Med-Surg: Musculoskeletal

A nurse is taking a patient’s health history related to musculoskeletal system. What are the common symptoms of musculoskeletal impairments? Select all that apply.
Stiffness
Weakness
Joint crepitation

The nurse is assisting the radiologist while doing magnetic resonance imaging (MRI) for a patient. Which action of the nurse would be helpful to the patient during the test?
The nurse allows the patient to listen to music.

During an assessment, the nurse observes a lateral S-shaped curvature of the patient’s thoracic and lumbar spine. The nurse anticipates which other clinical manifestation?
Asymmetric shoulders

During the nursing musculoskeletal assessment, the nurse assesses the joint movements. On the nurse’s instruction, the patient flexes his ankle and toes toward the shin. What should the nurse record this movement as?
Dorsiflexion

An 82-year-old patient is frustrated by her flabby belly and rigid hips. What should the nurse tell the patient about these frustrations?
“Decreased muscle mass and strength and increased hip rigidity are normal changes of aging.”

The nurse is grading a muscle-strength test on the patient and obtains a score of 4/5. What best describes this score?
Active movement against gravity and some resistance

The nurse finds that a patient has frequent, audible crackling sounds and grating upon joint movement. Which condition does the nurse suspect based on these findings?
Crepitation

A patient will undergo a computed tomography (CT) scan of the knee joint. What nursing interventions should the nurse perform to prepare the patient for the procedure? Select all that apply.
Inform the patient that procedure is painless.
Inform the patient of the importance of remaining still during the procedure.
If a contrast medium is being used, verify that patient does not have shellfish allergy.

A nurse is taking the health history of a patient suffering from a backache. What are the questions that she should include in the health history related to his complaint? Select all that apply.
Did you lift a heavy object?
Describe your usual daily activities.
Do you find it difficult to perform your daily activities?

After interacting with a patient, the nurse determines that the patient is at risk for developing musculoskeletal problems. Which statement made by the patient supports the nurse’s conclusion?
“I only exercise once in a while.”

During a physical assessment, the nurse asks the patient to perform inversion movement of the foot. What instruction should the nurse give to the patient?
Turn the sole inward toward the midline of the body.

The patient is having a musculoskeletal diagnostic test called an electromyogram (EMG). The nurse knows that this test:
Evaluates electrical potential related to skeletal muscle contraction

A patient scheduled for an arthrocentesis is anxious about the procedure. What information should the nurse give to the patient to alleviate anxiety? Select all that apply.
This procedure is performed to obtain samples of synovial fluid or to remove excess fluid from the joint cavity.
The procedure is performed under local anesthesia.
This procedure can be performed at the bedside or in an examination room.

In reviewing bone remodeling, what should the nurse know about the involvement of bone cells?
Osteoblasts deposit new bone

What questions should the nurse ask a patient with severe back pain in the lumbar region when taking the health history? Select all that apply.
Does your work involve lifting any heavy objects?
Has this pain affected your social or professional life?Do you consume any dietary supplements like calcium or vitamin D?
Do you require frequent change of position while you are sleeping because of the pain?

The nurse is performing a musculoskeletal assessment of an 81-year-old female patient whose mobility has been decreasing progressively in recent months. How should the nurse best assess the patient’s range of motion (ROM) in the affected leg?
Observe the patient’s unassisted ROM in the affected leg

A 54-year-old patient is about to have a bone scan. What information should be included when teaching the patient about this procedure?
The patient will be asked to drink increased fluids after the procedure

A 70-year-old male patient is admitted with slight erosion of cartilage in the knee joint. What are the symptoms that the nurse is likely to find in this patient? Select all that apply.
Crepitation
Joint stiffness
Limited range of motion

A patient presents with severe shoulder pain. Which techniques should the nurse use for assessing this patient? Select all that apply.
Inspection
Palpation
Obtain health history

A patient is scheduled for a technetium [Tc]-99m bone scan. What nursing interventions are appropriate for the patient? Select all that apply.
Ensure that patient’s bladder is emptied before scan
Explain to the patient that radioisotope is given 2 hours before the procedure.
Increase fluid intake after the examination.

Which movement helps to turn the sole of the foot outward away from the midline of the body?
Eversion

What are the types of movements that are possible at the shoulder joint in a patient suffering from elbow pain? Select all that apply.
Adduction
Abduction
Circumduction

A patient asks the nurse why an arthrogram has been scheduled. The nurse should reply that this test is designed to identify:
Disorders of the cartilage

When working with patients, the nurse knows that patients have the most difficulties with diarthrodial joints. Which joints are included in the group of diarthrodial joints? Select all that apply.
Hinge joint of the knee
Ball and socket joint of the shoulder or hip

A patient presents with severe pain in his left lower extremity and also has difficulty ambulating. The left leg appears to be slightly shorter than the right. What points should the nurse consider when taking the measurement of the lower extremity? Select all that apply.
Measure the muscle mass circumferentially at the largest area.
Measure the length and circumference at the same points of opposite limb.
Measure the length of the extremity from the anterior superior iliac spine to the medial malleolus.

The nurse is performing a health history assessment on the older patient. The nurse knows that which of these illnesses can affect the older patient’s musculoskeletal status? Select all that apply.
Poliomyelitis
Tuberculosis
Diabetes mellitus

A patient is admitted to the hospital with Boutonnière deformity. What are the signs and symptoms that the nurse is likely to find during assessment? Select all that apply.
Flexion of proximal interphalangeal joint
Hyperextension of the distal interphalangeal joint

The nurse is performing a physical examination on a patient with sciatica. Which statements are correct for the straight-leg-raising test? Select all that apply.
The test is positive if the patient complains of pain along the distribution of the sciatic nerve.
A positive test indicates nerve root irritation from intervertebral disc prolapse and herniation.
The nerve root at the level of L4-5 or L5-S1 may be involved

A patient is scheduled for an arthroscopy. The patient wants to know what an arthroscopy is. What information should the nurse provide to this patient? Select all that apply.
This procedure allows visualization of the interior portion of the joint capsule.
The procedure will be performed under anesthesia.
A needle is inserted in the joint, it is distended with fluid or air, and the joint cavity is examined.

A patient with gout underwent arthrocentesis. What would be the characteristics of the fluid aspirated? Select all that apply.
Whitish yellow in color
Presence of uric acid crystals

The nurse is performing a physical examination on a patient who is suffering from extreme pain in the right knee as well as weakness in the right leg. What should the nurse consider when performing palpation? Select all that apply.
Palpate the muscles as well as joints.
Rub your hands together before palpating.
Palpate from above to below (cephalopedal direction).

A nurse is taking the health history of a patient with severe lumbar back pain. What are the questions related to sleep-rest patterns that the nurse should ask this patient? Select all that apply.
Do you require frequent position changes at night?Do you wake up at night because of pain?
Do you use complementary and alternative therapies to help you sleep at night?
Do you experience any difficulty sleeping because of a musculoskeletal problem?

A patient will undergo electromyography. What information should the nurse give to the patient? Select all that apply.
Small-gauge needles are inserted into certain muscles.
There may be some discomfort because of the needles.
It is useful in identifying any lower motor neuron dysfunction or primary muscle diseases.

A nurse is interviewing a patient to assess the risk for developing musculoskeletal impairments. What are the conditions that increase the patient’s risk of developing a musculoskeletal ailment? Select all that apply.
Patient has a history of premenopausal amenorrhea and is taking oral contraceptives.
Patient has renal disease and has been taking a potassium-depleting diuretic for a long time.
Patient has a seizure disorder and has been taking antiseizure medications for a long time.

A patient with osteoarthritis is about to undergo total left-knee arthroplasty. The nurse assesses the patient carefully to be sure that there is no evidence of which sign in the preoperative period?
Infection

While completing an admission history for a 73-year-old man with osteoarthritis who was admitted for knee arthroplasty, the nurse asks about the patient’s perception of the reason for the admission. The nurse expects the patient to relate which response to this question?
Debilitating joint pain

A patient is found to have a partially dislocated shoulder. How should the nurse document this finding?
Subluxation

While completing an admission history for a 73-year-old man with osteoarthritis admitted for knee arthroplasty, the nurse asks him about his perception of the reason for admission. The nurse expects the patient to state:
Chronic knee pain

A nurse evaluates a patient who reports twisting an ankle while walking down steps. Besides edema, which symptoms would most likely be observed if a nondisplaced simple fracture were present?
Redness, warmth, and inability to use the affected part

An 80-year-old woman arrives in the emergency department after sustaining a fall. The initial assessment reveals that the left leg is shorter than the right and externally rotated. The nurse should suspect:
Fractured hip

A nurse is attending a patient who has sustained a fracture of the femur. What interventions should the nurse perform to ensure a healthy diet for optimal healing of the injured tissues? Select all that apply.
Include 1g/kg of protein daily.
Increase calcium-rich foods in the diet.
Include foods rich in vitamins C and D.

The nurse is providing postoperative care to a patient who underwent surgical repair of a fractured hip 2 days ago. Which assessment finding indicates the need for immediate nursing action and intervention?
Sudden shortness of breath (could be an indication of fat embolism syndrome)

A patient with severe osteoarthritis of the left knee has undergone left-knee arthroplasty with prosthetic replacement of the knee joint. After surgery, the nurse expects to include which intervention?
Physical therapy to achieve full knee flexion

A patient has presented with an unstable wrist fracture. What kind of cast is best for this patient?
Long arm cast

A patient will undergo debridement of the shoulder joint. After the nurse explains the procedure, the patient asks the nurse what will be removed from the joint. How should the nurse answer? Select all that apply.
Joint debris
Degenerated menisci
Osteophytes

A nurse is examining a patient who is in a body jacket brace. The patient complains that the brace is applied too tightly. What findings in the patient may indicate that the brace is too tightly applied? Select all that apply.
Abdominal pain
Increased abdominal pressure
Nausea and vomiting

The nurse formulates a nursing diagnosis of impaired physical mobility related to decreased muscle strength for a 73-year-old patient who has undergone a total knee replacement. What is an appropriate nursing intervention for this patient?
Encourage isometric exercises every six hours

A patient status post right total knee arthroplasty has a prescription to get out of bed to the chair. Which action would the nurse take to protect the knee joint while carrying out the prescription?
Ensure a knee immobilizer is in place and elevate the leg while sitting.

A nurse is planning discharge teaching for home care for a patient after hip replacement surgery. What exercises should be taught to the patient to restore strength and muscle tone in the quadriceps and muscles related to the hip? Select all that apply.
Tightening of the kneecap
Tightening of the buttocks
Leg raises in a supine position

The nurse is caring for a patient with a spinal bone fracture and osteoporosis. The patient asks the nurse for information on osteoporosis. The most appropriate response by the nurse is:
For many people, diseases such as osteoarthritis and osteoporosis are not a normal part of growing older.

A 65-year-old patient who was admitted with Parkinson’s disease fell down some stairs in the hospital. The nurse who was caring for him finds that he is conscious and is complaining of severe pain in the calf muscles. There are no apparent bone fractures. What should be the immediate course of action for the nurse? Select all that apply.
Apply ice to the painful area.
Elevate the affected limb

While examining a patient with an injury to the distal humerus, the nurse suspects that he has compartment syndrome. What findings in the patient could have raised this suspicion? Select all that apply.
Paralysis of the arm
Absence of the peripheral pulse
Pain unrelieved by opioids

A patient experiences a fat embolism. What clinical manifestations does the nurse expect?
Tachypnea, tachycardia, shortness of breath, petechial rash on the chest and neck

The nurse is instructed to apply a swathe to a patient. What is true about a swathe? Select all that apply.
It is used for shoulder dislocations
It encircles the trunk and humerus.
It may be used after surgical repairs

The nurse formulates a nursing diagnosis of impaired physical mobility related to decreased muscle strength for a 78-year-old male patient following left total knee replacement. What would be an appropriate nursing intervention for this patient?
Encourage isometric quadriceps-setting exercises at least four times daily.

The nurse is completing a neurovascular assessment on the patient with a tibial fracture and a cast. The feet are pulseless, pale, and cool. The patient says they are numb. What should the nurse suspect is occurring?
Compartment syndrome

An injured soldier had an amputation of his left leg and is reporting shooting pain and heaviness in the area of the missing leg. What would be the best response by the nurse for this patient?
Use mirror therapy

This morning a 21-year-old male patient had a long leg cast applied and wants to get up and try out his crutches before dinner. The nurse will not allow the patient to do this. What is the best rationale that the nurse should give the patient for this decision?
Excess edema and other problems are prevented when the leg is elevated for 24 hours.

A 25-year-old man is brought to the hospital with blood stains on his clothes and active bleeding from the nose. His right arm is deformed. The people who brought him in informed the nurse that he was found in this condition on the road. Prioritize the initial interventions to be done in this case.
1. Check if there is blood in the mouth.
2. Check for respiratory rate
3. Check for pulse rate.
4. Assess the neurovascular status of the right arm

A nurse is completing the discharge sheet for a patient with hip fracture, who has been treated by insertion of a prosthesis using a posterior approach. What instructions should be given to this patient before discharge? Select all that apply.
Place a chair inside the tub and remain seated while washing.
Keep the hip in a neutral, straight position when sitting or lying.
Inform the dentist about the prosthesis before any dental work.

After a motor vehicle collision, a 30-year-old man has a dislocated right hip joint, and his right thigh bone is fractured into three pieces, with one piece of the bone exposed. What type of fracture should the nurse document? Select all that apply.
Open
Comminuted
Displaced

A newborn baby has sustained an uncomplicated midshaft fracture of the femur. In how many weeks will the fracture heal? Record your answer as a whole number.
3 weeks

What instructions should be given to a patient with a cast to prevent edema and skin breakdown? Select all that apply.
Elevate the affected limb above heart level during the first 48 hours.
Apply ice on the fracture site during the first 24 hours.
Exercise joints above and below the cast.

What action should a nurse should implement to prevent foot drop in a patient who has a full-leg cast?
Support the foot with 90 degrees of flexion

The nurse is caring for a 76-year-old man who has undergone left knee arthroplasty with prosthetic replacement of the knee joint to relieve the pain of severe osteoarthritis. Postoperatively, what does the nurse expect to be included in the care of the affected leg?
Progressive leg exercises to obtain 90-degree flexion

During the discharge of an older patient who has had a history of repeated falls at home, what instructions should a nurse give to the patient to prevent falls? Select all that apply.
Use a walker or cane.
Exercise fingers and toes.
Avoid walking on uneven surfaces.

When the patient is diagnosed with muscular dystrophy, what information should the nurse include in the teaching about this disorder?
Remaining active will prevent skin breakdown and respiratory complications or distress

A patient with osteomyelitis asks the nurse how this problem will be treated first. What is the best response by the nurse?
“Intravenous antibiotics are the first treatment choice for this condition.”

A patient with osteomyelitis in the left femur has been receiving gentamicin (Garamycin) therapy for 2 weeks. During a follow up visit, which patient statement indicates that the treatment should be discontinued?
“I have a ringing sensation in my ear.” (indicates ototoxicity due to the gentamicin (Garamycin).

A 66-year-old patient, hospitalized with osteomyelitis, has a prescription for bed rest. The nurse would place the highest priority on which intervention?
Reposition the patient every two hours.

A bone cancer patient with a tumor in the left leg is complaining of severe pain at the site of the tumor. The patient asks the nurse why there is so much pain. The nurse explains to the patient that:
The tumor may be pressing on nerves near the bone.

The nurse determines that dietary teaching for a 75-year-old patient with osteoporosis has been successful when the patient selects which highest calcium meal?
A sardine (3 oz) sandwich on whole wheat bread, 1 cup of fruit yogurt, and 1 cup of skim milk

The nurse caring for a patient with muscular dystrophy (MD) recalls which true statement about the disease?
MD has an insidious onset with loss of muscle strength.

During a health screening event, which assessment finding would alert the nurse to the possible presence of osteoporosis in a white 61-year-old female?
A measurable loss of height

A patient who has been found to have osteomyelitis asks the nurse about the most effective treatment for this problem. The nurse should explain that osteomyelitis is best managed with:
IV antibiotics

The nurse is admitting a patient to the nursing unit with a history of a herniated lumbar disc and low back pain. In completing a more thorough pain assessment, the nurse should ask the patient if which action aggravates the pain?
Bending or lifting

A 68-year-old female patient with hypertension is admitted to the nursing unit with osteomyelitis. Which symptom will the nurse most likely find on physical examination?
Limited range of motion of the extremity

A patient receiving intravenous (IV) vancomycin needs to have a trough drug level drawn. The medication will infuse over 60 minutes and the next dose is due to be given at 1300. The nurse should obtain a blood sample at which time?
1230 (The trough level indicates the lowest concentration of medication in the bloodstream between doses and therefore should be measured just before infusion of the next dose to be sure the patient is metabolizing and excreting the medication effectively.)

A patient is receiving alendronate (Fosamax) for treatment of osteoporosis. The nurse would become concerned after noting which action by the patient? The patient:
Takes the medication immediately before bed

The nurse is caring for a patient following lumbar fusion. What nursing interventions should the nurse perform for this patient? Select all that apply.
Assess extremity circulation.
Report severe headache to the surgeon.
Monitor peripheral neurologic signs.

The nurse receives report on 4 clients. Which client should the nurse see first? 1. Client admitted 12 hours ago with acute asthma exacerbation who needs a dose of IV methylprednisolone [21%] 2. Client admitted 2 days ago with congestive …

A child, age 14, is hospitalized for nutritional management and drug therapy after experiencing an acute episode of ulcerative colitis. Which nursing intervention would be appropriate? 1. Administering digestive enzymes before meals as prescribed 2. Providing small, frequent meals 3. …

A patient with acute shortness of breath is admitted to the hospital. Which action should the nurse take during the initial assessment of the patient? a. Ask the patient to lie down to complete a full physical assessment. b. Briefly …

The nurse is participating at a health fair at the local mall giving influenza vaccines to senior citizens. What level of prevention is the nurse practicing? A) Primary prevention B) Secondary prevention C) Tertiary prevention D) Quaternary prevention Primary prevention …

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