NCLEX- PN Musculoskeletal Exam with Questions and Answers

A nurse is one of several people who witness a vehicle hit a pedestrian at a fairly low speed on a small street. The individual is dazed and tries to get up, and the leg appears fractured. The nurse would plan to: 1. Try to manually reduce the fracture. 2. Assist the person to get up and walk to the sidewalk. 3. Leave the person for a few moments to call an ambulance. 4. Stay with the person and encourage the person to remain still. - 4. Stay with the person and encourage the person to remain still. A nurse witnesses a client sustain a fall and suspects that the client's leg may be fractured. Which action is the priority? 1. Take a set of vital signs. 2. Call the radiology department. 3. Immobilize the leg before moving the client. 4. Reassure the client that everything will be fine. - 3. Immobilize the leg before moving the client. A client with a hip fracture asks the nurse why Buck's extension traction is being applied before surgery. The nurse's response is based on the understanding that Buck's extension traction primarily: 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 Rationale: Buck's extension traction is a type of skin traction often applied after hip fracture, before the fracture is reduced in surgery. It reduces muscle spasms and helps immobilize the fracture. It does not lengthen the leg for the purpose of preventing blood vessel severance. It also does not allow for bony healing to begin. A 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 A nurse is caring for the client who has had skeletal traction applied to the left leg. The client is complaining of severe left leg pain. Which action should the nurse take first? 1. Provide pin care. 2. Call the health care provider (HCP). 3. Check the client's alignment in bed. 4. Medicate the client with an analgesic. - 3. Check the client's alignment in bed. A nurse has provided instructions regarding specific leg exercises for the client immobilized in right skeletal lower leg traction. The nurse determines that the client needs further instruction if the nurse observes the client: 1. Pulling up on the trapeze 2. Flexing and extending the feet 3. Doing quadriceps-setting and gluteal-setting exercises 4. Performing active range of motion (ROM) to the right ankle and knee - 4. Performing active range of motion (ROM) to the right ankle and knee A nurse is checking the casted extremity of a client. The nurse would check for which of the following signs and symptoms 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 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 has elevated the limb, applied an ice bag, and administered an analgesic, which was ineffective in relieving the pain. The nurse interprets that this pain may be caused by: 1. Infection under the cast 2. The anxiety of the client 3. Impaired tissue perfusion 4. The newness of the fracture - 3. Impaired tissue perfusion A nurse is assigned to care for a client with multiple traumas who is admitted to the hospital. The client has a leg fracture, and a plaster cast has been applied. In positioning the casted leg, the nurse should: 1. Keep the leg in a level position. 2. Elevate the leg for 3 hours, and put it flat for 1 hour. 3. Keep the leg level for 3 hours, and elevate it for 1 hour. 4. Elevate the leg on pillows continuously for 24 to 48 hours. - 4. Elevate the leg on pillows continuously for 24 to 48 hours. A client is complaining of skin irritation from the edges of a cast applied the previous day. The nurse should plan for which of the following actions? 1. Massaging the skin at the rim of the cast 2. Petaling the cast edges with adhesive tape 3. Using a rough file to smooth the cast edges 4. Applying lotion to the skin at the rim of the cast - 2. Petaling the cast edges with adhesive tape A client is being discharged home after application of a plaster leg cast. The nurse determines that the client understands proper care of the cast if the client states to: 1. Avoid getting the cast wet. 2. Cover the casted leg with warm blankets. 3. Use the fingertips to lift and move the leg. 4. Use a padded coat hanger end to scratch under the cast. - 1. Avoid getting the cast wet. A nurse is planning to provide instructions to the client about how to stand on crutches. In the instructions, the nurse plans to tell the client to place the crutches: 1. 3 inches to the front and side of the client's toes 2. 8 inches to the front and side of the client's toes 3. 20 inches to the front and side of the client's toes 4. 15 inches to the front and side of the client's toes - 2. 8 inches to the front and side of the client's toes Rationale: The classic tripod position is taught to the client before giving instructions on gait. The crutches are placed anywhere from 6 to 10 inches in front and to the side of the client, depending on the client's body size. This provides a wide enough base of support to the client and improves balance. A nurse is evaluating the client's use of a cane for left-sided weakness. The nurse would intervene and correct the client if the nurse observed that the client: 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 Rationale: The cane is held on the stronger side to minimize stress on the affected extremity and provide a wide base of support. The cane is held 6 inches lateral to the fifth great toe. The cane is moved forward with the affected leg. The client leans on the cane for added support while the stronger side swings through. A nurse is caring for a client with fresh application of a plaster leg cast. The nurse plans to prevent the development of compartment syndrome by: 1. Elevating the limb and applying ice to the affected leg 2. Elevating the limb and covering the limb with bath blankets 3. Keeping the leg horizontal and applying ice to the affected leg 4. Placing the leg in a slightly dependent position and applying ice - 1. Elevating the limb and applying ice to the affected leg A nurse is preparing a list of cast care instructions for a client who just had a plaster cast applied to his right forearm. Which instructions should the nurse include on the list? Select all that apply. 1. Keep the cast and extremity elevated. 2. The cast needs to be kept clean and dry. 3. Allow the wet cast 24 to 72 hours to dry. 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 and extremity elevated. 2. The cast needs to be kept clean and dry. 3. Allow the wet cast 24 to 72 hours to dry. Which data would indicate a potential complication associated with age-related changes in the musculoskeletal system? 1. Decrease in height 2. Overall sclerotic lesions 3. Diminished lean body mass 4. Changes in structural bone tissue - 2. Overall sclerotic lesions Rationale: Sclerotic lesions occur as bone resorption increases and results in replacement of original bone with fibrous material. This condition occurs in Paget's disease, an agerelated disorder. Options 1, 3, and 4 identify normal age-related changes in the musculoskeletal system. A client has just had a cast removed and the underlying skin is yellow-brown and crusted. The nurse determines that further skin care instructions are required when the client states: 1. "I will soak the skin and then 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 it's exposed for a period of time." - 2. "I need to scrub the skin vigorously with soap and water." A client has had skeletal traction applied to the right leg and has an overhead trapeze available for use. The nurse should monitor which of the following as a high-risk area for pressure and breakdown? 1. Scapulae 2. Left heel 3. Right heel 4. Back of the head - 2. Left heel A client has been placed in Buck's extension traction. The nurse can provide for countertraction by: 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 A client with diabetes mellitus has had a right below-knee amputation. The nurse would be especially vigilant in monitoring for which of the following because of the client's history of diabetes mellitus? 1. Hemorrhage 2. Edema of residual limb 3. Slight redness of incision 4. Separation of wound edges - 4. Separation of wound edges A client is admitted to the nursing unit after a left below-knee amputation following 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." The nurse interprets the client's statement to be: 1. A normal response and indicates the presence of phantom limb pain 2. A normal response and indicates the presence of phantom limb sensation 3. An abnormal response and indicates that the client is in denial about the limb loss 4. An abnormal response and indicates that the client needs more psychological support - 2. A normal response and indicates the presence of phantom limb sensation A nurse has provided instructions to a client with a herniated lumbar disk about proper body mechanics and other items pertinent to low back care. The nurse determines that the client needs further instructions if the client verbalizes that he or she will: 1. Increase fiber and fluids in the diet. 2. Bend at the knees to pick up objects. 3. Strengthen the back muscles by swimming or walking. 4. Get out of bed by sitting straight up and swinging the legs over the side of the bed. - 4. Get out of bed by sitting straight up and swinging the legs over the side of the bed. A client with a left arm fracture exhibits loss of sensation in the left fingers, pallor, slow refill, and diminished left radial pulse. The nurse should take which of the following actions? Submit 1. Administer an analgesic. 2. Notify the registered nurse. 3. Check the circulation again in 30 minutes. 4. Provide range-of-motion exercises to the fingers of the left hand. - 2. Notify the registered nurse. A client is complaining of pain underneath a cast in the area of a bony prominence. The nurse interprets that this client may need to have: 1. The cast bivalved 2. A window cut in the cast 3. The cast replaced with an air splint 4. Extra padding put over this area of the cast - 2. A window cut in the cast A nursing instructor asks a nursing student about the risk factors associated with osteoporosis. The instructor tells the student that she needs to read and learn about this disorder if the student states that which of the following is an associated risk factor? 1. Postmenopausal age 2. Family history of osteoporosis 3. High-calcium diet consumption 4. Long-term use of corticosteroids - 3. High-calcium diet consumption A nurse is providing instructions to a client with osteoporosis regarding appropriate food items to include in the diet. The nurse tells the client that which food item would provide the least amount of calcium? 1. Pork 2. Seafood 3. Sardines 4. Plain yogurt - 1. Pork A nurse is caring for a client with osteoarthritis. The nurse collects data, knowing that which of the following is a clinical manifestation associated with the disorder? Submit 1. Morning stiffness 2. Positive rheumatoid factor 3. An elevated sedimentation rate 4. Dull aching pain in the affected joints - 4. Dull aching pain in the affected joints