Musculoskeletal NCLEX Questions (71-75)

Welcome to Musculoskeletal NCLEX Questions. Enjoy answering and I hope that NCLEX Review and Secrets can somehow help you in your future examination. 
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71. A client has sustained a closed fracture and has just has a cast applied to the affected arm. The client is complaining of intense pain. The nurse has elevated the limb, applied an ice bag, and administered an analgesic, which has provided very little pain relief. The nurse interprets that this pain may be caused by:

a) infection under the cast
b) the anxiety of the client
c) impaired tissue perfusion
d) the newness of the fracture

72. The client with a fractured femur experiences sudden dyspnea. A set of arterial blood gases reveal the following: pH is 7.32, PaCO2 is 43, PaO2 is 58, and HCO3 is 20. Which of the following components of the ABG results supports the nurse's suspicion of fat embolus?

a) pH
b) PaO2
c) HCO3
d) PaCO2

73. The rehabilitation nurse is providing home care instruction for a client being discharged after above-the-knee amputation of the right lower limb with a fitted prosthesis. The nurse determines the client requires further teaching if the client makes which of the following statements?

a) I will elevate the residual limb on a pillow
b) I will change the residual limb sock everyday
c) I will check the residual limb for skin irritation daily
d) I will notify my prosthesis if my residual limb sock becomes stretched or ill-fitting

74. A client arrives at the clinic complaining of knee pain. On assessment the nurse notes that the knee area is swollen. The nurse interprets that the client's signs and symptoms likely indicate:

a) osteoporosis
b) a recent injury
c) rheumatoid arthritis
d) degenerative joint disease

75. A client seeks treatment in the emergency department for a lower leg injury. There is visible deformity to the lower aspect of the leg, and the injured leg appears shorter than the other leg. The area is painful, swollen, and beginning to become ecchymotic. The nurse interprets that this client has experienced a:

a) strain
b) sprain
c) fracture
d) contusion

Musculoskeletal NCLEX Questions
Answers and Rationale

71) C
- Most pain associated with fractures can be minimized with rest, elevation, application of cold, and administration of analgesics. Pain that is not relieved from these measures should be reported to the physician, because it may be caused by impaired tissue perfusion, tissue breakdown, or necrosis. Because this is a new closed fracture and cast, infection would not have had time to set in.

72) B
- A key feature of fat embolism is a significant degree of hypoxemia with a Pao2 often less than 60 mm Hg. Other features that distinguish fat embolism from pulmonary embolism are an elevated temperature and the presence of fat in the blood with fat embolus.

73) A
- Clients must avoid elevation of the residual limb to prevent flexion contractures of the right hip. Additionally, sitting in a chair should be limited to 1-hour intervals to avoid the same. If there is no contraindication, clients should lie in the prone position three to four times a day to promote hip extension. Limb socks should be removed daily, laundered in mild soap, and replaced with a clean sock. When the sock is removed, the residual limb should be inspected for erythema and excoriation. As the edema resolves, the residual limb shrinks and the sock may not fit properly, leading to skin irritation. The prosthetist should be notified of the ill-fitting sock.

74) B
- Pain and swelling are associated with musculoskeletal inflammation, infection, or a recent injury. Degenerative joint disease, osteoporosis, and rheumatoid arthritis may be accompanied by pain, but swelling may or may not be present.

75) C
- Typical signs and symptoms of fracture include pain, loss of function in the area, deformity, shortening of the extremity, crepitus, swelling, and ecchymosis. Not all fractures lead to the development of every sign. A strain results from a pulling force on the muscle. Symptoms include soreness and pain with muscle use. A sprain is an injury to a ligament caused by a wrenching or twisting motion. Symptoms include pain, swelling, and inability to use the joint or bear weight normally. A contusion results from a blow to soft tissue and causes pain, swelling, and ecchymosis.

After you reviewed your answers through its rationale, you can also go back to the first page to start from the beginning:

Musculoskeletal NCLEX Questions (1-8)

Or proceed to the next set of questions:

Musculoskeletal NCLEX Questions (76-80)

NCLEX RN Questions: Musculoskeletal Injuries (66-70)

Welcome to NCLEX RN Questions about Musculoskeletal Injuries. Before you begin answering the questions, you may first want to take a peek about the material that will surely help you the pass the NCLEX examination :

Complete NCLEX Study Materials

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66. A client has undergone fasciotomy to treat compartment syndrome of the leg. The nurse prepares to provide which type of wound care to the fasciotomy site?

a) dry sterile dressings
b) hydrocolloid dressings
c) wet sterile saline dressings
d) one-half strength betadine dressings

67. An older client admitted to the hospital with a hip fracture is placed in Buck's extension traction. The nurse plans to frequently monitor which specimen item?

a) temperature
b) mental state
c) neurovascular status
d) range of motion ability

68. Buck's extension traction is applied to an older client following a hip fracture. The nurse explains to the client that this type of traction is:

a) traction involving the use of a cast
b) skeletal traction involving the use of surgically inserted pins
c) circumferential traction involving the use of a belt around the body
d) skin traction involving the use of traction attached to the skin and soft tissues

69. A client has Buck's extension traction applied to the right leg. The nurse plans which of the following interventions to prevent complications from the device?

a) provide pin care once a shift
b) massage the skin of the right leg with lotion every 8 hours
c) inspect the skin on the right leg at least once every 8 hours
d) release the weights on the right leg for range of motion exercises daily

70. The nurse is caring for a client with a newly applied leg cast. The nurse prevents the development of compartment syndrome by:

a) elevating the limb and applying ice to the affected leg
b) elevating the limb and covering the limb with bath blankets
c) keeping the leg horizontal and applying ice to the affected leg
d) placing the leg in a slight dependent position and applying ice

NCLEX RN Questions:
Answers and Rationale

66) C
- The fasciotomy site is not sutured but is left open to relieve pressure and edema. The site is covered with wet sterile saline dressings. After 3 to 5 days, when perfusion is adequate and edema subsides, the wound is debrided and closed. A hydrocolloid dressing is not indicated for use with clean, open incisions. The incision is clean, not dirty, so there should be no reason to require Betadine. Additionally, Betadine can be irritating to normal tissues.

67) C
- The neurovascular status of the extremity of the client in Buck's extension traction must be assessed frequently. Older clients are especially at risk for neurovascular compromise because many older clients already have disorders that affect the peripheral vascular system. Although the client's temperature is monitored, it is not specific to the use of Buck's extension traction. Although clients in some types of traction do become depressed after a few days or weeks, Buck's extension traction is usually used preoperatively, which typically involves a few hours or 1 to 2 days, at the most. Range of motion of the involved leg is contraindicated in hip fractures.

68) D
- Buck's extension traction is a form of skin traction and involves the use of a belt or boot that is attached to the skin and soft tissues. The purpose of this type of traction is to decrease painful muscle spasms that accompany fractures. The weight that is used as a pulling force is limited (usually 5 to 10 pounds) to prevent injury to the skin. Options A, B, and C are incorrect descriptions.

69) C
Buck's extension traction is a type of skin traction. The nurse inspects the skin of the limb in traction at least once every 8 hours for irritation or inflammation. Massaging the skin with lotion is not indicated. The nurse never releases the weights of traction unless specifically ordered by the physician. There are no pins to care for with skin traction.

70) A
- Compartment syndrome is prevented by controlling edema. This is achieved most optimally with the use of elevation and the application of ice. The use of bath blankets or a dependent or horizontal leg position will not prevent this syndrome.

After you reviewed your answers through its rationale, you can also go back to the first page to start from the beginning:

NCLEX RN Questions about Musculoskeletal Injuries (1-8)

Or proceed to the next set of questions:

NCLEX RN Questions about Musculoskeletal Injuries (71-75)