Deck 27: Musculoskeletal Care

Question 1

A nursing instructor recognizes that teaching has been effective if a student who is providing care for a patient with right-sided weakness reports:

A) "The top of the cane is level with the iliac crest."
B) "The patient is holding the cane in the right hand."
C) "The top of the cane is even with the patient's hip joint."
D) "The base of the cane is even with the tip of the patient's shoe."

Answer 1

"The top of the cane is even with the patient's hip joint."

Question 2

While checking on students who are caring for patients on an orthopedic unit, a nursing instructor would be most concerned if

A) A student assists a patient with a left hip replacement turn to the left side.
B) A student caring for a patient with a right knee replacement assists with continuous passive motion (CPM).
C) A student is noted inserting an abduction pillow between the legs of a patient with right hip replacement.
D) A student uses sterile technique to provide site care to tongs for a patient with cervical traction.

Answer 2

A student assists a patient with a left hip replacement turn to the left side.

Question 3

Which of the following assessments would be most concerning to a nurse caring for a patient who was recently admitted to the unit after a right knee replacement?

A) Pedal pulses on the operative side are weak compared with those on the nonoperative side.
B) A small amount of serosanguineous drainage is noted on the dressing.
C) The intravenous pump is infusing normal saline at 100 mL/hr.
D) The patient has a Foley catheter that is draining clear yellow urine.

Answer 3

Pedal pulses on the operative side are weak compared with those on the nonoperative side.

Question 4

While caring for a patient who is on a continuous passive motion machine (CPM) after a total knee replacement, a nurse notices that the patient is grimacing. Pain medication is not due for 2 hours, but the CPM machine is supposed to continue for another 20 minutes. The best action by the nurse is to

A) Call the physician for additional pain medication.
B) Encourage the patient to bear it for 20 minutes longer.
C) Instruct the patient to tense and then relax his or her leg muscles.
D) Teach the patient relaxation techniques.

Question 5

One indication that a continuous passive motion (CPM) machine was set up incorrectly would be

A) The break in the platform is centered beneath the patient's knee.
B) The motion of the CPM is causing severe pain.
C) The machine is in line with the patient's hip.
D) The flexion is set to 80 degrees.

Question 6

A motor vehicle accident resulting in a comminuted fracture of the right fibula has left a patient's right leg shorter than the left. A nurse identifies that bone lengthening can be stimulated by using

A) Plaster casting.
B) Skin traction.
C) An Ilizarov frame.
D) Internal fixators.

Question 7

The potential need for amputation will most likely be discussed as part of the medical and surgical care for

A) A 27-year-old with a comminuted fracture of the left femur from a car accident.
B) A 64-year-old with gangrene of the left foot due to decreased circulation.
C) A 71-year-old with arthritis in both knees.
D) A 54-year-old with a newly developed diabetic foot ulcer.

Question 8

A nursing instructor is evaluating elastic bandages applied to the ankle in a skills laboratory. The nursing instructor recognizes that additional teaching is needed because

A) The wrap has a crisscross pattern across the top of the foot.
B) The wrap progresses down the limb at a 45-degree angle.
C) The wrap comes around the inner ankle and behind the leg.
D) The wrap comes around the outer ankle and then across the top of the foot to the instep.

Question 9

A nurse caring for patients on an orthopedic unit should be most concerned by

A) A patient reporting pain at a 2 on a 0 to 10 scale.
B) A patient reporting itching under a plaster cast.
C) Redness and purulent drainage at an external pin site.
D) A patient with a hip replacement ambulating with assistance.

Question 10

While providing care for a patient with skeletal traction to the right leg, a nurse would report which of the following observations to the physician?

A) The patient turns toward the right to answer the phone.
B) Traction weights hang freely.
C) Traction ropes are not crossing.
D) Purulent drainage is noted at the pin site.

Question 11

A patient with a plaster cast tells the nurse, "This thing itches like crazy, and it is making me nuts." The best response by the nurse is:

A) "The cast itches because air is trapped between the cast and your skin."
B) "Try to ignore that. The cast will be off in a few weeks."
C) "Sometimes using a hair dryer on the cool setting to blow air down the cast can relieve itching."
D) "Itching is a sign of infection. Let me take your temperature."

Question 12

A 15-year-old football player is diagnosed with a bad sprain. A nurse recognizes that the injury involves

A) Torn ligaments.
B) A fine crack in the anklebone.
C) Injury to a long bone.
D) Damage to cartilage tissue.

Question 13

As a nurse enters the room of a patient who has had an amputation, the nurse notes that the patient is crying. The best response by the nurse is to

A) Say, "I'm here if you'd like to talk," while standing close to the patient's bed.
B) Say, "I'll leave you alone for a little while," while leaving the room.
C) Ask, "Is there someone you'd like me to call?" while picking up the phone.
D) Say, "Everyone feels this way at first, but it will get easier," while patting the patient's shoulder.

Question 14

A student nurse is providing care for a patient who is returning from the recovery room after a total hip replacement. During an initial assessment, the student notes serosanguineous drainage on the dressing. The student should

A) Remove the dressing and assess the wound site.
B) Draw a line around the drainage and write the time, date, and his or her initials on the dressing.
C) Notify the nursing instructor of the finding.
D) Document the finding in the chart.

Question 15

A nurse is caring for a patient with an order for non-weight-bearing to the left leg. Which of the following would indicate that the patient is using the correct crutch gait?

A) The patient moves one foot and the opposite crutch forward at the same time.
B) The patient moves the first crutch forward and then the opposite foot forward.
C) The patient moves both crutches and the nonaffected foot forward at the same time.
D) The patient moves both crutches forward at the same time and then swings both feet forward.

Question 16

Which of the following patients could successfully use a cane?

A) A 59-year-old with a left below-the-knee amputation
B) A 47-year-old with orders for non-weight-bearing on the left
C) A 69-year-old recovering from a stroke with mild right-sided weakness
D) A 70-year-old who cannot bear full weight on both legs

Question 17

A nurse is providing care for a patient with an Ilizarov frame. The nurse would chart:

A) "Rod, wires, and screw ring intact without evidence of redness or drainage."
B) "Pedaling performed to outer cast edge."
C) "Weight suspended at 90 degrees."
D) "Patient using abduction pillow as instructed."

Question 18

A nurse is assisting in the discharge of a patient who had a right hip replacement. Additional teaching is necessary if the patient states:

A) "I will need an extender to pick things up from the floor."
B) "I should keep a wide stance when I walk with my walker."
C) "I will have to bend way over to tie my shoes."
D) "I have to keep this special pillow between my legs when I'm sleeping."

Question 19

A student nurse approaches and asks a nurse to check and make sure the continuous passive motion (CPM) machine is correct before it is turned on. The most important action by the nurse is to

A) Verify that the sheepskin does not have any folds.
B) Stand at the foot of the bed to inspect the alignment.
C) Check to see whether the CPM machine is plugged in.
D) Ask the patient to rank his or her current level of pain.

Question 20

New crutches are the correct size if

A) The top of the crutch is 4 inches above the elbow.
B) The patient's arms are at 90 degrees when holding the handles.
C) The crutch tips are resting against the outer aspect of the patient's shoes.
D) Three fingers fit between the axilla and the axillary pad of each crutch.

Question 21

While caring for a patient with mild left-sided weakness who is using a walker for the first time, a nurse should make sure of which of the following?

A) The walker comes up to the patient's hip joint.
B) The patient grips the handles with his or her elbows at a 90-degree angle.
C) The patient stands behind the back legs of the walker.
D) The hand brakes are set before the patient sits in the seat.
E) The patient moves the affected leg forward with the walker, then moves the unaffected leg forward.

Question 22

A student nurse is assigned the care of a patient who is receiving skin traction. Which of the following does the student expect to observe?

A) A trapeze over the bed
B) A rope attached to a frame around the limb
C) A pin protruding from the limb
D) An elastic bandage wrapped around the limb
E) A suspended weight

Question 23

A patient has returned to the room after total hip replacement surgery. A nurse identifies that the correct immobilization device to keep the patient from accidentally moving the affected leg to or beyond the midline is a(n)

A) Abductor pillow.
B) Immobilizer.
C) Splint.
D) Elastic bandage.

Question 24

A patient who recently underwent knee replacement surgery has a suspected hairline fracture near the replaced joint. A nurse identifies that the correct type of diagnostic test for this patient would be a(n)

A) Bone scan.
B) Computed tomography (CT) scan.
C) Magnetic resonance imaging (MRI).
D) None of the above.

Question 25

A patient with a fractured leg is waiting to have surgery. To align the bone ends and prevent severe muscle spasm until surgery can be performed, a nurse should immobilize the patient using

A) Skeletal traction.
B) An immobilizer.
C) Skin traction.
D) An abductor pillow.

Question 26

A student nurse is caring for a patient who has been diagnosed with a cerebral vascular accident that resulted in right-sided weakness. In developing a plan of care that focuses on optimizing mobility, collaborative interventions should involve which of the following health-care team members?

A) Chaplain
B) Social worker
C) Physical therapist
D) Dietitian

Question 27

A student nurse is instructing a patient restricted to partial weight-bearing on the safe use of crutches. A nurse intervenes when she hears the student say:

A) "If the knee is flexed and the foot is held behind the crutches, it can affect your balance, causing you to fall backward."
B) "Since you are able to bear partial weight on the affected limb, you should use a two-point gait."
C) "Bearing weight on the axilla can cause compression of nerves and can lead to nerve damage affecting the arm and hand."
D) "When walking upstairs on crutches, you should place the affected leg on the step, then move up the crutches and the unaffected leg."
Multiple Response
Identify one or more choices that best complete the statement or answer the question.

Question 28

A patient is admitted for joint replacement surgery. A nurse identifies that this type of surgery is usually necessary due to

A) An amputated limb.
B) A comminuted fracture.
C) Advanced osteoarthritis.
D) A severe sprain.

Question 29

A student nurse is caring for a patient with a sprained ankle. An instructor says the acronym that should be used to help remember treatment for a sprain is

A) RIPE.
B) RICE.
C) RAMP.
D) HEAR.

Question 30

A patient arrives in the emergency department with a severe knee sprain. A nurse identifies that due to possible ligament and/or tendon damage, the correct type of diagnostic test for this patient would be a(n)

A) X-ray.
B) Computed tomography (CT) scan.
C) Magnetic resonance imaging (MRI).
D) Bone scan.

Question 31

After wrapping a stump with an elastic wrap for a patient who had an amputation 4 days earlier, a nurse would do which of the following?

A) Monitor for capillary refill.
B) Assess for pain or numbness.
C) Slip two fingers under the proximal end.
D) Dangle the limb on the side of the bed for 20 minutes.
E) Encourage the patient to soak the limb.

Question 32

While caring for a client with a newly placed plaster leg cast, a nurse should do which of the following?

A) Assess the toes for capillary refill.
B) Elevate the casted limb on pillows.
C) Handle the cast with the palms of the hand.
D) Lift the cast by gripping the ankle.
E) Teach the patient to use a nail file to scratch under the cast.

Question 33

In a long-term care setting, a nurse should do which of the following to help promote mobility in a patient's home?

A) Use the continuous passive motion (CPM) machine.
B) Evaluate the patient's need for physical therapy.
C) Ambulate joints beyond 90 degrees as quickly as possible.
D) Follow activity orders.
E) Encourage the patient to lie down as much as possible.

Question 34

An 8-year-old patient has a new cast for a hairline fracture of the radius. The child asks a nurse, "How long do I have to wear this?" The nurse's best response would be:

A) "It depends how fast your bones grow back together."
B) "The doctor will be able to tell you all about it before you leave."
C) "Don't worry. Before you know it, you'll be playing soccer again."
D) "Most broken bones take at least 4 weeks to heal all the way."

Question 35

When performing a neurovascular check, a nurse should do which of the following?

A) Ask the patient if he or she is experiencing numbness, burning, or tingling in the affected limb.
B) Test sensation of the affected and unaffected limbs by touching each with a paper clip.
C) Ambulate the affected limb to check for mobility.
D) Ask the patient to move the fingers or toes of the affected extremity.
E) Test capillary refill in the nailbeds of the fingers or toes distal to the surgical site or cast.