A client immobilized in skeletal leg traction complains of being bored and restless

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NCLEX Review Questions Musculoskeletal System

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1. The nurse is conducting health screening for osteoporosis. Which client is at greatest risk of developing this disorder? 
   1. A 25-year-old woman who jogs 
   2. A 36-year-old man who has asthma 
   3. A 70-year-old man who consumes excess alcohol 
   4. A sedentary 65-year-old woman who smokes cigarettes

   4. A sedentary 65-year-old woman who smokes cigarettes

2. The nurse has given instructions to a client returning home after knee arthroscopy. Which statement by the client indicates that the instructions are understood? 
   1. "I can resume regular exercise tomorrow." 
   2. "I can't eat food for the remainder of the day." 
   3. "I need to stay off the leg entirely for the rest of the day." 
   4. "I need to report a fever or site inflammation to my health care provider."

   4. "I need to report a fever or site inflammation to my health care provider."

3. The nurse is one of several persons who witnessed a vehicle hit a pedestrian at fairly low speed on a small street. The victim is dazed and tries to get up. The leg appears fractured. Which intervention should the nurse take? 
   1. Try to reduce the fracture manually. 
   2. Assist the victim to get up and walk to the sidewalk. 
   3. Leave the victim for a few moments to call an ambulance. 
   4. Stay with the victim and encourage the person to remain still.

   4. Stay with the victim and encourage the person to remain still.

4. Which cast care instructions should the nurse provide to a client who just had a plaster cast applied to the right forearm? Select all that apply. 
   1. Keep the cast clean and dry. 
   2. Allow the cast 24 to 72 hours to dry. 
   3. Keep the cast and extremity elevated. 
   4. Expect tingling and numbness in the extremity. 
   5. Use a hair dryer set on a warm to hot setting to dry the cast. 
   6. Use a soft padded object that will fit under the cast to scratch the skin under the cast.

   • 1. Keep the cast clean and dry. 
   • 2. Allow the cast 24 to 72 hours to dry. 
   • 3. Keep the cast and extremity elevated.

5. The nurse is evaluating the pin sites of a client in skeletal traction. The nurse would be least concerned with which finding? 
   1. Inflammation 
   2. Serous drainage 
   3. Pain at a pin site 
   4. Purulent drainage

   2. Serous drainage

6. The nurse is assessing the casted extremity of a client. Which sign is indicative of infection? 
   1. Dependent edema 
   2. Diminished distal pulse 
   3. Presence of a "hot spot" on the cast 
   4. Coolness and pallor of the extremity

   3. Presence of a "hot spot" on the cast

7. A client has sustained a closed fracture and has just had a cast applied to the affected arm. The client is complaining of intense pain. The nurse elevates the limb, applies an ice bag, and administers an analgesic, with little relief. Which problem may be causing this pain? 
   1. Infection under the cast 
   2. The anxiety of the client 
   3. Impaired tissue perfusion 
   4. The recent occurrence of the fracture

   3. Impaired tissue perfusion

8. The nurse is admitting a client with multiple trauma to the nursing unit. The client has a leg fracture and had a plaster cast applied. Which position would be best for the casted leg? 
   1. Flat for 12 hours, then elevated for 12 hours 
   2. Elevated for 3 hours and then flat for 1 hour 
   3. Flat for 3 hours and then elevated for 1 hour 
   4. Elevated on pillows continuously for 24 to 48 hours

   4. Elevated on pillows continuously for 24 to 48 hours

9. A client is being discharged to home after application of a plaster leg cast. Which statement indicates that the client understands proper care of the cast? 
   1. "I need to avoid getting the cast wet." 
   2. "I need to cover the casted leg with warm blankets." 
   3. "I need to use my fingertips to lift and move my leg." 
   4. "I need to use something like a padded coat hanger end to scratch under the cast if it itches."

   1. "I need to avoid getting the cast wet."

10. A client being measured for crutches asks the nurse why the crutches cannot rest up underneath the arm for extra support. The nurse responds knowing that which would most likely result from this improper crutch measurement? 
    1. A fall and further injury 
    2. Injury to the brachial plexus nerves 
    3. Skin breakdown in the area of the axilla 
    4. Impaired range of motion while the client ambulates

    2. Injury to the brachial plexus nerves

11. The nurse has given a client instructions about crutch safety. Which client statement indicates that the client understands the instructions? Select all that apply. 
    1. "I should not use someone else's crutches." 
    2. "I need to remove any scatter rugs at home." 
    3. "I can use crutch tips even when they are wet." 
    4. "I need to have spare crutches and tips available." 
    5. "When I'm using the crutches my arms need to be completely straight."

    • 1. "I should not use someone else's crutches." 
    • 2. "I need to remove any scatter rugs at home." 
    • 4. "I need to have spare crutches and tips available."

12. The nurse is caring for a client being treated for fat embolus after multiple fractures. Which data would the nurse evaluate as the most favorable indication of resolution of the fat embolus? 
    1. Clear mentation 
    2. Minimal dyspnea 
    3. Oxygen saturation of 85% 
    4. Arterial oxygen level of 78 mm Hg

    1. Clear mentation

13. The nurse has conducted teaching with a client in an arm cast about the signs and symptoms of compartment syndrome. The nurse determines that the client understands the information if the client states that he or she should report which early symptom of compartment syndrome? 
    1. Cold, bluish-colored fingers 
    2. Numbness and tingling in the fingers 
    3. Pain that increases when the arm is dependent 
    4. Pain that is out of proportion to the severity of the fracture

    2. Numbness and tingling in the fingers

14. A client with diabetes mellitus has had a right below-knee amputation. Given the client's history of diabetes mellitus, which should the nurse specifically observe in the postoperative period? 
    1. Hemorrhage 
    2. Edema of the residual limb 
    3. Slight redness of the incision 
    4. Separation of the wound edges

    4. Separation of the wound edges

15. The nurse is caring for a client who had an above-knee amputation 2 days ago. The residual limb was wrapped with an elastic compression bandage, which has come off. Which immediate action should the nurse take? 
    1. Apply ice to the site. 
    2. Call the health care provider (HCP). 
    3. Apply a dry sterile dressing and elevate it on one pillow. 
    4. Rewrap the residual limb with an elastic compression bandage.

    4. Rewrap the residual limb with an elastic compression bandage.

16. A client is complaining of low back pain that radiates down the left posterior thigh. The nurse should ask the client if the pain is worsened or aggravated by which factor? 
    1. Bed rest 
    2. Bending or lifting 
    3. Application of heat 
    4. Ibuprofen (Motrin IB)

    2. Bending or lifting

17. The nurse is caring for a client who has had spinal fusion, with insertion of hardware. The nurse would be most concerned with which assessment finding? 
    1. Temperature of 101.6° F orally 
    2. Complaints of discomfort during repositioning 
    3. Old bloody drainage outlined on the surgical dressing 
    4. Discomfort during coughing and deep-breathing exercises

    1. Temperature of 101.6° F orally

18. The nurse is caring for a client with a diagnosis of gout. Which laboratory value would the nurse expect to note in the client? 
    1. Calcium level of 9.0 mg/dL 
    2. Uric acid level of 8.6 mg/dL 
    3. Potassium level of 4.1 mEq/L 
    4. Phosphorus level of 3.1 mg/dL

    2. Uric acid level of 8.6 mg/dL

19. A client with a hip fracture asks the nurse why Buck's (extension) traction is being applied before surgery. The nurse provides a response based on which purpose of Buck's (extension) traction? 
    1. Allows bony healing to begin before surgery 
    2. Provides rigid immobilization of the fracture site 
    3. Lengthens the fractured leg to prevent severing of blood vessels 
    4. Provides comfort by reducing muscle spasms and provides fracture immobilization

    4. Provides comfort by reducing muscle spasms and provides fracture immobilization

20. The nurse is assigned to care for a client in traction. The nurse prepares a plan of care for the client and includes which nursing action in the plan? 
    1. Ensure that the knots are at the pulleys. 
    2. Check the weights to ensure that they are off of the floor. 
    3. Ensure that the head of the bed is kept at a 45- to 90-degree angle. 
    4. Monitor the weights to ensure that they are resting on a firm surface.

    2. Check the weights to ensure that they are off of the floor.

21. The nurse is caring for an older adult who has been placed in Buck's extension traction after a hip fracture. On assessment of the client, the nurse notes that the client is disoriented. What is thebest nursing action based on this information? 
    1. Apply restraints to the client. 
    2. Ask the family to stay with the client. 
    3. Place a clock and calendar in the client's room. 
    4. Ask the laboratory to perform electrolyte studies.

    3. Place a clock and calendar in the client's room.

22. The nurse is preparing a plan of care for a client in skin traction. The nurse should monitor for which priority finding in this client? 
    1. Urinary incontinence 
    2. Signs of skin breakdown 
    3. The presence of bowel sounds 
    4. Signs of infection around the pin sites

    2. Signs of skin breakdown

23. The home care nurse is visiting a client who is in a body cast. While performing an assessment, the nurse plans to evaluate the psychosocial adjustment of the client to the cast. What is the most appropriate assessment for this client? 
    1. The need for sensory stimulation 
    2. The amount of home care support available 
    3. The ability to perform activities of daily living 
    4. The type of transportation available for follow-up care

    1. The need for sensory stimulation

24. The nurse has completed giving discharge instructions to a client who has had total knee replacement (TKR) with a metal prosthesis. The nurse determines that the client understands the instructions if the client verbalizes which statement? 
    1. Fever, redness, or increased pain is expected. 
    2. Changes in the shape of the knee are expected. 
    3. Other caregivers should be told about the metal implant. 
    4. Bleeding gums or black stools may occur, but this is normal.

    3. Other caregivers should be told about the metal implant.

25. The nurse develops a plan of care for a client with a spica cast that covers a lower extremity and documents that the client is at risk for constipation. When planning for bowel elimination needs, the nurse should include which in the plan of care? 
    1. Administer an enema daily. 
    2. Use a fracture pan for bowel elimination. 
    3. Use a bedside commode for all elimination needs. 
    4. Use a regular bedpan to prevent spilling of contents in the bed.

    2. Use a fracture pan for bowel elimination.

26. The nurse is preparing to teach a client how to safely use crutches. Before initiating the teaching, the nurse performs an assessment on the client. The priority nursing assessment should include which information?  
    1. The client's fear related to the use of crutches  
    2. The client's feelings about the restricted mobility 
    3. The client's understanding of the need for increased mobility 
    4. The client's vital signs, muscle strength, and previous activity level

    4. The client's vital signs, muscle strength, and previous activity level

27. The nurse is providing instructions to a client regarding ambulation after the application of a fiberglass cast to the lower leg. The nurse determines that the client understands the instructions if the client states that weight bearing on the casted leg can begin at which time period? 
    1. In 48 hours 
    2. In 24 hours 
    3. In approximately 8 hours 
    4. Within 20 to 30 minutes of application

    4. Within 20 to 30 minutes of application

28. The nurse is preparing a plan of care for a client in skeletal leg traction with an overbed frame. Which nursing intervention should be included in the plan of care to best assist the client with self-positioning in bed? 
    1. Use the assistance of four nurses to reposition the client. 
    2. Place a draw sheet on the mattress for pulling the client up in bed. 
    3. Place a trapeze on the bed frame to provide a means for the client to lift the hips off the bed. 
    4. Encourage the client to push with the unaffected leg on the bed mattress to help with repositioning.

    3. Place a trapeze on the bed frame to provide a means for the client to lift the hips off the bed.

29. The nurse is caring for the client who has skeletal traction applied to the left leg. The client complains of severe left leg pain. The nurse checks the client's alignment in bed and notes that proper alignment is maintained. Which is the priority nursing action? 
    1. Provide pin care. 
    2. Medicate the client. 
    3. Call the health care provider (HCP). 
    4. Remove 2 pounds of weight from the traction system.

    3. Call the health care provider (HCP).

30. The home care nurse visits a client who has a cast applied to the left lower leg. On assessment of the client, the nurse notes the presence of skin irritation from the edges of a cast. Which nursing intervention is most appropriate? 
    1. Contact the health care provider (HCP). 
    2. Massage the skin at the edges of the cast. 
    3. Petal the cast edges with appropriate material. 
    4. Place a small facecloth in the cast around the edges of the cast.

    3. Petal the cast edges with appropriate material.

31. A client who has been taking high doses of acetylsalicylic acid (ASA, or aspirin) to relieve pain from osteoarthritis now has more generalized joint pain and an elevated temperature. The nurse should assess for which complication to determine whether the client has other signs of aspirin toxicity? 
    1. Diarrhea 
    2. Constipation 
    3. Double vision 
    4. Ringing in the ears

    4. Ringing in the ears

32. The nurse is developing a plan of care for a client in Buck's traction. The plan of care should include assessing the client for which finding indicating a complication associated with the use of this type of traction? 
    1. Hypotension 
    2. Weak pedal pulses 
    3. Redness at the pin sites 
    4. Drainage at the pin sites

    2. Weak pedal pulses

33. The nurse is caring for a client in skeletal traction. On assessing the pin sites, the nurse notes the presence of purulent drainage. Which nursing action is most appropriate? 
    1. Document the findings. 
    2. Notify the health care provider (HCP). 
    3. Apply antibiotic ointment to the pin sites. 
    4. Clean the pin sites more frequently than prescribed.

    2. Notify the health care provider (HCP).

34. A client arrives in the emergency department after sustaining an injury to the arm from a fall. An x-ray film is obtained because a fractured radius is suspected. The nurse is able to see the x-ray film as it is being reviewed and notes the presence of a complete fracture across the shaft of the bone, with splintering of the bone into fragments. The nurse concludes that the client has sustained which type of fracture? 
    1. Simple fracture 
    2. Greenstick fracture 
    3. Compound fracture 
    4. Comminuted fracture

    4. Comminuted fracture

35. A home care nurse is providing instructions to a client regarding the use of crutches. The client asks the nurse to demonstrate the method for going down the stairs with the crutches. How should the nurse accurately demonstrate this technique? 
    1. Crutches and the affected leg down, followed by the unaffected leg 
    2. Crutches and the unaffected leg down, followed by the affected leg 
    3. Unaffected leg down first, followed by the crutches and the affected leg 
    4. Affected leg down first, followed by the crutches and the unaffected leg

    1. Crutches and the affected leg down, followed by the unaffected leg

36. A home care nurse has instructed a client how to perform the three-point gait with the use of crutches. The nurse observes the client using this gait to ensure correct performance of the maneuvers. Which observation, if made by the nurse, would indicate that the client understands how to perform this type of gait? 
    1. The client moves both crutches forward and then swings both feet forward to the crutches. 
    2. The client moves both crutches forward, along with the affected leg, and then moves the unaffected leg forward. 
    3. The client moves the right crutch forward, along with the left foot, and then brings the right foot and the left crutch forward. 
    4. The client moves the left crutch forward, along with the right foot, and then brings the left foot and the right crutch forward.

    2. The client moves both crutches forward, along with the affected leg, and then moves the unaffected leg forward.

37. A male client arrives in the hospital emergency department and tells the nurse that he twisted his ankle while jogging. The client is seen by the health care provider (HCP) and is diagnosed with a sprained ankle. The nurse provides instructions to the client regarding home care for the injury. Which statement, if made by the client, would indicate an understanding of appropriate care measures for the next 24 hours? 
    1. "I should place hot packs on my ankle." 
    2. "I should wrap my ankle with blankets." 
    3. "I should elevate my foot above the level of the heart." 
    4. "I should try to ambulate at least 10 minutes out of every hour."

    3. "I should elevate my foot above the level of the heart."

38. A community health nurse is providing an educational session for community members regarding dietary measures that will assist in reducing the risk of osteoporosis. The nurse should instruct the community members to increase dietary intake of which food known to be helpful in minimizing this risk? 
    1. Yogurt 
    2. Turkey 
    3. Shellfish 
    4. Spaghetti

    1. Yogurt

39. The nurse is teaching a client with a right arm cast how to prevent stiff or frozen shoulder. What should the nurse instruct the client to do? 
    1. Wear the sling at nighttime. 
    2. Keep a sling on the arm at all times. 
    3. Avoid range-of-motion exercises to the affected arm. 
    4. Lift the shoulder of the casted arm over the head periodically throughout the day.

    4. Lift the shoulder of the casted arm over the head periodically throughout the day.

40. The nurse is preparing to perform pin site care for a client in skeletal traction. On assessment of the pin site, the nurse notes the presence of serous drainage. Which nursing action would be appropriate? 
    1. Document the findings. 
    2. Notify the health care provider (HCP). 
    3. Remove 2 pounds of weight from the traction. 
    4. Lift the weights and place them on the bed so that the HCP can assess the client.

    1. Document the findings.

41. The nurse is performing a neurovascular assessment on a client with a cast on the left lower leg. The nurse notes the presence of edema in the foot below the cast. The nurse should make which interpretation about this finding? 
    1. Arterial insufficiency 
    2. Impaired venous return 
    3. Impaired arterial circulation 
    4. The presence of an infection

    2. Impaired venous return

42. The nurse is caring for a client with a long bone fracture at risk for fat embolism. The nurse specifically monitors for the earliest signs of this complication by performing an assessment of which item(s)? 
    1. The client's mobility status 
    2. The renal and endocrine systems 
    3. The cardiovascular and renal systems 
    4. The neurological and respiratory systems

    4. The neurological and respiratory systems

43. The nurse is caring for a client who was just admitted to the hospital with a diagnosis of a fractured right hip sustained from a fall 5 hours earlier. The nurse develops a plan of care for the client and includes interventions related to monitoring for signs of fat embolism. Which findings should be listed in the care plan as a sign/symptom of fat embolism? 
    1. Dyspnea and chest pain 
    2. Fever and chills 
    3. External rotation of the right leg 
    4. Pallor, paresthesia, and pulselessness of the right lower leg

    1. Dyspnea and chest pain

44. The nurse is caring for a client at risk for fat embolism because of a fracture of the left femur and pelvis sustained in a fall. The client also sustained a head injury, is comatose, and is unable to communicate verbally. Which assessment findings should the nurse identify as early signs of possible fat embolism? 
    1. Decreased heart rate and increased restlessness 
    2. Decreased heart rate and decreased respiratory rate 
    3. Increased heart rate and adventitious breath sounds 
    4. Increased heart rate and increased oxygen saturation

    3. Increased heart rate and adventitious breath sounds

45. The nurse is caring for a client with a fractured tibia and fibula. Eight hours after a long leg cast is applied, the client reports a significant increase in pain level even after administration of the prescribed dose of opioid analgesic. What is the initial nursing action? 
    1. Elevate the casted leg. 
    2. Contact the health care provider (HCP). 
    3. Administer another dose of pain medication. 
    4. Check the neurovascular status of the toes on the casted leg.

    4. Check the neurovascular status of the toes on the casted leg.

46. The nurse is caring for a client after the application of a plaster cast for a fractured left radius. The nurse should suspect impairment with the neurovascular status of the client's casted extremity if which findings are noted? Select all that apply. 
    1. Capillary refill is less than 3 seconds 
    2. Pulses present and with swollen, pink fingers 
    3. Client report of severe, deep, unrelenting pain 
    4. Client report of pain as nurse assesses finger movement 
    5. Client report of numbness and tingling sensation in the fingers

    • 3. Client report of severe, deep, unrelenting pain 
    • 4. Client report of pain as nurse assesses finger movement 
    • 5. Client report of numbness and tingling sensation in the fingers

47. The nurse has delegated the ambulation of a client to the unlicensed assistive personnel (UAP). Which actions by the UAP support a clear understanding of the appropriate steps to carry out this task safely? Select all that apply. 
    1. Remove clutter that may interfere with ambulation. 
    2. Assist client in applying nonskid shoes before ambulation. 
    3. Instruct client to sit up on the bedside and dangle before ambulation. 
    4. Understand that the client may experience nausea as a normal expectation during ambulation. 
    5. Observe the client for dizziness during ambulation and report immediately.

    • 1. Remove clutter that may interfere with ambulation. 
    • 2. Assist client in applying nonskid shoes before ambulation. 
    • 3. Instruct client to sit up on the bedside and dangle before ambulation. 
    • 5. Observe the client for dizziness during ambulation and report immediately.

48. A client has had surgery to repair a fractured left hip. When repositioning the client from side to side in the bed, what should the nurse plan to use as the most important item for this maneuver? 
    1. Bed pillow 
    2. Abductor splint 
    3. Adductor splint 
    4. Overhead trapeze

    2. Abductor splint

49. A client with a 4-day-old lumbar vertebral fracture is experiencing muscle spasms. Which is the least appropriate way for the nurse to aid the client in relieving the spasm? 
    1. Ice 
    2. Heat 
    3. Analgesics 
    4. Prescribed intermittent traction

    1. Ice

50. The nurse has reviewed activity restrictions with a client who is being discharged after insertion of a femoral head prosthesis. What statement by the client will help the nurse determine that the client understands the material presented? 
    1. Use a raised toilet seat. 
    2. Bend carefully to put on socks and shoes. 
    3. Sit in chairs without arms for better mobility. 
    4. Exercise the leg past the point of 90-degree flexion.

    1. Use a raised toilet seat.

51. The nurse is talking to a client who had a below-the-knee amputation 2 days earlier. The client states, "I hate looking at this; I feel that I'm not even myself anymore." What client problem should the nurse incorporate in the plan of care based on the statement by this client? 
    1. Altered body image 
    2. Inability to care for self 
    3. Disruption in coping ability 
    4. Difficulty maintaining health

    1. Altered body image

52. The home health nurse is planning to teach a client with osteoporosis about home modifications to reduce the risk of falls. Which recommendations would be necessary to include in the teaching plan? Select all that apply. 
    1. Use night lights. 
    2. Remove scatter rugs. 
    3. Use staircase railings. 
    4. Remove wall-to-wall carpeting. 
    5. Place hand rails in the bathroom.

    • 1. Use night lights. 
    • 2. Remove scatter rugs. 
    • 3. Use staircase railings. 
    • 5. Place hand rails in the bathroom.

53. A client immobilized in skeletal leg traction complains of being bored and restless. Based on these complaints, the nurse identifies which client problem as the priority? 
    1. Lack of control 
    2. Lack of physical mobility 
    3. Inability to entertain self 
    4. Inability to maintain health

    3. Inability to entertain self

54. A client with a fractured femur experiences sudden dyspnea, tachypnea, and tachycardia. A set of arterial blood gas tests reveals the following: pH, 7.35; Paco2, 43 mm Hg; Pao2, 58 mm Hg; HCO3, 23 mEq/L. The nurse interprets that the client probably has experienced fat embolus because of the result of which parameter? 
    1. pH 
    2. Pao2 
    3. HCO3 
    4. Paco2

    2. Pao2

55. The nurse is caring for a client who had developed compartment syndrome from a severely fractured arm. The client asks the nurse how this can happen. The nurse should respond by incorporating which piece of information? 
    1. A bone fragment has injured the nerve supply in the area. 
    2. An injured artery causes impaired arterial perfusion through the compartment. 
    3. Bleeding and swelling cause increased pressure in an area that cannot expand. 
    4. The fascia expands with injury, causing pressure on underlying nerves and muscles.

    3. Bleeding and swelling cause increased pressure in an area that cannot expand.

56. The nurse is repositioning a client who has been returned to the nursing unit after internal fixation of a fractured right hip with a femoral head replacement. The nurse should use which method? 
    1. A trochanter roll to prevent abduction during turning 
    2. A pillow to keep the right leg abducted during turning 
    3. A pillow to keep the right leg adducted during turning 
    4. A trochanter roll to prevent external rotation during turning

    2. A pillow to keep the right leg abducted during turning

57. The nurse has completed giving discharge instructions to a client after total knee replacement with a metal prosthesis. The nurse determines that the client needs additional instructions if the client makes which statement? 
    1. Report bleeding gums or tarry stools. 
    2. Report fever, redness, or increased pain. 
    3. Expect changes in the shape of the knee. 
    4. Tell future caregivers about the metal implant.

    3. Expect changes in the shape of the knee.

58. The nurse is planning to teach the client with below-the-knee amputation about care to prevent skin breakdown. Which point should the nurse include in developing the teaching plan? 
    1. The residual limb is washed gently and dried every other day. 
    2. The socket of the prosthesis must be dried carefully before it is used. 
    3. A residual limb sock must be worn at all times and changed twice a week. 
    4. The socket of the prosthesis is washed with a harsh bactericidal agent daily.

    2. The socket of the prosthesis must be dried carefully before it is used.

59. A client has just undergone spinal fusion after experiencing herniation of a lumbar disk. The nurse would avoid which intervention to maintain client safety after this procedure? 
    1. Use the overhead trapeze. 
    2. Keep the head of the bed flat. 
    3. Place pillows under the length of the legs. 
    4. Use logrolling technique for repositioning.

    1. Use the overhead trapeze.

60. A client has several fractures of the lower leg, which has been placed in an external fixation device. The client is upset about the appearance of the leg, which is edematous. The nurse documents which client problem in the plan of care? 
    1. Feeling isolated 
    2. Body image alteration 
    3. Inability to perform activities 
    4. Inability to engage in physical mobility

    2. Body image alteration

61. A client has been placed in Buck's extension traction. The nurse can provide for countertraction to reduce shear and friction by performing which action? 
    1. Using a footboard 
    2. Providing an overhead trapeze 
    3. Slightly elevating the foot of the bed 
    4. Slightly elevating the head of the bed

    3. Slightly elevating the foot of the bed

62. The nurse is reviewing the postprocedure plan of care formulated by a nursing student for a client scheduled for a bone biopsy. The nurse determines that the student needs additional information about postprocedure care if which inaccurate intervention is documented? 
    1. Elevating the limb 
    2. Monitoring vital signs every 4 hours 
    3. Administering opioid analgesics intramuscularly 
    4. Monitoring the biopsy site for swelling, bleeding, or hematoma

    3. Administering opioid analgesics intramuscularly

63. A client has had a bone scan done. The nurse determines that the client demonstrates understanding of postprocedure care when the client makes which statement? 
    1. "Flushing indicates a complication." 
    2. "I should stay on liquids for a couple of days." 
    3. "I need to ambulate every couple of hours faithfully for a few days." 
    4. "I need to drink plenty of water for 1 to 2 days after the procedure."

    4. "I need to drink plenty of water for 1 to 2 days after the procedure."

64. A client seeks treatment in the hospital emergency department for a lower leg injury. Deformity of the lower portion of the leg is evident, and the injured leg appears shorter than the other. The area is painful, swollen, and beginning to become ecchymotic. The nurse interprets that this client has experienced which injury? 
    1. Strain 
    2. Sprain 
    3. Fracture 
    4. Contusion

    3. Fracture

65. The nurse is planning to teach a client with a left arm cast about measures to keep the left shoulder from becoming stiff and immovable. Which suggestion should the nurse include in the teaching plan? 
    1. Use a sling on the left arm. 
    2. Lift the left arm up over the head. 
    3. Lift the right arm up over the head. 
    4. Make a fist with the hand of the casted arm.

    2. Lift the left arm up over the head.

66. The nurse is evaluating a client's use of a cane for left-sided weakness. The nurse should intervene and correct the client if the nurse observed that the client performs which action? 
    1. Holds the cane on the right side 
    2. Moves the cane when the right leg is moved 
    3. Leans on the cane when the right leg swings through 
    4. Keeps the cane 6 inches out to the side of the right foot

    2. Moves the cane when the right leg is moved

67. The nurse is planning to teach a client how to stand on crutches. The nurse will incorporate into written instructions that the client should be told to place the crutches in what manner? 
    1. 3 inches to the front and side of the toes 
    2. 6 inches to the front and side of the toes 
    3. 15 inches to the front and side of the toes 
    4. 20 inches to the front and side of the toes

    2. 6 inches to the front and side of the toes

68. A client is admitted to the nursing unit after a left below-the-knee amputation after a crush injury to the foot and lower leg. The client tells the nurse, "I think I'm going crazy. I can feel my left foot itching." How should the nurse interpret this client statement? 
    1. A normal response that indicates the presence of phantom limb pain 
    2. A normal response that indicates the presence of phantom limb sensation 
    3. An abnormal response that indicates that the client is in denial about the limb loss 
    4. An abnormal response that indicates that the client needs more psychological support

    2. A normal response that indicates the presence of phantom limb sensation

69. A nurse has provided instructions to a client with a diagnosis of rheumatoid arthritis about measures to protect the joints. Which statement by the client indicates a need for further instruction? 
    1. "Pain or fatigue is expected, and I should try to continue with the activity if this occurs." 
    2. "I should use large joints instead of small joints when performing activities." 
    3. "I should try not to remain in the same position for a long period of time." 
    4. "I should slide objects rather than lifting them."

    1. "Pain or fatigue is expected, and I should try to continue with the activity if this occurs."

70. A nurse has provided discharge instructions to a client after a total hip replacement. Which statement by the client indicates a need for further instruction? 
    1. "I should sit in my recliner when I get home." 
    2. "I need to keep my legs apart while sitting or lying." 
    3. "I should try to obtain an elevated toilet seat for use at home." 
    4. "I should contact the health care provider (HCP) if the incision becomes red or irritated or if I note any drainage."

    1. "I should sit in my recliner when I get home."

71. Probenecid has been prescribed for a client with a diagnosis of gout, and the nurse provides instructions to the client regarding the medication. Which statement by the client indicates a need for further instruction? 
    1. "I need to increase my fluid intake." 
    2. "I need to take the medication with food." 
    3. "I need to have a periodic uric acid level drawn." 
    4. "I should take acetylsalicylic acid (aspirin) for relief of headache."

    4. "I should take acetylsalicylic acid (aspirin) for relief of headache."

72. Allopurinol (Zyloprim) has been prescribed for a client with a diagnosis of gout. A nurse develops a list of instructions for the client regarding the use of this medication. Which measures should be included on the list? Select all that apply. 
    1. Increase fluid intake. 
    2. Take the medication with food. 
    3. Consume items to maintain an alkaline urine. 
    4. Take vitamin C daily to enhance the effects of the medication. 
    5. Return to the health care clinic for liver and renal function tests.

    • 1. Increase fluid intake. 
    • 2. Take the medication with food. 
    • 3. Consume items to maintain an alkaline urine. 
    • 5. Return to the health care clinic for liver and renal function tests.

73. A community health nurse is providing a teaching session on osteoporosis to women living in the community. The nurse informs these community residents that which is a risk factor for this disorder? 
    1. A large skeletal frame 
    2. A diet low in vitamin D 
    3. Low thyroid hormone levels 
    4. A high dietary intake of calcium

    2. A diet low in vitamin D

74. A nurse is performing an assessment on a client with suspected Paget's disease. On assessment the nurse would expect the client to report which as the most common symptom of this disease? 
    1. Tinnitus 
    2. Fatigue 
    3. Bone pain 
    4. Difficulty with ambulating

    3. Bone pain

75. Diagnostic studies are prescribed for a client with suspected Paget's disease. In reviewing the client's record, the nurse would expect to note that the health care provider has prescribed which laboratory study? 
    1. Platelet count 
    2. Alkaline phosphatase 
    3. White blood cell count 
    4. Complete blood cell count

    2. Alkaline phosphatase

76. A hospitalized client has been diagnosed with osteomyelitis of the left tibia. The nurse understands that this condition is most likely to be a result of which events in the client's recent history? 
    1. Sprained left ankle 
    2. Decreased calcium intake 
    3. Open trauma to the left leg 
    4. Starting to smoke cigarettes

    3. Open trauma to the left leg

77. A nursing student is providing health maintenance education to a client with osteitis deformans (Paget's disease). Which statement by the client indicates a need for further education? 
    1. "I should perform low-impact exercises regularly." 
    2. "When I have pain, I will take ibuprofen (Motrin IB)." 
    3. "Because I have no symptoms, my disease is not progressing." 
    4. "I must notify my health care provider (HCP) if I experience any hearing loss."

    3. "Because I have no symptoms, my disease is not progressing."

78. An older female client is diagnosed with osteoporosis. The nurse teaches the client about self-care measures, knowing that the client is most at risk for which problem as a result of this disorder of the bones? 
    1. Infection 
    2. Fractures 
    3. Anemia 
    4. Muscle sprains

    2. Fractures

79. A client with rheumatoid arthritis exhibits bilateral deformities of the joints of the fingers. The nurse planning care for the client understands that these changes are most likely the result of which cause of inflammation? 
    1. Allergic 
    2. Metabolic 
    3. Endocrine 
    4. Autoimmune

    4. Autoimmune

80. A client has been diagnosed with osteomalacia, or adult rickets. The nurse plans care, knowing that this disorder, when it affects an adult, results from a deficiency of which vitamin? 
    1. Vitamin A 
    2. Vitamin D 
    3. Vitamin E 
    4. Vitamin K

    2. Vitamin D

81. A client is having a plaster cast placed on the lower extremity that will extend from mid-thigh to the center of the foot. Which instruction should be given to the client before hospital discharge? 
    1. How to petal the edges of the cast to prevent crumbling of these edges 
    2. The need to notify the nurse if the plaster cast becomes warm during the first 24 hours 
    3. The correct method of using a thin object when the client needs to scratch the area beneath the cast 
    4. The need to notify the health care provider immediately if the client notices numbness or swelling or the foot becomes cold and pale

    4. The need to notify the health care provider immediately if the client notices numbness or swelling or the foot becomes cold and pale

82. A client is complaining of knee pain. The knee is swollen, reddened, and warm to the touch. The nurse interprets that the client's signs and symptoms are compatible with which conditions? Select all that apply. 
    1. Infection 
    2. Recent injury 
    3. Inflammation 
    4. Degenerative disease 
    5. Developmental retardation

    • 1. Infection 
    • 2. Recent injury 
    • 3. Inflammation

83. The nurse witnesses a client sustain a fall and suspects that the right leg may be broken. The nurse should take which priority action? 
    1. Take a set of vital signs. 
    2. Call the radiology department. 
    3. Reassure the client that everything will be fine. 
    4. Immobilize the right leg before moving the client.

    4. Immobilize the right leg before moving the client.

84. The nurse in the hospital emergency department is caring for a client with a fractured arm and is preparing the client for a reduction of the fracture that will be done in the casting room in the emergency department. The nurse should take which actions? Select all that apply. 
    1. Obtain an anesthesia consent. 
    2. Administer a prescribed analgesic. 
    3. Explain the procedure to the client. 
    4. Obtain informed consent for the procedure. 
    5. Inform the anesthesiologist of the time of the procedure.

    • 2. Administer a prescribed analgesic. 
    • 3. Explain the procedure to the client. 
    • 4. Obtain informed consent for the procedure.

85. The nurse teaches a client who is going to have a plaster cast applied about the procedure. Which statement by the client indicates a need for further teaching? 
    1. "The cast will give off heat as it dries." 
    2. "I can bear weight on the cast in one-half hour." 
    3. "The cast edges may be trimmed with a cast knife." 
    4. "A stockinette will be placed over the leg area to be casted."

    2. "I can bear weight on the cast in one-half hour."

86. The nurse has suggested specific leg exercises for a client immobilized in right skeletal lower leg traction. The nurse determines that the client needs further instruction if the nurse observes the client performing which action? 
    1. Pulling up using the trapeze 
    2. Flexing and extending the feet 
    3. Doing quadriceps-setting and gluteal-setting exercises 
    4. Performing active range of motion to the right ankle and knee

    4. Performing active range of motion to the right ankle and knee

87. The nurse is giving a client with a left leg cast crutch-walking instructions using the three-point gait. The client is allowed touch-down of the affected leg. The nurse should tell the client to perform which action? 
    1. Advance the crutches along with both legs simultaneously. 
    2. Advance the crutches along with the right leg, and then advance the left leg. 
    3. Advance the crutches along with the left leg, and then advance the right leg. 
    4. Advance the left leg along with right crutch, and then the right leg and left crutch.

    3. Advance the crutches along with the left leg, and then advance the right leg.

88. A client has slight weakness in the right leg. On the basis of this assessment finding, the nurse determines that the client would benefit most from the use of which item? 
    1. A walker 
    2. A wooden crutch 
    3. A straight leg cane 
    4. A Lofstrand crutch

    3. A straight leg cane

89. A client who has experienced a stroke has partial hemiplegia of the left leg. The nurse interprets that the client could benefit from the support and stability provided by which item? 
    1. Quad cane 
    2. Wheelchair 
    3. Wooden crutch 
    4. Lofstrand crutch

    1. Quad cane

90. A client who is learning to use a cane is afraid it will slip with ambulation, causing a fall. The nurse provides the client with the most reassurance by making which statement? 
    1. "Canes prevent falls; they do not cause them." 
    2. "The cane would help to break a fall, even if you do slip." 
    3. "The cane has a flared tip with concentric rings to give stability." 
    4. "The physical therapist will determine if the cane is inadequate."

    3. "The cane has a flared tip with concentric rings to give stability."

91. The nurse is caring for a client who has just had a plaster leg cast applied. The nurse should plan to prevent the development of compartment syndrome by performing which action? 
    1. Elevate the limb slightly. 
    2. Elevate the limb above heart level. 
    3. Keep the leg horizontal, and cover the limb with bath blankets. 
    4. Place the leg in a slightly dependent position, and apply ice to the affected leg.

    1. Elevate the limb slightly.

92. A client has undergone fasciotomy to treat compartment syndrome of the leg. The nurse should anticipate that which type of wound care to the fasciotomy site will be prescribed? 
    1. Dry sterile dressings 
    2. Hydrocolloid dressings 
    3. Moist sterile saline dressings 
    4. One-half strength povidone-iodine (Betadine) dressings

    3. Moist sterile saline dressings

93. An older client is brought to the hospital emergency department by ambulance after sustaining a fall. The client's left leg is shortened, adducted, and externally rotated. The nurse interprets these signs as consistent with which condition? 
    1. Fractured knee 
    2. Dislocated knee 
    3. Fracture of the femoral neck 
    4. Fracture of the midshaft of the femur

    3. Fracture of the femoral neck

94. A client who has had a total knee replacement (TKR) tells the nurse that there is pain with extension of the knee. The nurse should perform which action? 
    1. Administer an analgesic. 
    2. Immobilize the knee temporarily. 
    3. Notify the health care provider (HCP). 
    4. Put the client's knee through full passive range of motion.

    1. Administer an analgesic.

95. The nurse has taught a client with a below-the-knee amputation about prosthesis and residual limb care. The nurse determines that the client has understood the instructions if the client makes which statement? 
    1. Wear a clean nylon residual limb sock daily. 
    2. Use a mirror to inspect all areas of the residual limb each day. 
    3. Toughen the skin of the residual limb by rubbing it with alcohol. 
    4. Prevent cracking of the skin of the residual limb by applying lotion daily.

    2. Use a mirror to inspect all areas of the residual limb each day.

96. A client with a herniated intervertebral lumbar disk complains of knife-like, stabbing pain in the lower back, as well as pain radiating into the right buttock. The nurse interprets that the sharp, stabbing pain probably is a result of which complication? 
    1. Pressure on the spinal cord 
    2. Pressure on the spinal nerve root 
    3. Muscle spasm in the area of the herniated disk 
    4. Excess cerebrospinal fluid production in the area

    3. Muscle spasm in the area of the herniated disk

97. The nurse has a prescription to place a client with a herniated lumbar intervertebral disk on bed rest in Williams' position to minimize the pain. The nurse should put the bed in what position? 
    1. Flat with the knees raised 
    2. In high Fowler's position, with the foot of the bed flat 
    3. In semi-Fowler's position, with the foot of the bed flat 
    4. In semi-Fowler's position, with the knees slightly flexed

    4. In semi-Fowler's position, with the knees slightly flexed

98. A client who has had spinal fusion and insertion of hardware is extremely concerned with the perceived lengthy rehabilitation period. The client expresses concerns about finances and the ability to return to prior employment. The nurse understands that the client's needs could best be addressed by referral to which member of the health care team? 
    1. The surgeon 
    2. A social worker 
    3. The physical therapist 
    4. The clinical nurse specialist

    2. A social worker

99. The nurse is planning to teach proper use of a thoracolumbosacral orthosis (TLSO) to a client who has had spinal fusion with instrumentation. The nurse should include which teaching points in the discussion with the client? 
    1. The brace should be applied directly next to the skin. 
    2. The device is applied before getting out of bed in the morning. 
    3. The self-adhering closures should be fairly loose to avoid constriction. 
    4. Areas of skin redness at the edges of the brace indicate a good, snug fit.

    2. The device is applied before getting out of bed in the morning.

100. A client is being transferred to the nursing unit from the postanesthesia care unit after spinal fusion with rod insertion. The nurse should prepare to transfer the client from the stretcher to the bed by using which best method? 
     1. A bath blanket and the assistance of four people 
     2. A bath blanket and the assistance of three people 
     3. A transfer (slider) board and the assistance of two people 
     4. A transfer (slider) board and the assistance of four people

     4. A transfer (slider) board and the assistance of four people

101. A client is being discharged to home after spinal fusion with insertion of instrumentation (rod). The unit nurse should consult with the continuing care nurse regarding the need for modification of the home environment if the client makes which statement? 
     1. "The bathroom has hand railings in the shower." 
     2. "There are three steps to get up to the front door." 
     3. "My family has rented a commode for me to use." 
     4. "My bedroom and bathroom are on the second floor of my home."

     4. "My bedroom and bathroom are on the second floor of my home."

102. The nurse in the hospital emergency department is assessing a client with an open leg fracture. The nurse should inquire about the last time the client had which done? 
     1. Tuberculin test 
     2. Tetanus vaccine 
     3. Chest radiograph 
     4. Physical examination

     2. Tetanus vaccine

103. A client who has experienced nonunion of a fracture is scheduled for bone grafting using cadaver bone. The client appears restless and anxious about the procedure. After determining that the client understands the surgical procedure, the nurse should explore which item next? 
     1. Concern about the level of postoperative pain 
     2. The availability of assistance for the client after discharge 
     3. Whether the client needs a PRN prescription for an antianxiety agent 
     4. Potential worry about contracting hepatitis or possibly human immunodeficiency virus (HIV) infection

     4. Potential worry about contracting hepatitis or possibly human immunodeficiency virus (HIV) infection

104. A client has just been admitted to the hospital with a fractured femur and pelvic fractures. The nurse should plan to carefully monitor the client for which signs? 
     1. Fever and bradycardia 
     2. Fever and hypertension 
     3. Tachycardia and hypotension 
     4. Bradycardia and hypertension

     3. Tachycardia and hypotension

105. A client is complaining of pain underneath a cast in the area of a bony prominence. The nurse interprets that this client may need which intervention? 
     1. To have the cast bivalved 
     2. To have a window cut in the cast 
     3. To have the cast replaced with an air splint 
     4. To have extra padding put over this area of the cast

     2. To have a window cut in the cast

106. A client is fearful about having an arm cast removed. Which action by the nurse would be the most helpful? 
     1. Telling the client that the saw makes a frightening noise 
     2. Reassuring the client that no one has had an arm lacerated yet 
     3. Stating that the hot cutting blades cause burns only very rarely 
     4. Showing the client the cast cutter and explaining how it works

     4. Showing the client the cast cutter and explaining how it works

107. A client has just had a cast removed, and the underlying skin is yellow-brown and crusted. The nurse gives the client instructions for skin care. The nurse determines that the client needs further teaching of the directions if he or she makes which statement? 
     1. "I need to soak the skin and wash it gently." 
     2. "I need to scrub the skin vigorously with soap and water." 
     3. "I need to apply an emollient lotion to enhance softening." 
     4. "I need to use a sunscreen on the skin if exposed to the sun for a period of time."

     2. "I need to scrub the skin vigorously with soap and water."

108. A client has skeletal traction applied to the right leg and has an overhead trapeze available for use. The nurse should assess which area as high-risk for pressure and breakdown? 
     1. Left heel 
     2. Scapulae 
     3. Right heel 
     4. Back of the head

     1. Left heel

109. The nurse is planning measures to increase bed mobility for a client in skeletal leg traction. Which item should the nurse consider to be most helpful for this client? 
     1. Television 
     2. Fracture bedpan 
     3. Overhead trapeze 
     4. Reading materials

     3. Overhead trapeze

110. The nurse is evaluating goal achievement for a client in traction with impaired physical mobility. The nurse determines that the plan of care needs to be revised if which outcome is noted? 
     1. Intact skin surfaces 
     2. Bowel movement every 4 days 
     3. Active range of motion of uninvolved joints 
     4. Absence of redness and swelling in the affected extremity

     2. Bowel movement every 4 days

111. The nurse is obtaining a health history from a client and is assessing for risk factors associated with osteoporosis. The nurse would be most concerned if which data were obtained? Select all that apply. 
     1. The client reports that she doesn't exercise much at all. 
     2. The client reports that she smokes a few cigarettes a day. 
     3. The client reports that she consumes calcium and vitamin foods and supplements daily. 
     4. The client reports that she is taking phenytoin (Dilantin) to treat a seizure disorder. 
     5. The client reports that she takes a daily low dose of prednisone to treat a chronic respiratory condition.

     • 1. The client reports that she doesn't exercise much at all. 
     • 2. The client reports that she smokes a few cigarettes a day.
     • 4. The client reports that she is taking phenytoin (Dilantin) to treat a seizure disorder. 
     • 5. The client reports that she takes a daily low dose of prednisone to treat a chronic respiratory condition.

112. The home health nurse visits a client who is having an acute attack of gout. The nurse determines that the client needs further instruction regarding the treatment of gout if the client states that he or she is taking which action? 
     1. Restricting fluids 
     2. Maintaining bed rest 
     3. Eating a low-purine diet 
     4. Taking nonsteroidal anti-inflammatory drugs (NSAIDs)

     1. Restricting fluids

113. The clinic nurse is performing an assessment on a client with a diagnosis of rheumatoid arthritis (RA). The nurse checks for which assessment finding that is associated with RA? 
     1. Age of onset is generally 65 years of age or older 
     2. Complaints of pain that is more severe after activity 
     3. Systemic symptoms such as fatigue, anorexia, and weight loss 
     4. Joint pain is asymmetrical and associated with past injuries to the joint

     3. Systemic symptoms such as fatigue, anorexia, and weight loss

114. A client who had a body cast applied 2 days earlier begins to complain of anorexia, nausea, and abdominal discomfort. The nurse should take which immediate action? 
     1. Test the client's stool for guaiac. 
     2. Notify the health care provider (HCP). 
     3. Administer the prescribed as-needed antacid. 
     4. Administer the prescribed as-needed antiemetic.

     2. Notify the health care provider (HCP).

115. The nurse is performing an assessment on a client after a closed reduction of a fractured right humerus and application of a plaster cast. To assess for signs of compartment syndrome, the nurse should perform which action? 
     1. Assess the client's cognitive level. 
     2. Assess the temperature of the cast. 
     3. Monitor for the presence of drainage or odors on or beneath the cast. 
     4. Assess capillary refill, temperature, color, and amount of pain in the right hand.

     4. Assess capillary refill, temperature, color, and amount of pain in the right hand.

116. Emergency department personnel are performing an assessment on an older client with a suspected fractured hip from a fall at home. The nurse should suspect that a fractured hip is present if the injured leg is in which position? 
     1. Shortened and abducted 
     2. Abducted and internally rotated 
     3. Shortened and externally rotated 
     4. Shortened and internally rotated

     3. Shortened and externally rotated

117. The nurse is preparing a plan of care for a client who is scheduled to return from the recovery room after a left total knee replacement. The nurse includes in the plan of care to assess the client's neurovascular status by monitoring which parameter? 
     1. The pain level of the client 
     2. Blood pressure and respiratory rate 
     3. Capillary refill, sensation, color, and pulse of the left foot 
     4. The range of motion at the left knee when a continuous passive motion machine is used

     3. Capillary refill, sensation, color, and pulse of the left foot

118. A client has been diagnosed with osteomalacia, or adult rickets. The nurse determines that this disorder, when it affects an adult, results from a deficiency in which vitamin? 
     1. Vitamin A 
     2. Vitamin D 
     3. Vitamin E 
     4. Vitamin K

     2. Vitamin D

119. An older woman is diagnosed with osteoporosis. The nurse understands that this client is most likely at risk for which complication as a result of this bone disorder? 
     1. Fractures 
     2. Weight loss 
     3. Hypocalcemia 
     4. Muscle atrophy

     1. Fractures

120. A clinical picture of the client with osteitis deformans (Paget's disease) includes back and leg pain, a crouched forward posture, and legs that bow outward. The nurse understands that these manifestations are caused by disturbances with which process? 
     1. Muscle metabolism and growth 
     2. Bone resorption and regeneration 
     3. Nervous system impulse transmission 
     4. Joint integrity and synovial fluid production

     2. Bone resorption and regeneration

121. A client has been diagnosed with osteomyelitis of the left tibia. The nurse understands that this condition is most likely caused by which occurrence in the client's recent history? 
     1. Cigarette smoking 
     2. A sprained left ankle 
     3. Decreased calcium intake 
     4. Open trauma to the left leg

     4. Open trauma to the left leg

122. A nurse is providing dietary instructions to a client with osteoporosis and is discussing appropriate food items to include in the diet. Which food items should the nurse recommend as being high in calcium? Select all that apply. 
     1. Tofu 
     2. Salmon 
     3. Peaches 
     4. Spinach 
     5. Sardines

     • 1. Tofu 
     • 2. Salmon 
     • 4. Spinach 
     • 5. Sardines

123. A client is seen in the health care provider's office for complaints of wrist pain. A diagnosis of carpal tunnel syndrome is made. In explaining this disorder to the client, the nurse states that it is caused by compression of which nerve? 
     1. Median 
     2. Peroneal 
     3. Trigeminal 
     4. Spinal accessory

     1. Median

124. A client has shoulder pain documented as being caused by a lesion of the rotator cuff. The nurse interprets this to mean that which structure is involved? 
     1. Nerve 
     2. Tendon 
     3. Ligament 
     4. Synovial fluid

     2. Tendon

125. A nurse is gathering subjective and objective data from a client with a diagnosis of suspected rheumatoid arthritis (RA). The nurse would expect to note which early signs and symptoms of RA? Select all that apply. 
     1. Fatigue 
     2. Weight gain 
     3. Restlessness 
     4. Morning stiffness 
     5. Pain with movement only

     • 1. Fatigue 
     • 4. Morning stiffness

126. An immobile client is at risk for disuse osteoporosis. The nurse understands that which substance plays an important role in the bone remodeling process? 
     1. Vitamin C 
     2. Vitamin A 
     3. Calcitonin 
     4. Thyroid hormone

     3. Calcitonin

127. A client is brought to the emergency department after experiencing a fall. Following radiographic examination, the health care provider (HCP) explains to the client that the leg was fractured, but the break did not extend all the way through the bone. The nurse providing care for this client understands that the HCP is referring to which type of fracture? 
     1. Open 
     2. Displaced 
     3. Complete 
     4. Incomplete

     4. Incomplete

128. A client has been diagnosed with subluxation of the shoulder. The nurse explains to the client that which injury has occurred to the joint? 
     1. It is strained. 
     2. It is contused. 
     3. It has completely dislocated. 
     4. It has incompletely dislocated.

     4. It has incompletely dislocated.

129. A client who suffered a contusion after being hit on the thigh with a racquetball has been told that it is acceptable to apply heat to the area 72 hours after the injury. The nurse explains the rationale for this treatment to the client, stating that which is the physiological benefit of heat, in this case? 
     1. It induces muscle relaxation. 
     2. It prevents abscess formation. 
     3. It reduces the likelihood of strain as a complication. 
     4. It promotes reabsorption of blood from the injured tissue.

     4. It promotes reabsorption of blood from the injured tissue.

130. A nurse coming on duty in the hospital emergency department is told that a client with a leg injury probably has a torn meniscus. The nurse plans care, knowing that this client most likely has an injury to which joint of the lower extremity? 
     1. Hip 
     2. Knee 
     3. Ankle 
     4. Great toe

     2. Knee

131. A client seeks treatment in the hospital emergency department for a right ankle injury. The client reportedly twisted the ankle while dancing. The ankle appears swollen, and the client has difficulty bearing weight on the leg. Until the results of x-ray studies are available to accurately pinpoint the problem, the nurse interprets that this client has most likely experienced which type of injury? 
     1. Strain 
     2. Sprain 
     3. Fracture 
     4. Contusion

     2. Sprain

132. A client with a short-leg plaster cast complains of an intense itching under the cast. The nurse provides instructions to the client regarding relief measures for the itching. Which client statement indicates an understanding of appropriate measures to relieve the itching? 
     1. "I can use the blunt part of a ruler to scratch the area." 
     2. "I can trickle small amounts of water down inside the cast." 
     3. "I need to obtain assistance when placing an object into the cast for the itching." 
     4. "I can use a hair dryer on the low setting and allow the cool air to blow into the cast."

     4. "I can use a hair dryer on the low setting and allow the cool air to blow into the cast."

133. A client has been experiencing muscle weakness over a period of several months. The health care provider suspects polymyositis. Which client statement correctly identifies a confirmation of test results and this diagnosis? 
     1. "If I have polymyositis, there will be a decrease in elastic tissue." 
     2. "I will know I have polymyositis if the muscle fibers are inflamed." 
     3. "The health care provider said there would be more fibers and tissue with polymyositis." 
     4. "The health care provider said if the muscle fibers were thickened, I would have polymyositis."

     2. "I will know I have polymyositis if the muscle fibers are inflamed."

134. A client has been diagnosed with gout. In developing a dietary plan for the client, the nurse plans to include which item on a list of foods to be avoided? 
     1. Liver 
     2. Carrots 
     3. Broccoli 
     4. Chocolate

     1. Liver

135. Which best describes why arthroscopy after a sports-related knee injury is commonly performed? 
     1. Assess whether the joint injury has healed. 
     2. Obtain a muscle biopsy for pathology studies. 
     3. Drain fluid that has accumulated within the swollen tissues. 
     4. Identify joint injuries and provide a route for surgical repair if indicated.

     4. Identify joint injuries and provide a route for surgical repair if indicated.

136. A client has had surgery to repair a fractured left hip. The nurse obtains items from the unit storage area, knowing that which will be most important to use when repositioning the client from side to side in bed? 
     1. Bed pillow 
     2. Adductor splint 
     3. Abductor splint 
     4. Overhead trapeze

     3. Abductor splint

137. The nurse has given activity guidelines to a client with chronic low back pain. The nurse determines that the client understands the instructions if the client states that they will avoid which position? 
     1. Lying prone 
     2. Sitting using a lumbar roll or pillow 
     3. Standing with one foot on a step or stool 
     4. Lying on the side, with knees and hips bent

     1. Lying prone

138. The nurse is assigned to care for a client who is in Buck's traction. The nurse prepares a plan of care for the client and includes which nursing action in the plan? 
     1. Make sure that the knots are at the pulleys. 
     2. Inspect the skin under the boot at least every 8 hours. 
     3. Make sure the head of the bed is kept at a 45- to 90-degree angle. 
     4. Monitor the weights to be sure that they are resting on a firm surface.

     2. Inspect the skin under the boot at least every 8 hours.

139. The nurse is preparing a plan of care for a client in skin traction. Which frequent assessment should the nurse include in the plan as a priority intervention? 
     1. Urinary incontinence 
     2. Signs of skin breakdown 
     3. The presence of bowel sounds 
     4. Signs of infection around the pin sites

     2. Signs of skin breakdown

140. The nurse has developed a plan of care for a client who is in traction and documents a problem of inability to perform self-care independently. The nurse evaluates the plan of care and determines that which observation indicates a successful outcome? 
     1. The client refuses care. 
     2. The client allows the family to assist in the care. 
     3. The client assists in self-care as much as possible. 
     4. The client allows the nurse to complete the care on a daily basis.

     3. The client assists in self-care as much as possible.

141. The nurse is caring for a client with osteoarthritis. The nurse performs an assessment, knowing that which clinical manifestations are associated with the disorder? Select all that apply. 
     1. Elevated white blood cell count 
     2. A decreased sedimentation rate 
     3. Joint pain that diminishes after rest 
     4. Elevated antinuclear antibody levels 
     5. Joint pain that intensifies with activity

     • 3. Joint pain that diminishes after rest 
     • 5. Joint pain that intensifies with activity

142. A client is treated in a health care provider's office for a sprained ankle after a fall. Radiographic examination has ruled out a fracture. Before sending the client home, the nurse plans to teach the client to avoid which activity in the next 24 hours? 
     1. Resting the foot 
     2. Applying a heating pad 
     3. Applying an elastic compression bandage 
     4. Elevating the ankle on a pillow while sitting or lying down

     2. Applying a heating pad

143. A client has Buck's extension traction applied to the right leg. Which intervention should the nurse plan to prevent complications of the device? 
     1. Give pin care once a shift. 
     2. Inspect the skin on the right leg. 
     3. Massage the skin of the right leg with lotion. 
     4. Release the weights on the right leg for daily range-of-motion exercises.

     2. Inspect the skin on the right leg.

144. The client is complaining of skin irritation from the edges of a cast applied the previous day. Which action should the nurse take? 
     1. Massage the skin at the rim of the cast. 
     2. Petal the cast edges with adhesive tape. 
     3. Use a rough file to smooth the cast edges. 
     4. Apply lotion to the skin at the rim of the cast.

     2. Petal the cast edges with adhesive tape.

145. The nurse determines that a client's skeletal traction needs correction if which observation is made? 
     1. Weights are not touching the floor. 
     2. Weights are hanging free of the bed. 
     3. Traction ropes rest against the footboard. 
     4. Traction ropes are aligned in each pulley.

     3. Traction ropes rest against the footboard.

146. A nurse is lecturing to a group of women who are at high risk for osteoporosis. The nurse should inform the women about which most important measure? 
     1. Limit caffeine intake. 
     2. Limit intake of vitamin D. 
     3. Limit participation in activities such as walking and swimming. 
     4. Limit protein in the diet because it contributes to the incidence of bone demineralization.

     1. Limit caffeine intake.

147. A client is admitted to the emergency department with an open fracture of the right tibia. What intervention is most appropriate for this client? 
     1. Apply a tourniquet above the area of bleeding and loosen it every 15 minutes. 
     2. Check the neurovascular status of the area distal to the extremity. 
     3. Place the client in a semi-Fowler's position. 
     4. Remove the client's shoes.

     2. Check the neurovascular status of the area distal to the extremity.

148. The nurse is caring for a client with a hip fracture who has just been placed in Buck's traction. What intervention is most important for the nurse to perform? 
     1. Ensure that the weight used as a pulling force is at least 20 lb. 
     2. Ensure that the weights rest on the floor and are not freely hanging. 
     3. Inspect the skin at least every 8 hours for signs of irritation or inflammation. 
     4. Remove the weights for at least 5 minutes every hour to give the client a rest.

     3. Inspect the skin at least every 8 hours for signs of irritation or inflammation.

149. A nurse plans care for an older adult female client with a diagnosis of osteoporosis knowing that the client is at greatest risk for which problem? 
     1. Fractures 
     2. Phosphatemia 
     3. Hypocalcemia 
     4. Muscle atrophy

     1. Fractures

150. The clinical picture of the client with osteitis deformans (Paget's disease) includes back and leg pain, a crouched forward posture, and legs that bow outward. The nurse plans care, knowing that these manifestations are caused by disturbances of which? 
     1. Muscle metabolism and growth 
     2. Bone resorption and regeneration 
     3. Nervous system impulse transmission 
     4. Joint integrity and synovial fluid production

     2. Bone resorption and regeneration

151. A nurse understands that the most significant rationale for the application of heat to an area of contusion 72 hours after the injury is to promote which? 
     1. Muscle relaxation 
     2. Prevention of abscess formation 
     3. Reabsorption of blood from the injured tissue 
     4. Reducing the likelihood of strain as a complication

     3. Reabsorption of blood from the injured tissue

152. A nurse is assisting in performing a physical assessment of a right-handed client's musculoskeletal system. Which would be an abnormal finding? 
     1. Presence of fasciculations 
     2. Muscle strength of normal power 
     3. Symmetrical movements bilaterally 
     4. Hypertrophy of right upper arm of 1 cm

     1. Presence of fasciculations

153. A client was admitted to the hospital 2 hours ago following multiple fractures to the pelvis and soft tissue injury to the abdomen. Diagnostic studies have ruled out perforation of abdominal organs. The nurse places highest priority on monitoring this client for which changes in vital signs? 
     1. Fever, bradycardia 
     2. Fever, hypertension 
     3. Tachycardia, hypotension 
     4. Bradycardia, hypertension

     3. Tachycardia, hypotension

154. Which teaching point is the priority when the nurse is teaching the client about caring for a plaster cast? 
     1. The cast gives off heat as it dries. 
     2. The client can bear weight on the cast in 1 hour. 
     3. A stockinette and soft padding are put over the leg area before casting. 
     4. Immediately report any increase in drainage or interruption in cast integrity.

     4. Immediately report any increase in drainage or interruption in cast integrity.

155. A nurse is receiving a client from the postanesthesia care unit following left above-knee amputation. Which is the priority nursing action at this time? 
     1. Elevate the foot of the bed. 
     2. Position the residual limb flat on the bed. 
     3. Put the bed in a reverse Trendelenburg's position. 
     4. Keep the residual limb flat, with the client lying on his or her operative side.

     1. Elevate the foot of the bed.

156. A client has been diagnosed with gout and the nurse provides dietary instructions. The nurse determines that the client needs additional teaching if the client states that it is acceptable to eat which food? 
     1. Carrots 
     2. Tapioca 
     3. Chocolate 
     4. Chicken liver

     4. Chicken liver

157. A nurse is caring for a client with acute back pain. Which are the most likely causes of this problem? Select all that apply. 
     1. Twisting of the spine 
     2. Curvature of the spine 
     3. Hyperflexion of the spine 
     4. Sciatic nerve inflammation 
     5. Degeneration of the facet joints 
     6. Herniation of an intervertebral disk

     • 1. Twisting of the spine 
     • 3. Hyperflexion of the spine 
     • 6. Herniation of an intervertebral disk

158. A client who sustained a severe sprain of the ankle is told by the health care provider that the pain experienced is caused by muscle spasm and swelling in the area of the injury. Which interventions should the nurse anticipate will be included in the client's initial plan of care? Select all that apply. 
     1. Ice bags 
     2. Elevation 
     3. Heating pad 
     4. Compression bandage 
     5. Range-of-motion exercises

     • 1. Ice bags 
     • 2. Elevation 
     • 4. Compression bandage

159. A nurse is collecting data related to a client's risk factors associated with osteoporosis. Which data should the nurse include? Select all that apply. 
     1. Thin body build 
     2. Smoking history 
     3. Postmenopausal age 
     4. Chronic corticosteroid use 
     5. High intake of dairy products 
     6. Family history of osteoporosis

     • 1. Thin body build 
     • 2. Smoking history 
     • 3. Postmenopausal age 
     • 4. Chronic corticosteroid use 
     • 6. Family history of osteoporosis

160. The nurse is caring for a client who had surgery to repair a fractured left-sided hip. Which device should the nurse use when repositioning the client from side to side in bed? 
     1. Bed pillow 
     2. Abductor splint 
     3. Adductor splint 
     4. Overhead trapeze

     2. Abductor splint

When caring for a client who has had a total hip replacement the nurse should position the client's affected limb in?

When using crutches The nurse should instruct the client to bear weight primarily on which of the following?

Which cast care instructions should the nurse provide to a client who just had a plaster?

Which hand would a nurse teach a client to use when holding a cane after right total hip replacement?