RN Musculoskeletal NCLEX Questions Related

The nurse provides discharge instructions to a client with a newly applied fiberglass cast for a fractured radius. Which of the following statements by the client would indicate a correct understanding of the teaching?

• A. The swelling can be reduced by keeping my extremity in a dependent position.'
• B. The edges of the cast can be cut with scissors until I feel comfortable.'
• C. To reduce pain and swelling, I should apply a warm compress.'
• D. If my cast gets slightly wet, pat it dry with a towel and try drying it with a hair dryer set on the cool setting.'

The PACU nurse is caring for a patient who is presenting with agitation following knee replacement surgery. What action should the nurse take first?

• A. Notify the anesthesiologist of the adverse reaction.
• B. Assess the patient's respiratory function.
• C. Obtain an order for additional sedation to keep the patient safe during agitation.
• D. Administer a benzodiazepine antagonist.

The following scenario applies to the next 1 items
The nurse in a urgent care facility cares for a 46-year-old male
Item 1 of 1
Triage Note
1400: 46-year-old man reports right ankle pain that started one hour ago while playing soccer with his children. He states that he was getting ready to kick the ball and lost his footing on wet grass. Focused assessment: swelling over the lateral malleolus down to the area of the fourth and fifth metatarsals is present, and pedal pulses are 2+ bilaterally. Pain is endorsed with movement, and the range of motion of the right ankle is very limited. No gross deformity of the ankle was observed. Pain is rated 9 on a scale of 0 (no pain) to 10 (severe pain). T 97.5° F (36.4° C), P 98, RR 18, BP 144/90, pulse oximetry reading 96% on room air. The client reports allergies to erythromycin with an unknown reaction. Medical history included a myocardial infarction 8 months ago, irritable bowel syndrome, and plaque psoriasis. Current medications include clopidogrel and atenolol.

Physician Orders
• Discharge home with an orthopedic referral
• Ketorolac 15 mg intramuscular (IM) x 1 dose
• Apply ace wrap to the right ankle
• Home prescription: Ketorolac 10 mg by mouth twice a day PRN pain for three days
• Home prescription: Oxycodone 5 mg by mouth twice a day PRN pain for three days
• Home prescription: Docusate 50 mg by mouth once a day for three days
• Home prescription: Crutches, no weight bearing to the right lower extremity until seen by orthopedics
Diagnostics
Right Ankle X-Ray
No obvious fracture is seen. Bones show normal alignment and architecture. Joint spaces and articular margins are intact. Soft tissue swelling noted.

The nurse implements the physician's orders. Complete the sentences below by choosing from the list of options. The nurse reviews the prescriptions and should question the prescribed……….. with the physician based on the client's medical history of…….The nurse is gathering the prescribed crutches and plans on teaching the client to ambulate using the……..The nurse should instruct the client that the crutches should be………To promote comfort and to reduce swelling, the nurse should instruct the client to apply…………..compresses to the ankle for no greater than………..

• A. Ketorolac
• B. Recent myocardial infarction.
• C. Three point gait.
• D. 6 inches (15 cm) in front of their feet while standing.
• E. Cold
• F. 20 minutes at a time.

The nurse is caring for assigned clients. The nurse should recognize that the client at greatest risk for compartment syndrome is the client who has which of the following?

• A. A left tibial fracture that was recently placed in a cast
• B. Swelling in the ankles and is wearing compression stockings
• C. Chronic osteomyelitis of the right femur
• D. Skin traction following a left hip fracture

The nurse in the medical-surgical unit is caring for a newly admitted client.
Item 5 of 6
History and Physical

1930: Client is a 45-year-old male who has a one-and-a-half-week history of pain, redness, and swelling in his right foot. He reported that the symptoms began after he accidentally cut his foot while walking barefoot in his backyard. Over the next few days, he developed pain and swelling around the cut, accompanied by redness and warmth. He went to urgent care two days later and was diagnosed with cellulitis in his right foot. He was prescribed antibiotics but could not afford the treatment. Three days ago, the pain escalated and was described as throbbing and constant, with a severity rating of 7/10 on the Numerical Pain Rating Scale. He states, "the pain is now in the bone of my foot; I don't know how else to describe it." He also noted occasional fever 101°F (38.3°C), chills, and general malaise. On physical examination, his right foot was erythematous, swollen, and warm to the touch. A 3 cm ulcer was noted on the plantar aspect of the right foot, with moderate purulent discharge present. The ulcer appeared deep, and palpation of the surrounding tissue elicited tenderness. There was limited range of motion in the right ankle due to pain. The distal pulses were palpable 2+, and there were signs of neuropathy in the feet (decreased sensation to light touch and pinprick). He has a medical history of uncontrolled diabetes mellitus (type two), obesity, peripheral neuropathy in all extremities, hypertension, hyperlipidemia, and epilepsy.

Orders
2100:
Magnetic resonance imaging of the right foot without contrast
Insert peripheral vascular access device
Laboratory tests: blood culture and sensitivity (C & S), complete blood count (CBC), complete metabolic panel (CMP), lactic acid
vancomycin 1 g, IV, every 12 hours
Wound culture
fentanyl 50 mcg IV, every 5 hours PRN pain

Consultation
Infectious Disease Consultation

2050: Client was evaluated and I strongly suspect osteomyelitis in his right foot. Labs are pending. Agree with admission and will follow closely.

Nurses' Notes
2110: Orders received and reviewed. Vital signs: T 103° F (39.4° C), P 92, RR 18, BP 141/87, pulse oximetry reading 98% on room air. Client reports pain '8' on the Numerical Pain Scale.

The nurse reviews the physician's orders, client's laboratory data, and makes an entry into the nurses' notes. Which of the following actions should the nurse take?

• A. Withhold administering the prescribed antibiotic and notify the physician.
• B. Place a dressing over the client's wound before transporting the client to MRI.
• C. Notify the physician to hold the ordered MRI because of the client's kidney function.
• D. Instruct the client to remove all metal objects before the MRI.
• E. Administer prescribed pain medication before the MRI.
• F. Irrigate the wound with 0.9% sodium chloride (normal saline) before obtaining wound culture.
• G. Request a prescription for a nonsteroidal anti-inflammatory drug.