NCLEX Review Questions Musculoskeletal System

NCLEX Review Questions Musculoskeletal System (1-5) Welcome to NCLEX Review Questions Musculoskeletal System. Enjoy answering and I hope that NCLEX Prep Course Online can somehow help you in your future examination. Good Luck 1. A client ha been taught to use a walker to aid with mobility after the internal fixation of a hip fracture. The nurse determines that the client is using the walker incorrectly if the client: a) holds the walker using the hand grips b) advances the walker with reciprocal motion c) leans forward slightly when advancing the walker d) supports the body weight on the hands while advancing the weaker leg 2. 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 stated that he should: a) wear a clean nylon sock over the residual limb every day b) use a mirror to inspect all areas of the residual limb each day c) toughen the skin of the residual limb by rubbing it with alcohol d) prevent cracking of the skin of the residual limb by applying lotion daily 3. The nurse is ambulating a client with a right-leg fracture who has an order for partial weight-bearing status. The nurse determines that the client demonstrates compliance with this restriction if the client: a) does not bear weight on the right leg b) allows the right leg to touch the floor only c) put 30% to 50% of the weight on the right leg d) puts 60% to 80% of the weight on the right leg 4. The nurse is planning to teach a client in skeletal leg traction about measures to increase bed mobility. Which item would be most helpful for this client? a) television b) fracture bedpan c) overhead trapeze d) reading materials 5. The nurse provides discharge instructions to a client with rheumatoid arthritis. The instructions focus on measures to lessen discomfort and to provide joint protection, and the nurse tells the client to: a) change positions every hour b) lift items rather than sliding them c) avoid stooping, bending, or overreaching d) perform prescribed exercises even if the joints are inflamed

NCLEX Review Questions Musculoskeletal System Answers and Rationale 1) B - The client should use the walker by placing the hands on the hand grips for stability. The client lifts the walker to advance it and leans forward slightly while moving it. The client walks into the walker, supporting the body weight on the hands while moving the weaker leg. A disadvantage of the walker is that it does not allow for reciprocal walking motion. If the client were to try to use reciprocal motion with a walker, the walker would advance forward one side at a time as the client walks; thus the client would not be supporting the weaker leg with the walker during ambulation. 2) B - The client should inspect all surfaces of the residual limb daily for irritation, blisters, and breakdown. The client should wear a clean woolen (not nylon) sock each day. The residual limb is cleansed daily with a gentle soap and water and dried carefully. Alcohol is avoided, because it could cause drying or cracking of the skin. Oils and creams are also avoided, because they are too softening to the skin for safe prosthesis use. 3) C - The client who has partial weight-bearing status places 30% to 50% of the body weight on the affected limb. Full weight-bearing status involves placing full weight on the limb. Non–weight-bearing status does not allow the client to let the limb touch the floor. Touchdown weight-bearing allows the client to let the limb touch the floor but not to bear weight. There is no classification for 60% to 80% weight-bearing status. 4) C - The use of an overhead trapeze is extremely helpful for assisting a client with moving about in bed and getting on and off the bedpan. This device has the greatest value for increasing overall bed mobility. Television and reading materials are helpful to reduce boredom and provide distraction. A fracture bedpan is useful for reducing discomfort with elimination. 5) C - The client with rheumatoid arthritis is instructed to avoid stooping, bending, or overreaching. The client should avoid remaining in one position and should change positions or stretch every 20 minutes. To reduce efforts by joints, the client should slide objects rather than lift them. The client should avoid exercises and activities other than gentle range-of-motion movements when the joints are inflamed.

NCLEX Review Questions Musculoskeletal System (6-10) Welcome to NCLEX Review Questions Musculoskeletal System. Enjoy answering and I hope that NCLEX Prep Course Online can somehow help you in your future examination. Good Luck 6. The nurse is teaching a client who is preparing for discharge from the hospital after a total hip replacement. Which statement by the client would indicate the need for further instructions? a) I cannot drive a car for probably 6 weeks b) I should not sit in one position for more than 4 hours c) I need to wear a support stocking on an unaffected leg d) I need to place a pillow between my knees when I lie down 7. The nurse has given the client with a nonplaster (fiberglass) leg cast instructions regarding cast care at home. The nurse determines that the client needs further instructions if the client makes which statement? a) I should avoid walking on wet, slippery floors b) I'm not supposed to scratch the skin underneath the cast c) It's all right to wipe dirt off of the top of the cast with a damp cloth d) if the cast gets wet, I can dry it with a dryer turned to the hot setting 8. The nurse is planning to teach a client with a below-the-knee amputation about skin care to prevent breakdown. Which of the following points should the nurse include in the teaching plan? a) a stump sock must be worn at all times and changed twice a week b) the socket of the prosthesis must be dried carefully before it is used c) the residual limb (stump) is washed gently and dried every other day d) the socket of the prosthesis needs to be washed with a strong bactericidal agent daily 9. The nurse is teaching a client how to stand on crutches. The nurse tells the client to place the crutches: a) 3 inches to the front and side of the toes b) 8 inches to the front and side of the toes c) 15 inches to the front and side of the toes d) 20 inches to the front and side of the toes 10. A client with a compound (open) fracture of the radius has a plaster cast applied in the emergency department. The nurse provides home-care instructions and tells the client to seek medical attention if which of the following occurs? a) numbness and tingling are felt in the fingers b) the cast feels heavy and damp after 24 hours of application c) the entire cast feels warm during the first 24 hours after application d) bloody drainage is noted in the cast during the first 6 hours after application

NCLEX Review Questions Musculoskeletal System Answers and Rationale 6) B - The client needs to be instructed to not sit continuously for more than 1 hour. The client should be instructed to stand, stretch, and take a few steps periodically. The client cannot drive a car for 6 weeks after surgery unless allowed to do so by a physician. A support stocking should be worn on the unaffected leg, and an Ace bandage usually is prescribed to be placed on the affected leg until there is no swelling in the legs and feet and until full activities are resumed. The legs are abducted by placing a pillow between them when the client lies down. 7) D - If the cast gets wet, it can be dried with a hair dryer set to a cool setting. The client is instructed to avoid walking on wet, slippery floors to prevent falls. If the skin under the cast itches, cool air from a hair dryer may be used to relieve it. The client should never scratch under the cast because of the risk of skin breakdown and infection. Surface soil on a cast may be removed with a damp cloth. 8) B - The socket of the prosthesis is cleansed with a mild detergent, rinsed, and dried carefully each day. A strong bactericidal agent would not be used. A stump sock must be worn at all times to absorb perspiration, and it is changed daily. The residual limb (stump) is washed, dried, and inspected for breakdown twice each day. 9) B - The classic tripod position is taught to the client before instructions regarding gait are given. The crutches are placed anywhere from 6 to 10 inches in front of and to the side of the client's toes, depending on the client's body size. This provides a wide enough base of support for the client and improves balance. 10) A - A limb encased in a cast is at risk for nerve damage and diminished circulation from increased pressure caused by edema. Signs of increased pressure from the cast include numbness, tingling, and increased pain. A cast can take up to 48 hours to dry and generates heat while drying. Some drainage may occur initially with a compound (open) fracture.

NCLEX Review Questions Musculoskeletal System (11-15) Welcome to NCLEX Review Questions Musculoskeletal System. Enjoy answering and I hope that NCLEX Prep Course Online can somehow help you in your future examination. Good Luck 11. The nurse monitors a client for brachial plexus compromise after shoulder arthroplasty and is checking the status of the ulnar nerve. Which technique should the nurse use to assess the status of this nerve? a) ask the client to raise the forearm above the head b) have the client spread all of the fingers wide and resist pressure c) ask the client to move the thumb toward the palm and then back to the neutral position d) have the client grasp the nurse's hand, and note the strength of the client's first and second fingers 12. A client has been experiencing muscle weakness for a period of several months. The physician suspects polymyositis, and the client asks the nurse about the disorder. The nurse tells the client that in this disorder: a) muscle fibers are inflamed b) muscle fibers are thickened c) there is a decrease in elastic tissue d) there are increased fibers and tissue 13. The nurse has given instructions to a client who is returning home after an arthroscopy of the knee. The nurse determines that the client understands the home-care instructions if the client states the need to: a) resume strenuous exercise the following day b) stay off the leg entirely for the rest of the day c) report fever or site inflammation to the physician d) refrain from eating food for the remainder of the day 14. The nurse provides home-care instructions to a client with multiple sclerosis. The nurse teaches the client to: a) maintain a low-fiber diet b) avoid becoming pregnant c) avoid taking hot baths or showers d) restrict fluid intake to 1,000 ml daily 15. The nurse has provided dietary instructions to a client to minimize the risk of osteoporosis. The nurse determines that the client understands the recommended changes if the client verbalizes the need to increase the intake of which food? a) rice b) yogurt c) sardines d) chicken

NCLEX Review Questions Musculoskeletal System Answers and Rationale 11) B - So that the nurse may assess the ulnar nerve status, the client is asked to spread all of the fingers wide and resist pressure. Weakness against pressure may indicate compromise of the ulnar nerve. Option A assesses the flexion of the biceps and determines the status of the cutaneous nerve. Option C describes the assessment of the status of the radial nerve. Option D describes the assessment of the status of the medial nerve. 12) A - Polymyositis is a diffuse inflammatory disorder of skeletal (striated) muscle that is characterized by symmetric weakness and atrophy. Option B describes the opposite of what is noted with this disorder. Option C is incorrect, but decreased elastic tissue in the aorta would be noted in a client with Marfan syndrome. Option D refers to the increased fibrous tissue seen in clients with ankylosis. 13) C - After arthroscopy, the client can usually walk carefully on the leg after 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 physician. 14) C - Because fatigue can be precipitated by warm temperatures, the client is instructed to take cool baths and to maintain a cool environmental temperature. The client should not be told to avoid pregnancy, but the nurse should assist the client with the making of informed decisions regarding pregnancy. A high-fiber diet and an adequate fluid intake of 2000 mL daily are encouraged to prevent alterations in elimination and bowel patterns. 15) B - Calcium intake is encouraged to minimize the risk of osteoporosis. The major dietary source of calcium is from dairy foods, including milk, yogurt, and a variety of cheeses. Calcium may also be added to certain products, such as orange juice, which are then advertised as being fortified with calcium. Calcium supplements are available and recommended for those with typically low calcium intake. Rice, sardines, and chicken are not high-calcium foods.

Musculoskeletal Nursing Questions (NCLEX 16-20) Welcome to Musculoskeletal Nursing Questions. Enjoy answering and I hope that NCLEX Prep Course Online can somehow help you in your future examination. Good Luck 16. An English-speaking Hispanic male with a newly applied long leg cast has a right proximal fractured tibia. During rounds at night, the nurse finds the client restless, withdrawn, and quiet. Which initial nursing statement would be appropriate? a) are you uncomfortable? b) tell me what you are feeling c) you'll feel better in the morning d) I'll get you pain medication right away 17. The nurse is caring for an older client who has been placed in Buck's extension traction after a hip fracture. During the assessment of the client, the nurse notes that the client is disoriented. What is the appropriate nursing intervention? a) apply restraints to the client b) ask the family to stay with the client c) ask the laboratory to perform electrolyte studies d) reorient the client frequently and place a calendar in the client's room 18. A male client is in hip spica cast as a result of hip fracture. On the day after the cast has been applied, the nurse finds the client surrounded by papers from his briefcase and planning a phone meeting. The nurse's interaction with the client about the client's activities should be based on the knowledge that: a) rest is an essential component of bone healing b) setting limits on a client's behavior is a mandated nursing role c) not keeping up with his job will increase the client's stress level d) immediate involvement in his job will keep the client from becoming bored while on bedrest 19. A client is admitted to the hospital with a fractured hip and is experiencing periods of confusion. The nurse formulates a nursing diagnosis of Disturbed thought processes and identifies which psychosocial outcome as a priority? a) improved sleep patterns b) reduced family fears and anxiety c) meeting self-care needs independently d) increased ability to concentrate and make decisions 20. An older client has been admitted to the hospital with a hip fracture. The nurse prepares a plan of care for the client and identifies desired outcomes related to surgery and impaired physical mobility. Which statement by the client supports a positive adjustment to the surgery and impairment in mobility? a) hurry up and go away. I want to be alone b) what took you so long? I called for you 30 minutes ago c) I wish you nurses would leave me alone! You are all telling me what to do! d) I find it difficult to concentrate since the doctor talked with me about the surgery tomorrow

Musculoskeletal Nursing Questions Answers and Rationale 16) B - Option B is open-ended and makes no assumptions about the client's psychological or emotional state. Option A is incorrect, because males in traditional standard Hispanic cultures practice "machismo" in which stoicism is valued, so this client may deny any pain when asked. False reassurance is never therapeutic, which makes option C incorrect. Option D is incorrect, because an assessment is necessary before administering medication for pain. 17) D - An inactive older person may become disoriented as a result of a lack of sensory stimulation. The appropriate nursing intervention would be to frequently reorient the client and to place objects such as a clock and a calendar in the client's room to maintain orientation. Restraints may cause further disorientation and should not be applied unless specifically prescribed. Agency policies and procedures should be followed before the application of restraints. The family can assist with the orientation of the client, but it is not appropriate to ask the family to stay with the client. It is not within the scope of nursing practice to prescribe laboratory studies. 18) A - Rest is an essential component of bone healing. Nurses can help clients understand the importance of rest and find ways to balance work demands to promote healing. Stress should be kept to a minimum to promote bone healing. Nurses cannot demand these changes, but they need to encourage clients to choose them. It may relieve stress to do work; however, during the immediate period after the cast is applied, it may not be therapeutic. Setting limits on a client's behavior is not a mandated nursing role. 19) D - The client needs to be able to concentrate and make decisions. When the client is able to do that, the nurse can work with the client to achieve the other outcomes. The client is the center of the nurse's concern. Options A and C address physiological needs rather than psychosocial outcomes. Option B is a secondary need and does not address the client. 20) D Option A demonstrates withdrawal behavior. Option B is a demanding response. Option C demonstrates acting out by the client. Demanding, acting out, and withdrawn clients have not coped with or adjusted to the injury or disease. Option D reflects an individual with moderate anxiety caused by a difficulty to concentrate. It most appropriately supports a positive adjustment.

Musculoskeletal Nursing Questions (NCLEX 21-25) Welcome to Musculoskeletal Nursing Questions. Enjoy answering and I hope that NCLEX Prep Course Online can somehow help you in your future examination. Good Luck 21. A client who is immobilized in skeletal leg traction complains of being bored and restless. On the basis of these complaints, the nurse formulates which nursing diagnosis for this client? a) powerlessness b) self-care deficit c) impaired physical mobility d) deficient diversional activity 22. A client is fearful about having an arm cast removed. Which action by the nurse would be helpful for alleviating the client's fear? a) telling the client that the saw makes a frightening noise b) stating that the hot cutting blades have rarely caused burns c) reassuring the client that no one has had an arm lacerated yet d) showing the client the cast cutter and explaining how it works 23. A client has several fractures of the lower leg and has been placed in an external fixation device. The client is upset about the appearance of the elg, which is very edematous. The nurse formulates which nursing diagnosis for the client? a) social isolation b) activity intolerance c) disturbed body image d) risk for impaired physical mobility 24. A female client with a long leg cast has been using crutches to ambulate for 1 week. She comes to the clinic with complaints of pain, fatigue, and frustration with crutch walking. She states, "I feel like I have a crippled leg." The nurse makes which response to the client? a) tell me what is bothersome for you b) I know how you feel. I had to use crutches before, too c) why don't you take a couple of days off work and rest d) just remember, you'll be done with the crutches in another month 25. The nurse in the ambulatory care unit is reviewing the surgical instructions with a client who will be admitted for knee replacement surgery. The nurse informs the client that crutches will be needed for ambulation after surgery and that the client will be instructed regarding the use of the crutches: a) before surgery b) on the first postoperative day c) on the second postoperative day d) at the time of discharge after surgery

Musculoskeletal Nursing Questions Answers and Rationale 21) D - A major defining characteristic of Deficient diversional activity is the expression of boredom by the client. The question also does not identify client feelings of a lack of control (Powerlessness) or an inability to perform activities of daily living (Self-care deficit). The question does not identify difficulties with coordination, range of motion, or muscle strength, which would indicate Impaired physical mobility. 22) D - Clients may be fearful of having a cast removed because of the cast-cutting blade. The nurse should show the cast cutter to the client before it is used and explain that the client may feel heat, vibration, and pressure. The cast cutter resembles a small electric saw with a circular blade. The nurse should reassure the client that the blade does not cut like a saw but instead cuts the cast by vibrating side to side. Options A, B, and C are inappropriate and may increase the client's fear. 23) C - The client is at risk for Disturbed body image related to a change in the structure and function of the affected leg. There are no data in the question to support a diagnosis of (actual) Activity intolerance or Social isolation. The client has actual Impaired mobility (rather than a risk for it) because of the fixation device. 24) A - Option A demonstrates the therapeutic communication technique of clarification and validation and indicates that the nurse is dealing with the client's problem from the client's perspective. Option B devalues the client's feelings and thus blocks communication. Option C gives advice and is a communication block. Option 4 provides false reassurances, because the client may not be done with the crutches in another month. Additionally, it does not focus on the present problem. 25) A It is best to assess crutch-walking ability and to instruct the client with regard to the use of the crutches before surgery, because this task can be difficult to learn when the client is in pain and not used to the imbalance that may occur after surgery. Options B, C, and D are not the appropriate times to teach a client about crutch walking.

Musculoskeletal Nursing Questions (NCLEX 26-30) Welcome to Musculoskeletal Nursing Questions. Enjoy answering and I hope that NCLEX Prep Course Online can somehow help you in your future examination. Good Luck 26. 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 statement by the client indicates an understanding of the measures used to relieve the itching? a) I can use the blunt part of a ruler to scratch the area b) I can trickle small amounts of water down inside the cast c) I need to obtain assistance when placing an object into the cast for the itching d) I can use a hair dryer on the low setting and allow the air to blow into the cast 27. The home-care nurse is visiting a client who is in a body cast. The nurse is performing an assessment of the psychosocial adjustment of the client to the cast. During the assessment, the nurse would most appropriately assess: a) the need for sensory stimulation b) the amount of home-care support available c) the ability to perform activities of daily living d) the type of transportation available for follow-up care 28. The nurse is developing a plan of care for a client in Buck's traction regarding measures to prevent complications. The nurse determines that the priority nursing diagnosis to be included in the plan is which of the following? a) potential for infection at pin sites b) impaired physical mobility related to traction c) deficient diversional activity related to bedrest d) bathing/hygiene self-care related to the need for traction 29. The nurse is developing a plan of care for a client on bedrest. During the planning, the nurse includes measures to limit the complications of prolonged immobility. The nurse includes which essential item in the plan? a) maintain the client in a supine position b) provide a daily fluid intake of 1000 mL c) limit the intake of milk and milk products d) monitor for signs of a low serum calcium level 30. An older client who has undergone internal fixation after fracturing a left hip has developed a reddened left heel. The nurse obtains which of the following as a priority item to manage this problem? a) trapeze b) sheepskin c) bed cradle d) draw sheet

Musculoskeletal Nursing Questions Answers and Rationale 26) D - Itching is a common complaint of clients with casts. Objects should not be put inside a cast because of the risk of scratching the skin and providing a point of entry for bacteria. A plaster cast can break down when wet. Therefore, the best way to relieve itching is with the forceful injection of air inside the cast. 27) A - A psychosocial assessment of the client who is immobilized would most appropriately include the need for sensory stimulation. This assessment should also include such factors as body image, past and present coping skills, and the coping methods used during the period of immobilization. Although homecare support, the ability to perform activities of daily living, and transportation are components of an assessment, they are not specifically related to psychosocial adjustment. 28) B - The priority nursing diagnosis for the client in Buck's traction is impaired physical mobility. Options C and D may also be appropriate for the client in traction, but immobility presents the greatest risk for the development of complications. Buck's traction is a skin traction, and there are no pin sites. 29) C - The formation of renal and urinary calculi is a complication of immobility. Daily fluid intake should be 2000 mL or more per day. The nurse should monitor for signs and symptoms of hypercalcemia, such as nausea, vomiting, polydipsia, polyuria, and lethargy. A supine position increases urinary stasis; therefore, this position should be limited or avoided. Limiting milk and milk products is the best measure to prevent the formation of calcium stones. 30) B - The reddened heel results from the pressure of the foot against the mattress. The nurse obtains a sheepskin, heel protectors, or an alternating pressure mattress. The bed cradle will keep the linens off of the client's lower extremities but will not assist with the management of a reddened heel. A draw sheet and trapeze are of general use for this client, but they are not specific for dealing with the reddened heel.