg will not improve perfusion if there is a problem.

Question 4

A hospitalized client’s strength of the upper extremities is rated at a 4. What does the nurse understand about the client’s ability to perform activities of daily living (ADLs)?

a. The client is able to perform ADLs but not lift some items.
b. The client is unable to perform ADLs alone.
c. No difficulties are expected with ADLs.
d. The client would need almost total assistance with ADLs.

Answer 4

ANS: C

This rating indicates good muscle strength with full range of motion.

Question 5

An older adult client is distressed at body changes related to kyphosis. What response by the nurse is appropriate?

a. Ask the client to explain more about these feelings.
b. Explain that these changes are irreversible.
c. Offer to help select clothes to hide the deformity.
d. Tell the client that safety is more important that looks.

Answer 5

ANS: A
Assessment is the first step of the nursing process, and the nurse would begin by getting as much information about the clients feelings as possible. Explaining that the changes are irreversible discounts the clients feelings. Depending on the extent of the deformity, clothing will not hide it. While safety is more objectively important than looks, the client is worried about looks and the nurse needs to address this issue.

Question 6

The nurse is taking a history from an older client who reports having frequent falls. Which dietary habit could be contributing to the client’s problem?

a. Consumes high-protein foods
b. Eats few concentrated sweets.
c. Limits fatty or greasy.
d. Avoids dairy products

Answer 6

ANS: D
Falls can occur when older adult clients have inadequate calcium and vitamin D because they are at risk for osteopenia and osteoporosis. Dairy products have a high concentration of both calcium and Vitamin D and this client avoids those foods. High-protein foods are recommended to help prevent osteopenia and sweets and fatty/greasy food have no impact on bone health.

Question 7

The client’s electronic health record indicates genu varum. What does the nurse understand this term to mean?

a. Bow-legged
b. Fluid accumulation
c. Knock-kneed
d. Spinal curvature

Answer 7

ANS: A
Genu varum is bow-legged deformity. A fluid accumulation is an effusion. Genu valgum is knocked-kneed. A spinal curvature could be kyphosis or lordosis.

Question 8

The nurse is teaching a client who had a left humeral biopsy about home care. Which statement by the client indicates understanding of the nurse’s teaching?

a. I will take my opioids only when I have severe pain.
b. I will keep my left arm elevated for 24 hours.
c. I will watch for tenderness and warmth around the biopsy site.
d. I will report any discomfort to my primary health care provider immediately.

Answer 8

ANS: C
Bone biopsy is an ambulatory procedure which can cause some discomfort but not severe pain. The client can use the affected arm soon after the procedure but should watch for tenderness and warmth which could indicate infection.

Question 9

The nurse is teaching assistive personnel (AP) about the risk for osteoporosis associated with race or ethnicity. Which population has a decreased incidence of osteoporosis when compared to Euro-Americans?

a. Irish Americans
b. African Americans
c. American Indians
d. Asian Americans

Answer 9

ANS: B
African Americans usually have more bone mass when compared the Euro-Americans which makes them at a decreased risk for osteoporosis.

Question 10

A female client is preparing to have open magnetic resonance imaging (MRI) of the spine. What action(s) by the nurse is (are) most important to assess before the test? (SATA)
a. Ask if the client has a history of kidney disease.
b. Ask the client if she could possibly be pregnant.
c. Ensure that the patient has no metal or electronic implants.
d, Assess the client for the ability to communicate.
e. Assess the client for a history of claustrophobia.

Answer 10

ANS: A, B, C, D
The contrast agent that is used for the MRI is gadolinium which can cause serious complications if the client is pregnant or has kidney disease. The client needs to be able to communicate and should not have any metal or electronic implants due to the magnetic nature of the machine. For and open MRI, claustrophobia is not an issue because the client is not encased in the device.

Question 11

The nurse is reviewing the laboratory profile for a client who has muscular dystrophy. Which laboratory value(s) would the nurse expect to be elevated? (Select all that apply.)

a. Calcium (Ca)
b. Phosphate (PO4)
c. Creatine kinase (CK) abirb.com/test
d. Lactic dehydrogenase (LDH)
e. Aspartate aminotransferase (AST)
f. Aldolase (ALD)

Answer 11

ANS: C,D,E,F
Muscular dystrophy causes elevations in muscle enzymes and does not affect minerals like
calcium and phosphorus.

Question 12

An older client’s serum calcium level is 8.7 mg/dL (2.18 mmol/L). What possible
etiology(ies) does the nurse consider for this result? (Select all that apply.)
a. Good dietary intake of calcium and vitamin D
b. Normal age-related decrease in serum calcium
c. Possible occurrence of osteoporosis or osteopenia
d. Potential for metastatic cancer or Paget disease
e. Recent bone fracture in a healing stage

Answer 12

ANS: B,C
This slightly low calcium level could be an age-related decrease in serum calcium or could indicate a metabolic bone disease, such as osteoporosis or osteopenia. A good dietary intake
would be expected to produce normal values. Metastatic cancer, Paget disease, or healing bone fractures will elevate calcium.

Question 13

4. When assessing gait, what feature(s) would the nurse inspect? (Select all that apply.)
   a. Balance
   b. Ease of stride
   c. Goniometer readings
   d. Length of stride
   e. Steadiness

Answer 13

ANS: A, B, D, E
To asses gait, look at balance, ease and length of stride, and steadiness. Goniometer readings assess flexing and extension or joint ROM.

Question 14

The nurse takes a history on a male client reporting chronic back pain. Which factor(s) in the client’s history may have contributed to his pain? SATA

a. Had a motor vehicle accident 10 years ago
b. Played football in college and high school
c. Has installed carpet and other flooring for 30 years
d. Typically takes walks 3 to 4 days each week
e. Eats two servings of dark, green, leafy vegetables daily

Answer 14

ANS: A, B, C
A history of trauma caused by an accident, occupation, or contact sports can result in chronic back pain. Regular exercise and diet helps to promote bone health.

Question 15

A patient, age 89, has had a right below-the-knee amputation. He is progressing well but continues to complain of pain in the toes on his right foot. The physician told him that he is suffering from “phantom pain” in his amputated extremity. He asks the nurse to explain phantom pain. The most appropriate response would be

a. “Phantom pain does not exist except in your mind.”
b. “I can’t answer that. You’ll have to ask the physician.”
c. “Phantom pain occurs because the nerve tracts that register pain in the amputated limb continue to send a message to the brain.”
d. “Phantom pain occurs when you start thinking about your loss. It’s best to keep your mind occupied with other things.”

Answer 15

ANS: C
Phantom pain (pain felt in the missing extremity as if it were still present) may occur and be frightening to the patient. Phantom pain occurs because the nerve tracts that register pain in the amputated area continue to send a message to the brain (this is normal).

Question 16

A patient, age 79, fell at home and suffered an intracapsular fracture of his left hip. The orthopedic surgeon inserted a prosthetic implant for a bipolar hip replacement. The physician has instructed the nurse to turn him every 2 hours. The nurse understands that the correct nursing intervention is to keep the legs

a. together so they don’t separate while turning.
b. from rubbing together.
c. abducted so the prosthesis does not become dislocated.
d. abducted to prevent additional pain for the patient with turning.

Answer 16

ANS: C
Nursing interventions also involve postoperative maintenance of leg abduction by using an abduction splint for 7 to 10 days to prevent dislocation of the prosthesis.

Question 17

A patient, age 24, has a compartment syndrome after a fracture of his radius and ulna. Nursing assessment will include careful observation for signs and symptoms of

a. buccal petechiae.
b. thromboembolism.
c. Volkmann’s contracture.
d. fat embolism.

Answer 17

Volkmann’s contracture is a permanent contracture that can occur as a result of circulatory obstruction secondary to compartment syndrome.

Question 18

A patient fell 2 days ago; he has a compound fracture of his left tibia. The physician performed an open reduction with internal fixation (ORIF) to treat the fracture. An important nursing assessment for him would include

a. hyperactive bowel sounds.
b. elevated temperature and presence of erythema at incision site.
c. ecchymosis and edema at incision site.
d. complaints of activity intolerance.

Answer 18

ANS: B
Collection of objective data includes careful inspection of any wounds. The drainage is assessed for color, amount, and presence of odor. Vital signs are assessed for signs of infection (temperature elevation, tachycardia, and tachypnea).

Question 19

A patient, age 24, is recovering from a fractured tibia. She has been wearing a leg cast for the past month to immobilize the fracture and promote proper alignment. She is being seen at the clinic for follow-up radiographic evaluation of the fracture. The physician tells her that he is hoping for good callus formation to have occurred. When she asks what callus formation is, the nurse tells her it is

a. when blood vessels of the bone are compressed.
b. a part of the bone healing process after a fracture when new bone is being formed over the fracture site.
c. the formation of a clot over the fracture site.
d. when the hematoma becomes organized and a fibrin meshwork is formed.

Answer 19

ANS: B
Callus formation occurs when the osteoblasts continue to lay the network for bone build-up and osteoclasts destroy dead bone

Question 20

A patient, age 24, had a traumatic amputation of his left foot in a motorcycle accident. He is receiving morphine by a patient-controlled analgesia (PCA) device.
He complains of a burning sensation in his left foot. The nurse should explain that
a. this is a phantom pain and that its cause is not clearly understood.
b. this is not possible because his foot was amputated.
c. his regular pain medication will relieve the pain.
d. this phantom pain will disappear in about 1 week

Answer 20

ANS: A
Phantom pain (pain felt in the missing extremity as if it were still present) may occur and be frightening to the patient. Phantom pain occurs because the nerve tracts that register pain in the amputated area continued to send a message to the brain (this is normal).

Question 21

A patient, age 68, has suffered an intertrochanteric fracture of the right hip. Before surgery, to provide support and comfort, an immobilizing device is applied. This is called a

a. Thomas splint.
b. Bryant’s traction.
c. Russell’s traction
d. Buck’s traction.

Answer 21

ANS: D
Buck’s traction is a form of traction used as a temporary measure to provide support and comfort to a fractured extremity until a more definite treatment is initiated.

Question 22

The patient has been diagnosed as having gouty arthritis. He asks the nurse to explain the cause of the inflammation of his great toe. The most appropriate nursing response is

a. “You have calcium oxalate deposits that are seen in gouty arthritis.”
b. “The inflammation is from small accumulations of uric acid crystals which are called tophi.”
c. “The small nodules are not related to the arthritis condition.”
d. “You have fat deposits that are common with gouty arthritis.”

Answer 22

ANS: B
Gout is a metabolic disease resulting from an accumulation of uric acid in the blood. It is an acute inflammatory condition associated with ineffective metabolism of purines.

Question 23

The office nurse has noted the presence of an increase in lumbar curvature in a 20- year-old female patient. This condition is known as

a. scoliosis.
b. lordosis.
c. kyphosis.
d. spondylitis

Answer 23

Common deformities include an increase in the curve at the lumbar space region that throws the shoulder back, making the “lordly or kingly” appearance that is known as lordosis. Scoliosis involves the S curvature of the spine. Kyphosis is the rounding of thoracic spine.

Question 24

Rheumatoid arthritis is distinguished from osteoarthritis in that:

a. Rheumatoid arthritis is an autoimmune, systemic disease; osteoarthritis is a degenerative disease of the joints.
b. Rheumatoid arthritis is an autoimmune, degenerative disease; osteoarthritis is a systemic inflammatory disease.
c. People with osteoarthritis are considered to be genetically predisposed; there is no known genetic component to rheumatoid arthritis.
d. Osteoarthritis is often caused by a virus; viruses play no part in the pathogenesis of rheumatoid arthritis.

Answer 24

ANS: A

RA is thought to be an autoimmune disorder. Degenerative joint disease is also known as osteoarthritis.

Question 25

The immediate medical management of any fracture is:

a. Observe patient for signs of shock.
b. Administer analgesics for pain.
c. Splint and elevate the involved part.
d. Apply heat to control pain.

Answer 25

ANS: C
Immediate management includes splinting and elevation of the involved part to prevent edema. After the immediate management, analgesic for pain, application of cold to prevent edema, and observing for signs of shock must be part of the plan of care.

Question 26

Calcium is a mineral found in many foods that can slow bone loss during the aging process. The following are high in calcium:

a. Oranges, yogurt
b. Oranges, bananas
c. Broccoli, yogurt
d. Skim milk, eggs

Answer 26

ANS: C
Fresh oranges, bananas, and eggs are not good calcium choices. Broccoli and green vegetables, as well as yogurt, are considered calcium-rich foods.

Question 27

A 76-year-old female patient is being seen for osteoarthritis of the knee in the clinic. In discussing strengthening exercises, which exercises would you recommend?

a. Jogging
b. Climbing stairs 2 to 3 times daily
c. Bicycling for short distances
d. Walking up and down small elevations

Answer 27

ANS: C
Bicycling or swimming is recommended for osteoarthritis of the hip or knee. Jogging would put undue stress on knee joints. Climbing stairs should be avoided. Walking should be done on level ground, not up or down elevations.

Question 28

Prolonged bed rest puts the older adult at risk for

a. ankylosing spondylitis.
b. pathological fractures.
c. osteomyelitis.
d. gout.

Answer 28

ANS: B
Immobilization results in bone resorption, and the bone tissue becomes less dense. Prolonged bed rest puts the patient at risk for pathological fracture. This is a serious concern for an older adult in terms of regaining mobility.

Question 29

. The main purpose of traction is to (Select all that are correct)

a. Align and stabilize a fracture
b. Prevent deformities
c. Relieve muscle spasms
d. Promote bed rest
e. Increase circulation to the rest of the body

Answer 29

ANS: A, B, C
Skin and skeletal traction provide alignment and stabilize a fracture. This prevents deformities and relieves muscle spasms by putting muscles under tension until they are fatigued.

Question 30

An older adult client has had an open reduction and internal fixation of a fractured right hip. Which intervention does the nurse implement for this client?
A. Keep the client’s heels off the bed at all times.
B. Re-position the client every 3 to 4 hours.
C. Administer preventive pain medication before deep-breathing exercises.
D. Prohibit the use of antiembolic stockings.

Answer 30

A. Keep the client’s heels off the bed at all times.

Because the client is an older adult and is more at risk for skin breakdown because of impaired circulation and sensation, the client’s heels must be kept off the bed at all times to avoid constant pressure on this sensitive area. Re-positioning the older adult client must be done every 2 hours, not every 3 to 4 hours, to prevent skin breakdown and to inspect the skin for any signs of breakdown. Pain medication would not be administered for deep-breathing exercises because this client typically would not experience pain upon breathing. Antiembolic stockings are not contraindicated for older adults; rather, they help prevent deep vein thrombosis.

Question 31

A client with a fracture asks the nurse about the difference between a compound fracture and a simple fracture. Which statement by the nurse is correct?

A “Simple fracture involves a break in the bone, with skin contusions.”
B “Compound fracture does not extend through the skin.”
C “Simple fracture is accompanied by damage to the blood vessels.”
D “Compound fracture involves a break in the bone, with damage to the skin.”

Answer 31

D “Compound fracture involves a break in the bone, with damage to the skin.”

A compound fracture involves a break in the bone with damage to the skin. A simple fracture does not extend through the skin. A compound fracture is accompanied by damage to blood vessels.

Question 32

Which statement indicates to the nursing instructor that the nursing student understands the normal healing process of bone after a fracture?

A “A callus is quickly deposited and transformed into bone.”
B “A hematoma forms at the site of the fracture.”
C “Calcium and vascular proliferation surround the fracture site.”
D “Granulation tissue reabsorbs the hematoma and deposits new bone.”

Answer 32

B “A hematoma forms at the site of the fracture.”

In stage 1, within 24 to 72 hours after a fracture, a hematoma forms at the site of the fracture because bone is extremely vascular. This then prompts the formation of fibrocartilage, providing the foundation for bone healing. Stage 2 of bone healing occurs within 3 days to 2 weeks after the fracture, when granulation tissue begins to invade the hematoma. Stage 3 of bone healing occurs as a result of vascular and cellular proliferation. In stage 4 of a healing fracture, callus is gradually reabsorbed and transformed into bone.

Question 33

A client’s left arm is placed in a plaster cast. Which assessment does the nurse perform before the client is discharged?

A Assess that the cast is dry.
B Ensure that the client has 4 × 4 gauze to take home for placement between the cast and the skin.
C Check the fit of the cast by inserting a tongue blade between the cast and the skin.
D Ensure that the capillary refill of the left fingernail beds is longer than 3 seconds.

Answer 33

A Assess that the cast is dry.

The cast must be dry and free of cracking and crumbling before the client is discharged. The client should not place anything between the cast and the skin. In assessing fit, one finger should easily fit between the cast and the skin. Capillary refill longer than 3 seconds indicates impairment of the circulation in the extremity and requires the health care provider’s immediate attention.

Question 34

A client with a compound fracture of the left femur is admitted to the emergency department after a motorcycle crash. Which action is most essential for the nurse to take first?

A Check the dorsalis pedis pulses.
B Immobilize the left leg with a splint.
C Administer the prescribed analgesic.
D Place a dressing on the affected area.

Answer 34

ANS: A

The first action should be to assess the circulatory status of the leg because the client is at risk for acute compartment syndrome, which can begin as early as 6 to 8 hours after an injury. Severe tissue damage can also occur if neurovascular status is compromised. Immobilization will be needed, but the nurse must assess the client’s condition first. Administering an analgesic and placing a dressing on the affected area should both be done after the nurse has assessed the client.

Question 35

A client has a bone density score of -2.8. What intervention would the nurse anticipate based on this assessment?

a. Asking the client to complete a food diary
b. Planning to teach the client about bisphosphonates
c. Scheduling another scan in 2 years
d. Scheduling another scan in 6 months

Answer 35

ANS:B
A T-score from a bone density scan at or lower than -2.5 indicates osteoporosis. The nurse would plan to teach about medications used to treat this disease, such as bisphosphonates. A food diary is helpful to determine if the client gets adequate calcium and vitamin D, but at this point, dietary changes will not prevent the disease. Simply scheduling another scan will not help treat the disease either.

Question 36

The nurse teaches assistive personnel about care of an older adult diagnosed with osteoporosis. What teaching would the nurse include?

a. “Teach the client to eat high-calcium foods in their diet.”
b. “Assist the client with activities of daily living.”
c. “Osteoporosis places the client is at risk for fractures”
d. “The client should stay in bed to prevent falling”

Answer 36

ANS:C
Any who has osteoporosis is at risk for fragility fractures even if he or she does not experience trauma like a fall. The client need to keep active rather than stay in bed where more bone could be lost. High-calcium foods may not be helpful because bone loss is already severe. There is no indication that the client needs assistance with ADLs.

Question 37

A client has been advised to perform weight-bearing exercises to help slow bone loss, but has not followed the advise. What response by the nurse is appropriate at this time?

a. Ask the client about feat of falling
b. Instruct the client to increase calcium
c. Suggest other exercises the client can do
d. Tell the client to try weight lifting

Answer 37

ANS: A
Fear of falling can limit participation in activity. The nurse would first assess if the client has this fear and then offer suggestions for dealing with it. The client may or may not need extra calcium, other exercises, or weight lifting.

Question 38

The nurse is caring for several clients with osteoporosis. For which client would bisphosphonates not be a good option?

a. Clients with diabetes who has a serum creatinine of 0.8 mg/dL
b. Client who recently fell and has vertebral compression fractures
c. Hypertensive client who take calcium channel blockers
d. Client with a spinal cord injury who cannot tolerate sitting up

Answer 38

ANS: D
clients on bisphosphonates must be able to sit upright for 30 to 60 minutes after taking them. The client who cannot tolerate sitting up is not a good candidate for this class of drug. Poor renal function also makes this client a poor candidate for this drug, but the client with a creatinine of 0.8 mg/dL is within normal range. Diabetes and hypertension are not related unless the client also has a renal disease. The client who recently fell and sustained fractures is a good candidate for this drug, if the fractures are related to osteoporosis.

Question 39

The nurse is performing an assessment of a client with possible plantar fasciitis in the right foot. What assessment finding would the nurse expect in the right foot?

a. Multiple toe deformities
b. Numbness and paresthesia
c. Severe pain in the arch of the foot
d. Redness and severe swelling

Answer 39

ANS: C
The most common assessment finding in the client’s report of severe pain in the arch of the foot especially when walking. The other findings are not typical in clients with this health problem.

Question 40

The nurse is caring for a young client who has been diagnosed with osteopenia. Which risk factor is the clients history most likely contributed to bone loss?

a. Osteoarthritis
b. Hypothyroidism
c. Addison Disease
d. Rheumatoid Arthritis

Answer 40

ANS: D
Rheumatoid arthritis often occurs in young female adult can lead to osteoporosis as a common complication. Cushing disease (rather than Addison disease) and hyperthyroidism (rather that hypothyroidism) are also risk factors. Osteoarthritis is a joint disease.

Question 41

A nurse is caring for four clients. After the hand-off report, which client would the nurse see first?

a. Client with osteoporosis and a white blood cell count of 27,000/mm
b. Client with osteoporosis and a bone fracture who requests pain medication.
c. Post-microvascular bone transfer client whose distal leg is cool and pale
d. Client with suspected bone tumor who just returned from having a spinal CT.

Answer 41

ANS: C
The client is the priority because the assessment findings indicate a critical lack of perfusion. A high WBC count is an expected finding for the client with osteoporosis. The client requesting pain medication should be seen second. The client who just returned from a CT scan is stable and needs no specific postprocedural care.

Question 42

A nurse is assessing a community group for dietary factors that contribute to osteoporosis. In addition to inquiring about calcium, the nurse also assesses for which other dietary components? (SATA)

a. alcohol
b. caffeine
c. fat
d. carbonated beverages
e. vitamin D

Answer 42

ANS: A, B, D, E

Dietary components that affect the development of osteoporosis include alcohol, caffeine, high phosphorus intake, carbonated beverages and vitamin D. Tobacco is also a contributing lifestyle factor. Fat intake does not contribute to osteoporosis.

Question 43

A nurse is providing education to a community women’s group about lifestyle changes helpful in preventing osteoporosis. What topics does the nurse cover? (SATA)

a. cut down on tobacco product use
b. Limit alcohol to two drinks a week
c. strengthening exercises are important
d. take recommended calcium and vitamin D
e. Walk for 30 minutes at least 3 times a week

Answer 43

ANS: C, D, E
Lifestyle changes can be made to decrease occurrence of osteoporosis and include strengthening and weight-bearing exercises and getting the recommended amounts of both calcium and vitamin d. Tobacco should be totally avoided. Women should not have more than one drink per day.

Question 44

A client who had a surgical fractured femur repair reports new-onset shortness of breath and increased respirations. What is the nurse’s first action?

a. Place the client in high-fowler position
b. Document the clients oxygen saturation level
c. Start oxygen therapy a 2L/min via nasal cannula
d. Contact the health care provider

Answer 44

ANS: A
The client is experiencing respiratory distress which could be due to pulmonary embolus, fat embolism syndrome, or anxiety. Regardless of the cause, the nurse would place the client in a sitting position first then perform additional assessment. Oxygen would likely be needed, especially if the clients oxygen saturation was under 95%.

Question 45

A client who had a fractured ankle open reduction internal fixation 4 weeks ago reports burning pain and tingling in the affected foot. For which potential complication would the nurse anticipate?

a. delayed bone healing
b. complex regional pain syndrome
c. peripheral neuropathy
d. compartment syndrome

Answer 45

ANS:B
Burning pain and tingling that occurs weeks or months after a fracture or other trauma may indicate complex regional pain syndrome. Compartment syndrome tends to occur within days of the initial injury.

Question 46

The nurse is performing a neurovascular assessment for an older adult client who has an extremity fracture. How many seconds would the nurse expect for a capillary refill in its is within normal range?

a. 20
b. 15
c. 10
d. 5

Answer 46

The normal capillary refill is usually 3 seconds, but for older adults who has an extremity fracture usually take up to 5 seconds due to vascular changes associated with age.

Question 47

The nurse is caring for a client who had a closed reduction of the left arm and notes a large wet area of drainage on the cast. What action is the most important?

a. cut off the old cast
b. document the assessment
c. notify the primary health care provider
d. wrap the cast with guaze

Answer 47

ANS: C
The primary health care provider should be notified to examine the client and determine the source of the drainage. The nurses assessment should be documented, but that is not the most important action

Question 48

A nurse assess a client with a hip fracture. Which assessment finding would the nurse identify as a complication of this injury?

a. hypertension
b. diarrhea
c. infection
d. hematuria

Answer 48

ANS: D
The pelvis is very vascular and close to major organs. Injury to the pelvis can cause integral damage that may manifest as blood in the urine or stool. Diarrhea and infection are not common complications of a pelvic fracture.

Question 49

A nurse is caring for a client with diabetes mellitus who fractured her arm. Which action would the nurse take first?

a. remove the medical alert bracelet from the fractured arm
b. Immobilize the arm by splinting the fractured arm
c. place the client in a supine position with a warm blanket
d. cover any open areas with a sterile dressing

Answer 49

ANS: A
A clients medical alert bracelet or any other jewelry would be removed from the fractured arm before the affected extremity swells. Immobilization, positioning, and dressing should occur after the bracelet is removed.

Question 50

After teaching a client with a fractured humerus, the nurse assesses the clients understanding. Which dietary choices demonstrates that the client correctly understands the nutrition needed to assist in healing the fracture?

a. Backed fish with orange juice and a vitamin d supplement
b. Vegetable lasagna with a green salad and a vitamin A supplement
c. bacon, lettuce, and tomato sandwich served with vitamin B supplement
d. roast beef with low-fat milk and a vitamin C supplement

Answer 50

ANS D: The client with healing fracture needs supplements of vitamins B and C and a high-protein, high-calorie diet. Milk for calcium supplementation and vitamin c supplementation is appropriate. Meat would increase protein in the diet that is necessary for bone healing. Fish, a sandwich, and vegetable lasagna would provide less protein.

Question 51

The nurse is caring for a 4-year-old child immobilized by a hip fracture. Which complication should the nurse monitor for?

a. Hypocalcemia
b. Decreased metabolic rate
c. positive nitrogen balance
d. increased production of stress hormones

Answer 51

ANS: B
Immobilization causes a decreased metabolic rate with slowing of all systems and a decreased food intake, leads to hypercalcemia, and causes a negative nitrogen balance secondary to muscle atrophy. A decreased production of stress hormones occurs with a decreased physical and emotional coping capacity

Question 52

What effect does immobilization have on the cardiovascular system?

a. venous stasis
b. increased vasopressor mechanism
c. normal distribution of blood volume
d. increased efficiency of orthostatic neurovascular reflexes

Answer 52

ANS: A

Because of decreased muscle contraction, the physiologic effects of immobilization include venous stasis.

Question 53

Which condition can result from the bone demineralization associated with immobility?

a. Osteoporosis
b. urinary retention
c. pooling of blood
d. susceptibility to infection

Answer 53

ANS: A
Bone demineralization leads to negative calcium balance, osteoporosis, pathologic fractures, extraosseous bone formation, and renal calculi. Urinary retention is secondary to the effect of immobilization on the urinary tract. Pooling of blood is a result of the cardiovascular effects of immobilization. Susceptibility to infection can result from the effects of immobilization on the respiratory system and renal systems.

Question 54

The nurse uses the palms of the hands when handling a wet cast to achieve what outcome?

a. assess dryness of the cast
b. facilitate easy turning
c. keep the patients limb balanced
d. avoid indenting the cast

Answer 54

ANS: D
Wet casts should be handled by the palms of the hands, not the fingers, to prevent creating pressure points. Assessing dryness, facilitating easy turning, or keeping the patients limb balanced are not reasons for using the palms of the hand rather than the fingers when handling a wet cast

Question 55

Which type of traction uses skin traction on the lower leg and a padded sling under the knee?
a. Dunlop
b. Bryant's
c. Russell
D, Bucks extension

Answer 55

ANS: C
Russell traction uses skin traction on the lower leg and sling under the knee. Dunlop traction is an upper-extremity traction used for fractures of the humerus. Bryants traction is skin traction with the legs flexed in an extended position. It is used primarily for-short term immobilization, before surgery with dislocated hips, correcting contracture, or for bone deformities.

Question 56

A neonate is born with mild clubfeet. When the parents ask the nurse how it will be corrected, the nurse should base the explanation on what fact?

a. Traction is tried first
b. Surgical intervention is needed
c. Frequent, serial casting is tried first.
d. children outgrow this condition when they learn to walk

Answer 56

ANS: C
Serial casting, the preferred treatment, is began shortly after birth before discharging from the nursery. Surgical intervention is only done when if serial casting in not successful. Children do not improve without intervention

Question 57

Which term is used to describe an abnormally increased increased convex angulation in the curvature of the thoracic spine?

a. Scoliosis
b. Ankylosis
c. Lordosis
d. Kyphosis

Answer 57

ANS: D

Kyphosis is an abnormally increased convex angulation in the curve of the thoracic spine.

Question 58

Four year old, placed in Buck’s extension traction for Legg-Calvé-Perthes disease, is crying
with pain as the nurse assesses that the skin of the right foot is pale with an absence of pulse.
What should the nurse do first?
a. Notify the practitioner of the changes noted.
b. Give the child medication to relieve the pain.
c. Reposition the child and notify the physician.
d. Chart the observations and check the extremity again in 15 minutes.

Answer 58

ANS: A
The absence of a pulse and change in color of the foot must be reported immediately for
evaluation by the practitioner. Pain medication and repositioning should be addressed after the
practitioner is notified. This is an emergency condition; immediate reporting is indicated. The
findings should be documented with ongoing assessment.

Question 59

What is an appropriate nursing intervention when caring for a child in traction?

a. Remove adhesive traction straps daily to prevent skin breakdown.
b. Assess for tightness, weakness, or contractures in uninvolved joints and muscles.
c. Provide active range-of-motion exercises to affected extremity 3 times a day.
d. Keep child in one position to maintain good alignment.

Answer 59

ANS: B
Traction places stress on the affected bone, joint, and muscles. The nurse must assess for
tightness, weakness, or contractures developing in the uninvolved joints and muscles. The
adhesive straps should be released/replaced only when absolutely necessary. Active, passive,
or active with resistance exercises should be carried out for the unaffected extremity only.
Movement is expected with children. Each time the child moves, the nurse should check to
ensure that proper alignment is maintained.

Question 60

The nurse is teaching a family how to care for their infant in a Pavlik harness to treat
developmental dysplasia of the hips (DDH). What information should be included?
a. Apply lotion or powder to minimize skin irritation.
b. Remove the harness several times a day to prevent contractures.
c. Hip stabilization usually occurs within 12 weeks.
d. Place a diaper over harness, preferably using a superabsorbent disposable diaper
that is relatively thin.

Answer 60

ANS: C
The harness is worn continuously until the hip is proved stable on both clinical and ultrasound
examination, usually within 6 to 12 weeks. Lotions and powders should not be used with the
harness. The harness should not be removed, except as directed by the practitioner. A thin
disposable diaper can be placed under the harness.

Question 61

When does idiopathic scoliosis become most noticeable?

a. Newborn period
b. When child starts to walk
c. During preadolescent growth spurt
d. Adolescence

Answer 61

ANS: C
Idiopathic scoliosis is most noticeable during the preadolescent growth spurt and is seldom
apparent before age 10 years.

Question 62

What is the initial method of treating osteomyelitis?

a. Joint replacement
b. Bracing and casting
c. Intravenous antibiotic therapy
d. Long-term corticosteroid therapy

Answer 62

ANS: C
Osteomyelitis is an infection of the bone, most commonly caused by Staphylococcus aureus.
The treatment of choice is antibiotics delivered intravenous and then possibly by the oral
route. Joint replacement, bracing and casting, and long-term corticosteroids are not indicated
for infectious processes

Question 63

Which medication is usually tried first when a child is diagnosed with juvenile idiopathic
arthritis (JIA)?
a. Aspirin
b. Corticosteroids
c. Cytotoxic drugs such as methotrexate
d. Nonsteroidal antiinflammatory drugs (NSAIDs)

Answer 63

ANS: D
NSAIDs are the first drugs used in JIA. Naproxen, ibuprofen, and tolmetin are approved for
use in children. Aspirin, once the drug of choice, has been replaced by the NSAIDs because
they have fewer side effects and easier administration schedules. Corticosteroids are used for
life-threatening complications, incapacitating arthritis, and uveitis. Methotrexate is a
second-line therapy for JIA.

Question 64

What nursing consideration is especially important when caring for a child diagnosed with
juvenile idiopathic arthritis (JIA)?
a. Apply ice packs to relieve stiffness and pain.
b. Administer acetaminophen to reduce inflammation.
c. Teach child and family the correct administration of medications.
d. Encourage range-of-motion exercises during periods of inflammation.

Answer 64

ANS:C
The management of JIA is primarily pharmacologic. The family should be instructed
regarding administration of medications and the value of a regular schedule of administration
to maintain a satisfactory blood level in the body. They need to know that nonsteroidal
antiinflammatory drugs should not be given on an empty stomach and to be alert for signs of
toxicity. Warm, moist heat is best for relieving stiffness and pain. Acetaminophen does not
have antiinflammatory effects. Range-of-motion exercises should not be done during periods
of inflammation.

Question 65

When infants are seen for fractures, which nursing intervention is a priority?

a. No intervention is necessary. It is not uncommon for infants to fracture bones.
b. Assess the family’s safety practices. Fractures in infants usually result from falls.
c. Assess for child abuse. Fractures in infants are often nonaccidental.
d. Assess for genetic factors.

Answer 65

ANS: C
Fractures in infants warrant further investigation to rule out child abuse. Fractures in children
younger than 1 year are unusual because of the cartilaginous quality of the skeleton; a large
amount of force is necessary to fracture their bones. Infants should be cared for in a safe
environment and should not be falling. Fractures in infancy are usually nonaccidental rather
than related to a genetic factor.

Question 66

Which nursing intervention is appropriate to assess for neurovascular competency in a child
suspected of experiencing compartment syndrome?
a. The degree of motion and ability to position the extremity.
b. The length, diameter, and shape of the extremity.
c. The amount of swelling noted in the extremity and pain intensity.
d. The skin color, temperature, movement, sensation, and capillary refill of the
extremity.

Answer 66

ANS: D
A neurovascular evaluation includes assessing skin color and temperature, ability to move the
affected extremity, degree of sensation experienced, and speed of capillary refill in the
extremity. The degree of motion in the affected extremity and ability to position the extremity
are incomplete assessments of neurovascular competency. The length, diameter, and shape of
the extremity are not assessment criteria in a neurovascular evaluation. Although the amount
of swelling is an important factor in assessing an extremity, it is not a criterion for a
neurovascular assessment.

Question 67

Which interaction is part of the discharge plan for a school-age child with osteomyelitis who
is receiving home antibiotic therapy?
a. Instructions for a low-calorie diet
b. Arrangements for tutoring and school work
c. Instructions for a high-fat, low-protein diet
d. Instructions for the parent to return the child to team sports immediately

Answer 67

ANS: B
Promoting optimal growth and development in the school-age child is important. It is
important to continue schoolwork and arrange for tutoring if indicated. The child with
osteomyelitis should be on a high-calorie, high-protein diet. The child with osteomyelitis may
need time for the bone to heal before returning to full activities.

Question 68

Discharge planning for the child diagnosed with juvenile arthritis includes the need for which
intervention?
a. Routine ophthalmologic examinations to assess for visual problems.
b. A low-calorie diet to decrease or control weight in the less mobile child.
c. Avoiding the use of aspirin to decrease gastric irritation.
d. Immobilizing the painful joints, which are the results of the inflammatory process.

Answer 68

ANS: A
The systemic effects of juvenile arthritis can result in visual problems, making routine eye
examinations important. Children with juvenile arthritis do not have problems with increased
weight and often are anorexic and in need of high-calorie diets. Children with arthritis are
often treated with aspirin. Children with arthritis are able to immobilize their own joints.
Range-of-motion exercises are important for maintaining joint flexibility and preventing
restricted movement in the affected joints.

Question 69

When assessing the child with osteogenesis imperfecta, the nurse should expect to observe
clinical feature?
a. Discolored teeth
b. Below-normal intelligence
c. Increased muscle tone
d. Above-average stature

Answer 69

ANS: A
Children with osteogenesis imperfecta have incomplete development of bones, teeth,
ligaments, and sclerae. Teeth are discolored because of abnormal enamel. Despite their
appearance, children with osteogenesis imperfecta have normal or above-normal intelligence.
The child with osteogenesis imperfecta has weak muscles and decreased muscle tone. Because
of compression fractures of the spine, the child appears short.

Question 70

A 10 year old sustained a fracture in the epiphyseal plate of the right fibula when falling from
a tree. When discussing this injury with the child’s parents, the nurse should consider which
statement?
a. Healing is usually delayed in this type of fracture.
b. Growth can be affected by this type of fracture.
c. This is an unusual fracture site in young children.
d. This type of fracture is inconsistent with a fall.

Answer 70

ANS: B
Detection of epiphyseal injuries is sometimes difficult, but fractures involving the epiphysis or
epiphyseal plate present special problems in determining whether bone growth will be
affected. Healing of epiphyseal injuries is usually prompt. The epiphysis is the weakest point
of the long bones. This is a frequent site of damage during trauma.

Question 71

A 4-year-old child is newly diagnosed with Legg-Calvé-Perthes disease. Nursing
considerations should include which action?
a. Encouraging normal activity for as long as is possible.
b. Explaining the cause of the disease to the child and family.
c. Preparing the child and family for long-term, permanent disabilities.
d. Teaching the family the care and management of the corrective appliance.

Answer 71

ANS: D
The family needs to learn the purpose, function, application, and care of the corrective device
and the importance of compliance to achieve the desired outcome. The initial therapy is rest
and nonweight bearing, which helps reduce inflammation and restore motion.
Legg-Calvé-Perthes is a disease with an unknown etiology. A disturbance of circulation to the
femoral capital epiphysis produces an ischemic aseptic necrosis of the femoral head. The
disease is self-limiting, but the ultimate outcome of therapy depends on early and efficient
therapy and the child’s age at onset

Question 72

A nurse is conducting discharge teaching for parents of an infant diagnosed with osteogenesis
imperfecta (OI). Further teaching is indicated if the parents make which statement?
a. “We will be very careful handling the baby.”
b. “We will lift the baby by the buttocks when diapering.”
c. “We’re glad there is a cure for this disorder.”
d. “We will schedule follow-up appointments as instructed.”

Answer 72

ANS: C
The treatment for OI is primarily supportive. Although patients and families are optimistic
about new research advances, there is no cure. The use of bisphosphonate therapy with IV
pamidronate to promote increased bone density and prevent fractures has become standard
therapy for many children with OI; however, long bones are weakened by prolonged
treatment. Infants and children with this disorder require careful handling to prevent fractures.
They must be supported when they are being turned, positioned, moved, and held. Even
changing a diaper may cause a fracture in severely affected infants. These children should
never be held by the ankles when being diapered but should be gently lifted by the buttocks or
supported with pillows. Follow-up appointments for treatment with bisphosphonate can be
expected.

Question 73

The nurse is caring for an infant with developmental dysplasia of the hips (DDH). Which
clinical manifestations should the nurse expect to observe? (Select all that apply.)
a. Positive Ortolani sign
b. Unequal gluteal folds
c. Negative Babinski’s sign
d. Trendelenburg’s sign
e. Telescoping of the affected limb
f. Lordosis

Answer 73

ANS: A, B
A positive Ortolani sign and unequal gluteal folds are clinical manifestations of
developmental dysplasia of the hips (DDH) seen from birth to 2 to 3 months. Trendelenburg’s
sign is noted in a child capable of standing alone. Negative Babinski’s sign, telescoping of the
affected limb, and lordosis are not clinical manifestations of developmental dysplasia of the
hips (DDH).

Question 74

A school-age child is diagnosed with systemic lupus erythematosus (SLE). The nurse should
plan to implement which interventions for this child? (Select all that apply.)
a. Instructions to avoid exposure to sunlight
b. Teaching about body changes associated with SLE
c. Preparation for home schooling
d. Restricted activity

Answer 74

ANS: A, B
Key issues for a child with SLE include therapy compliance; body-image problems associated
with rash, hair loss, and steroid therapy; school attendance; vocational activities; social
relationships; sexual activity; and pregnancy. Specific instructions for avoiding exposure to
the sun and ultraviolet B light, such as using sunscreens, wearing sun-resistant clothing, and
altering outdoor activities, must be provided with great sensitivity to ensure compliance while
minimizing the associated feeling of being different from peers. The child should continue
school attendance in order to gain interaction with peers and activity should not be restricted,
but promoted.

Question 75

The nurse is caring for a preschool child with a cast applied recently for a fractured tibia.
Which assessment findings indicate possible compartment syndrome? (Select all that apply.)
a. Palpable distal pulse
b. Capillary refill to extremity of <3 seconds
c. Severe pain not relieved by analgesics
d. Tingling of extremity
e. Inability to move extremity

Answer 75

ANS: C, D, E
Indications of compartment syndrome are severe pain not relieved by analgesics, tingling of
extremity, and inability to move extremity. A palpable distal pulse and capillary refill to the
extremity of <3 seconds are expected findings.