Saunders NCLEX Musculoskeletal
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: A sedentary 65-year-
old woman who smokes cigarettes
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.": "I need to
report a fever or swelling to my health care provider."
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
, Saunders NCLEX Musculoskeletal
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.: Stay with the
victim and encourage him or her to remain still.
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.
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.
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Keep the cast clean and dry.
2.
Allow the cast 24 to 72 hours to dry.
3.
Keep the cast and extremity elevated.
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: Thick, yellow drainage from the pin
sites
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.
, Saunders NCLEX Musculoskeletal
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: Presence of a "hot spot" on the cast
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: Impaired tissue perfusion
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
