NCLEX Practice Questions

Chapter 52: Assessment of the Musculoskeletal System

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• Keep the right leg elevated on a soft pillow for 12

hours.

• Maintain non-weight bearing by right leg for 48 hours.
• Use ice on the knee for 24 hours.
• Administer two tablets of oxycodone/APAP (Tylox)

every 4 hours for pain.

ANS: D

Each tablet of Tylox has 5 mg oxycodone with 500 mg acetaminophen. If the client took two tablets every 4 hours, the client would ingest a total of 6000 mg of acetaminophen, well over the safe maximum dose of 4000 mg in 24 hours. The rest of the orders are appropriate.An occupational therapist is treating a client with rheumatoid arthritis. Which assessment finding in the client does the nurse share with the occupational therapist?

• Difficulty sleeping because of pain in the knees and

elbows

• Difficulty tying shoelaces and doing zippers on

clothing

• Swollen knees with crepitus and limited range of

motion

• Generalized joint stiffness that is worse in the early

morning

ANS: B

The functional assessment helps nurses and therapists measure how functional the client is with activities of daily living, including dressing. The occupational therapist can assist the client to explore clothing options that are easier to manage with arthritic fingers. The other findings would not necessarily need to be shared with the occupational therapist for the treatment plan.

The nurse is caring for a client who is to have a computed tomography (CT) scan of the leg. Which assessment question does the nurse ask the client before the procedure?

• "Do you have any metal clips, plates, or pins in your

body?"

• "Have you had anything to eat or drink in the last 6

hours?"

• "Do you have someone to drive you home after the

procedure?"

• "Do you have any allergies to shrimp, scallops, or other

seafood?"

ANS: D

IV contrast that contains iodine may be required for CT scans to rule out malignancy. The client should be assessed for allergy to shellfish, which contain high amounts of iodine. The other questions are not relevant when a CT scan is to be obtained.The nurse is assessing a client who reports severe knee pain after a fall. Which question does the nurse ask to determine the radiation of the pain?

• "What makes the pain better or worse?"
• "Are you able to bear any weight on the knee at all?"
• "Does the pain move to another area from your knee?"
• "How would you rate the pain on a scale of 1 to 10?"

ANS: C

To determine radiation of the pain, the nurse asks the client if the pain moves to another area from the knee. The other questions address the amount, functional impact, and alleviating or aggravating factors of the pain.Which instruction does the nurse give to the client before he or she has electromyography (EMG)?

• "Make sure that you have someone to drive you home

after the test."

• "Do not eat or drink anything for at least 6 hours before

the test."

• "You will have to avoid heavy lifting for 24 hours

following the test."

• "Do not take your cyclobenzaprine (Flexeril) on the 2

days before the test."

ANS: D

Electromyography (EMG) testing measures nerve signal transmission to and through muscles. Skeletal muscle relaxants such as Flexeril can affect test results and should be avoided for at least 2 days before the test. The other instructions are not relevant before EMG testing.The nurse is caring for a client with prostate cancer.Which laboratory finding indicates to the nurse that the cancer has metastasized to the bone?

• Serum calcium, 21.6 mg/dL
• Creatine kinase, 55 U/mL
• Alkaline phosphatase, 45 IU/mL
• Lactate dehydrogenase, 120 U/L

ANS: A

Metastasis of tumor to bone results in release of calcium into the bloodstream, causing an elevation of the serum calcium level (normal range, 9 to 10.5 mg/dL).The other laboratory values are within normal limits and do not indicate metastasis to the bone.The nurse is caring for a client who presents with achy jaw pain. Which assessment technique does the nurse use to determine whether the client has inflammation of the temporomandibular joint (TMJ)?

• Checking for decayed, fractured, loose, or missing

teeth

• Observing the jaw joint as the client chews a piece of

food

• Palpating the joint during movement for tenderness or

crepitus

• Observing for asymmetric joint protrusion when the

client's mouth is closed

ANS: C

The temporomandibular joints are best assessed by palpation while the client opens his or her mouth. The other assessment techniques are not effective for assessing possible TMJ inflammation.

The nurse is caring for a client who is able to flex the right arm forward without difficulty or pain but is unable to abduct the arm because of pain and muscle spasms.Which condition does the nurse suspect based on these assessment findings?

• Dislocated elbow
• Lesion in the rotator cuff
• Osteoarthritis of the shoulder
• Atrophy of the supraspinatus muscle

ANS: B

Rotator cuff lesions may cause limited range of motion and pain and muscle spasm during abduction, whereas forward flexion stays fairly normal. The assessment findings are not consistent with the other conditions.The nurse is assessing a client who is suspected of having muscular dystrophy. Which statement by the client indicates that more teaching may be needed about the creatine kinase (CK) test that the health care provider has ordered?

• "The Lasix that I took this morning may affect the test

results."

• "The CK test is 90% accurate in demonstrating muscle

trauma or injury."

• "The level of CK will be decreased with skeletal muscle

disease."

• "When muscle is damaged, CK isoenzymes are

released over time."

ANS: C

All of the statements are correct, except that the level of creatine kinase will increase with any skeletal muscle damage.A client has cancer and a pacemaker, and suffers from claustrophobia. Which diagnostic test is the best indicator of the client's bone metastasis?

• Magnetic resonance imaging (MRI)
• Arthrogram
• Ultrasound
• Thallium bone scan

ANS: D

Because the client has a pacemaker and claustrophobia, MRI would not be an option as a diagnostic test. The arthrogram is an x-ray used to visualize bone chips and torn ligaments within a joint. Ultrasound is used to assess soft tissue disorders, traumatic joint injuries, and osteomyelitis. The thallium bone scan is ideal for obtaining information about the extent of bone cancer such as osteosarcoma or bony metastases.Which client does the nurse assess first at the start of the nursing shift?

• Client wanting to know information about a magnetic

resonance imaging (MRI) test scheduled in 3 hours

• Client who is verbalizing mild discomfort after an

electromyography (EMG)

• Client who reports increased pain and swelling after an

arthroscopy

• Client who refuses to drink more fluids after a nuclear

medicine scan

ANS: C

The client who should be the first priority is the one who is reporting increased pain and swelling after arthroscopy; this could indicate complications from the surgery. The client with mild discomfort after an EMG should be assessed for pain, but mild discomfort is common for this procedure. Pain medication can then be administered. After a nuclear medicine scan, the client must increase fluids to flush out the radioisotope used in the scan. The nurse could then visit with the client who had questions about the upcoming MRI.The nurse is performing a medical history and physical assessment on an older client. Which common findings in the older client are related to the musculoskeletal system? (Select all that apply.)

• Decrease in bone density
• Decrease in falls due to lack of activity
• Atrophy of the muscle tissue
• Decrease in bone prominence
• Degeneration of cartilage
• Reduced range of motion of the joints

ANS: A, C, E, F

In the older adult, common findings include a decrease in bone density, atrophy of muscle tissue, cartilage degeneration, and a decrease in range of motion. In addition, falls increase as the result of kyphotic posture, widened gait, and an alteration in the center of gravity, creating an unsteady walking pattern. Increased bony prominences are observed in the older adult because less soft tissue is present to cushion the bone, and pressure ulcers are a threat.