Deck 46: Nursing Care of Patients With Musculoskeletal and Connective Tissue Disorders

Question 1

The nurse is reinforcing teaching for a patient who has had a total hip replacement on correct sitting positions. Which position should the nurse teach the patient to avoid?

A)Elevating legs
B)Crossing legs
C)Flexing ankles
D)Extending knees

Answer 1

Crossing legs

Question 2

The nurse sees a neighbor fall and break a leg. What should the nurse do first for the neighbor?

A)Assess pain.
B)Immobilize the affected limb using minimal movement.
C)Transport to an emergency department.
D)Cover site of open fracture with clean dressing.

Answer 2

Immobilize the affected limb using minimal movement.

Question 3

The nurse is reinforcing teaching for a patient with gout. The selection by the patient of which of the following foods would indicate the need for additional teaching?

A)Perch
B)Sardines
C)Pike
D)Bass

Answer 3

Sardines

Question 4

The nurse is reinforcing teaching for gout. The nurse would evaluate a patient as understanding diet teaching for gout if the patient says that which one of these foods will be avoided?

A)Beets
B)Rice
C)Liver
D)Bananas

Question 5

The nurse is contributing to the plan of care for a patient who has systemic lupus erythematosus and recommends including Disturbed Body Image. Which of the following would be the appropriate long-term patient outcome for this diagnosis?

A)Verbalizes feelings about body changes
B)Returns to previous social involvement
C)Uses normal coping mechanisms
D)Engages in diversional activities.

Question 6

The nurse is reinforcing teaching for a patient who has been diagnosed with rheumatoid arthritis (RA). Which of these, if stated by a patient, indicates to the nurse correct understanding of symptoms of RA?

A)Fatigue
B)Paralysis
C)Shortness of breath
D)Crepitation

Question 7

The nurse is contributing to the plan of care for a patient who has Paget’s disease. Which of the following would be an appropriate outcome?

A) Identify coping skills.
B) Gain 5 lb weekly.
C) Pain is relieved at a satisfactory level.
D) Intake equals output.

Question 8

The nurse is contributing to the plan of care for a patient who has a fractured hip and is placed in Buck's (boot) traction while awaiting surgery. What is the desired outcome for placing the patient in Buck's traction?

A)Realign fracture.
B)Relieve patient pain.
C)Restrain patient.
D)Maintain fracture reduction.

Question 9

The nurse is caring for a patient who has a casted, fractured left leg and asks, "Why does my leg have to be elevated?" What would be the appropriate response?

A)"To allow the cast to dry evenly."
B)"To decrease swelling."
C)"To prevent cast cracking."
D)"To increase your comfort."

Question 10

The nurse is reinforcing teaching for a patient who has had a right total hip replacement. Which of the following statements by the patient would indicate a correct understanding of the teaching?

A)"Keep legs apart."
B)"Move right leg closer to the left leg."
C)"Do not bear any weight on the left leg."
D)"Lie prone in bed."

Question 11

The nurse is caring for a patient who has a 36-hour-old fractured femur and is in traction. Morphine 10 mg is ordered every 3 hours as needed. The patient had morphine, 10 mg IM, 3 hours ago and is reporting pain of 8. The patient is stable. Which of these actions would be appropriate for the nurse to take?

A)Give pain medication as ordered.
B)Hold medication.
C)Give pain medication in 30 minutes.
D)Notify the registered nurse.

Question 12

The nurse is caring for a patient who has had a right hip replacement. When turning the patient, a pillow is placed between the patient's legs to maintain which of these positions?

A)Flexion of the knees
B)Abduction of the thighs
C)Adduction of the hip joint
D)Hyperextension of the knees

Question 13

A patient has an open reduction of a radial fracture and is casted. Several hours after the operation, the patient reports a throbbing pain in the arm. What nursing action is essential for the nurse to take?

A)Administer analgesics as ordered.
B)Perform neurovascular checks.
C)Notify the physician immediately.
D)Reposition arm.

Question 14

The nurse is contributing to the plan of care for a patient who has an upper extremity amputation. The nurse understands that this can be more debilitating than a lower extremity amputation due to which of the following?

A)The upper extremity is more visible.
B)There is greater blood supply to the upper extremity.
C)The upper extremity is more specialized.
D)Prosthetic fitting is easier for the leg.

Question 15

The nurse is monitoring a patient with a casted left tibial fracture and a contusion of the thigh. The patient reports increasing pain in the left foot that has not been relieved by morphine injections. What should the nurse do?

A)Reposition the casted leg.
B)Ensure physician is immediately notified.
C)Repeat the morphine injection now.
D)Give a higher ordered dose of morphine.

Question 16

The nurse finds a 2-day postoperative patient who had a right total hip replacement lying supine with crossed legs. What observation should be made?

A)The right knee for crepitation
B)The left leg for internal rotation
C)The left leg for loss of function
D)The right leg for shortening

Question 17

The nurse is caring for a patient who has a closed reduction of the ulna with a cast applied. Later the patient reports left arm pain. What should the nurse do?

A)Administer an analgesic as ordered.
B)Perform neurovascular check on fingers.
C)Notify the physician immediately.
D)Pad the edges of the cast.

Question 18

The nurse is contributing to the plan of care for a patient who has a right fractured femur. What intervention would be essential to include in the plan of care to prevent fat emboli?

A)Maintain immobilization of the right leg.
B)Decrease dietary consumption of fats.
C)Encourage coughing and deep breathing hourly.
D)Perform passive range of motion on the right leg.

Question 19

The nurse is reinforcing teaching for a patient who has gout and takes allopurinol (Zyloprim). Which of these, if stated by a patient, indicates to the nurse correct understanding of the action of allopurinol?

A)"Increases formation of purines."
B)"Excretes proteins."
C)"Blocks formation of uric acid."
D)"Increases metabolism of purines."

Question 20

The nurse is caring for a patient who has a newly casted, fractured wrist. Data collection reveals slightly puffy fingers with good capillary refill. What should the nurse do now to prevent complications?

A)Apply heat to the cast.
B)Notify the RN.
C)Remove the pillow under the cast.
D)Elevate the cast on pillows.

Question 21

The nurse is caring for a patient in traction. What nursing action would be appropriate in caring for the traction weights? (Select all that apply.?

A)Allow weights to hang freely in place.
B)Hold weights up if the patient is shifting position in bed.
C)Remove weights if the patient is being moved up in bed.
D)Lighten weights for short periods if the patient reports pain.
E)Use assistance to reposition the patient in bed.

Question 22

The nurse is reinforcing teaching on positioning for a patient after a right total knee replacement. Which of the following statements by the patient would indicate a correct understanding of the teaching?

A)"Prone."
B)"Supine with pillow under right knee."
C)"Supine with three pillows between legs."
D)"Side lying."

Question 23

The nurse is caring for a patient who has a displaced midshaft fracture of the left femur and is in balanced suspension skeletal traction with 35 pounds of weights. The patient reports calf pain with right foot dorsiflexion. Which of the following actions would be most appropriate for the nurse to take?

A)Notify the RN.
B)Encourage dorsiflexion more frequently.
C)Check the traction setup.
D)Reduce 5 pounds of weight.

Question 24

The nurse is caring for a patient who has a fractured pelvis with a left acetabular fracture and is in a Thomas splint with a Pearson attachment with orders of bedrest. When the patient asks to toilet, which of these measures would be appropriate?

A)Ask patient to lift straight up using a trapeze mounted above the bed and slide a bedpan underneath from the right side.
B)Turn patient onto right side, place the bedpan behind, and turn back.
C)Help patient up on a commode very carefully.
D)Have patient sit up as high as possible and lift self up with hands pushing on the bed, then slide the bedpan underneath.

Question 25

The nurse is caring for a patient with gout. Which of the following laboratory values would indicate that the treatment plan was effective?

A)Blood urea nitrogen: 15 mg/dL
B)Creatinine: 0.8 mg/dL
C)Uric acid: 7.9 mg/dL
D)Low-density lipoprotein (LDL): 115 mg/dL

Question 26

The nurse is reinforcing teaching for carpal tunnel syndrome treatment. Which of the following statements by the patient would indicate a correct understanding of the teaching?

A)"Bedrest."
B)"Hand exercises."
C)"Wrist splint."
D)"Arm sling."

Question 27

The nurse is reinforcing teaching for a patient who is using a continuous passive motion (CPM) machine. Which of these, if stated by the patient, indicates to the nurse correct understanding of its purpose?

A)"To control pain."
B)"To relieve foot swelling."
C)"To strengthen leg muscles."
D)"To restore joint function."

Question 28

The nurse checks a casted right leg resting upon a pillow and finds that the cast appears too tight. What should the nurse do?

A)Remove the pillow under the cast.
B)Apply an extra blanket to the leg.
C)Administer pain medication.
D)Notify the registered nurse.

Question 29

The nurse is reinforcing teaching for a patient with osteoporosis. Which of the following should the nurse recommend be included in the patient's plan of care as a risk factor for osteoporosis development?

A)Increased dairy food intake
B)Daily use of antacid
C)Increased caffeine intake
D)Walking 1 mile daily

Question 30

The nurse has reinforced medication teaching with a patient who has rheumatoid arthritis. Which of these medications, if stated by the patient, indicates to the nurse correct understanding of symptom control with a medication?

A)"Digoxin."
B)"Ibuprofen."
C)"Morphine."
D)"Penicillin."

Question 31

The nurse is providing care to an 87-year-old female with a history of osteoarthritis. The patient reports an average generalized pain score of 4 on a 0-to-10 scale wile using acetaminophen prn. Which of the following statements by the nurse is best?

A)"Research shows that acetaminophen is not really effective for osteoarthritis pain."
B)"Are you satisfied with this level of pain control?"
C)"Do you take a daily calcium supplement?"
D)"I'm glad the acetaminophen is working for you."
Multiple Response
Identify one or more choices that best complete the statement or answer the question.

Question 32

The nurse is reinforcing teaching for a patient who has osteoporosis and is being taught complications that can occur from osteoporosis. Which of these, if stated by the patient, indicates to the nurse correct understanding of a complication of osteoporosis?

A)"Hip fracture."
B)"Increased bone density."
C)"Overgrowth of bone."
D)"Bone spur formation."

Question 33

The nurse understands when collecting data on a patient that the appearance of a petechial rash and respiratory distress 3 days after a fracture of the femur are indications of which of these complications?

A)Infection
B)Pleural effusion
C)Pneumonia
D)Fat embolism

Question 34

The nurse is reinforcing teaching for a patient who is postmenopausal, has lost 2 inches of height, and has osteoporosis. Which of these, if stated by a patient, indicates to the nurse correct understanding of the purpose of calcium supplements?

A)To decrease bone loss
B)To increase energy levels
C)To increase excretion of calcium
D)To decrease serum calcium

Question 35

The nurse is collecting data for a patient suspected of developing a fat embolus from a fracture of the right femur. Which of these manifestations would the nurse expect? (Select all that apply.?

A)Mental confusion
B)A migraine
C)Numbness in the right leg
D)Muscle spasms in the right thigh
E)Petechiae
F)Tachycardia

Question 36

The nurse is contributing to the plan of care for a patient who has a bone fracture that is splintered or shattered into numerous fragments. Which of the following describes this type of fracture?

A)Avulsion
B)Greenstick
C)Comminuted
D)Impacted

Question 37

The nurse has reinforced teaching with a patient who has an open fracture of the right leg about prevention of osteomyelitis. Which of the following statements by the patient would indicate a correct understanding of the teaching?

A)"Wash hands prior to touching fracture area."
B)"Increase calcium intake in diet."
C)"Keep leg immobilized."
D)"Apply ice to right leg."

Question 38

Which of the following are manifestations that are characteristic of rheumatoid arthritis and help distinguish it from osteoarthritis? (Select all that apply.?

A)Early morning stiffness
B)Heberden's nodes
C)Activity increases pain
D)Low-grade fever
E)Involvement of other major organs
F)Autoimmune disease

Question 39

The nurse, when collecting data on a patient 48 hours after surgery for a fractured femoral shaft, notes mental confusion, tachycardia and tachypnea, dyspnea, high blood pressure, and petechiae on the chest and reports the findings to the RN. What nursing interventions are appropriate while awaiting the physician's specific orders? (Select all that apply.?

A)Place patient in high Fowler's position or raise the head of the bed.
B)Ask patient to move affected limb to see if pain is worse.
C)Prepare patient for chest x-ray or lung scan.
D)Maintain bedrest and keep movement to a minimum.
E)Administer oxygen.
F)Prepare patient for arterial blood gas tests.

Question 40

The nurse is contributing to the plan of care for a patient who is scheduled for a below-the-knee amputation. What nursing diagnosis should be recommended for the preoperative plan of care?

A)Fluid Volume Deficit
B)Anxiety
C)Ineffective Airway Clearance
D)Self-Care Deficit

Question 41

The nurse is contributing to the plan of care for a patient who has received a total hip replacement. Which of the following exercises should the nurse recommend to help prevent deep vein thrombosis (DVT) formation? (Select all that apply.?

A)Straight leg raises (SLRs)
B)Deep knee bends
C)Foot circles
D)Heel pumping
E)Quadriceps setting
F)Toe touches
Completion
Complete each statement.

Question 42

The nurse is collecting data for a patient who has osteogenesis imperfecta. Which of the following signs and symptoms would the nurse expect? (Select all that apply.?

A)Blue, purple, or gray tint to sclera
B)Increased height
C)Triangle-shaped face
D)Thickening of skin tissue
E)Brittle or discolored teeth
F)Scoliosis

Question 43

The nurse is caring for a patient who has a flare of systemic lupus erythematosis. Prednisone, 60 mg PO, in three equal doses has been prescribed. Prednisone is available as 1-mg, 2.5-mg, and 5-mg tablets. The nurse should administer ________________5-mg tablets three times each day.

Question 44

The nurse is reinforcing patient teaching on the characteristics of scleroderma. Which of the following statements by the patient would indicate a correct understanding of the teaching? (Select all that apply.?

A)"Tissue inflammation caused by abnormal antibodies."
B)"Butterfly rash."
C)"Taut, shiny skin."
D)"Pitting edema."
E)"Telangiectasia."
F)"Muscle weakness."