NCLEX Musculoskeletal Disorders Practice Exam Quiz
A 45-year-old patient with a history of rheumatoid arthritis (RA) is experiencing increased joint pain and swelling. Which of the following interventions is most appropriate?
A) Apply a heating pad to the affected joints
B) Encourage the patient to perform vigorous exercises
C) Administer prescribed corticosteroids as ordered
D) Encourage the patient to rest in a non-weight-bearing position
A nurse is teaching a patient with osteoporosis about safety measures to prevent fractures. Which of the following instructions should the nurse include?
A) Wear high heels to improve balance
B) Engage in high-impact exercise to strengthen bones
C) Keep pathways free of clutter to avoid tripping
D) Take calcium supplements only when fractures occur
Which of the following signs and symptoms would most likely be seen in a patient with a fractured femur?
A) Sudden onset of chest pain and shortness of breath
B) Decreased range of motion and pain at the fracture site
C) Nausea and vomiting after a fall
D) Severe swelling and bruising at the hip joint
A patient with a recent hip replacement surgery asks when they can resume walking. Which is the nurse’s best response?
A) “You should wait at least 6 months before walking.”
B) “You can begin walking with assistance within a few days.”
C) “You should avoid walking until all sutures are removed.”
D) “Walking is only allowed after a follow-up visit in 2 weeks.”
A nurse is caring for a patient who is post-operative after a spinal fusion. The nurse notes the patient is complaining of muscle weakness and a sensation of heaviness in the legs. Which of the following is the most important intervention?
A) Monitor vital signs every 2 hours
B) Assess for signs of deep vein thrombosis (DVT)
C) Provide analgesia and reposition the patient frequently
D) Encourage early ambulation as tolerated
A nurse is caring for a patient who has been diagnosed with osteoarthritis. Which of the following statements by the patient indicates a need for further teaching?
A) “I will take acetaminophen for pain relief as needed.”
B) “I should avoid any exercise to reduce joint pain.”
C) “I will use a heating pad on my affected joints.”
D) “I can take nonsteroidal anti-inflammatory drugs (NSAIDs) for pain relief.”
A patient has been admitted with suspected compartment syndrome following a tibial fracture. Which of the following signs should the nurse monitor for?
A) Decreased peripheral pulses and cool skin
B) Increased pain unrelieved by medication and swelling
C) Numbness and tingling in the affected limb
D) All of the above
A patient is recovering from a total knee replacement. Which of the following should the nurse include in the discharge teaching plan?
A) “Avoid bending your knee more than 90 degrees for the first 6 weeks.”
B) “You should bear weight on the leg immediately after surgery.”
C) “You can resume all activities within 2 weeks after surgery.”
D) “You will need to perform range-of-motion exercises regularly.”
A nurse is caring for a patient with a diagnosis of gout. Which of the following is the priority intervention for this patient during an acute attack?
A) Administer prescribed NSAIDs as ordered
B) Encourage the patient to increase fluid intake
C) Restrict high-protein foods from the patient’s diet
D) Apply a warm compress to the affected joint
A nurse is teaching a patient who is recovering from a fracture about the use of a bone stimulator. Which of the following instructions should the nurse provide?
A) “You can wear the bone stimulator only while sleeping.”
B) “The bone stimulator should be used as prescribed, typically for 20 hours per day.”
C) “The bone stimulator will automatically heal the fracture.”
D) “You should only use the bone stimulator if pain occurs.”
A 70-year-old patient with osteoporosis asks the nurse about the risks of falling. Which of the following is the best response?
A) “You should avoid all physical activity to prevent falls.”
B) “You may want to consider wearing non-slip socks to improve your balance.”
C) “Try walking briskly on uneven surfaces to strengthen your bones.”
D) “Increasing your calcium intake will completely prevent falls.”
A nurse is caring for a patient with a history of scoliosis. Which of the following findings would indicate that the patient needs further evaluation?
A) Mild back pain that improves with rest
B) Uneven shoulder height and waist asymmetry
C) Pain with movement after prolonged sitting
D) A small curve in the spine that does not progress
A nurse is caring for a patient with a dislocated shoulder. Which of the following interventions should the nurse prioritize?
A) Apply ice to the shoulder
B) Assist with reducing the dislocation immediately
C) Administer analgesics as prescribed
D) Provide range-of-motion exercises for the shoulder
A patient with osteoporosis is prescribed bisphosphonates. Which of the following should the nurse include in the teaching plan for this medication?
A) “Take the medication with food to avoid gastric irritation.”
B) “Take the medication first thing in the morning on an empty stomach.”
C) “You may lie down for 30 minutes after taking the medication.”
D) “Take the medication with calcium and vitamin D.”
Which of the following is the most appropriate action for a nurse to take when caring for a patient who has a fractured leg in a cast and is complaining of increasing pain?
A) Reposition the leg to reduce swelling
B) Provide the patient with extra pillows to elevate the leg
C) Check for signs of compartment syndrome (e.g., pain, pallor, pulse)
D) Apply a heating pad to the casted leg to relax the muscles
A patient with a hip fracture is being prepared for surgery. Which of the following should the nurse prioritize in the preoperative care plan?
A) Administer pain medications as ordered
B) Encourage the patient to resume normal activities
C) Provide educational materials about hip replacement surgery
D) Encourage deep breathing exercises to improve lung function
A patient with osteoarthritis has been prescribed a nonsteroidal anti-inflammatory drug (NSAID). Which of the following is the most important consideration when taking this medication?
A) The patient should take the NSAID on an empty stomach to enhance absorption.
B) The patient should be monitored for signs of gastrointestinal bleeding.
C) The patient should increase fluid intake to prevent dehydration.
D) The patient should avoid using any type of joint support.
A patient with rheumatoid arthritis is prescribed methotrexate. Which of the following is most important for the nurse to include in the teaching plan?
A) “You should increase your intake of vitamin D and calcium while on this medication.”
B) “Methotrexate is taken to reduce inflammation and prevent joint damage.”
C) “You will need to take methotrexate daily for the rest of your life.”
D) “This medication can increase your risk of developing an infection.”
A nurse is caring for a patient who is being treated for a herniated disc. Which of the following interventions is most important for managing the patient’s pain?
A) Encourage the patient to perform strengthening exercises
B) Provide heat therapy to the affected area
C) Limit physical activity to avoid further strain
D) Monitor for signs of neuropathy
A 72-year-old patient with osteoarthritis complains of difficulty performing activities of daily living due to joint stiffness. Which of the following interventions should the nurse prioritize?
A) Encourage the patient to rest the joints completely for several weeks
B) Teach the patient to perform joint-strengthening exercises as tolerated
C) Recommend that the patient try an alternative diet high in protein
D) Provide education on the use of joint protection devices and assistive devices
A nurse is preparing a patient for discharge after a total hip replacement. The nurse should instruct the patient to avoid which of the following activities?
A) Walking with a walker for support
B) Crossing the legs while sitting
C) Using a raised toilet seat for comfort
D) Sleeping on the unaffected side
A nurse is caring for a patient after a spinal cord injury. The patient has a decreased sensation in the legs. Which of the following interventions is the priority for preventing complications?
A) Administer analgesics as prescribed
B) Monitor for signs of pressure ulcers
C) Encourage a high-fiber diet
D) Reposition the patient every 2 hours
A patient with a fractured tibia is in a plaster cast. The nurse notes that the patient’s toes are pale, cold, and painful. Which of the following actions should the nurse take?
A) Elevate the leg and recheck the pulses in 1 hour
B) Apply warm compresses to the toes
C) Notify the healthcare provider and prepare for removal of the cast
D) Encourage the patient to move the toes frequently
A patient with chronic low back pain is prescribed opioid pain medication. Which of the following interventions is the most important to include in the care plan?
A) Encourage the patient to take the medication only at bedtime
B) Monitor for signs of respiratory depression
C) Recommend that the patient participate in yoga therapy
D) Instruct the patient to restrict fluid intake to avoid urinary retention
A nurse is caring for a patient with a cast on the left arm. The nurse is concerned about possible compartment syndrome. Which of the following signs would be most indicative of this condition?
A) Increased warmth and redness at the cast site
B) Numbness, tingling, and increased pain despite medication
C) Increased mobility and a decrease in pain
D) Pallor and increased swelling of the hand
A 58-year-old patient has been diagnosed with a torn rotator cuff. Which of the following is the most likely cause of this injury?
A) Trauma or overuse of the shoulder joint
B) Autoimmune attack on the shoulder joints
C) Genetic predisposition to muscle weakness
D) A history of excessive alcohol consumption
A nurse is caring for a patient with a suspected muscle strain. Which of the following actions should the nurse take first?
A) Apply ice to the affected area to reduce swelling
B) Recommend the patient take a hot bath to relax the muscles
C) Encourage the patient to rest and elevate the injured limb
D) Administer an NSAID as prescribed
A nurse is preparing to administer an intramuscular injection to a patient with a hip replacement. Which of the following sites is the most appropriate for injection?
A) Dorsogluteal site
B) Vastus lateralis
C) Rectus femoris
D) Deltoid
A nurse is caring for a patient with a hip fracture. Which of the following findings would most likely indicate a complication of the injury?
A) The patient reports increased pain in the affected leg
B) The patient exhibits decreased range of motion in the hip joint
C) The patient’s affected leg is externally rotated and shorter than the other leg
D) The patient is able to ambulate with crutches
A patient with a recent lumbar laminectomy is being prepared for discharge. Which of the following should the nurse include in the discharge teaching plan?
A) “Avoid bending at the waist and lifting heavy objects for at least 6 weeks.”
B) “You should start vigorous physical therapy immediately to regain strength.”
C) “You may resume normal activities within 2 weeks.”
D) “You should avoid walking as much as possible until the pain subsides.”
A nurse is teaching a patient with rheumatoid arthritis about the use of disease-modifying antirheumatic drugs (DMARDs). Which of the following statements by the patient indicates a need for further teaching?
A) “I need to have regular blood tests to check for liver damage.”
B) “These medications help slow the progression of my disease.”
C) “I should avoid being around sick people while on this medication.”
D) “I can stop taking the medication once my symptoms improve.”
A patient is diagnosed with gout. The nurse should instruct the patient to avoid which of the following foods?
A) Chicken and turkey
B) Low-fat dairy products
C) Whole grains
D) Green leafy vegetables
A nurse is caring for a patient with osteoporosis. The patient asks about the best exercise to prevent further bone loss. Which of the following activities is most appropriate?
A) Swimming
B) Weight-bearing exercises such as walking
C) Stretching and yoga
D) Cycling
A patient with osteoarthritis is prescribed a corticosteroid injection. The nurse should explain to the patient that this treatment is used to:
A) Relieve pain and inflammation in the affected joint
B) Strengthen bone tissue and prevent fractures
C) Cure the condition and regenerate cartilage
D) Increase blood flow to the joint area
A nurse is caring for a patient who is recovering from a hip replacement. The patient is at risk for postoperative complications. Which of the following is most important to monitor for in the first 24 hours after surgery?
A) Deep vein thrombosis (DVT)
B) Infection at the surgical site
C) Skin breakdown
D) Urinary retention
A nurse is educating a patient with scoliosis about their treatment options. Which of the following would indicate a need for a brace?
A) A mild curvature that does not affect daily activities
B) A curvature of 25–40 degrees in a growing child
C) A curvature greater than 40 degrees that is causing severe pain
D) A curvature that is decreasing with physical therapy
A patient with a lumbar herniated disk is complaining of numbness and tingling in their legs. What is the nurse’s priority action?
A) Encourage the patient to rest in a supine position
B) Administer pain medication as prescribed
C) Assess for signs of nerve compression and notify the healthcare provider
D) Apply heat to the affected area
A nurse is assessing a patient with a new cast. Which of the following findings requires immediate intervention?
A) The cast is warm to the touch
B) The patient reports a dull ache in the limb
C) The toes of the affected leg are cool and have no pulse
D) The patient has mild swelling around the cast edges
A patient with a history of osteoporosis asks the nurse about the effects of smoking on their condition. The nurse should explain that smoking:
A) Has no effect on bone health
B) Increases bone mineral density
C) Increases the risk of fractures
D) Helps the body absorb calcium
A patient with an ankle sprain is being treated with R.I.C.E. therapy. The nurse explains that “R.I.C.E.” stands for which of the following?
A) Rest, ice, compression, elevation
B) Repositioning, ice, compression, exercise
C) Rest, immobilization, compression, elevation
D) Range of motion, ice, compression, exercise
A nurse is caring for a patient who is at risk for a fat embolism following a long bone fracture. Which of the following is the earliest sign of a fat embolism?
A) Tachypnea and hypoxemia
B) Cyanosis and increased blood pressure
C) Hemoptysis and chest pain
D) Sudden onset of severe headache
A nurse is caring for a patient who underwent an open reduction and internal fixation (ORIF) for a fractured femur. The patient’s left leg is positioned in external rotation. Which of the following is the most likely cause of this condition?
A) Normal anatomical alignment of the hip after surgery
B) The patient’s hip is dislocated
C) The patient is experiencing muscle spasms
D) The cast or dressing is too tight
A nurse is assessing a patient with rheumatoid arthritis who has been prescribed methotrexate. The nurse should monitor the patient for which of the following side effects?
A) Liver toxicity
B) Hypercalcemia
C) Excessive thirst
D) Hypoglycemia
A patient with ankylosing spondylitis asks the nurse how to manage their condition. Which of the following would be the best response?
A) “Regular exercise and good posture are important to reduce stiffness.”
B) “You should avoid all physical activity to prevent worsening symptoms.”
C) “You will need to take pain medication regularly to manage the discomfort.”
D) “Surgical correction is the only option for this condition.”
A nurse is caring for a patient with a herniated lumbar disc. The nurse should instruct the patient to:
A) Use a firm mattress for sleeping
B) Perform exercises that flex the spine
C) Avoid sitting for prolonged periods
D) Avoid all physical activity until symptoms subside
A nurse is caring for a patient who is postoperative following a total knee arthroplasty (TKA). Which of the following is the most important intervention in the immediate postoperative period?
A) Perform passive range-of-motion exercises
B) Maintain the affected leg in a straight position
C) Apply ice to the knee joint
D) Encourage the patient to ambulate as soon as possible
A nurse is teaching a patient with fibromyalgia about managing their condition. Which of the following lifestyle changes should the nurse recommend?
A) Avoid all exercise until symptoms subside
B) Practice stress-reduction techniques and get regular exercise
C) Increase caffeine intake to reduce fatigue
D) Focus on improving your sleep schedule without other lifestyle changes
A nurse is caring for a patient with osteopenia. The nurse should instruct the patient to:
A) Increase calcium and vitamin D intake
B) Avoid weight-bearing exercises to prevent injury
C) Take bisphosphonates daily
D) Limit physical activity to prevent fractures
A nurse is caring for a patient with a hip fracture who is being prepared for surgery. The nurse should explain to the patient that the purpose of the preoperative fast is to:
A) Reduce the risk of aspiration during surgery
B) Promote faster healing after surgery
C) Decrease the need for postoperative pain medications
D) Ensure adequate fluid intake before surgery
A nurse is caring for a patient with a fracture. Which of the following is the priority assessment after the injury?
A) Assess for signs of hypovolemic shock
B) Assess the degree of pain and administer analgesics
C) Check neurovascular status distal to the fracture site
D) Prepare the patient for possible surgery
A nurse is caring for a patient with osteoarthritis who is receiving nonsteroidal anti-inflammatory drugs (NSAIDs) for pain relief. The nurse should monitor the patient for which of the following side effects?
A) Hypertension
B) Gastrointestinal bleeding
C) Hypoglycemia
D) Hyperkalemia
A nurse is caring for a patient with a long leg cast following a fracture. The nurse notes that the patient’s toes are cool and the capillary refill time is prolonged. The nurse’s priority action is to:
A) Elevate the leg and apply cold compresses
B) Check for signs of compartment syndrome and notify the healthcare provider
C) Administer pain medication as prescribed
D) Monitor the patient for signs of infection
A patient is diagnosed with carpal tunnel syndrome. The nurse should instruct the patient to avoid which of the following activities?
A) Performing wrist stretches
B) Resting the wrist in a neutral position
C) Repetitive wrist movements
D) Using a wrist splint at night
A nurse is educating a patient with osteoporosis about diet. The nurse should recommend increasing the intake of which of the following to improve bone health?
A) Iron-rich foods
B) Vitamin D and calcium
C) Foods high in phosphorus
D) Foods rich in potassium
A patient is being discharged after a total hip replacement. The nurse should instruct the patient to avoid which of the following positions to prevent dislocation of the hip?
A) Flexion of the hip beyond 90 degrees
B) External rotation of the hip
C) Abduction of the hip
D) Elevation of the knee above the heart
A nurse is providing discharge instructions to a patient with a recent hip fracture who is using a walker for mobility. The nurse should emphasize which of the following safety measures?
A) Avoid wearing shoes with slippery soles
B) Use the walker with one hand for increased balance
C) Lean forward when using the walker to improve balance
D) Walk with the walker only when someone is present
A nurse is caring for a patient with a spinal cord injury at the T6 level. The nurse should be especially alert for signs of which of the following complications?
A) Respiratory depression
B) Urinary tract infection (UTI)
C) Autonomic dysreflexia
D) Deep vein thrombosis (DVT)
A nurse is caring for a patient with rheumatoid arthritis who is receiving a corticosteroid injection. The nurse should monitor the patient for which of the following side effects?
A) Hyperglycemia
B) Hypotension
C) Osteoporosis
D) Hypokalemia
A patient has been diagnosed with a herniated disc and is scheduled for surgery. The nurse should explain to the patient that the primary goal of the surgery is to:
A) Relieve pain and improve mobility
B) Prevent the need for any future physical therapy
C) Correct the curvature of the spine
D) Repair the ruptured disc permanently
A nurse is caring for a patient with a fresh fracture who is in a cast. The nurse notes that the patient is complaining of increasing pain and swelling. What is the most appropriate intervention?
A) Apply ice to the cast
B) Elevate the limb above the heart
C) Administer analgesics as prescribed
D) Assess the neurovascular status distal to the injury
A nurse is caring for a patient who is recovering from a total knee replacement. The nurse should prioritize which of the following interventions to prevent complications?
A) Administer anticoagulants to prevent deep vein thrombosis
B) Monitor the patient for signs of infection at the surgical site
C) Encourage the patient to flex and extend the knee frequently
D) Keep the leg immobilized for the first 48 hours
A patient with a spinal cord injury is at risk for developing a pressure ulcer. The nurse should recommend which of the following interventions to help prevent this complication?
A) Maintain a constant pressure on the affected area to prevent friction
B) Reposition the patient at least every 2 hours
C) Use a firm mattress to prevent skin breakdown
D) Limit fluid intake to prevent incontinence
A nurse is caring for a patient with osteoarthritis of the knee. The patient reports difficulty walking due to pain. The nurse should recommend which of the following interventions to help relieve the patient’s pain?
A) Apply heat to the knee joint
B) Perform high-impact aerobic exercises
C) Avoid any weight-bearing activities
D) Use cold packs to reduce inflammation
A patient with a herniated disk is experiencing severe pain and muscle spasms. The nurse should first administer which of the following medications?
A) Antipyretics
B) Muscle relaxants
C) Nonsteroidal anti-inflammatory drugs (NSAIDs)
D) Opioid analgesics
A nurse is caring for a patient with a recent knee arthroscopy. The nurse should instruct the patient to:
A) Keep the knee elevated to reduce swelling
B) Begin weight-bearing activities immediately
C) Avoid applying ice to the knee for the first 24 hours
D) Remove the dressing after 24 hours
A nurse is caring for a patient with a history of severe osteoarthritis who is undergoing a total joint replacement. The nurse should plan to monitor the patient for which of the following complications after the surgery?
A) Pneumonia
B) Paralysis
C) Hemorrhage
D) Cerebrovascular accident (CVA)
A nurse is providing discharge instructions to a patient who has had a hip replacement. Which of the following activities should the nurse recommend that the patient avoid?
A) Crossing the legs at the knees
B) Walking with crutches
C) Using a raised toilet seat
D) Sleeping on the unaffected side
A patient with rheumatoid arthritis is prescribed methotrexate. The nurse should instruct the patient to:
A) Take the medication with food to prevent nausea
B) Drink plenty of fluids to prevent kidney damage
C) Avoid sun exposure due to increased sensitivity
D) Avoid taking folic acid supplements while on this medication
A nurse is educating a patient with fibromyalgia on management strategies. Which of the following should the nurse emphasize?
A) The importance of maintaining a consistent exercise routine
B) The need for complete bed rest to avoid muscle strain
C) The benefits of avoiding any physical activity
D) The importance of a high-protein diet to reduce symptoms
A nurse is assessing a patient with a history of a compression fracture of the spine. The nurse should expect to see which of the following findings?
A) Kyphosis (humpback posture)
B) Scoliosis
C) Decreased lumbar curve
D) Hyperlordosis
A patient with osteoporosis is prescribed alendronate (Fosamax). The nurse should instruct the patient to take the medication:
A) With food to reduce gastrointestinal upset
B) At bedtime to increase absorption
C) With a full glass of water and remain upright for at least 30 minutes
D) After a meal to reduce the risk of esophageal irritation
A nurse is caring for a patient with a fractured humerus who is in a sling. Which of the following is the most important assessment?
A) Inspect the skin for signs of irritation under the sling
B) Assess the patient’s ability to move the fingers on the affected arm
C) Check the patient’s vital signs for signs of shock
D) Inquire about the patient’s pain level to determine the need for analgesics
A nurse is caring for a patient following a total hip replacement (THR). The patient asks if they can cross their legs. Which of the following is the best response?
A) “It is important to avoid crossing your legs for the first six weeks after surgery.”
B) “You may cross your legs as long as the affected hip is not under pressure.”
C) “You should cross your legs frequently to promote circulation.”
D) “It is safe to cross your legs as soon as the anesthesia wears off.”
A nurse is teaching a patient with osteoarthritis (OA) about the use of hot and cold compresses for pain relief. Which of the following is a benefit of using a cold compress?
A) Increases blood flow to the affected joint
B) Decreases inflammation and numbs the area
C) Promotes the healing of damaged tissues
D) Relieves muscle spasms associated with OA
A nurse is caring for a patient with a fractured tibia who has been placed in a long leg cast. The patient reports pain that is increasing despite analgesics. What is the nurse’s priority action?
A) Increase the dose of the prescribed analgesic
B) Reassess the neurovascular status of the affected limb
C) Encourage the patient to perform range-of-motion exercises
D) Apply a heating pad to the casted leg
A nurse is assessing a patient with a suspected bone infection (osteomyelitis). Which of the following is a classic sign of osteomyelitis?
A) Nausea and vomiting
B) Fever, redness, and swelling at the affected site
C) Sudden onset of joint stiffness
D) Hypercalcemia and muscle weakness
A nurse is caring for a patient who has been prescribed methotrexate for the treatment of rheumatoid arthritis. Which of the following should the nurse monitor for while the patient is on this medication?
A) Elevated liver enzymes
B) Increased calcium levels
C) Decreased potassium levels
D) Increased white blood cell count
A nurse is teaching a patient with scoliosis about bracing. Which of the following statements by the patient indicates understanding of the teaching?
A) “I will wear the brace all day and night until the curve is corrected.”
B) “I should wear the brace only during physical activities like sports.”
C) “The brace will stop the progression of the scoliosis but won’t correct the curve.”
D) “I should expect complete recovery with just the use of the brace.”
A nurse is caring for a patient with osteoarthritis. Which of the following interventions is most appropriate for managing this patient’s pain?
A) Applying a heating pad to the affected joint
B) Encouraging rest to avoid further damage to the joint
C) Limiting fluid intake to decrease joint inflammation
D) Suggesting a high-protein diet to promote cartilage repair
A nurse is caring for a patient who has just had a below-the-knee amputation. Which of the following is the most important intervention during the first 24 hours postoperatively?
A) Elevate the stump to reduce swelling
B) Apply a compression bandage to the stump
C) Administer analgesics as prescribed to manage pain
D) Assist the patient with ambulation as soon as possible
A patient with a musculoskeletal injury is prescribed nonsteroidal anti-inflammatory drugs (NSAIDs) for pain management. Which of the following should the nurse instruct the patient to avoid while taking NSAIDs?
A) Alcohol consumption
B) Dairy products
C) Caffeine
D) Exercise
A patient is diagnosed with a herniated disc and is being treated with conservative measures. Which of the following interventions is most appropriate for this patient?
A) Provide frequent, prolonged bed rest
B) Encourage proper body mechanics and postural alignment
C) Apply heat and massage directly to the spine
D) Restrict all physical activity for several months
A nurse is caring for a patient with a musculoskeletal injury. The nurse assesses the patient’s neurovascular status, which includes all of the following except:
A) Pulse assessment below the injury site
B) Skin temperature and color
C) Capillary refill and sensation
D) Blood pressure measurements
A nurse is caring for a patient with a dislocated shoulder. Which of the following should the nurse prioritize when planning care for this patient?
A) Administering corticosteroids to reduce inflammation
B) Immobilizing the joint in a proper position
C) Encouraging the patient to move the joint gently to improve range of motion
D) Applying a cold compress to the affected shoulder
A patient with rheumatoid arthritis asks about the benefits of exercise. The nurse should tell the patient that exercise will:
A) Strengthen the joints and cure the disease
B) Increase flexibility and reduce stiffness
C) Promote weight loss and improve skin tone
D) Stop the progression of the disease entirely
A nurse is caring for a patient who has undergone spinal fusion surgery. The patient complains of severe back pain that is unrelieved by medications. The nurse’s first action is to:
A) Administer a higher dose of pain medication
B) Assess the patient’s neurovascular status and the surgical site
C) Reposition the patient to provide comfort
D) Notify the surgeon about the patient’s pain
A patient with Paget’s disease asks about treatment options. The nurse should explain that the goal of therapy for Paget’s disease is to:
A) Prevent fractures by promoting bone healing
B) Increase calcium levels in the blood
C) Control pain and manage deformities
D) Correct the bone deformities with surgery
A nurse is preparing a patient for discharge after hip replacement surgery. The nurse should include which of the following in the discharge teaching?
A) “You should avoid bending forward at the waist for the first six weeks.”
B) “You will need to follow up with your surgeon within two years.”
C) “You may sleep on your stomach after the first few days.”
D) “You should not put weight on your leg until after one year.”
A patient with a fractured arm is to be discharged with a fiberglass cast. Which of the following instructions should the nurse include?
A) “The cast should be kept dry at all times.”
B) “You should apply a hot compress to the cast if it becomes itchy.”
C) “It is important to wear the cast for at least six months.”
D) “You may use a hair dryer to dry the cast if it gets wet.”
A nurse is caring for a patient who is experiencing acute low back pain. The nurse should instruct the patient to:
A) Sleep on their back with a pillow under the knees
B) Engage in high-impact activities to strengthen the back muscles
C) Maintain a high-protein diet to promote muscle repair
D) Lie flat on their stomach to stretch the lower back
A nurse is educating a patient with osteoporosis about lifestyle modifications. The nurse should recommend which of the following actions to promote bone health?
A) Engage in weight-bearing exercises such as walking
B) Limit calcium intake to avoid kidney stones
C) Avoid taking vitamin D supplements
D) Stop all physical activity to prevent bone stress
A nurse is caring for a patient with a suspected fractured femur. The patient is experiencing severe pain and limited movement. Which of the following is the priority action by the nurse?
A) Immobilize the limb
B) Apply heat to the injured area
C) Encourage deep breathing exercises
D) Massage the affected area for comfort
A nurse is assessing a patient with rheumatoid arthritis. Which of the following laboratory results would the nurse expect to find in this patient?
A) Elevated red blood cell count
B) Positive rheumatoid factor (RF)
C) Decreased white blood cell count
D) Low hemoglobin levels
A nurse is caring for a patient who has had a below-the-knee amputation. The nurse should include which of the following in the patient’s plan of care to prevent the development of a contracture?
A) Position the patient with the knee flexed for comfort
B) Keep the residual limb elevated above the level of the heart
C) Encourage the patient to perform active range-of-motion exercises
D) Limit the amount of weight-bearing on the residual limb
A nurse is providing discharge teaching for a patient with a recent hip replacement. The nurse should instruct the patient to avoid:
A) Bending the knee to 90 degrees
B) Using a toilet seat riser
C) Sleeping on the affected side
D) Crossing the legs at the knees
A patient with osteoarthritis is prescribed acetaminophen for pain management. The nurse should educate the patient about which of the following?
A) Taking no more than the recommended dose to avoid liver damage
B) Avoiding nonsteroidal anti-inflammatory drugs (NSAIDs) while on acetaminophen
C) Limiting fluid intake to prevent kidney damage
D) Increasing protein intake to prevent side effects
A nurse is caring for a patient with gout. Which of the following interventions should the nurse prioritize in the patient’s care?
A) Encourage fluid intake to promote uric acid excretion
B) Administer corticosteroids to reduce inflammation
C) Limit fluid intake to prevent renal complications
D) Promote the use of ice to decrease joint swelling
A nurse is caring for a patient with scoliosis. The nurse should monitor for which of the following complications?
A) Increased risk for respiratory distress
B) Increased risk for fractures
C) Impaired vision
D) Decreased appetite and weight loss
A nurse is assessing a patient with a recent diagnosis of fibromyalgia. Which of the following symptoms would the nurse most likely observe?
A) Decreased joint mobility
B) Widespread musculoskeletal pain
C) High fever and chills
D) Swelling of the joints
A nurse is caring for a patient with a fractured tibia who is in a long leg cast. The patient reports increasing pain and pressure in the cast. The nurse should first:
A) Elevate the leg above the level of the heart
B) Administer pain medication as prescribed
C) Check for signs of compartment syndrome
D) Apply ice to the cast
A nurse is caring for a patient with osteoporosis. The nurse should assess for which of the following signs and symptoms related to the condition?
A) Muscle spasms and twitches
B) History of frequent fractures and back pain
C) Shortness of breath and chest pain
D) Excessive bruising and swelling
A nurse is caring for a patient with a recent lumbar laminectomy. The nurse should instruct the patient to avoid which of the following actions to prevent complications?
A) Lifting objects heavier than 10 pounds
B) Sitting with the knees elevated
C) Walking with a cane for support
D) Sleeping on the unaffected side
A nurse is caring for a patient with severe osteoarthritis of the knee. The patient is scheduled for a total knee replacement. The nurse should include which of the following interventions in the preoperative plan of care?
A) Instruct the patient to avoid using any assistive devices postoperatively
B) Provide education on the importance of deep breathing exercises
C) Restrict fluid intake the night before surgery
D) Instruct the patient to continue taking nonsteroidal anti-inflammatory drugs (NSAIDs)
A patient who has a recent diagnosis of rheumatoid arthritis is prescribed methotrexate. The nurse should teach the patient to:
A) Take the medication on an empty stomach
B) Increase their intake of vitamin C to enhance absorption
C) Have regular liver function tests to monitor for toxicity
D) Avoid all physical activity to prevent injury
A nurse is caring for a patient who has sustained a fracture of the humerus and is in a sling. The nurse should instruct the patient to:
A) Remove the sling while sleeping to avoid stiffness
B) Elevate the arm to reduce swelling
C) Apply heat to the area to promote healing
D) Avoid moving the arm to prevent further injury
A nurse is caring for a patient with a suspected strain. Which of the following interventions should the nurse prioritize?
A) Apply ice to the affected area for the first 48 hours
B) Encourage the patient to perform exercises to strengthen the muscle
C) Provide warmth to the area to relax the muscle
D) Perform passive range-of-motion exercises to prevent stiffness
A nurse is educating a patient with scoliosis about treatment options. The nurse should include which of the following statements?
A) “Surgery is always required to correct the curve.”
B) “A back brace can help prevent further curvature.”
C) “There is no need for physical therapy if the curve is less than 20 degrees.”
D) “Scoliosis can be fully reversed with the correct treatment.”
A nurse is caring for a patient who has a cast on the lower leg. The patient complains of tingling in the toes. The nurse should:
A) Reassess the neurovascular status and report findings to the healthcare provider
B) Administer analgesics and apply heat to the cast
C) Increase the height of the bed to promote circulation
D) Remove the cast to assess the skin for breakdown
A nurse is caring for a patient who is post-operative following a total hip replacement. The nurse should instruct the patient to avoid:
A) Using a raised toilet seat
B) Sitting in low chairs or bending the hips past 90 degrees
C) Sleeping on the unaffected side
D) Walking with crutches for assistance
A nurse is caring for a patient who is recovering from a recent spinal fusion surgery. The nurse should encourage the patient to:
A) Remain on bed rest for the first few weeks
B) Avoid bending and twisting the back
C) Start physical therapy immediately to strengthen the back
D) Apply heat to the surgical area to promote healing
A nurse is caring for a patient who is post-operative following a knee arthroplasty (knee replacement). The nurse should monitor for which of the following complications in the immediate post-operative period?
A) Deep vein thrombosis (DVT)
B) Hypertension
C) Hypothermia
D) Respiratory acidosis
A nurse is teaching a patient with gout about the importance of dietary modifications. Which of the following foods should the nurse instruct the patient to avoid?
A) Fresh vegetables
B) Whole-grain bread
C) Organ meats such as liver
D) Low-fat dairy products
A nurse is caring for a patient with a dislocated shoulder. Which of the following is the most important nursing intervention?
A) Encourage the patient to use the affected arm for support
B) Assess the neurovascular status of the affected extremity
C) Apply a heating pad to the shoulder area
D) Encourage the patient to perform shoulder exercises immediately
A nurse is caring for a patient with a fractured femur. The patient reports pain despite receiving pain medication. Which of the following should the nurse assess for?
A) Compartment syndrome
B) Pulmonary embolism
C) Wound infection
D) Low blood pressure
A nurse is caring for a patient with rheumatoid arthritis (RA). Which of the following interventions should the nurse include in the plan of care to help manage the patient’s symptoms?
A) Encourage the patient to rest affected joints during flare-ups
B) Recommend high-impact exercises to strengthen muscles
C) Limit the patient’s intake of calcium and vitamin D
D) Encourage prolonged use of heating pads on affected joints
A nurse is caring for a patient with a sprained ankle. The nurse should recommend which of the following actions for the first 24 to 48 hours after the injury?
A) Apply heat to reduce swelling
B) Elevate the ankle above the level of the heart
C) Perform weight-bearing exercises to improve mobility
D) Use a heating pad to relax the muscles
A nurse is educating a patient with osteoporosis about the importance of weight-bearing exercises. Which of the following should the nurse include in the teaching?
A) Walking and light jogging are good forms of weight-bearing exercises
B) Weight-bearing exercises should be avoided to prevent fractures
C) Swimming is a good form of exercise for osteoporosis
D) Weight-bearing exercises should be limited to 5 minutes per day
A nurse is caring for a patient with multiple fractures. The patient is in severe pain and has limited movement. What is the priority nursing action?
A) Administer prescribed pain medications
B) Encourage the patient to ambulate to prevent complications
C) Apply ice to the affected areas
D) Perform a neurovascular assessment on the affected limb
A nurse is educating a patient with osteoarthritis about pain management. Which of the following interventions should the nurse include in the teaching plan?
A) Use heat therapy for joint stiffness and pain relief
B) Engage in intense physical activity to strengthen the joints
C) Take corticosteroids regularly to reduce joint inflammation
D) Avoid using assistive devices to maintain independence
A nurse is caring for a patient with Paget’s disease. Which of the following would the nurse expect to find in this patient’s assessment?
A) Increased bone density and deformities
B) Severe bone pain and muscle weakness
C) Excessive bone resorption and soft bones
D) Decreased calcium levels and joint swelling
A nurse is caring for a patient with osteomyelitis. Which of the following interventions should the nurse prioritize?
A) Administering prescribed antibiotics
B) Encouraging ambulation to improve circulation
C) Applying heat to the affected area
D) Limiting oral intake to reduce stress on the kidneys
A nurse is caring for a patient who is post-operative following a total hip replacement. The nurse should be concerned if the patient exhibits which of the following signs and symptoms?
A) Swelling and bruising around the surgical site
B) Pain and inability to move the affected leg
C) Redness and warmth around the incision site
D) Absence of pulses in the affected leg
A nurse is caring for a patient with a recent hip fracture. Which of the following actions should the nurse include in the plan of care to prevent complications of immobility?
A) Encourage the patient to remain in bed as much as possible
B) Encourage the patient to perform deep breathing exercises
C) Restrict fluid intake to reduce swelling
D) Administer pain medications on a fixed schedule
A nurse is caring for a patient with scoliosis. Which of the following is an important intervention in the management of this condition?
A) Encourage the patient to wear a back brace to prevent further curvature
B) Recommend avoiding exercise and sports to prevent injury
C) Provide education on the use of a cervical collar for neck support
D) Advise the patient to limit sitting to less than 30 minutes at a time
A nurse is assessing a patient who is post-operative following spinal fusion. The nurse should monitor the patient for which of the following complications?
A) Hemorrhage and hypotension
B) Hyperglycemia and dehydration
C) Infection and nerve damage
D) Respiratory acidosis and hypoxia
A nurse is educating a patient with a diagnosis of fibromyalgia. The nurse should include which of the following statements in the teaching plan?
A) “Chronic pain in multiple areas is the hallmark symptom of fibromyalgia.”
B) “Exercise should be avoided to reduce the risk of flare-ups.”
C) “Fibromyalgia is most common in older adults, especially men.”
D) “The condition is usually caused by autoimmune disorders.”
A nurse is caring for a patient who has had a lumbar laminectomy. The nurse should include which of the following instructions in the post-operative plan of care?
A) “Remain in a sitting position for long periods to avoid stiffness.”
B) “Perform exercises to strengthen the back muscles and promote healing.”
C) “Avoid lifting heavy objects to prevent stress on the spine.”
D) “Use a firm mattress for sleeping to maintain spinal alignment.”
A nurse is caring for a patient with a severe strain of the back. The nurse should teach the patient to:
A) Apply cold packs to the area for the first 24 hours
B) Engage in vigorous physical activity to improve flexibility
C) Avoid sitting for long periods to reduce pressure on the spine
D) Perform back exercises immediately to prevent muscle atrophy
A nurse is caring for a patient who has recently been diagnosed with ankylosing spondylitis. The nurse should instruct the patient to:
A) Limit movement of the spine to reduce pain
B) Perform exercises to improve posture and flexibility
C) Avoid weight-bearing exercises to reduce strain on the spine
D) Use hot compresses to relieve muscle stiffness
A nurse is educating a patient with osteoporosis about preventing falls. The nurse should suggest which of the following?
A) Wear shoes with thick soles for extra cushioning
B) Install grab bars in the bathroom and along stairways
C) Use a walker only when absolutely necessary
D) Avoid walking outdoors during the day to reduce risk of falls
A nurse is caring for a patient with a fractured clavicle. The nurse should instruct the patient to:
A) Avoid immobilizing the arm to maintain full mobility
B) Elevate the arm above the head for 24 hours
C) Wear a sling to support the arm during the healing process
D) Apply ice directly to the wound site without protection
A nurse is teaching a patient about the treatment of a herniated disc. Which of the following interventions should the nurse include in the teaching?
A) Perform heavy lifting to strengthen the back muscles
B) Use a soft mattress to relieve pressure on the spine
C) Maintain proper posture and avoid prolonged sitting
D) Apply heat therapy to the back for extended periods
A nurse is caring for a patient with a diagnosis of muscular dystrophy. Which of the following is a priority for the nurse to monitor in this patient?
A) Respiratory function and cardiac complications
B) Gastrointestinal upset and vomiting
C) Eye infections and vision changes
D) Temperature regulation and skin breakdown
A nurse is caring for a patient with a diagnosis of osteoarthritis. The nurse should anticipate which of the following medications to be prescribed to manage the patient’s pain?
A) Methotrexate
B) Acetaminophen
C) Nonsteroidal anti-inflammatory drugs (NSAIDs)
D) Calcitonin
A nurse is caring for a patient with a lumbar herniated disc. The nurse should prioritize which of the following interventions?
A) Encourage the patient to perform activities of daily living independently
B) Administer prescribed pain medications as needed
C) Apply a heating pad to the lower back for 20 minutes
D) Instruct the patient to avoid any form of movement for the next 24 hours
A nurse is caring for a patient with a torn rotator cuff. Which of the following actions should the nurse recommend for the patient to manage the injury?
A) Perform range-of-motion exercises immediately after the injury
B) Rest the shoulder and apply ice to reduce inflammation
C) Use heat therapy to relieve muscle spasms
D) Immobilize the shoulder in a sling for extended periods
A nurse is caring for a patient with Paget’s disease. Which of the following is the most common complication associated with this condition?
A) Osteosarcoma
B) Osteoporosis
C) Fractures and bone deformities
D) Spinal cord compression
A nurse is educating a patient with rheumatoid arthritis (RA) about medication management. The nurse should instruct the patient to monitor for which of the following side effects when taking methotrexate?
A) Nausea, vomiting, and diarrhea
B) Fever, sore throat, and easy bruising
C) Hyperglycemia and weight gain
D) Decreased appetite and hair loss
A nurse is caring for a patient with a recent diagnosis of osteoarthritis. The nurse should recommend which of the following to help manage the pain?
A) Use a warm compress to decrease joint stiffness
B) Increase physical activity to strengthen the joints
C) Limit the intake of fluids to reduce inflammation
D) Rest affected joints for extended periods to reduce pain
A nurse is educating a patient with osteoporosis about lifestyle changes. Which of the following statements should the nurse include?
A) “Avoid weight-bearing exercises to reduce stress on your bones.”
B) “Take calcium and vitamin D supplements as prescribed.”
C) “Rest as much as possible to prevent fractures.”
D) “Limit your intake of protein to protect your bones.”
A nurse is caring for a patient with a fresh hip fracture. Which of the following is the priority action for the nurse?
A) Administer pain medications as prescribed
B) Assess the patient’s neurovascular status
C) Encourage the patient to remain in bed to prevent movement
D) Apply a traction device to the affected leg
A nurse is caring for a patient with a diagnosis of scoliosis. The nurse should expect which of the following treatment options?
A) Bracing or spinal fusion surgery for severe cases
B) Routine use of muscle relaxants to reduce pain
C) Physical therapy to maintain joint mobility
D) Prolonged bed rest to prevent spinal curve progression
A nurse is caring for a patient with a fractured tibia. The nurse should prioritize monitoring for which of the following complications?
A) Hyperkalemia
B) Deep vein thrombosis (DVT)
C) Hyperglycemia
D) Respiratory acidosis
A nurse is teaching a patient with a diagnosis of gout about the management of the condition. Which of the following instructions should the nurse include?
A) “Avoid foods high in purines, such as shellfish and red meats.”
B) “Increase the intake of alcohol to help manage uric acid levels.”
C) “Take vitamin C supplements to prevent uric acid build-up.”
D) “Limit fluid intake to reduce kidney strain.”
A nurse is caring for a patient with a recent diagnosis of carpal tunnel syndrome. Which of the following interventions should the nurse include in the plan of care?
A) Elevate the affected hand above the level of the heart
B) Apply a splint to keep the wrist in a neutral position
C) Instruct the patient to perform wrist exercises immediately
D) Use heat therapy to relieve nerve compression
A nurse is educating a patient who is undergoing treatment for osteoporosis. Which of the following statements should the nurse include in the teaching plan?
A) “You can stop taking your calcium supplements once you begin hormone therapy.”
B) “Ensure that you have adequate vitamin D intake to assist with calcium absorption.”
C) “You should avoid weight-bearing exercises to protect your bones.”
D) “Smoking will help to strengthen your bones.”
A nurse is caring for a patient post-operatively following a total knee replacement. The patient reports severe pain and the nurse finds that the knee is swollen and tense. What is the nurse’s priority action?
A) Apply a warm compress to the knee
B) Assess the patient’s neurovascular status
C) Administer pain medication
D) Encourage the patient to move the knee joint
A nurse is caring for a patient who has a fresh compound fracture. The nurse should be most concerned about which of the following?
A) Risk for infection and shock
B) Risk for muscle weakness
C) Risk for deep vein thrombosis (DVT)
D) Risk for bone density loss
A nurse is caring for a patient with a diagnosis of osteomyelitis. Which of the following treatments should the nurse expect to be prescribed?
A) Nonsteroidal anti-inflammatory drugs (NSAIDs)
B) High-dose intravenous antibiotics
C) Muscle relaxants to relieve spasms
D) Corticosteroids to reduce inflammation
A nurse is caring for a patient with a severe strain. The nurse should teach the patient to follow the R.I.C.E. method. What does “C” in R.I.C.E. stand for?
A) Cold
B) Compression
C) Care
D) Circulation
NCLEX Musculoskeletal Disorders Questions and Answers for Study Guide
Discuss the pathophysiology, clinical manifestations, and nursing interventions for a patient diagnosed with osteoarthritis (OA).
Answer:
Pathophysiology: Osteoarthritis (OA) is a degenerative joint disease characterized by the breakdown of articular cartilage, which leads to pain, stiffness, and decreased range of motion in the affected joint. The cartilage gradually deteriorates, and the underlying bone may become exposed, leading to inflammation. Over time, the bone may form osteophytes, also known as bone spurs, which further contribute to joint stiffness and limited mobility. OA primarily affects weight-bearing joints such as the knees, hips, and spine, but can also impact the hands and other joints.
Clinical Manifestations: The clinical manifestations of OA include:
- Joint Pain: The pain often worsens with activity and improves with rest. It may be described as aching, and patients may experience stiffness after prolonged rest or inactivity.
- Swelling: Inflammation and synovial fluid accumulation may cause mild swelling around the joint.
- Limited Range of Motion: Patients often report difficulty moving the joint, especially after long periods of inactivity.
- Crepitus: A grating or crackling sound when the joint is moved.
- Joint Deformity: In advanced cases, there may be visible joint deformities, especially in the hands.
Nursing Interventions:
- Pain Management: The primary focus is controlling pain. Nonsteroidal anti-inflammatory drugs (NSAIDs) or acetaminophen are commonly prescribed to manage pain. In some cases, corticosteroid injections into the joint may be recommended.
- Physical Therapy: Strengthening the muscles around the joint and improving flexibility can help relieve pain and improve mobility. The nurse should encourage the patient to perform joint exercises as prescribed.
- Weight Management: Since obesity increases stress on weight-bearing joints, weight loss may be advised to reduce symptoms, particularly for patients with knee OA.
- Assistive Devices: The nurse may suggest using assistive devices like canes or braces to support the joints and reduce strain.
- Patient Education: The nurse should educate the patient about avoiding excessive joint use, using proper body mechanics, and avoiding prolonged standing or sitting in one position.
Describe the nursing care and interventions for a patient recovering from a total hip replacement (THR) surgery.
Answer:
Nursing Care Post-Total Hip Replacement:
Total hip replacement (THR) surgery is performed to relieve pain and improve function in patients with hip joint arthritis or fractures. Post-operatively, nursing care focuses on managing pain, preventing complications, and promoting recovery.
1. Pain Management: Pain is a primary concern following THR. Nurses should administer prescribed pain medications, such as opioids or non-opioid analgesics, based on the patient’s pain level. The use of patient-controlled analgesia (PCA) pumps may be considered for effective pain control. Non-pharmacological interventions, such as ice packs, may also be helpful in reducing inflammation and providing comfort.
2. Preventing Complications:
- Infection Prevention: Surgical wounds are at risk for infection. Nurses should monitor for signs of infection (e.g., redness, increased warmth, drainage, fever). The surgical site should be kept clean and dry, and appropriate antibiotic prophylaxis should be administered.
- Deep Vein Thrombosis (DVT) Prevention: THR patients are at increased risk for DVT. Nurses should encourage the use of anti-embolism stockings, perform regular leg exercises, and monitor for signs of DVT (e.g., swelling, redness, pain in the calf).
- Hip Dislocation Prevention: Nurses must teach patients the proper positioning of the hip joint. The patient should avoid crossing their legs or bending the hip beyond 90 degrees, as this may dislocate the hip. Assistive devices, such as a raised toilet seat, may be used to prevent hip flexion beyond the safe range.
3. Mobilization and Physical Therapy: The nurse should encourage early mobilization to prevent complications such as pneumonia and DVT. The patient should be encouraged to begin ambulating with a walker or crutches as soon as tolerated, usually within a day of surgery. Physical therapy is crucial for strengthening muscles and improving mobility. The nurse should assist with passive and active range-of-motion exercises to prevent stiffness.
4. Patient Education: Patient education is vital for a successful recovery. The nurse should explain the importance of following activity restrictions, taking prescribed medications, and attending follow-up appointments. Education on maintaining a safe home environment (e.g., removing rugs, using grab bars) is also important to prevent falls.
Explain the nursing considerations for a patient with rheumatoid arthritis (RA) who is prescribed disease-modifying antirheumatic drugs (DMARDs).
Answer:
Nursing Considerations for Disease-Modifying Antirheumatic Drugs (DMARDs) in Rheumatoid Arthritis: Rheumatoid arthritis (RA) is an autoimmune disorder that causes chronic inflammation of the joints, leading to pain, stiffness, and potential joint destruction. Disease-modifying antirheumatic drugs (DMARDs) are used to slow the progression of the disease, reduce inflammation, and prevent joint damage. The most commonly prescribed DMARDs include methotrexate, sulfasalazine, and hydroxychloroquine.
1. Monitoring for Side Effects: DMARDs can have significant side effects. Methotrexate, for example, can cause hepatotoxicity, bone marrow suppression, and gastrointestinal upset. Nurses should monitor the patient for signs of infection, unusual bruising or bleeding, and liver dysfunction (e.g., jaundice, dark urine). Regular blood tests are essential to monitor liver function, complete blood count (CBC), and kidney function.
2. Patient Education: Nurses should educate patients about the importance of adherence to the prescribed medication regimen. Patients should be informed about potential side effects and instructed to report any unusual symptoms, such as abdominal pain, fatigue, or signs of infection. Education on safe sun exposure is important for patients taking hydroxychloroquine, as this drug can increase sensitivity to sunlight.
3. Preventing Infections: As DMARDs suppress the immune system, patients are at increased risk for infections. Nurses should educate patients to practice good hygiene, avoid crowds or individuals with infections, and ensure they are up to date with vaccinations before starting treatment with DMARDs.
4. Providing Pain Management: In addition to DMARDs, nurses may need to provide adjunctive therapies for pain relief, such as NSAIDs or corticosteroids. Nurses should monitor the patient’s response to pain management strategies and adjust the plan as necessary.
5. Lifestyle Modifications: Nurses should also educate the patient on the importance of maintaining a healthy lifestyle. This includes regular low-impact exercises, such as swimming or walking, to improve joint function and prevent stiffness. A balanced diet rich in calcium and vitamin D can help maintain bone health, particularly in patients taking corticosteroids.
Discuss the nursing care plan for a patient with scoliosis.
Answer:
Nursing Care Plan for a Patient with Scoliosis: Scoliosis is a lateral curvature of the spine that can range from mild to severe. It is commonly diagnosed in childhood or adolescence but may occur at any age. The care plan for a patient with scoliosis is focused on monitoring the degree of curvature, preventing complications, and providing emotional support.
1. Assessment: The nurse should perform a comprehensive assessment to evaluate the patient’s posture, gait, and spinal alignment. The degree of curvature is typically measured using the Cobb angle on an X-ray. The nurse should also assess for pain, signs of respiratory compromise, or neurologic deficits that may occur in severe cases.
2. Pain Management: For patients with scoliosis, pain management is often necessary, especially if the curvature is causing discomfort. The nurse should assess the level of pain using a pain scale and provide pain relief as prescribed. Over-the-counter NSAIDs or acetaminophen may be used for mild pain, while stronger analgesics may be prescribed for moderate to severe pain.
3. Bracing and Posture Correction: In patients with moderate scoliosis, a brace may be prescribed to prevent further progression of the curve. Nurses should educate the patient about wearing the brace correctly and the importance of maintaining proper posture. The nurse should ensure that the brace is fitted properly to avoid skin irritation and pressure sores.
4. Surgery and Post-Operative Care: In severe cases, surgery may be required to correct the spinal curve. The nurse should prepare the patient for surgery by explaining the procedure, potential complications, and recovery process. Post-operatively, the nurse should monitor for signs of infection, neurovascular compromise, and respiratory function. The patient should also be encouraged to perform deep breathing exercises and early ambulation to prevent complications such as pneumonia and DVT.
5. Emotional Support: Scoliosis, especially in children and adolescents, can have a significant emotional impact. The nurse should provide emotional support and reassure the patient and family that scoliosis is a manageable condition. Nurses can refer patients to support groups or counseling services if needed to address any concerns about body image or coping with chronic illness.
Explain the nursing care for a patient with a sprained ankle.
Answer:
Nursing Care for a Patient with a Sprained Ankle: A sprained ankle occurs when the ligaments around the ankle are stretched or torn due to excessive force. Nursing care focuses on managing pain, reducing swelling, and promoting healing through rest, ice, compression, and elevation (R.I.C.E.).
1. Pain Management: Pain control is a priority. The nurse should assess the level of pain using a pain scale and administer pain relief as prescribed, including nonsteroidal anti-inflammatory drugs (NSAIDs) or acetaminophen. For severe pain, opioids may be prescribed in the short term. The nurse should also apply cold compresses or ice packs to the affected area to reduce pain and inflammation.
2. Rest, Ice, Compression, Elevation (R.I.C.E.): The nurse should instruct the patient to rest the injured ankle, avoid weight-bearing activities, and use crutches if necessary. Ice should be applied for 15-20 minutes every 2-3 hours during the first 48 hours to reduce swelling. Compression with an elastic bandage can help minimize swelling but should be done carefully to avoid restricting circulation. The ankle should be elevated above the level of the heart to further reduce swelling.
3. Monitoring for Complications: The nurse should assess for complications, such as impaired circulation, infection, or deep vein thrombosis (DVT). Signs of complications may include increased redness, warmth, swelling, or pain beyond the normal recovery process. The nurse should monitor for changes in the color or temperature of the toes, indicating possible circulation problems.
4. Education on Mobility: The nurse should educate the patient on using assistive devices, such as crutches or a brace, to prevent further injury and encourage proper weight distribution. After initial rest and when swelling has decreased, the nurse should promote gradual mobility through gentle range-of-motion exercises, as tolerated.
5. Follow-Up and Rehabilitation: The nurse should educate the patient on the importance of rehabilitation exercises once the initial pain and swelling subside. Strengthening the muscles around the ankle is key to preventing future injuries. Physical therapy may be recommended if the sprain is moderate to severe. The nurse should also inform the patient about the risks of re-injury and the importance of proper footwear and ankle support.
Describe the nursing considerations for a patient with a fractured femur.
Answer:
Nursing Considerations for a Patient with a Fractured Femur: A fractured femur is a serious injury that often occurs due to high-impact trauma, such as a fall or motor vehicle accident. Nursing care focuses on pain management, preventing complications, and promoting recovery.
1. Pain Management: The patient with a fractured femur often experiences severe pain. Immediate pain relief is crucial, and the nurse should administer pain medications as prescribed, such as opioids or NSAIDs. The nurse should assess the patient’s pain level frequently and provide additional analgesia if necessary. Using ice packs may also help reduce swelling and pain around the fracture site.
2. Immobilization and Fracture Care: The femur should be immobilized to prevent further injury and alleviate pain. Depending on the type and location of the fracture, this may include the use of a traction device, a splint, or surgical fixation (internal or external). The nurse should ensure the fracture site remains aligned and that the immobilization device is properly positioned and secured.
3. Monitoring for Complications: Patients with femur fractures are at risk for serious complications, such as deep vein thrombosis (DVT), pulmonary embolism, and fat embolism syndrome. Nurses should monitor the patient for signs of DVT, including swelling, redness, and pain in the calf, and promote the use of compression stockings or anticoagulants as prescribed. The nurse should also assess for symptoms of fat embolism, such as respiratory distress, confusion, and petechial rash.
4. Postoperative Care (if Surgery is Required): If surgery is necessary to realign and stabilize the fracture, the nurse should provide post-operative care, including monitoring vital signs, checking the surgical site for infection, and assessing neurovascular status (e.g., checking for circulation, sensation, and movement in the affected limb). The nurse should encourage deep breathing exercises to prevent pneumonia and assist with early ambulation, as tolerated, to prevent complications like DVT and muscle atrophy.
5. Rehabilitation and Mobility: After initial stabilization, the nurse should assist the patient with mobility. If the patient requires weight-bearing restrictions, the nurse should educate them on the use of assistive devices, such as crutches, a walker, or a cane. Rehabilitation therapy will likely be needed to restore strength, flexibility, and function to the affected leg. The nurse should encourage adherence to physical therapy recommendations to optimize recovery.
Explain the nursing considerations for a patient with gout.
Answer:
Nursing Considerations for a Patient with Gout: Gout is a form of inflammatory arthritis caused by the accumulation of uric acid crystals in the joints, leading to intense pain, swelling, and redness. It commonly affects the big toe but can also impact other joints.
1. Pain Management: Gout attacks are characterized by severe pain, often starting suddenly and affecting one joint. The nurse should assess the patient’s pain level using a pain scale and administer pain relief as prescribed, such as nonsteroidal anti-inflammatory drugs (NSAIDs) or corticosteroids. Colchicine is another medication commonly prescribed to reduce the severity and duration of a gout attack. The nurse should monitor the patient’s response to medications and ensure they are taken as directed.
2. Reducing Inflammation: The nurse should apply interventions to reduce inflammation and swelling. Ice packs or cold compresses can be applied to the affected joint to reduce swelling and pain. The nurse should advise the patient to rest the affected joint and elevate it if possible, to minimize swelling and discomfort.
3. Education on Lifestyle Modifications: The nurse should educate the patient on lifestyle changes to prevent future gout attacks. This includes advising the patient to avoid foods high in purines, such as red meat, shellfish, and organ meats, as they can increase uric acid levels. Alcohol, particularly beer, should also be avoided, as it can exacerbate gout. The patient should be encouraged to drink plenty of water to help flush uric acid from the body.
4. Medications and Monitoring: Patients with chronic gout may be prescribed urate-lowering therapy, such as allopurinol, to prevent further attacks. The nurse should monitor the patient for potential side effects of these medications, including liver or kidney function abnormalities, and ensure that the patient adheres to the prescribed regimen. Regular blood tests are required to monitor uric acid levels and kidney function.
5. Preventing Complications: The nurse should educate the patient about the long-term effects of untreated gout, including joint damage and kidney stones. Nurses should advise the patient to attend regular follow-up appointments for monitoring uric acid levels and overall joint health. Early treatment and lifestyle modifications are key to preventing complications.
Describe the nursing care plan for a patient with a herniated disc.
Answer:
Nursing Care Plan for a Patient with a Herniated Disc: A herniated disc occurs when the soft, gel-like center of a spinal disc pushes through a crack in the outer layer, pressing on nearby nerves. This condition can cause pain, numbness, and weakness, especially in the lower back and legs.
1. Pain Management: The primary concern for patients with a herniated disc is managing pain. The nurse should assess the patient’s pain level and administer prescribed medications, including NSAIDs or opioids for severe pain. If necessary, muscle relaxants may be used to reduce muscle spasms. Non-pharmacological interventions, such as heat or cold packs, may be applied to relieve pain and inflammation.
2. Promoting Rest and Mobility: During the acute phase, the nurse should encourage the patient to rest and avoid movements that could exacerbate the pain. However, prolonged bed rest is not recommended, as it can lead to muscle weakness and stiffness. The nurse should encourage the patient to engage in light activities as tolerated, such as walking, to promote healing. The use of a lumbar support device or brace may be recommended to provide stability during movement.
3. Posture and Body Mechanics: The nurse should educate the patient about the importance of maintaining proper posture and using correct body mechanics to avoid straining the spine. This includes avoiding bending at the waist, lifting heavy objects, and twisting motions. Patients should be instructed to use their legs for lifting and to keep the back straight when standing or sitting.
4. Surgical Intervention (if necessary): In cases where conservative treatments fail to alleviate symptoms, surgery may be considered. The nurse should educate the patient on surgical options, such as a discectomy or spinal fusion, and provide preoperative and postoperative care. Post-surgical nursing care includes monitoring for complications such as infection, neurovascular compromise, and ensuring proper alignment of the spine.
5. Physical Therapy and Rehabilitation: The nurse should promote physical therapy to strengthen the muscles surrounding the spine and improve flexibility. Physical therapy can help prevent future injuries and reduce the risk of recurring herniated discs. The nurse should encourage adherence to the prescribed rehabilitation plan and assist the patient in managing activities of daily living.
Discuss the nursing interventions for a patient with osteoarthritis (OA).
Answer:
Nursing Interventions for a Patient with Osteoarthritis (OA): Osteoarthritis (OA) is a degenerative joint disease characterized by the breakdown of cartilage, leading to pain, stiffness, and impaired movement. The nursing care plan focuses on managing pain, improving joint function, and promoting lifestyle modifications.
1. Pain Management: Pain relief is the cornerstone of care for OA. The nurse should assess the severity of pain using a standardized pain scale and administer prescribed medications such as acetaminophen or NSAIDs. For patients with more severe pain, the nurse may administer opioids or corticosteroid injections as prescribed. Non-pharmacological interventions such as heat or cold therapy, massage, and transcutaneous electrical nerve stimulation (TENS) can also provide pain relief.
2. Joint Protection: The nurse should educate the patient on ways to protect the affected joints. This includes using assistive devices, such as canes or braces, to reduce stress on the joints. The nurse should also teach proper body mechanics when sitting, standing, or lifting to minimize strain on the joints. Additionally, patients should be instructed to avoid high-impact activities and to perform low-impact exercises, such as swimming or cycling.
3. Exercise and Physical Activity: The nurse should encourage regular physical activity to maintain joint flexibility and muscle strength. Low-impact exercises, such as walking or stretching, are recommended to improve range of motion and reduce stiffness. The nurse should also educate the patient about the importance of maintaining a healthy weight to reduce stress on weight-bearing joints, such as the knees and hips.
4. Patient Education on Medications: The nurse should educate the patient about the proper use of medications, including the risks and side effects of NSAIDs (e.g., gastrointestinal bleeding, renal damage) and corticosteroids. Patients should also be informed about the potential for drug interactions and the importance of taking medications as prescribed to manage symptoms effectively.
5. Psychological Support: Osteoarthritis can lead to emotional distress due to chronic pain and disability. The nurse should assess the patient’s psychological well-being and provide support as needed. Referral to a counselor or support group may be beneficial for patients coping with depression or anxiety related to OA.
Explain the nursing management of a patient with scoliosis.
Answer:
Nursing Management of a Patient with Scoliosis: Scoliosis is a lateral curvature of the spine that may be congenital or develop during adolescence. Severe scoliosis can cause pain, breathing difficulties, and nerve compression. Nursing care focuses on monitoring the progression of the curve, promoting comfort, and educating the patient and family about treatment options.
1. Assessment and Monitoring: The nurse should assess the degree of spinal curvature and monitor any changes over time. The Cobb angle, measured via X-ray, is used to determine the severity of scoliosis. Regular follow-up appointments should be scheduled to monitor the condition’s progression, especially in children and adolescents who are still growing.
2. Pain Management: Patients with scoliosis may experience back pain or muscle spasms. The nurse should assess pain regularly using a pain scale and provide appropriate analgesics, such as NSAIDs or acetaminophen. Physical therapy, heat or cold applications, and posture correction techniques may help alleviate discomfort.
3. Education on Bracing: In mild to moderate cases of scoliosis, a brace may be prescribed to prevent the curve from worsening. The nurse should educate the patient and family on the proper use of the brace, including wearing it for the prescribed amount of time each day, ensuring proper fit, and caring for the device. Bracing may be most effective when worn during periods of growth.
4. Surgical Intervention (for Severe Cases): In cases of severe scoliosis or when bracing is ineffective, surgery, such as spinal fusion, may be necessary. The nurse should provide preoperative care, including explaining the procedure, obtaining consent, and preparing the patient for surgery. Postoperative care includes monitoring for complications like infection, blood loss, and neurovascular changes. The nurse should also assist with pain management and early mobilization to prevent complications like pneumonia and deep vein thrombosis (DVT).
5. Psychological Support: Scoliosis can affect a patient’s body image, particularly in adolescents. The nurse should assess the patient’s emotional and psychological state and offer support. The nurse should encourage open communication and address any concerns the patient may have regarding appearance, activity limitations, and potential surgery.
Describe the nursing care for a patient with rheumatoid arthritis (RA).
Answer:
Nursing Care for a Patient with Rheumatoid Arthritis (RA): Rheumatoid arthritis (RA) is an autoimmune disease that causes chronic inflammation of the joints, leading to pain, deformity, and loss of function. Nursing care focuses on managing inflammation, controlling symptoms, and promoting joint protection and mobility.
1. Pain Management: Pain management is essential for patients with RA. The nurse should assess pain levels regularly and administer medications as prescribed, such as NSAIDs, disease-modifying antirheumatic drugs (DMARDs), or biologics. Analgesics and corticosteroids may also be used to reduce inflammation and pain. The nurse should educate the patient on the importance of adhering to the prescribed medication regimen to prevent flare-ups.
2. Inflammation Control: The nurse should assist in controlling inflammation through pharmacological and non-pharmacological means. Medications such as methotrexate, hydroxychloroquine, and biologics (e.g., TNF inhibitors) can slow disease progression and reduce inflammation. Non-drug interventions such as heat or cold applications, rest, and positioning can also help manage swelling and stiffness.
3. Joint Protection and Mobility: The nurse should educate the patient on joint protection techniques, such as using assistive devices like canes or splints to reduce strain on affected joints. The nurse should also teach exercises to improve joint mobility and muscle strength, focusing on low-impact activities like swimming, walking, or stretching. This can help prevent muscle atrophy and maintain functional independence.
4. Monitoring for Complications: RA patients are at increased risk for complications such as osteoporosis, cardiovascular disease, and infections due to the use of immunosuppressive drugs. The nurse should monitor for signs of infection, such as fever, redness, and swelling, and ensure that the patient adheres to immunizations. Bone density tests may be necessary to monitor for osteoporosis, and blood tests should be performed regularly to assess liver and kidney function.
5. Education and Emotional Support: The nurse should provide education on the chronic nature of RA, including lifestyle modifications, stress reduction techniques, and the importance of regular follow-up visits. Psychological support may also be necessary, as RA can lead to emotional challenges due to chronic pain and disability. The nurse should encourage the patient to join support groups or counseling to cope with the emotional impact of RA.
Discuss the nursing interventions for a patient undergoing hip replacement surgery.
Answer:
Nursing Interventions for a Patient Undergoing Hip Replacement Surgery: Hip replacement surgery is commonly performed to treat severe osteoarthritis or fractures of the hip joint. The nursing care plan focuses on preoperative preparation, postoperative monitoring, pain management, and promoting rehabilitation.
1. Preoperative Care: Before surgery, the nurse should provide education on the procedure, answer any questions, and explain the expected postoperative course. The nurse should assess the patient’s medical history, perform preoperative screenings, and ensure informed consent is obtained. The patient should be instructed to stop taking blood thinners and fasting as prescribed to prevent complications during surgery.
2. Postoperative Care: After surgery, the nurse should monitor for complications such as infection, blood loss, and thromboembolism. Vital signs should be assessed regularly, and the surgical site should be inspected for signs of infection, such as redness, swelling, or drainage. The nurse should encourage deep breathing exercises to prevent pneumonia and use of compression stockings to reduce the risk of deep vein thrombosis (DVT).
3. Pain Management: Effective pain control is essential for promoting early mobilization. The nurse should administer analgesics as prescribed, including opioids or NSAIDs, and assess the patient’s pain levels regularly. Non-pharmacological techniques, such as positioning, ice, and relaxation techniques, can also be employed to enhance comfort.
4. Rehabilitation and Mobility: The nurse should assist with early mobilization to promote circulation, prevent complications, and restore functional mobility. This may include using assistive devices such as a walker or crutches. The nurse should educate the patient on hip precautions, including avoiding crossing the legs or bending the hip past a 90-degree angle, to prevent dislocation of the new joint.
5. Patient Education and Discharge Planning: Before discharge, the nurse should educate the patient on home care, including wound care, medication management, and follow-up appointments. The patient should be instructed on exercises to strengthen the hip and improve flexibility, as well as safety measures to prevent falls. The nurse should also provide information on community resources, such as physical therapy services, to assist with recovery.