MUSCULOSKELETAL QUESTION BANK
The nurse provides discharge teaching to a client who had total hip
replacement 4 days ago. Which client statement indicates that additional
teaching is necessary?
"I will concentrate on leaning forward as I carefully sit down in a
chair." [55%]
"I will do my leg raises and quadriceps and buttock isometric
exercises 2-3 times a day." [23%]
"I will use the sock puller that the therapist gave me when I get
dressed." [2%]
"My child got me a riser for the toilet seat at home. I hope my feet
reach the floor!" [18%]
To prevent hip prosthesis dislocation following hip arthroplasty, a client
must not force the hip into >90 degrees of flexion.
Clients should use a chair with armrests and a high firm seat and proceed
to place the hands on the armrests for support while lowering themselves
onto the seat and when rising from it.
Bending forward when getting into a chair creates excessive hip flexion
(>90 degrees) and must be avoided.
(Option 2) The client performs leg exercises 2-3 times a day to help
strengthen the muscles surrounding the hip and continues them for
several months after discharge.
These include isometric quadriceps and gluteal setting, leg raises,
and abduction exercises from the supine and standing positions.
(Option 3) The client must not twist from the waist, reach across the
affected extremity, or bend forward >90 degrees when dressing or putting
on slippers, shoes, and socks.
The client is instructed to use assistive equipment when getting dressed,
such as a reacher/grabber, sock puller, or a long-handled shoehorn.
(Option 4) The client should use a toilet riser or a bedside commode
chair with arms to prevent excessive hip flexion when getting on and off
the toilet seat.
Educational objective:
To avoid prosthesis dislocation following hip arthroplasty, key discharge
,teaching points include performing leg exercises to strengthen the
muscles around the hip and avoiding excessive hip flexion (>90 degrees)
when sitting, dressing, and toileting.
An elderly client with osteoporosis falls onto an out-stretched hand and
injures the wrist. The client has severe wrist edema, deformity, and pain
rated a 10 on a pain scale of 0-10. What should be the
nurse's first action?
Administer analgesia [12%]
Apply an ice pack to the wrist [10%]
Assess capillary refill and sensation [64%]
Elevate the wrist above heart level [12%]
A Colles' fracture is a type of wrist fracture (distal radius fracture) that
causes a characteristic dinner fork deformity of the wrist. It usually
occurs when the client tries to break a fall with an outstretched arm or
hand, and lands on the heel of the hand.
It is one of the most common fractures in women age >50 and is related
to osteopenia or osteoporosis.
,While the client is undergoing evaluation by the health care provider
(HCP) in the emergency department (ED), nursing interventions should
include:
• Performing a neurovascular assessment (eg, pulse, temperature,
color, capillary refill, sensation, movement). This is
the priority nursing action as neurovascular insufficiency related
to swelling (eg, compartment syndrome) or arterial/nerve damage
by the bone fragments is associated with a Colles' fracture. If
neurovascular status is compromised, urgent reduction of the
fracture is indicated.
• Administering analgesia to promote comfort (Option 1).
• Applying an ice pack to the wrist to help reduce edema and
inflammation (Option 2).
• Elevating the extremity on a pillow above heart level to reduce
edema (Option 4).
• Instructing the client to move the fingers to reduce edema,
increase venous return, and help improve range of motion.
Educational objective:
While a client with a traumatic wrist fracture is undergoing evaluation by
the HCP in the ED to determine appropriate treatment, the nurse assesses
circulation, sensation, and movement of the affected hand, and then
performs nursing interventions to reduce pain and edema.
The health care provider (HCP) suspects a fat embolism syndrome (FES)
in a client who has had multiple long bone fractures. Which findings
does the nurse expect to assess to support this diagnosis? Select all that
apply.
Confusion and restlessness
Increasing pain despite the opioid analgesia
Paresthesia of the affected extremity
Petechiae over neck and chest
Pulse oximeter showing hypoxia
, 5.
FES is a rare, but life-threatening complication that occurs in clients
with long bone and pelvis fractures.
It can also occur in nontrauma–related conditions, such as pancreatitis
and liposuction. It usually develops 24-72 hours following the injury or
surgical repair.
There are no specific diagnostic tests to identify FES. However, the
initial characteristic signs and symptoms include:
• Respiratory problems (eg, dyspnea, tachypnea, hypoxemia) after
a fat embolus travels through the pulmonary circulation and lodges
in a pulmonary capillary, leading to impaired gas exchange and
acute respiratory failure. This pathophysiology is similar to that of
a pulmonary embolus (Option 5).
• Neurologic changes (eg, altered mental status, confusion,
restlessness), which occur due to cerebral embolism and
hypoxia (Option 1).
• Petechial rash (eg, pin-sized purplish spots that do not blanch with
pressure), which appears on the neck, chest, and axilla due to
microvascular occlusion. This defining characteristic differentiates
a fat embolus from a PE (Option 4).
• Fever (>101.4 F [38.6 C]), which is due to a cerebral embolism
leading to hypothalamus dysfunction.
The nurse provides discharge teaching to a client who had total hip
replacement 4 days ago. Which client statement indicates that additional
teaching is necessary?
"I will concentrate on leaning forward as I carefully sit down in a
chair." [55%]
"I will do my leg raises and quadriceps and buttock isometric
exercises 2-3 times a day." [23%]
"I will use the sock puller that the therapist gave me when I get
dressed." [2%]
"My child got me a riser for the toilet seat at home. I hope my feet
reach the floor!" [18%]
To prevent hip prosthesis dislocation following hip arthroplasty, a client
must not force the hip into >90 degrees of flexion.
Clients should use a chair with armrests and a high firm seat and proceed
to place the hands on the armrests for support while lowering themselves
onto the seat and when rising from it.
Bending forward when getting into a chair creates excessive hip flexion
(>90 degrees) and must be avoided.
(Option 2) The client performs leg exercises 2-3 times a day to help
strengthen the muscles surrounding the hip and continues them for
several months after discharge.
These include isometric quadriceps and gluteal setting, leg raises,
and abduction exercises from the supine and standing positions.
(Option 3) The client must not twist from the waist, reach across the
affected extremity, or bend forward >90 degrees when dressing or putting
on slippers, shoes, and socks.
The client is instructed to use assistive equipment when getting dressed,
such as a reacher/grabber, sock puller, or a long-handled shoehorn.
(Option 4) The client should use a toilet riser or a bedside commode
chair with arms to prevent excessive hip flexion when getting on and off
the toilet seat.
Educational objective:
To avoid prosthesis dislocation following hip arthroplasty, key discharge
,teaching points include performing leg exercises to strengthen the
muscles around the hip and avoiding excessive hip flexion (>90 degrees)
when sitting, dressing, and toileting.
An elderly client with osteoporosis falls onto an out-stretched hand and
injures the wrist. The client has severe wrist edema, deformity, and pain
rated a 10 on a pain scale of 0-10. What should be the
nurse's first action?
Administer analgesia [12%]
Apply an ice pack to the wrist [10%]
Assess capillary refill and sensation [64%]
Elevate the wrist above heart level [12%]
A Colles' fracture is a type of wrist fracture (distal radius fracture) that
causes a characteristic dinner fork deformity of the wrist. It usually
occurs when the client tries to break a fall with an outstretched arm or
hand, and lands on the heel of the hand.
It is one of the most common fractures in women age >50 and is related
to osteopenia or osteoporosis.
,While the client is undergoing evaluation by the health care provider
(HCP) in the emergency department (ED), nursing interventions should
include:
• Performing a neurovascular assessment (eg, pulse, temperature,
color, capillary refill, sensation, movement). This is
the priority nursing action as neurovascular insufficiency related
to swelling (eg, compartment syndrome) or arterial/nerve damage
by the bone fragments is associated with a Colles' fracture. If
neurovascular status is compromised, urgent reduction of the
fracture is indicated.
• Administering analgesia to promote comfort (Option 1).
• Applying an ice pack to the wrist to help reduce edema and
inflammation (Option 2).
• Elevating the extremity on a pillow above heart level to reduce
edema (Option 4).
• Instructing the client to move the fingers to reduce edema,
increase venous return, and help improve range of motion.
Educational objective:
While a client with a traumatic wrist fracture is undergoing evaluation by
the HCP in the ED to determine appropriate treatment, the nurse assesses
circulation, sensation, and movement of the affected hand, and then
performs nursing interventions to reduce pain and edema.
The health care provider (HCP) suspects a fat embolism syndrome (FES)
in a client who has had multiple long bone fractures. Which findings
does the nurse expect to assess to support this diagnosis? Select all that
apply.
Confusion and restlessness
Increasing pain despite the opioid analgesia
Paresthesia of the affected extremity
Petechiae over neck and chest
Pulse oximeter showing hypoxia
, 5.
FES is a rare, but life-threatening complication that occurs in clients
with long bone and pelvis fractures.
It can also occur in nontrauma–related conditions, such as pancreatitis
and liposuction. It usually develops 24-72 hours following the injury or
surgical repair.
There are no specific diagnostic tests to identify FES. However, the
initial characteristic signs and symptoms include:
• Respiratory problems (eg, dyspnea, tachypnea, hypoxemia) after
a fat embolus travels through the pulmonary circulation and lodges
in a pulmonary capillary, leading to impaired gas exchange and
acute respiratory failure. This pathophysiology is similar to that of
a pulmonary embolus (Option 5).
• Neurologic changes (eg, altered mental status, confusion,
restlessness), which occur due to cerebral embolism and
hypoxia (Option 1).
• Petechial rash (eg, pin-sized purplish spots that do not blanch with
pressure), which appears on the neck, chest, and axilla due to
microvascular occlusion. This defining characteristic differentiates
a fat embolus from a PE (Option 4).
• Fever (>101.4 F [38.6 C]), which is due to a cerebral embolism
leading to hypothalamus dysfunction.
