Deck 32: Care of Patients with Musculoskeletal and Connective Tissue Disorders

Question 1

A patient presents to the emergency department immediately after an injury.An x-ray has been ordered for a suspected dislocation.Before confirmation by x-ray,which finding(s)support the potential diagnosis?

A) History of forceful injury
B) Purple-black hematoma over joint
C) Severe pain, aggravated by motion
D) Muscle spasm
E) Abnormal appearance of joint

Answer 1

History of forceful injury
Severe pain, aggravated by motion
Muscle spasm
Abnormal appearance of joint

Question 2

Which major advantage is specific to external fixation devices?

A) Faster healing time
B) Allowance for immediate weight bearing
C) Greater freedom of movement
D) Pain reduction

Answer 2

Greater freedom of movement

Question 3

The nurse is caring for a patient who works as a legal secretary.The patient asks the nurse about ways to avoid developing carpal tunnel syndrome (CTS).Which action should the nurse suggest?

A) "Exercise your wrists with repetitive flexion movements nightly."
B) "Wrap your wrists with elastic bandages."
C) "Acquire a pad to support your wrists while typing."
D) "Apply warm compresses to wrists every evening."

Answer 3

"Acquire a pad to support your wrists while typing."

Question 4

The nurse is instructing a patient with rheumatoid arthritis about a prescribed exercise program.Which information should the nurse include?

A) Perform exercises every day, 3 to 10 times for every joint.
B) Perform exercises even if inflammation is present.
C) Perform exercises past the point of pain.
D) Perform twice the number of exercises the next day if one day is missed.

Question 5

A patient has come to the ambulatory care clinic with a sprain.The nurse correctly differentiates a grade 2 sprain from a grade 3 sprain with the assessment of which finding?

A) Pain
B) Swelling
C) Bleeding into the joint
D) Minor loss of function

Question 6

Which vitamin is essential in treating osteoporosis?

A) Vitamin A
B) Vitamin D
C) Vitamin B₁₂
D) Vitamin C

Question 7

When the clinic nurse starts to take the "air cast" off the grade 2 sprain,the patient asks why it is being removed since he still has pain.Which explanation is best?

A) "Long-term immobilization can interfere with adequate circulation."
B) "Long-term immobilization may increase long-term edema."
C) "Long-term immobilization can cause permanent disability."
D) "This cast will be replaced with a heavier cast."

Question 8

The patient with osteoporosis calls the nurse in the doctor's office to report that she should have taken but has forgotten to take her weekly bisphosphonate (alendronate [Fosamax])that was due 2 days ago.How should the nurse advise the patient?

A) "Take the dose now with 8 ounces of water."
B) "Take two doses 3 days apart."
C) "Skip this week and pick up the schedule next week."
D) "Take two tablets now with a snack."

Question 9

The nurse is performing an assessment on the patient who is in bilateral Buck traction.Which finding indicates the need to reposition the patient?

A) The patient's heels are not touching the surface of the mattress.
B) The elastic bandages need to be rewrapped.
C) The patient's feet are against the footboard.
D) The weights are hanging free.

Question 10

A patient in Russell traction with a Pearson attachment for a fracture of the tibia complains of intense pain at the fracture site.The nurse assesses a temperature of 102° F and increased swelling at the fracture site.Which complication do these findings suggest?

A) Osteomyelitis
B) Fat embolism
C) Traction misalignment
D) Nonunion of the fracture

Question 11

Soft-tissue injuries require the nurse to assist with or instruct about the importance of which components of care?

A) Bed rest
B) Pain control
C) Immobilization
D) Activity restrictions
E) Prevention of recurrence

Question 12

Which statement indicates that the patient needs further instruction about application of ice to a sprain?

A) "I know this ice will reduce the swelling."
B) "I will keep the ice on this knee for the rest of the day."
C) "I will use the ice as you have directed for 24 hours."
D) "I can elevate my leg and use ice to reduce swelling."

Question 13

Carpal tunnel syndrome (CTS)is caused when the carpal tunnel compresses which location?

A) Radial artery
B) Brachial artery
C) Median nerve
D) Ulnar nerve

Question 14

The nurse is caring for a patient who just returned from surgical decompression of the carpal tunnel.Which finding requires the nurse's immediate action?

A) The patient's fingers swollen and warm.
B) The patient complains of generalized pain 5/10.
C) The capillary refill time is 8 seconds.
D) The patient's fingers are pink and cool bilaterally.

Question 15

The nurse is performing morning care for a patient who sustained a fractured pelvis and bilateral femur fractures yesterday in a motorcycle collision.The patient complains of shortness of breath.Assessment reveals audible wheezes and oxygen saturation of 76%.What action should the nurse take first?

A) Establish a peripheral intravenous (IV) line.
B) Inform the charge nurse.
C) Explain the patient's change in status to his family.
D) Raise patient to high Fowler position.

Question 16

An 80-year-old man falls and suffers a compound fracture of the femur.Which immediate action is most appropriate?

A) Position him flat on his back.
B) Apply a tourniquet on the leg.
C) Carefully splint the leg as it is.
D) Carefully straighten the leg.

Question 17

When caring for a patient who has an abductor wedge in place after a total hip replacement,for which finding should the nurse assess?

A) Muscle spasms
B) Alteration in peripheral circulation
C) Compression fracture
D) Appropriateness of the size of the wedge

Question 18

The industrial nurse examines an employee who complains of right shoulder pain on abduction.He points with one finger to the exact location of the pain and mentions that he won a racquetball tournament yesterday.The nurse suspects the employee is suffering from which problem?

A) Rotator cuff tear
B) Bursitis
C) Dislocation
D) Subluxation

Question 19

The patient in a long arm cast (from below the shoulder to the wrist,with a 90-degree elbow flexion)complains of a burning sensation over the elbow.The nurse's initial intervention should be:

A) Elevate the casted arm on pillows.
B) Check to see if the cast is properly supported.
C) Notify the charge nurse of developing pressure ulcer.
D) Cut a "window" in the cast.

Question 20

An older adult has fallen and sprained his ankle in a local park.Which action should the responder perform first?

A) Elevate the foot.
B) Apply ice.
C) Administer aspirin.
D) Assist the patient with ambulation.

Question 21

Match the fracture type to the description that characterizes it.

Bone shattered in more than two pieces

A)Complete fracture
B)Comminuted fracture
C)Closed fracture
D)Compound fracture
E)Greenstick fracture

Question 22

Match the type of fracture stabilization with the characteristics that best describe it.(The options can be used once, more than once, or not at all.)

Used with older adults when brittle bones do not heal quickly

A)Closed reduction
B)Open reduction
C)Internal fixation
D)External fixation

Question 23

Match the fracture type to the description that characterizes it.

Fracture that has not broken through skin

A)Complete fracture
B)Comminuted fracture
C)Closed fracture
D)Compound fracture
E)Greenstick fracture

Question 24

Match the type of fracture stabilization with the characteristics that best describe it.(The options can be used once, more than once, or not at all.)

Used with infected fractures that do not heal properly

A)Closed reduction
B)Open reduction
C)Internal fixation
D)External fixation

Question 25

Match the fracture type to the description that characterizes it.

Bone is partially broken and partially bent

A)Complete fracture
B)Comminuted fracture
C)Closed fracture
D)Compound fracture
E)Greenstick fracture

Question 26

Match the fracture type to the description that characterizes it.

Bone that is in two distinct pieces

A)Complete fracture
B)Comminuted fracture
C)Closed fracture
D)Compound fracture
E)Greenstick fracture

Question 27

Match the type of fracture stabilization with the characteristics that best describe it.(The options can be used once, more than once, or not at all.)

Reduction of fracture and fixation to device that maintains alignment

A)Closed reduction
B)Open reduction
C)Internal fixation
D)External fixation

Question 28

Place the steps of the process of fracture healing in proper order.

Step 3

A)Medullary canal is reconstructed.
B)Mature bone cells form ossification.
C)Callus is formed.
D)Granulation tissue is formed.
E)Hematoma is formed between broken ends of bone.

Question 29

The nurse suspects compartment syndrome in a patient with a side arm cast and traction when observing which finding(s)?

A) Warm, rosy fingers
B) Intense pain in hand and fingers
C) Edema of fingers
D) Weak radial pulse
E) Tingling and numbness

Question 30

Which statement(s)accurately describe the advantage(s)of fiberglass casts?

A) Lighter weight
B) Allowance of weight bearing after 30 minutes
C) Cheaper
D) Dries more quickly
E) Easily pliable
F) Smooth surface that is less abrasive to skin

Question 31

Place the steps of the process of fracture healing in proper order.

Step 2

A)Medullary canal is reconstructed.
B)Mature bone cells form ossification.
C)Callus is formed.
D)Granulation tissue is formed.
E)Hematoma is formed between broken ends of bone.

Question 32

Match the type of fracture stabilization with the characteristics that best describe it.(The options can be used once, more than once, or not at all.)

Manual reduction and manipulation of bones into alignment

A)Closed reduction
B)Open reduction
C)Internal fixation
D)External fixation

Question 33

Match the type of fracture stabilization with the characteristics that best describe it.(The options can be used once, more than once, or not at all.)

Metal appliances are used to stabilize pieces of fracture

A)Closed reduction
B)Open reduction
C)Internal fixation
D)External fixation

Question 34

Match the type of fracture stabilization with the characteristics that best describe it.(The options can be used once, more than once, or not at all.)

Reduction of fracture through surgical incision

A)Closed reduction
B)Open reduction
C)Internal fixation
D)External fixation

Question 35

The nurse explains that the "C" in the acronym RICE for sprain treatment stands for _______.

Question 36

Place the steps of the process of fracture healing in proper order.

Step 1

A)Medullary canal is reconstructed.
B)Mature bone cells form ossification.
C)Callus is formed.
D)Granulation tissue is formed.
E)Hematoma is formed between broken ends of bone.

Question 37

The patient is returning to the unit with a wet long leg cast.To prevent damage to the wet cast,what action(s)should the nurse take?

A) Determine the cast material.
B) Prop the casted limb on a footboard and elevate it until the cast is dry.
C) Support the cast with the palms of the hands rather than holding it with the fingers.
D) Assess heat generated from the drying cast.
E) Explain that the cast has dried when it acquires a grayish color.

Question 38

The nurse is educating a patient going home with a short arm synthetic cast.Which instructions should the nurse include in the teaching plan?

A) Cover the cast with a plastic bag when taking a shower.
B) Blow warm air into the cast to relieve itching.
C) Observe skin at the edge of the cast for irritation or injury.
D) Check circulation and sensation in the fingers frequently.
E) Move and flex the fingers to stimulate circulation.

Question 39

Match the fracture type to the description that characterizes it.

Fracture bone end protruding through skin

A)Complete fracture
B)Comminuted fracture
C)Closed fracture
D)Compound fracture
E)Greenstick fracture

Question 40

The nurse uses a visual aid to show the difference between a complete dislocation and a partial dislocation,which is also called a(n)__________.

Question 41

Place the steps of the process of fracture healing in proper order.

Step 5

A)Medullary canal is reconstructed.
B)Mature bone cells form ossification.
C)Callus is formed.
D)Granulation tissue is formed.
E)Hematoma is formed between broken ends of bone.

Question 42

Place the steps of the process of fracture healing in proper order.

Step 4

A)Medullary canal is reconstructed.
B)Mature bone cells form ossification.
C)Callus is formed.
D)Granulation tissue is formed.
E)Hematoma is formed between broken ends of bone.