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NURSING MEDSURGE| musculoskeletal EXAM questions with updated answers and rationale 2022/2023
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NURSING MEDSURGE| musculoskeletal EXAM questions with updated answers and rationale 2022/2023
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NURSING MEDSURGE| musculoskeletal EXAMquestions with updated answers and rationale
2022/2023
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 runs
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
Rationale:
Risk factors for osteoporosis include female gender, being postmenopausal,
advanced age, a low-calcium diet, excessive alcohol intake, being sedentary,
and smoking cigarettes. Long-term use of corticosteroids, anticonvulsants,
and/or furosemide also increases the risk.
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 swelling to my health care provider."
Rationale:
After arthroscopy, the client usually can walk carefully on the leg once sensation
has returned. The client is instructed to avoid strenuous exercise for at least a
few days. The client may resume the usual diet. Signs and symptoms of
infection should be reported to the health care provider.
3- The nurse witnessed a vehicle hit a pedestrian. The victim is dazed and
tries to get up. A 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 him or her to remain still.
Rationale:
With a suspected fracture, the victim is not moved unless it is dangerous to
remain in that spot. The nurse should remain with the victim and have someone
else call for emergency help. A fracture is not reduced at the scene. Before the
victim is moved, the site of fracture is immobilized to prevent further injury.
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.
NURSING MEDSURGE| musculoskeletal EXAM
questions with updated answers and rationale
2022/2023
,NURSING MEDSURGE| musculoskeletal EXAM
questions with updated answers and rationale
2022/2023
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.
Rationale:
A plaster cast takes 24 to 72 hours to dry (synthetic casts dry in 20 minutes).
The cast and extremity should be elevated to reduce edema if prescribed. A wet
cast is handled with the palms of the hand until it is dry, and the extremity is
turned (unless contraindicated) so that all sides of the wet cast will dry. A cool
setting on the hair dryer can be used to dry a plaster cast (heat cannot be used
on a plaster cast because the cast heats up and burns the skin). The cast needs
to be kept clean and dry, and the client is instructed not to stick anything under
the cast because of the risk of breaking skin integrity. The client is instructed to
monitor the extremity for circulatory impairment, such as pain, swelling,
discoloration, tingling, numbness, coolness, or diminished pulse. The health
care provider is notified immediately if circulatory impairment occurs.
5- The nurse is evaluating a client in skeletal traction. When evaluating the
pin sites, the nurse would be most concerned with which finding?
1. Redness around the pin sites
2. Pain on palpation at the pin sites
3. Thick, yellow drainage from the pin sites
4. Clear, watery drainage from the pin sites
Rationale:
The nurse should monitor for signs of infection such as inflammation, purulent
drainage, and pain at the pin site. However, some degree of inflammation, pain
at the pin site, and serous drainage would be expected; the nurse should
correlate assessment findings with other clinical findings, such as fever,
elevated white blood cell count, and changes in vital signs. Additionally, the
nurse should compare any findings to baseline findings to determine if there
were any changes.
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
NURSING MEDSURGE| musculoskeletal EXAM
questions with updated answers and rationale
2022/2023
,NURSING MEDSURGE| musculoskeletal EXAM
questions with updated answers and rationale
2022/2023
4. Coolness and pallor of the extremity
Rationale:
Signs of infection under a casted area include odor or purulent drainage from
the cast or the presence of "hot spots," which are areas of the cast that are
warmer than others. The health care provider should be notified if any of these
occur. Signs of impaired circulation in the distal limb include coolness and
pallor of the skin, diminished distal pulse, and edema.
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
Rationale:
Most pain associated with fractures can be minimized with rest, elevation,
application of cold, and administration of analgesics. Pain that is not relieved by
these measures should be reported to the health care provider because pain
unrelieved by medications and other measures may indicate neurovascular
compromise. Because this is a new closed fracture and cast, infection would not
have had time to set in. Intense pain after casting is normally not associated
with anxiety or the recent occurrence of the injury. Treatment following the
fracture should assist in relieving the pain associated with the injury.
8- The nurse is admitting a client with multiple trauma injuries 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. Elevated for 3 hours, then flat for 1 hour
2. Flat for 3 hours, then elevated for 1 hour
3. Flat for 12 hours, then elevated for 12 hours
4. Elevated on pillows continuously for 24 to 48 hours
Rationale:
A casted extremity is elevated continuously for the first 24 to 48 hours to
minimize swelling and promote venous drainage. Options 1, 2, and 3 are
incorrect.
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?
NURSING MEDSURGE| musculoskeletal EXAM
questions with updated answers and rationale
2022/2023
, NURSING MEDSURGE| musculoskeletal EXAM
questions with updated answers and rationale
2022/2023
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."
Rationale:
A plaster cast must remain dry to keep its strength. The cast should be handled
with the palms of the hands, not the fingertips, until fully dry; using the
fingertips results in indentations in the cast and skin pressure under the cast.
Air should circulate freely around the cast to help it dry; the cast also gives off
heat as it dries. The client should never scratch under the cast because of the
risk of altered skin integrity; the client may use a hair dryer on the cool setting
to relieve an itch.
10-A 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
Rationale:
Crutches are measured so that the tops are 2 to 3 fingerwidths from the axillae.
This ensures that the client's axillae are not resting on the crutch or bearing the
weight of the crutch, which could result in injury to the nerves of the brachial
plexus. Although the conditions in options 1, 3, and 4 can occur, they are not
the most likely result from resting the axilla directly on the crutches.
11- The nurse has given the client instructions about crutch safety. Which
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."
Rationale:
The client should use only crutches measured for the client. When assessing for
NURSING MEDSURGE| musculoskeletal EXAM
questions with updated answers and rationale
2022/2023
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