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

Question 1

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

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

Answer 1

Immobilize the affected limb using minimal movement.

Question 2

The nurse is reinforcing teaching provided to a patient with rheumatoid arthritis (RA).Which patient statement indicates understanding of the symptoms of RA?

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

Answer 2

Fatigue

Question 3

The nurse is contributing to the plan of care for a patient who has an upper extremity amputation.Why should the nurse keep in mind that this type of amputation can be more debilitating than a lower extremity amputation when planning care?

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

Answer 3

The upper extremity is more specialized.

Question 4

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

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

Question 5

The nurse is reinforcing teaching provided to a patient recovering from right total hip replacement.Which patient statement indicates a correct understanding of the teaching?

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

Question 6

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

Question 7

The nurse is evaluating teaching provided to a patient with gout.Which patient menu selection indicates that additional teaching is required?

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

Question 8

The nurse is caring for a patient who has had a right hip replacement.For which position is the nurse attempting to achieve when a pillow is placed between the legs during turning?

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

Question 9

A patient with a 36-hour-old fractured femur is in traction and is prescribed morphine 10 mg every 3 hours as needed.The patient received a dose 3 hours ago and is now reporting a pain level of 8.The patient is stable.Which action should the nurse take?

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

Question 10

The nurse observes a petechial rash and respiratory distress in a patient recovering from a fractured femur.What should these findings suggest to the nurse?

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

Question 11

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

Question 12

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

Question 13

A patient with a casted,fractured left leg asks why the leg has to be elevated.What should the nurse respond to this patient?

A) "Decreases swelling."
B) "Prevents cast cracking."
C) "Increases your comfort."
D) "Allows the cast to dry evenly."

Question 14

A patient with gout has been instructed on the prescribed medication allopurinol (Zyloprim).Which patient statement indicates understanding of the action of this medication?

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

Question 15

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

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

Question 16

The nurse is reinforcing teaching provided to a patient with gout.Which food should the patient state will be avoided that indicates teaching has been effective?

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

Question 17

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

Question 18

The nurse is contributing to the plan of care for a patient with Paget's disease.Which outcome should the nurse identify as being appropriate for this patient?

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

Question 19

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

Question 20

The nurse finds a 2-day postoperative patient who had a right total hip replacement lying supine with crossed legs.What data should the nurse collect on this patient?

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

Question 21

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

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

Question 22

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

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

Question 23

The nurse reinforces medication teaching provided to a patient with rheumatoid arthritis.Which medication should the patient identify as helpful to control the symptoms of the health problem?

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

Question 24

An 87-year-old female with a history of osteoarthritis reports an average generalized pain score of 4 on a 0-to-10 scale while using acetaminophen prn.Which response about this pain level should the nurse make to the patient?

A) "Do you take a daily calcium supplement?"
B) "I'm glad the acetaminophen is working for you."
C) "Are you satisfied with this level of pain control?"
D) "Research shows that acetaminophen is not really effective for osteoarthritis pain."

Question 25

A patient who has a displaced mid-shaft fracture of the left femur and is in balanced suspension skeletal traction with 35 pounds of weights is experiencing calf pain with right foot dorsiflexion.Which action should the nurse take?

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

Question 26

The nurse is reinforcing teaching provided to a patient for carpal tunnel syndrome treatment.Which patient statement indicates a correct understanding of the teaching?

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

Question 27

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

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

Question 28

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

Question 29

The nurse reinforces teaching on prevention of osteomyelitis with a patient who has an open fracture of the right leg.Which patient statement indicates that teaching has been effective?

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

Question 30

A patient is diagnosed with osteomyelitis of the right lower leg.What should the nurse expect to be prescribed for this patient's care?

A) Anticoagulant therapy
B) Casting of the extremity
C) Fasciotomy of the wound
D) Long-term antibiotic therapy

Question 31

The nurse is reviewing data collected during the health history for a patient with osteoporosis.What should the nurse identify as a risk factor for osteoporosis development?

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

Question 32

A patient is completing instructions about complications that can occur from osteoporosis.Which complication should the patient state as evidence that teaching has been effective?

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

Question 33

A patient 48 hours after surgery for a fractured femoral shaft is experiencing mental confusion,tachycardia,tachypnea,and dyspnea.The patient's blood pressure is elevated and petechiae are present on the chest.After reporting the findings to the RN what should the nurse do while awaiting the physician's specific orders? (Select all that apply.)

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

Question 34

The nurse is caring for a patient in traction.Which actions are appropriate when caring for this patient? (Select all that apply.)

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

Question 35

The nurse is contributing to the plan of care for a patient who has a bone fracture that is splintered and has shattered into numerous fragments.Which term should the nurse use to document this type of fracture?

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

Question 36

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

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

Question 37

The nurse is caring for a patient with gout.Which laboratory value should the nurse review which indicates that the treatment plan is effective?

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

Question 38

A patient asks the difference between osteoarthritis and rheumatoid arthritis.What manifestations should the nurse explain are characteristic of rheumatoid arthritis? (Select all that apply.)

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

Question 39

The nurse is reinforcing teaching on positioning for a patient after a right total knee replacement.Which patient statement indicates a correct understanding of the teaching?

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

Question 40

A patient with a fractured pelvis and a left acetabular fracture is prescribed bedrest.When the patient asks to toilet,which measure would be appropriate?

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

Question 41

During a health history the nurse becomes concerned that a patient is at risk for developing osteoporosis.Which modifiable risk factors did the nurse use to come to this conclusion? (Select all that apply.)

A) Small boned
B) Postmenopausal
C) Cigarette smoking
D) Sedentary lifestyle
E) Low calcium intake

Question 42

The nurse is caring for a patient with a minor rotator cuff shoulder injury.What should the nurse emphasize when reviewing care with this patient? (Select all that apply.)

A) Apply ice
B) Rest the shoulder
C) Take NSAIDs as prescribed
D) Begin out-patient physical therapy
E) Use 2 lb hand weights for exercising

Question 43

The nurse is assisting in the development of an educational seminar on prevention of osteoporosis for a group of community members.Which actions should the nurse suggest be included in this presentation? (Select all that apply.)

A) Drink one cup of caffeinated coffee each day
B) Ensure an adequate intake of calcium each day
C) Participate in weight-bearing exercise every day
D) Wear well-supporting nonskid shoes at all times
E) Consider participating in resistance exercise training

Question 44

A patient in the ambulatory clinic is diagnosed with a muscle strain.What actions should the nurse instruct the patient to do to treat this injury? (Select all that apply.)

A) Rest the limb.
B) Elevate the limb.
C) Apply heat for 1 hour.
D) Apply ice to the area.
E) Wrap with an elastic bandage.