Medical-Surgical Nursing: Musculoskeletal and Neurological Flashcards

A client with a fractured femur is placed in skeletal traction. The LPN's priority assessment is:

Answer: Neurovascular status of the affected extremity

Neurovascular assessment — checking the 6 Ps (Pain, Pallor, Pulselessness, Paresthesia, Paralysis, Poikilothermia) — is the priority because traction can impair circulation or nerve function.

A client had a left-sided stroke with resulting right-sided hemiplegia. When assisting with meals, the LPN should:

Answer: Place food on the left side of the tray within the client's visual field

Left hemisphere stroke often causes right-sided visual field deficits (right homonymous hemianopia). Placing food on the intact left visual field enables the client to see and reach food safely.

A client with a cervical spine injury at C5-C6 is being bathed. Which finding requires the LPN to stop and immediately notify the charge nurse?

Answer: Sudden severe headache, sweating above the injury, and bradycardia

These are classic signs of autonomic dysreflexia, a life-threatening condition in clients with SCI at T6 or above, caused by an unrecognized stimulus below the injury level.

A client with osteoporosis is taught about fall prevention. Which statement indicates correct understanding?

Answer: I will remove loose rugs and install grab bars in my bathroom

Removing fall hazards (loose rugs, poor lighting) and installing safety equipment (grab bars, non-slip mats) directly reduces fracture risk in osteoporosis.

A client with Parkinson's disease is at risk for which complication requiring the highest nursing vigilance?

Answer: Aspiration pneumonia from dysphagia and choking

Dysphagia and slowed swallowing in Parkinson's disease significantly increase the risk of aspiration, which is a leading cause of morbidity and mortality in this population.

A client returns from hip replacement surgery. The LPN should position the client to prevent hip dislocation by:

Answer: Using an abduction pillow between the legs and avoiding crossing the legs

After total hip arthroplasty, dislocation is prevented by keeping the hip in abduction, avoiding adduction past midline, crossing legs, or flexing the hip beyond 90 degrees.

A client with multiple sclerosis (MS) is experiencing a relapse with worsening fatigue. The most important nursing intervention is:

Answer: Scheduling rest periods throughout the day and avoiding heat exposure

Fatigue management in MS includes scheduled rest, energy conservation techniques, and avoiding heat (Uhthoff's phenomenon), which worsens symptoms by slowing nerve conduction.

A client with Alzheimer's disease becomes agitated and combative during bathing. The LPN's best approach is to:

Answer: Stop the activity, allow the client to calm down, and attempt bathing later

Agitation in dementia is often a response to overwhelming stimuli or discomfort. The best person-centered approach is to stop, allow the client to de-escalate, and retry the task with a modified approach.

A client with a herniated lumbar disc (L4-L5) reports severe left leg pain radiating to the foot. The LPN recognizes this as:

Answer: Sciatica from nerve root compression

Radiating leg pain from herniated disc at L4-L5 compresses the sciatic nerve, causing sciatica — sharp, shooting pain that travels from the lower back down the leg to the foot.

A client after craniotomy for a brain tumor develops a blood pressure of 170/52 mmHg (widened pulse pressure), bradycardia of 48 bpm, and irregular respirations. The LPN recognizes this as:

Answer: Cushing's triad — a sign of increased intracranial pressure requiring immediate escalation

Cushing's triad (hypertension with widened pulse pressure, bradycardia, and irregular respirations) is a late sign of severely increased ICP and impending brain herniation.

A client with myasthenia gravis is admitted to the hospital. The LPN recognizes that a myasthenic crisis differs from a cholinergic crisis in that myasthenic crisis presents with:

Answer: Muscle weakness that improves with edrophonium (Tensilon) test

In myasthenic crisis, the Tensilon test shows temporary improvement in muscle strength because insufficient acetylcholine is reaching the neuromuscular junction.

A client with Guillain-Barré syndrome is being monitored in the hospital. Which assessment finding is the most critical?

Answer: Declining forced vital capacity and inability to cough effectively

Guillain-Barré syndrome causes ascending paralysis that can involve the respiratory muscles. Declining FVC and inability to cough signals impending respiratory failure requiring immediate intervention.

A client with a newly applied leg cast reports increasing pain, tingling, and tightness in the foot. The capillary refill time is 4 seconds. The LPN should:

Answer: Immediately notify the charge nurse — these signs suggest compartment syndrome

Increasing pain, paresthesia, pallor, and prolonged capillary refill (>3 seconds) with a cast are signs of compartment syndrome — a surgical emergency requiring fasciotomy if confirmed.

A client with a C4 spinal cord injury requires suctioning. The LPN should limit each suction pass to:

Answer: 5–10 seconds

Each suctioning pass should last no more than 10 seconds to minimize hypoxia and prevent vagal stimulation, which can cause life-threatening bradycardia in high SCI clients.

The LPN is caring for a client with a new diagnosis of amyotrophic lateral sclerosis (ALS). Which nursing diagnosis takes the highest priority?

Answer: Risk for aspiration related to bulbar involvement

Bulbar involvement in ALS causes dysphagia and dysarthria, dramatically increasing aspiration risk, which can cause pneumonia — the most common immediate cause of death in ALS.

A client with low back pain is being treated with muscle relaxants and NSAIDs. Which patient education point is most important?

Answer: Alcohol should be avoided while taking muscle relaxants due to CNS depression

Muscle relaxants cause CNS depression; combining them with alcohol significantly enhances sedation and can cause respiratory depression, falls, and dangerous intoxication.

A client with a spinal cord injury at T10 is being taught to perform intermittent self-catheterization. This client is ABLE to perform self-catheterization because:

Answer: Injury below T6 preserves upper extremity motor function needed for the procedure

A T10 spinal cord injury spares the cervical and thoracic motor function, preserving arm and hand function needed to perform intermittent self-catheterization.

During a post-fall neurological assessment, the nurse uses the Glasgow Coma Scale (GCS). A client opens eyes to voice, makes incomprehensible sounds, and withdraws from pain. The GCS score is:

Answer: 9

GCS: Eye opening to voice = 3, Verbal incomprehensible sounds = 2, Motor withdrawal = 4. Total = 9.

A client with rheumatoid arthritis (RA) asks about managing morning joint stiffness. The LPN's best recommendation is:

Answer: Take a warm shower or apply warm compresses to stiff joints before activity

Warm therapy (shower, warm compress) increases circulation and reduces viscosity of synovial fluid, helping relieve the characteristic morning stiffness of RA.

A client post-laminectomy is reporting increased back pain with new onset weakness in both legs and bladder incontinence. The LPN should:

Answer: Notify the charge nurse immediately — these signs suggest cauda equina syndrome

New bilateral leg weakness and bladder dysfunction after spinal surgery are hallmark signs of cauda equina syndrome — a neurosurgical emergency that can cause permanent paralysis and incontinence.