Musculoskeletal System review-Key answers

1. A patient is seen at the urgent care center after falling on the right arm and shoulder. It will be most
important for the nurse to determine

a. Whether there is bruising at the shoulder area.

b. Whether the right arm is shorter than the left.
c. The amount of pain the patient is experiencing.
d. How much range of motion (ROM) is present?

Correct Answer: B
Rationale: A shorter limb after a fall indicates a possible dislocation, which is an orthopedic emergency.
The nurse will expect bruising and pain at the area, even without an injury that requires surgery. The
shoulder should be immobilized until it is evaluated by the health care provider.

2. When counseling an older patient about ways to prevent fractures, which information will the nurse
include?
a. Tacking down scatter rugs in the home is recommended.
b. Occasional weight-bearing exercise will improve muscle and bone strength.
c. Most falls happen outside the home.
d. Buying shoes that provide good support and are comfortable to wear is recommended.

Correct Answer: D
Rationale: Comfortable shoes with good support will help to decrease the risk for falls. Scatter rugs
should be eliminated, not just tacked down. Regular weight-bearing exercise will improve strength, but
occasional exercise is not helpful in improving strength. Falls inside the home are responsible for many
injuries.

3. When working with a patient whose job involves many hours of word processing, the nurse will teach
the patient about the need to
a. Do stretching and warm-up exercises before starting work.
b. Wrap the wrists with a compression bandage every morning.
c. Use acetaminophen (Tylenol) instead of NSAIDs for wrist pain.
d. Obtain a keyboard pad to support the wrist while word processing.
Correct Answer: D
Rationale: Repetitive strain injuries caused by prolonged times working at a keyboard can be prevented
using a pad that will keep the wrists in a straight position. Stretching exercises during the day may be
helpful, but these would not be needed before starting. Use of a compression bandage is not needed,
although a splint may be used for carpal tunnel syndrome. NSAIDs are appropriate to use to decrease
swelling.

4. A patient arrives in the emergency department with ankle swelling and severe pain after twisting the
ankle playing soccer. All the following orders are written by the health care provider. Which one will the
nurse act on first?
a. Administer naproxen (Naprosyn) 500 mg PO.
b. Wrap the ankle and apply an ice pack.
c. Give acetaminophen with codeine (Tylenol #3).
d. Take the patient to the radiology department for x-rays.

Correct Answer: B
Rationale: Immediate care after a sprain or strain injury includes the application of cold and compression
to the injury to minimize swelling. The other actions should be taken after the ankle is wrapped with a
compression bandage and ice is applied.

5. A 22-year-old patient started an exercise regimen 2 months ago that includes running 3 to 4 miles a
day. The patient tells the nurse, "I enjoy my daily runs, but now I have shin splints." Which response by
the nurse is appropriate?
a. "You may be increasing your running time too quickly and need to cut back a little bit."
b. "You need to have x-rays of your lower legs to be sure you do not have stress fractures."
c. "You should expect some leg pain while running."
d. "You should try speed-walking rather than running."

Correct Answer: A
Rationale: The patient's information about running 3 to 4 miles daily after starting an exercise program
only 2 months previously suggests that the shin splints are caused by overuse. Radiographs are not
indicated for the type of injury described by the patient. Shin splints are not a normal or expected
response to running. Because the patient expresses enjoyment of running, it would not be appropriate
for the nurse to suggest a different sport.
6. A patient with a fractured radius asks when the cast can be removed. The nurse will instruct the
patient that the cast can be removed only after the bone.
a.is strong enough to stand mild stress.
b. Union is complete on the x-ray.
c. Fragments are fully fused.
d. Healing has started.

Correct Answer: A
Rationale: The cast may be removed when callus ossification has occurred. It is not necessary to wait
until radiologic union or complete bone fusion occurs. Bone healing starts immediately after the injury,
but the cast will need to be worn at least 3 weeks.

7.Following a motor-vehicle accident, a patient arrives in the emergency department with massive right
lower-leg swelling. Which action will the nurse take first?
a. Elevate the leg on pillows.
b. Apply a compression bandage.
c. Place ice packs on the lower leg.
d. Check leg pulses and sensation.

Correct Answer: D
Rationale: The initial action by the nurse will be to assess the circulation to the leg and to observe for
any evidence of injury such as fractures or dislocations. After the initial assessment, the other actions
may be appropriate based on what is observed during the assessment.

8.In developing a care plan for a patient with an open reduction and internal fixation (ORIF) of an open,
displaced fracture of the tibia, the priority nursing diagnosis is
a. Risk for constipation related to prolonged bed rest.
b. Activity intolerance related to deconditioning.
c. Risk for infection related to disruption of skin integrity.
d. Risk for impaired skin integrity related to immobility.

Correct Answer: C
Rationale: A patient having an ORIF is at risk for problems such as wound infection and osteomyelitis.
After an ORIF, patients typically are mobilized starting the first postoperative day, so problems caused
by immobility are not as likely.

9. A patient with lower-leg fractures has an external fixation device in place and is scheduled for
discharge. Which information will the nurse include in the discharge teaching?
a. "You will need to remain on bed rest until bone healing is complete."
b. "The external fixator can be removed during the bath or shower."
c. "Prophylactic antibiotics are needed until the external fixator is removed."
d. "You will need to assess and clean the pin insertion sites daily."

Correct Answer: D
Rationale: Pin insertion sites should be cleaned daily to decrease the risk for infection at the site. An
external fixator allows the patient to be out of bed and avoid the risks of prolonged immobility. The
device is surgically placed and is not removed until the bone is stable. Prophylactic antibiotics are not
routinely given when an external fixator is used.

10. A patient who has severe peripheral arterial disease and ischemic foot ulcers is upset with the health
care provider's recommendation to have an above-the-knee amputation. The patient tells the nurse, "If
they want to cut off my leg, they should just shoot me instead." The most appropriate response to the
patient's statement is,
a. "Let's talk about how you feel this surgery will affect you."
b. "If you do not want the surgery, you do not have to have it."
c. "I understand why you are upset, but there really is no choice because your leg is so badly diseased."
d. "Many people are able to function normally with a prosthesis after amputation, and you can too."

Correct Answer: A
Rationale: The initial nursing action should be to assess how the patient feels about the amputation and
what the patient knows about the procedure and rehabilitation process. Discussion about the patient's
option to not have the procedure, the reason the procedure is needed, or rehabilitation after the
procedure may be appropriate after the nurse knows more about the patient's current level of
knowledge and emotional state.

11. A client with osteoporosis asks the nurse why it is important to take vitamin D. Which response by
the nurse is correct?

a. Vitamin D improves the absorption of calcium.

b. Vitamin D reduces excretion of calcium in the kidneys.

c. Vitamin D helps prevent constipation from increased calcium intake.

d. Vitamin D minimizes the risk of kidney stones.

Correct answer: A

Rationale: Taken with calcium, vitamin D aids with calcium absorption which is essential for bone
building and slowing the progression of osteoporosis. It is taken to enhance calcium absorption and does
not influence how much is excreted by the kidneys. Increased calcium intake can lead to constipation,
but vitamin D will not improve this condition. Renal calculi are common in clients with hypercalcemia,
and hypercalcemia is common in clients with osteoporosis. However, vitamin D does not influence the
occurrence of renal calculi.

12. Which nursing action is contraindicated when caring for a client with a newly applied long leg cast?

a. Elevating the cast on a pillow.

b. Drying the cast by using a fan.
c. Leaving the cast exposed to air.
d. Handling the cast with fingertips.

Correct answer: D

Rationale: Handling the cast with fingertips before it is dried may create indentations that can cause
pressure.

Elevating the casted extremity on a pillow will help reduce edema. b, and c this will increase air flow
that facilitates drying of the cast.

13. A nurse is caring for a client who has suffered a fracture to the humerus after falling on their
outstretched arm. The ends of the bone were driven into each other during the fall. This type of fracture
is best described as which of the following?

a. Impacted fracture.
b. Greenstick fracture.
c. Comminuted fracture.
d. Oblique fracture.

Correct answer: A

Rationale: An impacted fracture is one in which the ends of the bone in a fracture are driven into
each other. This type of fracture is most likely the result of a fall, such as onto an outstretched arm.
It may also occur when the bone breaks from collapse of the structure, which is known as a buckle
fracture.
14.Which foods should the nurse teach a client with gout to avoid to limit painful attacks? Select all that
apply. Gout is a common form of inflammatory arthritis that is very painful

a. Eggs
b. Liver
c. Cheese
d. Salmon
e. Shellfish

Correct answer: A and E

Rationale: Eggs have insignificant amounts of purine and are unrestricted. Like other organ meats, liver
is ahigh-purine food (range of 150 to 1000 mg/100 g) and should be avoided. Cheese has insignificant
amounts of purine and is unrestricted. Foods that contain a moderate amount of purine (50 to 150
mg/dL), such as salmon, may be eaten four times a week. Shellfish (e.g., shrimp, lobster) are high-purine
foods and should be avoided.

15. A nurse suspects the development of compartment syndrome for a client who has sustained blunt
trauma to the forearm. For which early sign of compartment syndrome should the nurse assess the
client?

a. Warm skin at site of injury

b. Escalating pain in the fingers
c. Rapid capillary refill in affected hand
d. Bounding radial pulse in the injured arm

Correct answer: B

Rationale: Elevated tissue pressure restricts blood flow, causing increasing ischemia and increasing
pain; it is the cardinal early symptom of compartment syndrome.

The arm will feel cool, not warm, because of a decrease in circulation. Sluggish, not rapid, capillary
refill is a sign of compartment syndrome. The pulse will be diminished, not bounding, increasing
edema impairs circulation.
16. A client has an amputation of a lower limb. What instructions should the nurse give the client to
prevent a hip flexion contracture?

a. Turn from side to side every 1 to 2 hours.

b. Sit in a chair for 30 minutes three times a day.
c. Lie on the abdomen 30 minutes four times daily.
d. Perform quadriceps muscle setting exercises twice daily.

Correct answer: C

Rationale: The hips are in extension when the client is prone; this keeps the hips from flexing.

Turning In the left side-lying position the right hip will be flexed, promoting contracture formation.
Sitting promotes flexion contracture formation. Muscle setting exercises is not related to the
prevention of hip-flexion contractures.

17: When should the nurse begin the process of rehabilitation when a client is scheduled for an
amputation?

a. Before the surgery

b. During the convalescent phase
c. On discharge from the hospital
d. When it is time for a prosthesis

Correct answer: A

Rationale: Rehabilitation should begin immediately. This includes preoperative discussion of the nature
of the operation and rehabilitation techniques.

b, c, d This is too late; valuable rehabilitation time has been wasted.

18 .The nurse questions a client with rheumatoid arthritis about pain. When should the nurse expect the
client to experience increased pain and limited movement of the joints?

a. After assistive exercise.

b. When the room is cool.
c. In the morning on awakening.
d. When the latex fixation test is positive.
 Correct answer: C

Rationale: Inactivity over an extended time increases stiffness and pain in joints.

19. What does the nurse determine is the most likely cause of renal calculi in clients with paraplegia?

a. High fluid intake

b. Increased intake of calcium
c. Inadequate kidney function
d. Accelerated bone demineralization
Kidney stones (also called renal calculi, nephrolithiasis or urolithiasis) are hard deposits made of minerals and
salts that form inside your kidney

Paraplegia is a term used to describe the inability to voluntarily move the lower parts of the body
Correct answer: D

Rationale: Calcium that has left the bones as a response to prolonged inactivity enters the blood and
may precipitate in the kidneys, forming calculi.

20. Following x-rays of an injured wrist, the patient is informed that it is badly sprained. In teaching the
patient to care for the injury, the nurse tells the patient to

a. Apply a heating pad to reduce muscle spasms.

b. Wear an elastic compression bandage continuously.
c. Use pillows to keep the arm elevated above the heart.
d. Gently exercise the joint to prevent muscle shortening.

Correct Answer: C
Rationale: Elevation of the arm will reduce the amount of swelling and pain. For the first 24 to 48 hours,
cold packs are used to reduce swelling. Compression bandages are not left on continuously. The wrist
should be rested and kept immobile to prevent further swelling or injury.