60 Item Medical Surgical Nursing : Musculoskeletal Examination Answers 1. A client is 1 day postoperative after a total hip replacement.

The client sho uld be placed in which of the following position? a. Supine b. Semi Fowler's c. Orthopneic d. Trendelenburg 2. A client who has had a plaster of Paris cast appl ied to his forearm is receiving pain medication. To detect early manifestations of compartment syndrome, which of these assessments should the nurse make? a. Ob serve the color of the fingers b. Palpate the radial pulse under the cast c. Che ck the cast for odor and drainage d. Evaluate the response to analgesics 3. Afte r a computer tomography scan with intravenous contrast medium, a client returns to the unit complaining of shortness of breath and itching. The nurse should be prepared to treat the client for: a. An anaphylactic reaction to the dye b. Infl ammation from the extravasation of fluid during injection. c. Fluid overload fro m the volume of the infusions d. A normal reaction to the stress of the diagnost ic procedure. 4. While caring for a client with a newly applied plaster of Paris cast, the nurse makes note of all the following conditions. Which assessment fi nding requires immedite notification of the physician? a. Moderate pain, as repo rted by the client b. Report, by client, the heat is being felt under the cast c . Presence of slight edema of the toes of the casted foot d. Onset of paralysis in the toes of the casted foot 5. Which of these nursing actions will best promo te independence for the client in skeletal traction? a. Instruct the client to c all for an analgesic before pain becomes severe. b. Provide an overhead trapeze for client use c. Encourage leg exercise within the limits of traction d. Provid e skin care to prevent skin breakdown. 6. A client presents in the emergency dep artment after falling from a roof. A fracture of the femoral neck is suspected. Which of these assessments best support this diagnosis. a. The client reports pa in in the affected leg b. A large hematoma is visible in the affected extremity c. The affected extremity is shortenend, adducted, and extremely rotated

d. The affected extremity is edematous. 7. The nurse is caring for a client with compound fracture of the tibia and fibula. Skeletal traction is applied. Which of these priorities should the nurse include in the care plan? a. Order a trapez e to increase the client's ambulation b. Maintain the client in a flat, supine p osition at all times. c. Provide pin care at least every hour d. Remove traction weights for 20 minutes every two hours. 8. To prevent foot drop in a client wit h Buck's traction, the nurse should: a. Place pillows under the client's heels. b. Tuck the sheets into the foot of the bed c. Teach the client isometric exerci ses d. Ensure proper body positioning. 9. Which nursing intervention is appropri ate for a client with skeletal traction? a. Pin care b. Prone positioning c. Int ermittent weights d. 5lb weight limit 10. In order for Buck's traction applied t o the right leg to be effective, the client should be placed in which position? a. Supine c. Sim's b. Prone d. Lithotomy 11. An elderly client has sustained int ertrochanteric fracture of the hip and has just returned from surgery where a na il plate was inserted for internal fixation. The client has been instructed that she should not flex her hip. The best explanation of why this movement would be harmful is: a. It will be very painful for the client b. The soft tissue around the site will be damaged c. Displacement can occur with flexion d. It will pull the hip out of alignment 12. When the client is lying supine, the nurse will pr event external rotation of the lower extremity by using a: a. Trochanter roll by the knee b. Sandbag to the lateral calf c. Trochanter roll to the thigh d. Foot board 13. A client has just returned from surgery after having his left leg ampu tated below the knee. Physician's orders include elevation of the foot of the be d for 24 hours. The nurse observes that the nursing assistant has placed a pillo w under the client's amputated limb. The nursing action is to:

a. Leave the pillow as his stump is elevated b. Remove the pillow and elevate th e foot of the bed c. Leave the pillow and elevate the foot of the bed d. Check w ith the physician and clarify the orders 14. A client has sustained a fracture o f the femur and balanced skeletal traction with a Thomas splint has been applied . To prevent pressure points from occurring around the top of the splint, the mo st important intervention is to: a. Protect the skin with lotion b. Keep the cli ent pulled up in bed c. Pad the top of the splint with washcloths d. Provide a f ootplate in the bed 15. The major rationale for the use of acetylsalicylic acid (aspirin) in the treatment of rheumatoid arthritis is to: a. Reduce fever b. Red uce the inflammation of the joints c. Assist the client's range of motion activi ties without pain d. Prevent extension of the disease process 16. Following an a mputation, the advantage to the client for an immediate prosthesis fitting is: a . Ability to ambulate sooner b. Less change of phantom limb sensation c. Dressin g changes are not necessary d. Better fit of the prosthesis 17. One method of as sessing for sign of circulatory impairment in a client with a fractured femur is to ask the client to: a. Cough and deep breathe b. Turn himself in bed c. Perfo rm biceps exercise d. Wiggle his toes 18. The morning of the second postoperativ e day following hip surgery for a fractured right hip, the nurse will ambulate t he client. The first intervention is to: a. Get the client up in a chair after d angling at the bedside. b. Use a walker for balance when getting the client out of bed c. Have the client put minimal weight on the affected side when getting u p d. Practice getting the client out of bed by having her slightly flex her hips 19. A young client is in the hospital with his left leg in Buck's traction. The team leader asks the nurse to place a footplate on the affected side at the bot tom of the bed. The purpose of this action is to: a. Anchor the traction b. Prev ent footdrop c. Keep the client from sliding down in bed

d. Prevent pressure areas on the foot 20. When evaluating all forms of traction, the nurse knows the direction of pull is controlled by the: a. Client's positio n b. Rope/pulley system c. Amount of weight d. Point of friction 21. When a clie nt has cervical halter traction to immobilize the cervical spine counteraction i s provided by: a. Elevating the foot of the bed b. Elevating the head of the bed c. Application of the pelvic girdle d. Lowering the head of the bed 22. After f alling down the basement steps in his house, a client is brought to the emergenc y room. His physician confirms that his leg is fractured. Following application of a leg cast, the nurse will first check the client's toes for: a. Increase in the temperature b. Change in color c. Edema d. Movement 23. A 23 year old female client was in an automobile accident and is now a paraplegic. She is on an inte rmittent urinary catheterization program and diet as tolerated. The nurse's prio rity assessment should be to observe for: a. Urinary retention b. Bladder disten tion c. Weight gain d. Bower evacuation 24. A female client with rheumatoid arth ritis has been on aspirin grain TID and prednisone 10mg BID for the last two yea rs. The most important assessment question for the nurse to ask related to the c lient's drug therapy is whether she has a. Headaches b. Tarry stools c. Blurred vision d. Decreased appetite 25. A 7 year old boy with a fractured leg tells the nurse that he is bored. An appropriate intervention would be to a. Read a story and act out the part b. Watch a puppet show c. Watch television d. Listen to th e radio

26. On a visit to the clinic, a client reports the onset of early symptoms of rh eumatoid arthritis. Which of the following would be the nurse most likely to ass es: a. Limited motion of joints b. Deformed joints of the hands c. Early morning stiffness d. Rheumatoid nodules 27. After teaching the client about risk factor s for rheumatoid arthritis, which of the following, if stated by the client as a risk factor, would indicate to the nurse that the client needs additional teach ing? a. History of Epstein-Barr virus infection b. Female gender c. Adults betwe en the ages 60 to 75 years d. Positive testing for human leukocyte antigen (HLA) DR4 allele 28. When developing the teaching plan for the client with rheumatoid arthritis to promote rest, which of the following would the nurse expect to ins truct the client to avoid during the rest periods? a. Proper body alignment b. E levating the part c. Prone lying positions d. Positions of flexion 29. After tea ching the client with severe rheumatoid arthritis about the newly prescribed med ication methothrexate (Rheumatrex 0), which of the following statements indicate s the need for further teaching? a. "I will take my vitamins while I am on this drug" b. "I must not drink any alcohol while I'm taking this drug" c. I should b rush my teeth after every meal" d. "I will continue taking my birth control pill s" 30. When completing the history and physical examination of a client diagnose d with osteoarthritis, which of the following would the nurse assess? a. Anemia c. Weight loss b. Osteoporosis d. Local joint pain 31. At which of the following times would the nurse instruct the client to take ibuprofen (Motrin), prescribe d for left hip pain secondary to osteoarthritis, to minimize gastric mucosal irr itation? a. At bedtime b. On arising c. Immediately after meal

d. On an empty stomach 32. When preparing a teaching plan for the client with os teoarthritis who is taking celecoxib (Celebrex), the nurse expects to explain th at the major advantage of celecoxib over diclofenac (Voltaren), is that the cele coxib is likely to produce which of the following? a. Hepatotoxicity b. Renal to xicity c. Gastrointestinal bleeding d. Nausea and vomiting 33. After surgery and insertion of a total joint prosthesis, a client develops severe sudden pain and an inability to move the extremity. The nurse interprets these findings as indi cating which of the following? a. A developing infection b. Bleeding in the oper ative site c. Joint dislocation d. Glue seepage into soft tissue 34. Which of th e following would the nurse assess in a client with an intracapsular hip fractur e? a. Internal rotation c. Shortening of the affected leg b. Muscle flaccidity d . Absence of pain the fracture area 35. Which of the following would be inapprop riate to include when preparing a client for magnetic resonance imaging (MRI) to evaluate a rupture disc? a. Informing the client that the procedure is painless b. Taking a thorough history of past surgeries c. Checking for previous complai nts of claustrophobia d. Starting an intravenous line at keep-open rate 36. Whic h of the following actions would be a priority for a client who has been in the postanesthesia care unit (PACU) for 45 minutes after an above the knee amputatio n and develops a dime size bright red spot on the ace bondage above the amputati on site? a. Elevate the stump b. Reinforcing the dressing c. Calling the surgeon d. Drawing a mark around the site 37. A client in the PACU with a left below th e knee amputation complains of pain in her left big toe. Which of the following would the nurse do first? a. Tell the client it is impossible to feel the pain b . Show the client that the toes are not there c. Explain to the client that the pain is real d. Give the client the prescribed narcotic analgesic

38. The client with an above the knee amputation is to use crutches until the pr osthesis is being adjusted. In which of the following exercises would the nurse instruct the client to best prepare him for using crutches? a. Abdominal exercis es b. Isometric shoulder exercises c. Quadriceps setting exercises d. Triceps st retching exercises 39. The client with an above the knee amputation is to use cr utches until the prosthesis is properly lifted. When teaching the client about u sing the crutches, the nurse instructs the client to support her weight primaril y on which of the following body areas? a. Axillae b. Elbows c. Upper arms d. Ha nds 40. Three hours ago a client was thrown from a car into a ditch, and he is n ow admitted to the ED in a stable condition with vital signs within normal limit s, alert and oriented with good coloring and an open fracture of the right tibia . When assessing the client, the nurse would be especially alert for signs and s ymptoms of which of the following? a. Hemorrhage b. Infection c. Deformity d. Sh ock 41. The client with a fractured tibia has been taking methocarbamol (Robaxin ), when teaching the client about this drug, which of the following would the nu rse include as the drug's primary effect? a. Killing of microorganisms b. Reduct ion in itching c. Relief of muscle spasms d. Decrease in nervousness 42. A clien t who has been taking carisoprodol (Soma) at home for a fractured arm is admitte d with a blood pressure of 80/50 mmHg, a pulse rate of 115bpm, and respirations of 8 breaths/minute and shallow, the nurse interprets these finding as indicatin g which of the following? a. Expected common side effects b. Hypersensitivity re actions c. Possible habituating effects d. Hemorrhage from GI irritation 43. Whe n admitting a client with a fractured extremity, the nurse would focus the asses sment on which of the following first? a. The area proximal to the fracture b. T he actual fracture site

c. The area distal to the fracture d. The opposite extremity for baseline compar ison 44. A client with fracture develops compartment syndrome. When caring for t he client, the nurse would be alert for which of the following signs of possible organ failure? a. Rales b. Jaundice c. Generalized edema d. Dark, scanty urine 45. Which of the following would lead the nurse to suspect that a client with a fracture of the right femur may be developing a fat embolus? a. Acute respirator y distress syndrome b. Migraine like headaches c. Numbness in the right leg d. M uscle spasms in the right thigh 46. The client who had an open femoral fracture was discharged to her home, where she developed, fever, night sweats, chills, re stlessness and restrictive movement of the fractured leg. The nurse interprets t hese finding as indicating which of the following? a. Pulmonary emboli b. Osteom yelitis c. Fat emboli d. Urinary tract infection 47. When antibiotics are not pr oducing the desired outcome for a client with osteomyelitis, the nurse interpret s this as suggesting the occurrence of which of the following as most likely? a. Formation of scar tissue interfering with absorption b. Development of pus lead ing to ischemia c. Production of bacterial growth by avascular tissue d. Antibio tics not being instilled directly into the bone 48. Which of the following would the nurse use as the best method to assess for the development of deep vein thr ombosis in a client with a spinal cord injury? a. Homan's sign c. Tenderness b. Pain d. Leg girth 49. The nurse is caring for the client who is going to have an arthogram using a contrast medium. Which of the following assessments by the nu rse are of highest priority? a. Allergy to iodine or shellfish b. Ability of the client to remain still during the procedure c. Whether the client has any remai ning questions about the procedure d. Whether the client wishes to void before t he procedure 50. The client immobilized skeletal leg traction complains of being bored and restless. Based on these complaints, the nurse formulates which of th e following nursing diagnoses for this client?

a. Divertional activity deficit b. Powerlessness c. Self care deficit d. Impaire d physical mobility 51. The nurse is teaching the client who is to have a galliu m scan about the procedure. The nurse includes which of the following items as p art of the instructions? a. The gallium will be injected intravenously 2 to 3 ho urs before the procedure b. The procedure takes about 15 minutes to perform c. T he client must stand erect during the filming d. The client should remain on bed rest for the remainder of the day after the scan 52. The nurse is assessing the casted extremity of a client. The nurse assesses for which of the following sig ns and symptoms indicative of infection? a. Coolness and pallor of the extremity b. Presence of a "hot spot" on the cast c. Diminished distal pulse d. Dependent edema 53. The client has Buck's extension applied to the right leg. The nurse p lans which of the following interventions to prevent complications of the device ? a. Massage the skin of the right leg with lotion every 8 hours b. Give pin car e once a shift c. Inspect the skin on the right leg at least once every 8 hours d. Release the weights on the right leg for range of motion exercises daily 54. The nurse is giving the client with a left cast crutch walking instructions usin g the three point gait. The client is allowed touchdown of the affected leg. The nurse tells the client to advance the: a. Left leg and right crutch then right leg and left crutch b. Crutches and then both legs simultaneously c. Crutches an d the right leg then advance the left leg d. Crutches and the left leg then adva nce the right leg 55. The client with right sided weakness needs to learn how to use a cane. The nurse plans to teach the client to position the cane by holding it with the: a. Left hand and placing the cane in front of the left foot b. Rig ht hand and placing the cane in front of the right foot c. Left hand and 6 inche s lateral to the left foot d. Right hand and 6 inches lateral to the left foot 5 6. The nurse is repositioning the client who has returned to the nursing unit fo llowing internal fixation of a fractured right hip. The nurse uses a: a. Pillow to keep the right leg abducted during turning b. Pillow to keep the right leg ad ducted during turning

c. Trochanter roll to prevent external rotation while turning d. Trochanter roll to prevent abduction while turning 57. The nurse has an order to get the client out of bed to a chair on the first postoperative day after a total knee replace ment. The nurse plans to do which of the following to protect the knee joint: a. Apply a knee immobilizer before getting the client up and elevate the client's surgical leg while sitting b. Apply an Ace wrap around the dressing and put ice on the knee while sitting c. Lift the client to the bedside change leaving the C PM machine in place d. Obtain a walker to minimize weight bearing by the client on the affected leg 58. The nurse is caring for the client who had an above the knee amputation 2days ago. The residual limb was wrapped with an elastic compres sion bandage which has come off. The nurse immediately: a. Calls the physician b . Rewrap the stump with an elastic compression bandage c. Applies ice to the sit e d. Applies a dry sterile dressing and elevates it on a pillow 59. The nurse ha s taught the client with a below the knee amputation about prosthesis and stump care. The nurse evaluates that the client states to: a. Wear a clean nylon stump sock daily b. Toughen the skin of the stump by rubbing it with alcohol c. Preve nt cracking of the skin of the stump by applying lotion daily d. Using a mirror to inspect all areas of the stump each day 60. The nurse is caring for a client with a gout. Which of the following laboratory values does the nurse expect to n ote in the client? a. Uric acid level of 8 mg/dl b. Calcium level of 9 mg/dl c. Phosphorus level of 3 mg/dl d. Uric acid level of 5 mg/dl