MSK 1
A nurse is caring for a client with a cast on the left arm after sustaining a fracture. Which assessment finding is most significant for this client?
A. Fingers on the left hand are swollen and cool
B. Presence of a normal popliteal pulse
C. Cast edges are rough, with skin irritation present
D. Mild pain in the left arm
A. Fingers on the left hand are swollen and cool
Swollen and cool fingers on the left hand are the most significant assessment findings. They represent altered circulation to the hand caused by the cast. A normal radial, not popliteal, pulse should be present in the left arm; the popliteal pulse is found on the leg. Skin irritation is an abnormal assessment finding but it isn't as significant as altered circulation. Minimal pain in the left arm is expected.
Which aspect should a nurse include in the teaching plan for a client with osteomalacia?
A. Avoid dairy products
B. Include vitamin D supplements
C. Avoid green, leafy vegetables
D. Avoid any activity or exercise
B. Include vitamin D supplements
The nurse should encourage clients with osteomalacia to include calcium, phosphorus, and vitamin D supplements; adequate nutrition; exposure to sunlight; and progressive exercise and ambulation. Clients need not avoid dairy products, leafy vegetables, or mild exercise.
A school nurse is screening an 11-year-old child for idiopathic scoliosis. Which of the following instructions should the nurse give the child for this examination?
A. "Lie prone on the examination table."
B. "Touch your chin to your chest, and then look up at the ceiling."
C. "Turn to the side, and remain in a relaxed position."
D. "Bend forward from the waist with your head and arms downward."
D. "Bend forward from the waist with your head and arms downward."
Answer Rationale:
Called Adams position, this posture will make any asymmetry of the ribs and flanks easier for the nurse to recognize.
A nurse is reinforcing teaching with a parent of an 8-year-old child who has a fracture of the epiphyseal plate. Which of the following statements should the nurse include in the teaching?
A. "Fractures in a child take longer to heal than fractures in an adult."
B. "Normal bone growth can be affected by the fracture."
C. "Bone marrow can be lost though the fracture."
D. "Your child will need to increase his calcium intake to 3,000 milligrams daily."
B. "Normal bone growth can be affected by the fracture."
Answer Rationale:
A fracture of the epiphyseal plate can affect growth in a child. Therefore, it needs to be detected and treated rapidly.
A patient is admitted to the hospital with an acute gout attack. The nurse expects that which medication will ordered to treat acute gout?
A) colchicine
B) allopurinol
C) cyclobenzaprine (Flexeril)
D) alendronate (Fosamax)
A) colchicine
A nurse is assisting a client who is 2 days postoperative following a total hip arthroplasty to walk to a chair. When the nurse offers to help the client ambulate, the client refuses to get out of bed. Which of the following actions should actions should nurse take?
A. Ask for assistance from a physical therapist to help move the client out of bed.
B. Tell the client that if she does not get out of bed she will not receive any assistance with bathing.
C. Instruct the assistive personnel (AP) to transfer the client to a chair.
D. Acknowledge the client’s wishes.
D. Acknowledge the client’s wishes.
Answer Rationale:
The nurse should acknowledge the client’s wishes because she has the right to refuse treatment.
A client with fibromyalgia is hesitant to talk about the symptoms. Which statement will the nurse make to help support the client?
A. “Tell me what you’ve been experiencing.”
B. “Every client I talk with has similar symptoms."
C. “Odd pain responses occur as a normal part of aging."
D. "Most treatments for your kind of pain are not effective.”
A. “Tell me what you’ve been experiencing.”
Clients with fibromyalgia have endured their symptoms for a long period of time. They may feel as if their symptoms have not been taken seriously. Nurses need to pay special attention to supporting these clients and providing encouragement as they begin their program of therapy. Support groups may be helpful.
A client was playing softball and was hit in the right ankle by the ball sustaining a contusion. What is the first action taken to help alleviate pain and swelling?
A. Apply heat to the ankle.
B. Apply a cold pack to the ankle.
C. Administer ibuprofen (Advil).
D. Ask the client to walk to stretch the ligaments.
B. Apply a cold pack to the ankle.
Applying cold packs helps to alleviate local pain, swelling, and bruising. Heat is not used initially after injury, because it can dilate the blood vessels, causing increased bruising and pain. Ibuprofen (Advil) would not be a priority action at this time. The client should not walk on the injured foot or ankle until serious injury is ruled out.
A health care provider diagnoses primary osteoporosis in a client who has lost bone mass. For which client is primary osteoporosis most common?
A. elderly man
B. young child
C. young menstruating woman
D. elderly postmenopausal woman
D. elderly postmenopausal woman
Although the cause of primary osteoporosis is unknown, an important contributing factor may be faulty protein metabolism resulting from estrogen deficiency and a sedentary lifestyle. Typically, these conditions occur in elderly postmenopausal women.
Alendronate (Fosamax) is prescribed for a patient. The nurse teaches the patient that:
a )the tablet must be chewed thoroughly prior to swallowing.
b )bisphosphonates prevent calcium from being taken from the bones.
c )lying down after taking the drug prevents light-headedness and dizziness.
d ) the drug must be taken before bed.
b )bisphosphonates prevent calcium from being taken from the bones.
The nurse is teaching a client about rheumatic disease. What statement best helps to explain autoimmunity?
A. “You have inherited your parent’s immunity to the disease.”
B. “Your symptoms are a result of your body attacking itself.”
C. “You have antigens to the disease, but they do not prevent the disease.”
D. “You are not immune to the disease causing the symptoms.”
B. “Your symptoms are a result of your body attacking itself.”
In autoimmunity, the body mistakes its own tissue for foreign tissue and begins to attack it. Symptoms develop as the body destroys tissue. The body is in effect attacking itself. The other statements do not explain autoimmunity.
A nurse is contributing to the plan of care for a client who is postoperative following a total hip arthroplasty. Which of the following information should the nurse include?
A. Instruct the client to avoid movement of the affected leg.
B. Prevent hip flexion of the affected extremity.
C. Position the lower extremities so that they are touching.
D. Ensure that the client's heels are touching the bed.
B. Prevent hip flexion of the affected extremity.
Answer Rationale:
The nurse should implement measures to prevent hip flexion of the affected extremity due to the risk of dislocation.
When caring for a client with a fracture, what assessment would take priority?
A. Neurovascular compromise
B. Hormonal imbalances
C. Cardiac problems
D. Altered kidney function
A. Neurovascular compromise
When caring for a client with a fracture, the nurse assesses for the neurovascular compromise. A fracture or a treatment for fracture is not known to lead to hormonal imbalances, cardiac problems, or an altered kidney function.
A client is admitted with acute osteomyelitis that developed after an open fracture of the right femur. When planning this client's care, the nurse should anticipate which measure?
A. Administering large doses of oral antibiotics as ordered
B. Instructing the client to ambulate twice daily
C. Withholding all oral intake
D. Administering large doses of I.V. antibiotics as ordered
D. Administering large doses of I.V. antibiotics as ordered
Treatment of acute osteomyelitis includes large doses of I.V. antibiotics (after blood cultures identify the infecting organism). Surgical drainage may be indicated, and the affected bone is immobilized. The client usually requires I.V. fluids to maintain hydration, but oral intake isn't necessarily prohibited.
The patient has been prescribed adalimumab (Humira) for severe rheumatoid arthritis. Her spouse calls the clinic and states his wife has a fever of 101.9 degrees F, chills, nausea, and vomiting, and is very dizzy. What will the nurse advise the patient's spouse to do?
A) Nothing. These are common side effects of infliximab
B) Have the patient take a cool bath
C) Wait 24 hours and if symptoms continue, call back
D) Bring the patient to the emergency department or clinic for further evaluation
D) Bring the patient to the emergency department or clinic for further evaluation
A nurse is providing education to a client recently diagnosed with gout. Which of the following statements should the nurse include as part of the teaching plan? Select all that apply.
A. "Avoid consuming foods high in purines, such as red meat and shellfish, as they can exacerbate gout symptoms."
B. "It's important to drink plenty of fluids, particularly water, to help flush uric acid from your system."
C. "You should limit your intake of dairy products, as they can contribute to gout attacks."
D. "Try to minimize stress and maintain a healthy weight, as obesity and stress can trigger gout flare-ups."
E. "You should increase your intake of alcohol, particularly beer, as it can help reduce uric acid levels."
A, B, D.
Foods high in purines, such as red meat and shellfish, can increase uric acid levels and trigger gout attacks. Drinking plenty of fluids helps to flush uric acid from the body and can aid in preventing gout attacks. Dairy products, especially low-fat ones, are generally not associated with triggering gout attacks and may even be beneficial. Managing stress and maintaining a healthy weight can help prevent gout flare-ups. Alcohol, particularly beer, can increase uric acid levels and is generally advised to be consumed in moderation or avoided in gout management.
Which of the following would the nurse expect to assess as the most common finding associated with fibromyalgia?
A. Heberden’s nodes
B. Crepitus
C. Widespread chronic pain
D. Infection
C. Widespread chronic pain
A client sustains a fractured right humerus in an automobile accident. The arm is edematous, the client states not being able to move or feel the fingers, and the nurse does not feel a pulse. What condition should the nurse be concerned about that requires emergency measures?
A. Compartment syndrome
B. Dislocation
C. Muscle spasms
D. Subluxation
A. Compartment syndrome
The injury may disrupt local blood supply to structures such as the joint cartilage, causing degeneration, chronic pain, and restricted movement. Compartment syndrome is a condition in which a structure such as a tendon or nerve is constricted in a confined space.
Which of the following statements about osteoporosis are accurate? Select all that apply.
A. Weight-bearing exercises, such as walking and weightlifting, can help strengthen bones and reduce the risk of fractures in individuals with osteoporosis.
B. Osteoporosis primarily affects young adults and is rarely seen in older populations.
C. Medications such as bisphosphonates can be used to treat osteoporosis and improve bone density.
D. Adequate intake of calcium and vitamin D is important for bone health and can help prevent osteoporosis.
E. Osteoporosis can be diagnosed with a bone density test known as dual-energy X-ray absorptiometry (DXA).
A, C, D, & E.
Weight-bearing exercises are beneficial for strengthening bones and reducing fracture risk in individuals with osteoporosis. Osteoporosis is most commonly seen in older adults, particularly postmenopausal women, and is less common in young adults. Medications such as bisphosphonates are used to treat osteoporosis and can help improve bone density. Adequate calcium and vitamin D intake is crucial for maintaining bone health and can help prevent osteoporosis. A bone density test using dual-energy X-ray absorptiometry (DXA) is commonly used to diagnose osteoporosis.
A nurse is assessing a client who has been taking acetaminophen for pain management. Which of the following statements about acetaminophen is correct?
A. Acetaminophen is a nonsteroidal anti-inflammatory drug (NSAID) that reduces inflammation and pain.
B. The maximum recommended daily dose of acetaminophen for an adult is 4,000 mg to avoid liver toxicity.
C. Acetaminophen is safe to use in combination with alcohol without any risk of liver damage.
D. The use of acetaminophen is contraindicated in clients with renal impairment due to the risk of kidney damage.
B
Acetaminophen is not an NSAID and does not have anti-inflammatory properties; it primarily relieves pain and reduces fever. The maximum recommended daily dose of acetaminophen for an adult is typically 4,000 mg. Exceeding this dose can lead to liver toxicity. Combining acetaminophen with alcohol increases the risk of liver damage and should be avoided. Acetaminophen is not contraindicated in clients with renal impairment. It is generally considered safer for the kidneys compared to NSAIDs, though liver function is a more critical consideration.
`Which of the following statements accurately describe differences between rheumatoid arthritis (RA) and osteoarthritis (OA)? Select all that apply.
A. Rheumatoid arthritis commonly affects the small joints of the hands and feet, while osteoarthritis typically affects larger weight-bearing joints like the hips and knees.
B. Osteoarthritis is characterized by symmetrical joint involvement, whereas rheumatoid arthritis often presents with asymmetrical joint involvement.
C. Rheumatoid arthritis involves systemic inflammation and can affect organs beyond the joints, while osteoarthritis primarily involves localized joint degeneration without systemic symptoms.
D. Morning stiffness lasting more than one hour is a common symptom of osteoarthritis, while rheumatoid arthritis is more likely to cause stiffness that improves with activity.
E. Rheumatoid arthritis is usually diagnosed with specific autoantibodies, such as rheumatoid factor (RF) and anti-CCP antibodies, whereas osteoarthritis diagnosis is based primarily on clinical findings and X-ray results.
A, C, E.
RA often affects the small joints of the hands and feet, whereas OA commonly affects larger weight-bearing joints. RA typically causes symmetrical joint involvement, while OA usually has asymmetrical joint involvement. RA involves systemic inflammation and can affect organs beyond the joints, whereas OA is more localized to the joints. Morning stiffness lasting more than one hour is more characteristic of RA, not OA. OA stiffness usually improves with activity. RA diagnosis often involves specific autoantibodies, while OA is diagnosed mainly through clinical evaluation and X-rays.
`A nurse is collecting data from a client who has an exacerbation of gout. Which of the following findings should the nurse expect? (Select all that apply.)
A. Tophi
B. Edema
C. Symmetrical joint pain
D. Erythema
E. Tight skin
A, B, D, & E
The nurse teaches the client which intervention to avoid hip dislocation after replacement surgery?
A. Keep the knees together at all times
B. Never cross the affected leg when seated
C. Avoid placing a pillow between the legs when sleeping
D. Bend forward only when seated in a chair
B. Never cross the affected leg when seated
Crossing the affected leg may result in dislocation of the hip joint after total hip replacement. The client should be taught to keep the knees apart at all times, to put a pillow between the legs when sleeping, and to avoid bending forward when seated in a chair.
A nurse is assessing a patient who recently sustained a compound fracture of the tibia and fibula. Which of the following complications should the nurse monitor for in this patient? Select all that apply.
A. Deep vein thrombosis (DVT) and pulmonary embolism
B. Osteomyelitis and infection at the fracture site
C. Rheumatoid arthritis
D. Compartment syndrome
E. Air embolism
A, B, & D
Deep vein thrombosis (DVT) and pulmonary embolism are potential complications due to immobilization and reduced mobility following a fracture. Osteomyelitis and infection at the fracture site are concerns, especially with compound (open) fractures where the bone is exposed. Compartment syndrome, characterized by increased pressure within a muscle compartment, can compromise blood flow and lead to tissue damage. Fat embolism syndrome can occur when fat globules from the bone marrow enter the bloodstream and travel to the lungs or other organs. Rheumatoid arthritis is not a direct complication of fractures; it is a chronic inflammatory joint disease unrelated to the acute fracture process.
A nurse is educating a client with osteoarthritis about the long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs). Which of the following adverse effects and complications should the nurse include in the teaching? Select all that apply.
A. Increased risk of gastrointestinal bleeding and ulcer formation
B. Development of kidney impairment or acute kidney injury
C. Significant weight loss and malnutrition
D. Potential for hyperglycemia and worsening of diabetes mellitus
A, B, C
Long-term NSAID use can lead to gastrointestinal bleeding and ulcer formation due to the drugs' effects on the stomach lining. NSAIDs can impair kidney function and potentially lead to acute kidney injury, especially with prolonged use. Significant weight loss and malnutrition are not typical adverse effects of NSAIDs. Hyperglycemia and worsening of diabetes are not typically direct effects of NSAIDs, though caution is needed in diabetic patients due to potential cardiovascular risks.