Utilizing NCLEX RN Practice Questions as a study tool can significantly enhance students' ability to recall and apply nursing concepts under pressure.
NCLEX Musculoskeletal System/Drugs Questions - NCLEX Questions on Musculoskeletal System/Drugs
Musculoskeletal System/Drugs NCLEX Practice Questions
Question 1.
An older adult community group is learning about healthy aging. What is the best recommendation the nurse can make for prevention of osteoarthritis (OA)?
(a) Contact sports should be avoided
(b) Increase calcium intake
(c) Lose weight if necessary
(d) Perform weight-bearing exercises
Answer:
(c) Lose weight if necessary
Explanation:
Osteoarthritis, or degenerative joint disease, is the breakdown of cartilage in joints that leads to stiffness, pain, and usually affects the wrists, neck, knees, hips, hands, or back. Risk for OA increases with age. Maintaining ideal body weight can prevent osteoarthritis by decreasing the weight on joints that leads to osteoarthritis.
Rationale:
(a) is incorrect because obesity is a more significant contributor to OA than contact sports. Contact sports do not need to be avoided, but if repetitive sports activities cause pain, the patient should consider switching activities. Other repetitive activities may include occupations such as carpet installation, manufacturing assembly line work, construction work, and farming.
(b) is incorrect because calcium intake is important for preventing osteoporosis. (d) is incorrect because weight-bearing exercise is important for preventing osteoporosis.
Question 2.
A family clinic nurse is educating a client who was recently diagnosed with osteoarthritis (OA). Which medications for treating OA does the nurse primarily plan teaching around?
(a) Acetaminophen
(b) Cyclobenzaprine hydrochloride
(c) Hyaluronate
(d) Cyclosporine
Answer:
(a) Acetaminophen
Explanation:
Osteoarthritis, or degenerative joint disease, is the breakdown of cartilage in joints that leads to stiffness, pain, and usually affects the wrists, neck, knees, hips, hands, or back. The first line medication for osteoarthritis pain is acetaminophen, which rarely causes side effects.
Rationale:
(b) is incorrect because cyclobenzaprine is appropriate for OA but is given for muscle spasms, not pain. Side effects include dizziness, fatigue, and dry mouth.
(c) is incorrect because hyaluronate is appropriate for OA but is a joint fluid synthetic injection. Hyaluronate is used to increase effectiveness of fluid within a joint to act as a lubricant and a shock absorber. This medication is not typically prescribed unless other pain treatment options fail.
(d) is incorrect because cyclosporine is given to transplant patients to prevent organ rejection.
Question 3.
A client with diabetes is assessed in the family practice clinic by the nurse. The client has a history of osteoarthritis (OA), and blood glucose readings have been higher than usual. What is the most appropriate question by the nurse?
(a) “Do you take chondroitin?”
(b) “Are you taking glucosamine supplements?”
(c) “How much do you exercise each week?”
(d) “You’re taking diabetic medication, correct?”
Answer:
(b) “Are you taking glucosamine supplements?”
Explanation:
Osteoarthritis, or degenerative joint disease, is the breakdown of cartilage in joints that leads to stiffness, pain, and usually affects the wrists, neck, knees, hips, hands, or back. Glucosamine is sometimes taken for OA in order to promote collagen synthesis. Glucosamine can impede insulin secretion and raise blood sugar levels, so the nurse should ask the patient whether it is being used. Glucosamine can also cause nausea, heartburn, and diarrhea.
Rationale:
(a) is incorrect because the chondroitin does not impact blood sugar. Chondroitin is often with glucosamine to aide in collagen synthesis for musculoskeletal problems, such as OA. Chondroitin can potentiate the effectiveness of anticoagulants.
(c) is incorrect because asking about exercise is appropriate but will not elicit specific information related to the OA and increased blood glucose.
(d) is incorrect because asking the patient about taking diabetic medication in this manner is patronizing (treats the patient with kindness but portrays a feeling of superiority).
Question 4.
A 72-year-old patient is transferred to the medical-surgical unit to recover from total hip replacement. Upon assessment, the nurse finds the patient is restless and disoriented. What is the most important intervention to prevent injury?
(a) Mild sedation administration
(b) Maintain all siderails raised
(c) Restrain patient’s hands
(d) Use abduction pillow
Answer:
(d) Use abduction pillow
Explanation:
Total hip replacement is a surgical procedure performed to replace a joint damaged by osteoarthritis, fracture, or other causes. Older patients have a slower metabolism of anesthetics as well as pain medication, which could cause restlessness and confusion following surgery. The abduction pillow should be used at this time to prevent hip dislocation as the patient may be unable to follow directions and maintain proper body alignment post-op. The abduction pillow prevents the patient from getting into a position that can cause hip prosthesis dislocation (adduction, internal rotation.)
Rationale:
(a) is incorrect because sedation can worsen restlessness and disorientation. The nurse should avoid sedating a disoriented patient if at all possible.
(b) is incorrect because all siderails raised is considered a restraint and the nurse should attempt to provide for safety with least restrictive measures. The concern here is dislocation of hip prosthesis, not falling out of bed.
(c) is incorrect because restraining the patient’s hands is unnecessary and even more restrictive than siderails raised. Restraining hands may increase risk for injury and will not keep the hip in proper alignment.
Question 5.
A 54-year-old female patient is admitted to the surgical unit for total knee replacement. The patient has a history of asthma. Which action is most important for perioperative staff to prevent surgical wound infection?
(a) Administer ordered preoperative antibiotic
(b) Assess white blood cell (WBC) count
(c) Instruct patient to take a shower the night before
(d) Monitor postoperative temperature
Answer:
(a) Administer ordered preoperative antibiotic
Explanation:
Preoperative antibiotics are administered within one hour of surgery to prevent infection of surgical wounds. Along with aseptic technique when caring for the incision afterwards, this is a very important component of infection prevention.
Rationale:
(b) is incorrect because monitoring white blood cell count will not prevent infection.
(c) is incorrect because a shower with antimicrobial soap is beneficial but not as effective as preoperative antibiotics.
(d) is incorrect because monitoring temperature may show an indication of infection but is not a preventative measure.
Question 6.
While assessing a patient recovering from total hip replacement, the nurse notes the leg with the replacement hip is shorter than the other and the patient is reporting pain 10/10. What is the best action by the nurse to perform while another nurse calls the surgeon?
(a) Assess bilateral neurovascular status
(b) Elevate the surgical leg and apply an ice pack
(c) Administer pain medication
(d) Attempt to place surgical leg in abduction
Answer:
(a) Assess bilateral neurovascular status
Explanation:
Total hip replacement is a surgical procedure performed to replace a joint damaged by osteoarthritis, fracture, along with several other causes. One leg shorter than the other and extreme pain is characteristic of hip dislocation, a complication that can occur with this surgery. Dislocation of the hip can lead to neurovascular compromise, so this should be assessed bilaterally for the lower extremities. Other complications after hip replacement include excessive wound drainage, thromboembolism, and infection.
Rationale:
(b) is incorrect because elevation of the leg is contraindicated if hip dislocation is suspected. Ice packs can be applied to reduce swelling and minimize pain, but assessing circulation is more important.
(c) is incorrect because pain medication should be administered, but neurovascular assessment should be performed first. Physical assessment needs take priority over pain treatment.
(d) is incorrect because abducting the leg is contraindicated when dislocation is suspected.
Question 7.
A patient recovering from total knee replacement has a continuous passive motion (CPM) device ordered. After the patient is returned to bed and the leg placed in the device, which action can be delegated to the unlicensed assistive personnel (UAP) by the nurse?
(a) Assess distal circulation
(b) Decrease range of motion settings if patient complains of pain
(c) Raise the bed’s lower siderail on the patient’s affected side
(d) Determine if the patient needs pain medication
Answer:
(c) Raise the bed’s lower siderail on the patient’s affected side
Explanation:
Continuous passive motion (CPM) is utilized after joint surgery to keep the joint moving and prevent stiffness and maintain range of motion. The device slowly flexes and extends the knee. With the leg strapped in the CPM machine, the movement of the machine could cause it to shift and fall off of the bed, in turn injuring the patient’s leg and new joint.
The UAP should be instructed to raise the siderails to prevent the CPM machine from shifting off the bed. Another important nursing action is to protect skin from rubbing on the CPM frame by applying sheepskin padding between the skin and the frame.
Rationale:
(a) is incorrect because assessment of distal circulation is the nurse’s responsibility.
(b) is incorrect because the CPM settings are only adjusted by the surgeon, physical therapist, or trained technician.
(d) is incorrect because it is not within the UAP’s scope of practice to assess pain or offer pain medication.
Question 8.
A patient recovering from total right knee replacement has continuous right femoral nerve blockade. While assessing the patient, the nurse notes the pedal pulses are 2+/4+ bilaterally, skin is pale pink, warm, and dry, and the patient does not have the ability to point or flex the foot. What is the next action by the nurse?
(a) Document findings and continue to monitor
(b) Reassess pulses with a bedside Doppler
(c) Notify the surgeon or anesthesiologist immediately
(d) Palpate bladder or scan bladder with scanner
Answer:
(c) Notify the surgeon or anesthesiologist immediately
Explanation:
Continuous femoral nerve blockade is administered to prevent pain distal to the infusion, usually after surgery or joint replacement. With this blockade, the patient retains the ability to dorsiflex and plantarflex the affected foot, so if the patient is unable to do this, the surgeon or anesthesiologist should be notified immediately.
Rationale:
(a) is incorrect because patient care takes priority over documentation. Abnormal findings must be addressed before documentation is completed.
(b) is incorrect because a Doppler may be used to reassess pulses, but the most important action is to notify the healthcare provider.
(d) is incorrect because palpation of the bladder is unrelated to loss of neuromuscular function in the affected foot.
Question 9.
A patient is being discharged to short-term rehabilitation after total hip replacement procedure. Which is the most important action by the nurse?
(a) Administer pain medication prior to transport
(b) Answer last-minute questions by patient
(c) Provide directions to the rehabilitation facility to family
(d) Provide a verbal hand-off report to the facility
Answer:
(d) Provide a verbal hand-off report to the facility
Explanation:
A hand-off report is a Joint Commission standard that must be performed for patient safety and prevention of errors. JCAHO recommends adequate time for successful hand-off, use of standardized procedure such as SBAR (situation, background, assessment, recommendation), and shared accountability during all points of transition.
Rationale:
(a) is incorrect because pain medication is important, but an accurate and complete hand-off report is greater priority.
(b) is incorrect because answering patient questions is important but not priority.
(c) is incorrect because directions to the facility can be given by another member of the care team; the nurse is specifically responsible for the hand-off report.
Question 10.
Which patient with rheumatoid arthritis (RA) should the nurse in the clinic assess first?
(a) Patient reporting jaw pain with eating
(b) Patient whose right wrist is red, hot, and swollen
(c) Patient who developed a swollen area behind the right knee
(d) Patient whose joint deformity is worse since the last exam
Answer:
(b) Patient whose right wrist is red, hot, and swollen
Explanation:
Rheumatoid arthritis (RA) is an autoimmune form of arthritis that affects wrists, small joints of the hands, knuckles, and other joints. It is characterized by swelling, pain, and decreased mobility of the joints. A joint that is red, hot, and swollen may be infected and needs to be assessed first.
Rationale:
(a) is incorrect because jaw pain is possibly due to RA but is not priority.
(c) is incorrect because swelling behind the knee is possibly due to RA but is not priority.
(d) is incorrect because joint deformity is possibly due to RA but is not priority. Progressive joint deformity is a characteristic of RA and is expected.
Question 11.
A patient with a history of rheumatoid arthritis (RA) is recovering from elective surgery on the postoperative unit. The patient is reporting pain in the neck since surgery. What is the first action the nurse should take?
(a) Assist the patient in changing positions
(b) Document findings in the patient’s chart
(c) Encourage neck range of motion exercises
(d) Monitor respiratory status
Answer:
(d) Monitor respiratory status
Explanation:
Rheumatoid arthritis (RA) is a chronic, autoimmune form of arthritis that affects wrists, small joints of the hands, knuckles, and other joints. It is characterized by swelling, pain, and decreased mobility of the joints. The neck can be affected by RA and could lead to phrenic nerve compression, which can paralyze the diaphragm and compromise respiratory status. Permanent injury to the spinal cord can also occur. Respiratory status should be assessed, and the healthcare provider should be notified.
Rationale:
(a) is incorrect because changing positions may alleviate the pain but could also worsen the patient’s condition.
(b) is incorrect because documentation is priority after patient care has been completed. The compromise to the neck and respiratory system must be addressed ahead of documentation.
(c) is incorrect because range of motion exercise could worsen the patient’s condition.
Question 12.
The nurse cares for a female 49-year-old patient with rheumatoid arthritis (RA) and Sjogren's syndrome. Which is the most important action for the nurse to take?
(a) Perform an abdominal assessment
(b) Teach the patient to avoid nasal spray
(c) Draw blood to test for renal function
(d) Assess visual acuity
Answer:
(d) Assess visual acuity
Explanation:
Sjogren’s syndrome is an immune system disorder that commonly occurs with RA and lupus and leads to dry mouth and eyes, as well as vaginal dryness. The nurse must assess visual acuity as disturbances in vision may occur with Sjogren’s syndrome. This syndrome mostly affects people over the age of 40 and is more common in women.
Rationale:
(a) is incorrect because abdominal assessment is unrelated to Sjogren’s and RA.
(b) is incorrect because dry nose and mouth are common with Sjogren’s syndrome and can lead to a stuffy nose, which can make breathing difficult and uncomfortable. Saline nasal spray can help keep the nasal passages moist and facilitate easier breathing.
(c) is incorrect because renal function is unrelated to Sjogren’s and RA.
Question 13.
The client with rheumatoid arthritis (RA) has been identified by the nurse as having poor body image. Which finding demonstrates that goals for the client problem are progressing towards being met?
(a) Attends book club meetings
(b) Positive outlook of life
(c) Takes medications as prescribed
(d) Protects joints by using assistive devices at home
Answer:
(a) Attends book club meetings
Explanation:
Rheumatoid arthritis (RA) is an autoimmune form of arthritis that affects wrists, small joints of the hands, knuckles, and other joints. It is characterized by swelling, pain, and decreased mobility of the joints. Patients with poor body image usually avoid being in public, so attendance at book club meetings would indicate the goal is being met.
Rationale:
(b) is incorrect because a positive outlook on life is appropriate but does not indicate a goal being met related to poor body image.
(c) is incorrect because taking medications as prescribed is appropriate but does not indicate a goal being met related to poor body image.
(d) is incorrect because using assistive devices is appropriate for physical health and safety but is unrelated to body image. Assistive devices may need to be used outside of the home, as well. A patient with poor body image may be at risk for avoiding use of assistive devices in public due to concerns about what others will think of them.
Question 14.
What is the most appropriate education the nurse can provide for the patient starting treatment with etanercept?
(a) Subcutaneous injection administration
(b) Annual chest X-ray
(c) Medications taken with food
(d) Applying heat to injection site
Answer:
(a) Subcutaneous injection administration
Explanation:
Etanercept is administered for autoimmune diseases that interferes with tumor necrosis factor (TNF) and is given by subcutaneous injection two times a week. The patient should be taught how to self-administer the medication. Side effects include headache, rhinitis, upper respiratory infection, and injection site reaction. Etanercept can also cause thrombocytopenia and leukopenia.
Rationale:
(b) is incorrect because an annual chest X-ray is not necessary for etanercept.
(c) is incorrect because taking etanercept with food is not necessary.
(d) is incorrect because applying heat to the injection site is not necessary for etanercept.
Question 15.
What non-pharmacologic comfort measure does the nurse recommend for the patient with rheumatoid arthritis (RA) who has an acutely inflamed and painful joint?
(a) Consume more dairy products
(b) Apply ice packs to the affected joint
(c) Apply a splint to the affected joint
(d) Use a paraffin wax dip on the affected joint
Answer:
(b) Apply ice packs to the affected joint
Explanation:
Rheumatoid arthritis (RA) is an autoimmune form of arthritis that affects wrists, small joints of the hands, knuckles, and other joints. Acute inflammation is treated best with ice packs.
Rationale:
(a) is incorrect because rheumatoid arthritis symptoms may flare in response to certain proteins found in milk products.
(c) is incorrect because splints are used to immobilize injured joints, not for RA inflammation.
(d) is incorrect because wax dip provides warmth which is for chronic stiffness and pain.
Question 16.
A patient with systemic sclerosis has taut skin, affecting how the patient opens their mouth. The nurse has consulted with the registered dietitian, but what other consultation should be facilitated by the nurse?
(a) Dentist
(b) Massage therapist
(c) Occupational therapy
(d) Physical therapy
Answer:
(a) Dentist
Explanation:
Systemic sclerosis or scleroderma is a disease of the connective tissues that leads to fibrosis, vasomotor disturbance, skin atrophy, and atrophy of tissues, muscles, and organs including the lungs, kidney, and heart. Due to taut skin around the mouth, the patient may not be able to perform effective dental hygiene, so the nurse should facilitate consultation with a dentist.
Rationale:
(b) is incorrect because a massage therapist may facilitate facial motor movement but is not as important as oral hygiene.
(c) is incorrect because occupational therapy is aimed at helping patients regain function for performing household activities.
(d) is incorrect because physical therapy will not help the mouth as specifically as a dentist.
Question 17.
A patient with gout is learning dietary strategies from the nurse to prevent exacerbations. Which is the most appropriate statement by the nurse?
(a) “Drink 2 liters of water daily.”
(b) “Avoid butter and buttermilk.”
(c) “Liver is an excellent source of dietary iron.”
(d) “Avoid low-fat yogurt.”
Answer:
(a) “Drink 2 liters of water daily.”
Explanation:
Gout is due to uric acid metabolized in a defective manner which is deposited in small bones such as in the feet, causing joint pain, swelling, and limitation of movement. Patients with gout commonly develop kidney stones, so increasing water intake can prevent kidney stones from occurring. Patients should avoid foods rich in purines, such as organ meats, fish, alcohol, and sardines. Medications used to treat gout include colchicine with NSAIDs, probenecid, and allopurinol. Obesity, family history, and diuretics can contribute to gout formation.
Rationale:
(b) is incorrect because butter and buttermilk are not high in purines and do not need to be avoided with gout.
(c) is incorrect because organ meats should be avoided.
(d) is incorrect because low-fat yogurt reduces the risk of gout.
Question 18.
A client with psoriatic arthritis was just prescribed golimumab. What is the most important information the nurse should teach about taking the medication?
(a) “Avoid crowds and sick people.”
(b) “Sit upright for an hour after taking the medication.”
(c) “This medication could cause you to lose hair.”
(d) “If pain is severe, you can double your dose.”
Answer:
(a) “Avoid crowds and sick people.”
Explanation:
Psoriatic arthritis is a type of arthritis commonly seen in patients diagnosed with psoriasis. Golimumab is a disease-modifying antirheumatic drug (DMARD) immunosuppressant administered for autoimmune types of arthritis. Due to the immunosuppressant action, the patient should be taught to avoid crowds and sick people to prevent serious and opportunistic infection.
Rationale:
(b) is incorrect because sitting upright is unrelated to golimumab. Patients taking bisphosphonates must remain upright after taking their medication.
(c) is incorrect because hair loss is unrelated to golimumab. Hair loss is a side effect of some antineoplastic and chemotherapy medications.
(d) is incorrect because golimumab dosing should not be doubled.
Question 19.
A patient with fibromyalgia who has just been prescribed duloxetine hydrochloride is calling the nurse at the clinic to ask why they need to take an antidepressant. What is the best response by the nurse?
(a) “The sedation will help you sleep.”
(b) “Depression often occurs with fibromyalgia.”
(c) “The medication works in the brain for decreasing pain.”
(d) “I’ll contact the ordering healthcare provider and ask for your call to be returned.”
Answer:
(c) “The medication works in the brain for decreasing pain.”
Explanation:
Fibromyalgia is a syndrome that affects soft tissue and muscles and contributes to muscle pain, sleep disturbance, fatigue, and generalized pain. Duloxetine hydrochloride increases neurotransmitter serotonin as well as norepinephrine release, which can reduce pain due to fibromyalgia. The recommended dosage for fibromyalgia is 60 mg taken PO, once daily.
Rationale:
(a) is incorrect because duloxetine does not cause sedation. It should be taken in the morning because it can cause insomnia.
(b) is incorrect because depression does not often occur with fibromyalgia.
(d) is incorrect because duloxetine is useful in decreasing pain associated with fibromyalgia with or without comorbid depression. The healthcare provider does not need to be called. The nurse should provide information to the patient and not delay communication.
Question 20.
The nurse in the clinic is assessing clients with osteoporosis. Which client would not be advised to take bisphosphonates?
(a) 55-year-old female patient with diabetes and serum creatinine 0.9 mg/dL
(b) 63-year-old female patient with recent fall and compression fractures of vertebrae
(c) 68-year-old male with history of hypertension taking verapamil daily
(d) 59-year-old female patient who is unable to sit up due to spinal cord injury
Answer:
(d) 59-year-old female patient who is unable to sit up due to spinal cord injury
Explanation:
Osteoporosis causes bones to become brittle and porous due to loss of bone tissue, usually due to hormonal changes or deficiencies in vitamin D or calcium. Both men and women can develop osteoporosis, and women are more likely to. Bisphosphonates, when administered, require the patient sit up for a period of 30 minutes to an hour afterward, so the patient who is unable to sit up is not the best candidate for the medication. If chest discomfort is experienced within 30 minutes, the medication should be discontinued and the healthcare provider should be notified as this can be a sign of esophageal erosion, a serious side effect of bisphosphonates. The ages of these patients are insignificant for bisphosphonate use.
Rationale:
(a) is incorrect because diabetes is unrelated to bisphosphonates. Creatinine tests renal function, and the normal level is 0.7-1.4 mg/dL. A diabetic patient with normal renal function is a candidate for bisphosphonate therapy.
(b) is incorrect because a recent fall and fracture are not contraindications for bisphosphonate use.
(c) is incorrect because hypertension is unrelated and calcium channel blockers do not interact with bisphosphonates.
Question 21.
A patient with a lower extremity fracture is treated with balanced skeletal traction. Which assessment finding would warrant the nurse urgently notifying the healthcare provider?
(a) Blood pressure increase to 132/88 mmHg
(b) Traction weights resting on floor
(c) Pin sites oozing clear fluid
(d) Capillary refill less than three seconds
Answer:
(b) Traction weights resting on floor
Explanation:
Skeletal traction is applied to realign fractured bones and prevent further injury prior to surgery. Weights are attached to pins inserted into the patient’s bones. The weights must remain suspended in order to properly apply traction to the bones. Weights resting on the floor should not be manipulated by the nurse. The weights must be reapplied by the healthcare provider.
Rationale:
(a) is incorrect because blood pressure is only slightly elevated and could be due to pain. This BP should be compared to earlier measurements and should be monitored for further increase. The nurse should expect to treat pain and muscle spasms in the patient in traction.
(c) is incorrect because clear fluid oozing from pin sites is normal. Pin sites should be assessed and cleaned with half-strength hydrogen peroxide every eight hours. Pus-colored or foul-smelling drainage is a sign of infection at the pin sites.
(d) is incorrect because the capillary refill is normal. This needs to be assessed frequently on the affected leg, and delayed refill time can be a sign of circulatory compromise.
Question 22.
A patient is admitted to the emergency department with a crush injury to the right lower extremity. When the patient reports numbness and tingling of the injured leg, what is the first action the nurse should take?
(a) Assess pedal pulses
(b) Apply oxygen with nasal cannula
(c) Increase IV fluid rate
(d) Apply traction
Answer:
(a) Assess pedal pulses
Explanation:
A crash injuiy is caused by an object that compresses a portion of the body and causes trauma. This can lead to compartment syndrome, which is characterized by numbness and tingling, which often leads to irreversible motor or vascular damage without intervention. The nurse needs to assess for equal pedal pulses, and if decreased on the injured side, the healthcare provider must be notified.
Rationale:
(b) is incorrect because oxygen is indicated for signs of hypoxia; this patent is exhibiting signs of neurovascular compromise, which will not be corrected with oxygen.
(c) is incorrect because IV fluids will help treat low blood circulation, but pulses must be assessed first.
(d) is incorrect because it is not within the nurse’s scope of practice to apply traction.
Question 23.
A patient who had a cast applied to the wrist several days ago tells the nurse the cast has become loose and unsupportive. What is the best response by the nurse?
(a) “Keep the arm above your heart.”
(b) “The cast will loosen as muscles atrophy.”
(c) “A bandage can be wrapped around the cast to prevent slipping.”
(d) “Since the swelling has decreased, you will need a new cast.”
Answer:
(d) “Since the swelling has decreased, you will need a new cast.”
Explanation:
A cast is applied to a fracture in order to ensure fractured bones stay in alignment and aid in proper healing. Swelling can be present in soft tissues when a cast is applied initially, so once swelling decreases and two or more fingers can be placed between the skin and the cast, the cast will need to be replaced.
Rationale:
(a) is incorrect because the purpose of elevating the arm is to reduce swelling. This patient’s arm swelling has already decreased, so elevation is not necessary and will not help the cast to fit better.
(b) is incorrect because muscle atrophy does not occur in several days. Muscle atrophy under a cast occurs after several weeks.
(c) is incorrect because a bandage will not help. If the cast is too loose, the only correction is application of a new cast.
Question 24.
A patient recovering after above the knee amputation reports pain in the foot of the surgical side. After reviewing the medications ordered for the patient, which medication should the nurse give first?
(a) IV morphine
(b) Oral acetaminophen
(c) IV calcitonin
(d) Oral ibuprofen
Answer:
(c) IV calcitonin
Explanation:
Amputations are performed to remove an extremity due to infection, crush injury, non-healing wounds, and poor circulation, among several other indications. The patient who has an extremity amputated may report burning, cramping, or crushing pain, which are manifestations of phantom limb pain. Intravenous calcitonin can reduce the symptoms of phantom limb pain, which may occur immediately post-op up to three months following amputation. Non-pharmacologic treatments to relieve phantom limb pain include use of a mirror box, acupuncture, and nerve stimulation.
Rationale:
(a) is incorrect because IV morphine will not be as effective as calcitonin. Morphine is a narcotic that can also cause other adverse reactions, so it should only be used if the calcitonin is ineffective for treating the phantom limb pain.
(b) is incorrect because acetaminophen is not used for phantom limb pain.
(d) is incorrect because ibuprofen is not used for phantom limb pain.
Question 25.
A patient recovering after below the knee amputation has their care planned by the nurse. Which intervention should be included in the plan of care?
(a) Placing pillows between the knees
(b) Range of motion exercise
(c) Prophylactic antibiotics
(d) Strict bedrest
Answer:
(b) Range of motion exercise
Explanation:
Amputations are performed to remove an extremity due to infection, crush injury, non-healing wounds, and poor circulation, among several other indications. Range of motion exercises should be performed for prevention of contractions of the extremity and in preparation for prosthesis.
Rationale:
(a) is incorrect because pillows are placed under the affected limb for support. Pillows are placed between the knees for hip replacement post-operative patients.
(c) is incorrect because antibiotics are not indicated unless signs of infection are present, such as pus or foul-odor drainage oozing from the dressing, elevated temperature, chills, or elevated white blood cells.
(d) should be up out of the bed and moving as soon as possible.
Question 26.
A patient with rotator cuff injury is being assessed by the inpatient nurse. Which finding should the nurse expect?
(a) Unable to maintain adduction longer than 30 seconds on the affected side
(b) Shoulder pain relieved by overhead stretching and at night
(c) Unable to abduct affected arm at shoulder
(d) Referred pain to affected shoulder and opposite arm
Answer:
(c) Unable to abduct affected arm at shoulder
Explanation:
Rotator cuff injury affects muscles and tendons supporting the shoulder joint and keeping the humeral head in the socket, causing aching shoulder pain which is worse when pressure is applied. A patient who has a rotator cuff injury cannot abduct the arm at the shoulder, which is determined by a drop arm test.
Rationale:
(a) is incorrect because adduction is not affected. Adduction is the normal position of the shoulder joint. If abduction cannot be held for 30 seconds, this can be a sign of rotator cuff injury.
(b) is incorrect because the pain associated with rotator cuff injury is often worse at night, causing sleep disturbances. Overhead stretching is often very painful to the lateral portion of the shoulder and the upper arm.
(d) is incorrect because pain is not referred to the opposite shoulder with rotator cuff injury.
Question 27.
A client with cast to the left arm calls the phone triage nurse about swelling and a tight feeling to the cast. What is the best response by the nurse?
(a) “Elevate the arm on pillows and apply ice to the cast.”
(b) “Take ibuprofen until swelling subsides.”
(c) “Swelling and a tight feeling are normal. Call back if improvement is not noted by tomorrow.”
(d) “Come in to the clinic and the healthcare provider will check it.”
Answer:
(d) “Come in to the clinic and the healthcare provider will check it.”
Explanation:
A cast is applied to a fracture in order to ensure fractured bones stay in alignment and aid in proper healing. Swelling can be present in soft tissues when a cast is applied initially; however, compartment syndrome can develop. The nurse should tell the patient to come into the clinic to have it checked immediately to prevent permanent damage. Signs of compartment syndrome include decreased pulse, pallor, tingling, inability to move distal to the cast, and pain.
Rationale:
(a) is incorrect because elevation of the arm may help by decreasing blood flow to the arm, but this is only a temporary measure. The safest action is to have the patient come in to be seen immediately. If circulation is compromised, the cast will need to be removed, and any delay could cause loss of limb. Ice will not help when a cast is applied because the cold will not reach the limb through the cast.
(b) is incorrect because although it is within the nurse’s scope of practice to instruct the patient to take over-the-counter medications, and ibuprofen may reduce swelling, this is not the safest action.
(c) is incorrect because swelling and tightness are not normal. The cast needs to be checked and circulation needs to be assessed to determine if removal of the cast is indicated. Upon arrival at the healthcare facility, the patient must be assessed for ability to move fingers, capillary refill, pulses, sensation, and skin color to determine circulation. If cast removal is delayed, the patient may lose the arm.
Question 28.
A patient had a long-leg cast placed for fractures last week. They tell the nurse it is difficult to breathe, and they feel lightheaded. Which is the next action the nurse should take?
(a) Auscultate anterior and posterior lung fields
(b) Administer oxygen to maintain higher than 92%
(c) Check blood glucose level
(d) Have the patient take deep breaths
Answer:
(b) Administer oxygen to maintain higher than 92%
Explanation:
Fractures of bones can lead to bone fragments and dispersion of bone contents including blood clots and fat cells. The patient has symptoms that are consistent with pulmonary embolism, which could be due to the fracture or the immobility due to the long cast. Oxygen must be administered, and pulse oximetry should be monitored. Once oxygen is applied, the nurse should then auscultate lung fields.
Rationale:
(a) is incorrect because when signs of hypoxia are present (difficult breathing and lightheadedness), oxygen delivery should not be delayed. Auscultation of lung fields should be performed after oxygen therapy is initiated.
(c) is incorrect because checking blood glucose will not help. Hypoglycemia is not likely with long bone fracture or cast application, and there is no indication that this patient is diabetic or on insulin.
(d) is incorrect because taking deep breaths will help after oxygen has been applied.
Question 29.
A patient recovering from vertebroplasty is educated by the nurse. Which patient statement demonstrates a need for further education?
(a) “I can drive myself home.”
(b) “I will monitor the puncture site for infection.”
(c) “I will begin walking tomorrow and slowly increase activity.”
(d) “The dressing can be removed the day following discharge.”
Answer:
(a) “I can drive myself home.”
Explanation:
Vertebroplasty is performed to stabilize a compression fracture of the spine with bone cement injected into the vertebrae. The fractures are usually due to osteoporosis. Expected outcomes of vertebroplasty include decreased pain and increased spinal strength with better ability to perform ADLS. For the first 24 hours following vertebroplasty, the patient should not drive or operate machinery.
Rationale:
(b) is incorrect because monitoring for infection is appropriate. Redness, swelling, or warmth at the injection site should be reported to the healthcare provider.
(c) is incorrect because walking and activity are appropriate. Decreased ability to move the arms or legs is a sign of nerve damage, a rare complication of vertebropplasty, and should be reported immediately.
(d) is incorrect because removing the dressing the day after discharge is appropriate.
Question 30.
A patient has been prescribed skeletal traction with external fixation, and the nurse is planning their care. Which intervention should be included in the care plan to decrease risk of infection?
(a) Wash traction ropes and sockets daily
(b) Release traction twice a day for 30 minutes
(c) Gently rest traction weights on the floor during position changes to minimize pain
(d) Perform pin care every eight hours
Answer:
(d) Perform pin care every eight hours
Explanation:
Skeletal traction is applied to realign fractured bones and prevent further injury prior to surgery. Weights are attached to pin sites inserted into the patient’s bones. The weights must remain suspended, and the nurse should take caution not to bump or manipulate the weights, as this can cause increased pain or disrupt the pull of the traction. Pin sites of the external fixator should be cared for with half-strength hydrogen peroxide every eight hours in order to prevent infection.
Rationale:
(a) is incorrect because traction ropes should not be removed without the healthcare provider’s order and cleaning the ropes will not prevent infection. The ropes are attached to pins, which come into direct contact with the patient, so the pins are the concern for proper cleaning.
(b) is incorrect because traction should not be released by the nurse, and this would not prevent infection.
(c) is incorrect because traction weights should not be placed on the floor. Any patient equipment that comes into contact with the floor increases the risk for infection.
Question 31.
A nursing student is caring for a patient with rheumatoid arthritis (RA). Which of the following are facts about RA? (Select all that apply.)
(a) Only single joints are affected
(b) Inflammation is caused by antibodies
(c) It is an autoimmune process
(d) Morning stiffness is rare
(e) Permanent damage is inevitable
Answer:
(b) Inflammation is caused by antibodies
(c) It is an autoimmune process
Explanation:
Rheumatoid arthritis (RA) is an autoimmune form of arthritis that affects wrists, small joints of the hands, knuckles, and other joints. It is characterized by swelling, pain, and decreased mobility of the joints. This chronic autoimmune disorder occurs when the body fails to recognize its own cells. Normal antibodies attack healthy cells and tissues in autoimmune disorders.
Rationale:
(a) is incorrect because RA can affect many joints. Other body systems may be affected too, such as the skin, eyes, the heart, lungs, and blood vessels.
(d) is incorrect because morning stiffness with RA is common.
(e) is incorrect because early, aggressive treatment can prevent permanent damage.
Question 32.
The nurse caring for a 44-year-old female patient with rheumatoid arthritis (RA) is teaching her about methotrexate (MTX). What information should be included by the nurse? (Select all that apply.)
(a) “Avoid over-the-counter medications with ibuprofen.”
(b) “Pain relief effects may take several weeks.”
(c) “MTX is safe to take while pregnant or breastfeeding.”
(d) “Avoid large crowds and sick people.”
(e) “Folic acid may reduce side effects.”
Answer:
(b) “Pain relief effects may take several weeks.”
(d) “Avoid large crowds and sick people.”
(e) “Folic acid may reduce side effects.”
Explanation:
Rheumatoid arthritis (RA) is an autoimmune form of arthritis that affects wrists, small joints of the hands, knuckles, and other joints. It is characterized by swelling, pain, and decreased mobility of the joints. MTX is an anti-rheumatic drug and first line treatment for RA. It can take up to six weeks for the medication to effectively relieve pain. Large crowds and sick people should be avoided due to immunosuppression from MTX. Side effects include nausea, vomiting, diarrhea, stomatitis, hepatic, and renal dysfunction. Folic acid can reduce side effects for some patients. MTX is also used to treat acute lymphocytic leukemia, psoriasis, and sickle cell anemia.
Rationale:
(a) is incorrect because ibuprofen is safe to take with MTX. Liver toxicity is a risk, so acetaminophen-containing medications should be avoided.
(c) is incorrect because MTX is contraindicated in pregnancy and breastfeeding.
Question 33.
A patient recently diagnosed with fibromyalgia refuses to take her medications. Which non- pharmacologic measures should the nurse suggest in order to manage the patient's condition? (Select all that apply.)
(a) Acupuncture treatments
(b) Daily stretching
(c) Nutritional supplement beverages
(d) Tai chi exercises
(e) Aerobics
Answer:
(a) Acupuncture treatments
(b) Daily stretching
(d) Tai chi exercises
Explanation:
Fibromyalgia is a syndrome that affects soft tissue and muscles and contributes to muscle pain, sleep disturbance, fatigue, and pain. Non-pharmacologic measures that can help control fibromyalgia symptoms include acupuncture, stretching, swimming, biking, massage, and hypnosis. Yoga and Tai chi are beneficial low-impact stretching activities that can also be beneficial in increasing movement and decreasing pain.
Rationale:
(c) is incorrect because nutritional supplement beverages can have interactions with many medications and are not recommended for fibromyalgia.
(e) is incorrect because aerobics are high impact and are not recommended for fibromyalgia.
Question 34.
The nurse in the rheumatology clinic is assessing clients for late manifestations of rheumatoid arthritis (RA). Which of the following does the nurse look for? (Select all that apply.)
(a) Anorexia
(b) Felty’s syndrome
(c) Joint deformity
(d) Low grade fever
(e) Weight loss
Answer:
(b) Felty’s syndrome
(c) Joint deformity
(e) Weight loss
Explanation:
Rheumatoid arthritis (RA) is an autoimmune form of arthritis that affects wrists, small joints of the hands, knuckles, and other joints. It is characterized by swelling, pain, and decreased mobility of the joints. Felty’s syndrome is a complication of long-term RA and includes enlarged spleen and abnormally low WBC count. Joint deformity, organ involvement, anemia, osteoporosis, weight loss, and extreme fatigue are all late manifestations of RA.
Rationale:
(a) is incorrect because anorexia is an early manifestation of RA.
(d) is incorrect because low-grade fever is an early manifestation of RA.
Question 35.
A 73-year-old patient is returned to the nursing unit after hip replacement surgery. The patient is disoriented and restless. Which actions can be delegated to the unlicensed assistive personnel (UAP) by the nurse? (Select all that apply.)
(a) Apply an abduction pillow to patient’s legs
(b) Assess skin under the abduction pillow straps
(c) Elevate heels off the bed with pillows
(d) Determine ability of the patient to get up by monitoring cognition
(e) Take and document vital signs
Answer:
(a) Apply an abduction pillow to patient’s legs
(c) Elevate heels off the bed with pillows
(e) Take and document vital signs
Explanation:
Total hip replacement is a surgical procedure performed to replace a joint damaged by osteoarthritis, or fracture, along with several other causes. It is within the scope of practice of the UAP to apply the abduction pillow, elevate the heels, and take and document vital signs. Routine tasks that routinely occur in the care of patients and are performed according to an established set of steps can be delegated to the UAP.
Rationale:
(b) is incorrect because assessment of skin is the responsibility of the nurse. Any task that requires assessment should not be delegated.
(d) is incorrect because determining the patient’s ability to get out of bed requires nursing judgment and is the responsibility of the nurse.
Question 36.
Clients with connective tissue diseases are being assessed by the clinic nurse. Which diseases are correctly paired with their clinical findings? (Select all that apply.)
(a) Dry, scaly skin rash - Systemic lupus erythematosus (SLE)
(b) Esophageal dysmotility - Systemic sclerosis
(c) Excess hydrochloric acid - Gout
(d) Foot drop, paresthesia - Osteoarthritis
(e) Organ damage caused by vasculitis - Rheumatoid arthritis
Answer:
(a) Dry, scaly skin rash - Systemic lupus erythematosus (SLE)
(b) Esophageal dysmotility - Systemic sclerosis
(e) Organ damage caused by vasculitis - Rheumatoid arthritis
Explanation:
SLE is most often manifested by dry, scaly skin rash. Systemic sclerosis leads to motility problems of the esophagus. Rheumatoid arthritis causes vasculitis and organ damage.
Rationale:
(c) is incorrect because hyperuricemia leads to gout. Excess hydrochloric acid in gastric secretions can lead to stomach and intestinal ulcers.
(d) is incorrect because RA leads to foot drop and paresthesia.
Question 37.
The clinic nurse is reviewing medication records for patients with gout. Which gout classifications and their corresponding drug treatments are correctly matched? (Select all that apply.)
(a) Allopurinol - Acute gout
(b) Colchicine - Acute gout
(c) Febuxostat - Chronic gout
(d) Indomethacin - Acute gout
(e) Probenecid - Chronic gout
Answer:
(b) Colchicine - Acute gout
(c) Febuxostat - Chronic gout
(d) Indomethacin - Acute gout
(e) Probenecid - Chronic gout
Rationale:
Gout is due to uric acid metabolized in a defective manner which is deposited in small bones such as in the feet, causing arthritis and pain. Colchicine and indomethacin are for use in acute gout. Febuxostat blocks xanthine oxidase (which lowers uric acid levels in blood), and probenecid helps urine excretion of uric acid and is for use in chronic gout.
A is incorrect because allopurinol is for use in chronic gout as it blocks the formation of uric acid. Aspirin should be avoided when taking allopurinol because it decreases the effectiveness of this drug.
Question 38.
A patient with a history of systemic sclerosis (SSc) is admitted to the medical unit. Which comfort measures for this patient can be delegated to the unlicensed assistive personnel (UAP) by the nurse? (Select all that apply.)
(a) Collaborate with the registered dietician for meals
(b) Inspect skin and note ulcerated areas
(c) Keep the room at comfortable temperature
(d) Place a foot cradle on the bed to lift sheets
(e) Remind patient to keep the head of the bed elevated after meals
Answer:
(c) Keep the room at comfortable temperature
(d) Place a foot cradle on the bed to lift sheets
(e) Remind patient to keep the head of the bed elevated after meals
Explanation:
Systemic sclerosis, or scleroderma, is a disease of the connective tissues that leads to fibrosis, vasomotor disturbance, skin atrophy, and atrophy of tissues, muscles, and organs including the lungs, kidneys, and heart. It is within the scope of practice for the UAP to maintain a warm, comfortable temperature in the room, place the foot cradle on the bed, and remind the patient to elevate the head of the bed after meals.
Rationale:
(a) is incorrect because collaboration with the registered dietician is the responsibility of the nurse.
(b) is incorrect because any form of assessment, such as inspecting skin, is the responsibility of the nurse.
Question 39.
The home health nurse is performing a home assessment for a client with rheumatoid arthritis (RA). Which of the following can the nurse suggest to assist the patient in maintaining independence? (Select all that apply.)
(a) Grab bars for high items
(b) Long-handled bath brush
(c) Soft rocker chair
(d) Toothbrush with a large handle
(e) Wheelchair cushion
Answer:
(a) Grab bars for high items
(b) Long-handled bath brushes
(d) Toothbrush with a large handle
Explanation:
Rheumatoid arthritis (RA) is an autoimmune form of arthritis that affects wrists, small joints of the hands, knuckles, and other joints. It is characterized by swelling, pain, and decreased mobility of the joints. Grab bars for high items, long-handled bath brushes, and large-handled toothbrushes are all appropriate modifications for the patient with RA to use for ADLs.
Rationale:
(c) is incorrect because the soft rocker chair is a comfort measure and does not increase independence.
(e) is incorrect because the wheelchair cushion is a comfort measure and does not increase independence.
Question 40.
The home health nurse is visiting a client who had a hip replacement last week. The client is still using a walker and using partial weight bearing. What safety precautions should the nurse recommend? (Select all that apply.)
(a) Elevated toilet seat
(b) Grab bars by the toilet and in the shower
(c) Use affected leg to step into vehicle first
(d) Remove throw mgs from the home
(e) Use of a shower chair
Answer:
(a) Elevated toilet seat
(b) Grab bars by the toilet and in the shower
(d) Remove throw mgs from the home
(e) Use of a shower chair
Explanation:
Total hip replacement is a surgical procedure performed to replace a joint damaged by osteoarthritis or fracture, along with several other causes. An elevated toilet seat, grab bars, removal of throw rugs, and a shower chair are all appropriate safety precautions for the patient who has had a hip replacement. The patient may also need assistive devices to help with putting on socks and shoes. The patient should be taught about appropriate leg positioning for the first 12 weeks after surgery: flexion no more than 90 degrees and avoid internal rotation of the affected leg.
Rationale:
(c) is incorrect because the patient is partial weight bearing and cannot step in to the vehicle with the affected leg first. A stool should be used near the vehicle and the patient should step in with the unaffected leg.
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