Deck 4: Care of the Patient With a Musculoskeletal Disorder

Question 1

A patient, age 24, has a compartment syndrome after a fracture of his radius and ulna. Nursing assessment will include careful observation for signs and symptoms of

A) buccal petechiae.
B) thromboembolism.
C) Volkmann's contracture.
D) fat embolism.

Answer 1

Volkmann's contracture.

Question 2

Which diagnostic exam is used to find pathological abnormalities of the brain?

A) CT scan
B) Nuclear medicine scan
C) MRI
D) Radiograph

Answer 2

MRI

Question 3

A patient has sustained a fractured femur in a car accident. The physician has stated concern about the possibility of a fat embolism. The patient's wife asks the nurse about the cause of a fat embolism. The nurse's most appropriate response would be

A) "Arterial blood flow is interrupted at the site of injury."
B) "Floating fat sometimes causes problems."
C) "The break in the bone forces molecules of fat into the bloodstream."
D) "We don't know the cause. We just know that it sometimes happens."

Answer 3

"The break in the bone forces molecules of fat into the bloodstream."

Question 4

A patient, age 18, has multiple soft tissue injuries from a bicycle accident. Primary medical management for soft tissue injuries includes

A) rest and heat to control edema.
B) elevation and ice to control edema.
C) immediate immobilization to halt pain.
D) aspiration of excessive fluid.

Question 5

The movement of an extremity away from the midline of the body is called

A) abduction.
B) adduction.
C) flexion.
D) extension.

Question 6

The term unicompartmental knee arthroplasty is also referred to as

A) partial knee replacement.
B) removal of the kneecap.
C) total knee replacement.
D) total knee replacement bilaterally.

Question 7

A patient, age 45, has worked as a basket weaver for the past 10 years. She is being seen at the clinic for symptoms of carpal tunnel syndrome. Collection of subjective data might include

A) complaints of burning pain or tingling in the hands.
B) edema of the fingers.
C) radicular pain.
D) complaints of weight loss and fatigue.

Question 8

Which nursing intervention would be appropriate for a patient with rheumatoid arthritis?

A) Sleeping at least 8 hours at night and a nap during the day
B) Sleeping at 4-hour intervals at night
C) No exercise regimen and apply ice to joints as needed
D) Jogging at least 20 minutes three days a week

Question 9

A patient, age 79, fell at home and suffered an intracapsular fracture of his left hip. The orthopedic surgeon inserted a prosthetic implant for a bipolar hip replacement. The physician has instructed the nurse to turn him every 2 hours. The nurse understands that the correct nursing intervention is to keep the legs

A) together so they don't separate while turning.
B) from rubbing together.
C) abducted so the prosthesis does not become dislocated.
D) abducted to prevent additional pain for the patient with turning.

Question 10

A patient, age 89, has had a right below-the-knee amputation. He is progressing well but continues to complain of pain in the toes on his right foot. The physician told him that he is suffering from "phantom pain" in his amputated extremity. He asks the nurse to explain phantom pain. The most appropriate response would be

A) "Phantom pain does not exist except in your mind."
B) "I can't answer that. You'll have to ask the physician."
C) "Phantom pain occurs because the nerve tracts that register pain in the amputated limb continue to send a message to the brain."
D) "Phantom pain occurs when you start thinking about your loss. It's best to keep your mind occupied with other things."

Question 11

A patient fell 2 days ago; he has a compound fracture of his left tibia. The physician performed an open reduction with internal fixation (ORIF) to treat the fracture. An important nursing assessment for him would include

A) hyperactive bowel sounds.
B) elevated temperature and presence of erythema at incision site.
C) ecchymosis and edema at incision site.
D) complaints of activity intolerance.

Question 12

A patient, age 24, had a traumatic amputation of his left foot in a motorcycle accident. He is receiving morphine by a patient-controlled analgesia (PCA) device. He complains of a burning sensation in his left foot. The nurse should explain that

A) this is a phantom pain and that its cause is not clearly understood.
B) this is not possible because his foot was amputated.
C) his regular pain medication will relieve the pain.
D) this phantom pain will disappear in about 1 week.

Question 13

When caring for a patient who is 34 years old and has rheumatoid arthritis, the nurse should remember that

A) exercise should be avoided to decrease pain.
B) the patient should be discouraged from performing activities of daily living.
C) rest and exercise are both important parts of therapy.
D) pain is best controlled by use of narcotic analgesics.

Question 14

The large, fan-shaped muscle that covers the anterior chest from the sternum to the proximal end of the humerus and acts on the joint of the shoulder to flex, adduct, and rotate is

A) serratus anterior.
B) intercostal.
C) transversus abdominis.
D) pectoralis major.

Question 15

The patient has been diagnosed as having gouty arthritis. He asks the nurse to explain the cause of the inflammation of his great toe. The most appropriate nursing response is

A) "You have calcium oxalate deposits that are seen in gouty arthritis."
B) "The inflammation is from small accumulations of uric acid crystals which are called tophi."
C) "The small nodules are not related to the arthritis condition."
D) "You have fat deposits that are common with gouty arthritis."

Question 16

A patient, age 24, is recovering from a fractured tibia. She has been wearing a leg cast for the past month to immobilize the fracture and promote proper alignment. She is being seen at the clinic for follow-up radiographic evaluation of the fracture. The physician tells her that he is hoping for good callus formation to have occurred. When she asks what callus formation is, the nurse tells her it is

A) when blood vessels of the bone are compressed.
B) a part of the bone healing process after a fracture when new bone is being formed over the fracture site.
C) the formation of a clot over the fracture site.
D) when the hematoma becomes organized and a fibrin meshwork is formed.

Question 17

A patient, age 68, has suffered an intertrochanteric fracture of the right hip. Before surgery, to provide support and comfort, an immobilizing device is applied. This is called a

A) Thomas splint.
B) Bryant's traction.
C) Russell's traction
D) Buck's traction.

Question 18

A patient, age 28, has a fractured tibia and fibula. The nurse is performing an assessment of her extremities. The purpose of assessing capillary filling or performing a blanching test is to assess for adequate

A) arterial peripheral circulation.
B) cardiac output.
C) venous peripheral circulation.
D) nutritional deficiency.

Question 19

The first priority nursing intervention for an impending fat embolism is to administer

A) oxygen in a respiratory emergency.
B) intravenous fluids in hypovolemic emergency.
C) Lasix IV for fluid overload.
D) blood therapy in a cardiac emergency.

Question 20

The patient who undergoes total hip replacement may be prescribed prophylactic drugs such as heparin or warfarin (Coumadin). The rationale for this is that it

A) decreases the risk of thrombus formation.
B) decreases the risk of hemorrhage.
C) facilitates the wound-healing process.
D) decreases the risk of systemic infection.

Question 21

A patient has undergone a bipolar hip repair (hemiarthroplasty). She should be instructed to

A) sit in whatever position is most comfortable.
B) sit in a firm, straight-backed chair at a 90-degree angle.
C) avoid crossing her legs.
D) begin full weight-bearing as soon as tolerated.

Question 22

A 71-year-old patient is manifesting signs and symptoms of gout. When assessing him for signs and symptoms of gout, the nurse should pay particular attention to

A) dietary intake of foods high in cholesterol.
B) mobility in the hip and knee joints.
C) edema or discoloration of the great toe.
D) a history of trauma or occupational injury.

Question 23

Calcium is a mineral found in many foods that can slow bone loss during the aging process. The following are high in calcium:

A) Oranges, yogurt
B) Oranges, bananas
C) Broccoli, yogurt
D) Skim milk, eggs

Question 24

The office nurse has noted the presence of an increase in lumbar curvature in a 20-year-old female patient. This condition is known as

A) scoliosis.
B) lordosis.
C) kyphosis.
D) spondylitis.

Question 25

A patient's patellar-femoral cartilage has deteriorated due to arthritis. The medial and lateral cartilage is undamaged. This patient is likely to undergo _________ knee replacement surgery.

Question 26

A patient, age 72, has a left intertrochanteric fracture as a result of a fall. In planning ways to increase her safety, the nurse realizes it is most important to determine

A) preexisting health conditions.
B) nutritional status.
C) psychosocial history.
D) pain level.

Question 27

The immediate medical management of any fracture is:

A) Observe patient for signs of shock.
B) Administer analgesics for pain.
C) Splint and elevate the involved part.
D) Apply heat to control pain.

Question 28

Certain foods may increase the pain associated with gout. Which foods have the highest concentration of purines?

A) Brain, liver, kidney
B) Lettuce, corn, potatoes
C) Beef, pork, chicken
D) Fruits and fruit juices

Question 29

When caring for the patient who is in shock, the nurse should provide

A) adequate oral fluids to replace blood loss.
B) external heat to combat shivering.
C) sedatives to decrease anxiety and apprehension.
D) oxygen to support respiratory function.

Question 30

A patient, age 45, has had a left intramedullary rod placed into his left femur. He is presenting with signs and symptoms of postoperative shock. The recommended position for a person going into shock is

A) semi-Fowler's.
B) supine.
C) Fowler's
D) Trendelenburg.

Question 31

Which ethnic group is at a highest risk of developing osteoporosis?

A) African American women
B) Caucasian and Asian women
C) African American men
D) Latino women

Question 32

A 28-year-old male patient has a fractured left humerus. He has a cast on his arm. The nurse observes pallor, coolness, and a decrease in capillary refill time to his left hand and fingers. These observations are likely to indicate

A) compartment syndrome.
B) early infection.
C) hemorrhage.
D) shock.

Question 33

In gangrene, there is an acute infection to the skeletal muscle. If untreated, _________ will destroy the tissue.

Question 34

Rheumatoid arthritis is distinguished from osteoarthritis in that:

A) Rheumatoid arthritis is an autoimmune, systemic disease; osteoarthritis is a degenerative disease of the joints.
B) Rheumatoid arthritis is an autoimmune, degenerative disease; osteoarthritis is a systemic inflammatory disease.
C) People with osteoarthritis are considered to be genetically predisposed; there is no known genetic component to rheumatoid arthritis.
D) Osteoarthritis is often caused by a virus; viruses play no part in the pathogenesis of rheumatoid arthritis.

Question 35

A patient, age 44, has chronic osteomyelitis. He should be taught to

A) take antibiotics prophylactically.
B) avoid trauma to the affected bone.
C) decrease activity levels.
D) increase dietary intake of calcium and vitamin D.

Question 36

The patient, age 58, is diagnosed with osteoporosis after densitometry testing. She has been menopausal for 5 years and has been concerned about her risk for osteoporosis because her mother has osteoporosis. In teaching her about her osteoporosis, which information does the nurse include?

A) Even with a family history of osteoporosis, the calcium loss from bones can be slowed by increased calcium intake and exercise.
B) Estrogen replacement therapy must be started to prevent rapid progression of her osteoporosis.
C) With a family history of osteoporosis, there is no way to prevent or slow bone reabsorption.
D) Continuous, low-dose corticosteroid treatment is effective in stopping the course of osteoporosis.

Question 37

A patient, age 64, has osteoarthritis of the left hip. He has had a left total hip replacement. The nurse should

A) encourage use of the high Fowler's position.
B) administer oxygen through a nasal cannula.
C) encourage use of an incentive spirometer.
D) turn the patient frequently from side to side.

Question 38

Prolonged bed rest puts the older adult at risk for

A) ankylosing spondylitis.
B) pathological fractures.
C) osteomyelitis.
D) gout.

Question 39

A 76-year-old female patient is being seen for osteoarthritis of the knee in the clinic. In discussing strengthening exercises, which exercises would you recommend?

A) Jogging
B) Climbing stairs 2 to 3 times daily
C) Bicycling for short distances
D) Walking up and down small elevations

Question 40

The patient is a 20-year-old who has suffered a compound fracture of the femur. The nurse would expect the physician to order ____ intramuscularly.

A) tetanus toxoid
B) morphine gluconate
C) low-molecular-weight heparin
D) calcium gluconate

Question 41

Among the most common fractures in older women are _______fractures.

Question 42

The main purpose of traction is to (Select all that are correct)

A) Align and stabilize a fracture
B) Prevent deformities
C) Relieve muscle spasms
D) Promote bed rest
E) Increase circulation to the rest of the body

Question 43

__________ traction is utilized to provide support for the patient with a hip fracture.

Question 44

A female patient has been diagnosed with a pelvic fracture that she sustained during a fall. The physician has ordered strict bed rest for this patient. The patient is crying and states, "I'm not used to lying in bed all day. I have many things I need to do at home." An appropriate nursing diagnosis for this patient would be ____________ related to decreased mobility.

Question 45

Which of the significant neurovascular impairment symptoms, following a musculoskeletal trauma, should be reported to the physician? (Select all that apply.)

A) Extremity feels warm to touch
B) Slow capillary refill
C) Diminished or absent pulses,
D) Extremity pink in color
E) +1 edema of extremity
F) Unrelieved pain after administration of pain medication

Question 46

The three vital functions muscles perform when they contract are: (Select all that apply.)

A)To allow for accumulation of uric acid in blood
B)Maintenance of posture
C)Motion
D)To serve as a storage area for various minerals
E)Production of heat
F) To assist in return of venous blood to the left side of the heart