Deck 63: Musculoskeletal Problems

Question 1

A 54-yr-old woman who recently reached menopause and has a family history of osteoporosis is diagnosed with osteopenia following densitometry testing. In teaching the woman,the nurse explains that

A)with a family history of osteoporosis, there is no way to prevent or slow bone resorption.
B)estrogen replacement therapy must be started to prevent rapid progression to osteoporosis.
C)continuous, low-dose corticosteroid treatment is effective in stopping the course of osteoporosis.
D)calcium loss from bones can be slowed by increasing calcium intake and weight-bearing exercise.

Answer 1

calcium loss from bones can be slowed by increasing calcium intake and weight-bearing exercise.

Question 2

Which assessment finding for a patient who has had surgical reduction of an open fracture of the right radius requires notification of the health care provider?

A)Serous wound drainage
B)Right arm muscle spasms
C)Right arm pain with movement
D)Temperature 101.4° F (38.6° C)

Answer 2

Temperature 101.4° F (38.6° C)

Question 3

A patient is being discharged after 1 week of IV antibiotic therapy for acute osteomyelitis in the right leg. Which information will be included in the discharge teaching?

A)How to apply warm packs to the leg to reduce pain
B)How to monitor and care for a long-term IV catheter
C)The need for daily aerobic exercise to help maintain muscle strength
D)The reason for taking oral antibiotics for 7 to 10 days after discharge

Answer 3

How to monitor and care for a long-term IV catheter

Question 4

Which action will the nurse take first when a patient is seen in the outpatient clinic with neck pain?

A)Provide information about therapeutic neck exercises.
B)Ask about numbness or tingling of the hands and arms.
C)Suggest the patient alternate the use of heat and cold to the neck.
D)Teach about the use of nonsteroidal antiinflammatory drugs (NSAIDs).

Question 5

The nurse should reposition the patient who has just had a laminectomy and diskectomy by

A)instructing the patient to move the legs before turning the rest of the body.
B)having the patient turn by grasping the side rails and pulling the shoulders over.
C)placing a pillow between the patient's legs and turning the entire body as a unit.
D)turning the patient's head and shoulders first, followed by the hips, legs, and feet.

Question 6

A patient with muscular dystrophy is hospitalized with pneumonia. Which nursing action will be included in the plan of care?

A)Logroll the patient every 2 hours.
B)Assist the patient with ambulation.
C)Discuss the need for genetic testing with the patient.
D)Teach the patient about the muscle biopsy procedure.

Question 7

An appropriate nursing intervention for a patient who has acute low back pain and muscle spasms is to teach the patient to

A)keep both feet flat on the floor when prolonged standing is required.
B)twist gently from side to side to maintain range of motion in the spine.
C)keep the head elevated slightly and flex the knees when resting in bed.
D)avoid the use of cold packs because they will exacerbate the muscle spasms.

Question 8

A patient is receiving IV antibiotics at home to treat chronic osteomyelitis of the left femur. The nurse identifies a need for additional teaching related to health maintenance when the nurse finds that the patient

A)is frustrated with the length of treatment required.
B)takes and records the oral temperature twice a day.
C)is unable to plantar flex the foot on the affected side.
D)uses crutches to avoid weight bearing on the affected leg.

Question 9

Which action will the nurse take when caring for a patient with osteomalacia?

A)Teach about the use of vitamin D supplements.
B)Educate about the need for weight-bearing exercise.
C)Discuss the use of medications such as bisphosphonates.
D)Emphasize the importance of sunscreen use when outside.

Question 10

When administering alendronate (Fosamax)to a patient with osteoporosis,the nurse will

A)ask about any leg cramps or hot flashes.
B)assist the patient to sit up at the bedside.
C)be sure that the patient has recently eaten.
D)administer the ordered calcium carbonate.

Question 11

Which menu choice by a patient with osteoporosis indicates the nurse's teaching about appropriate diet has been effective?

A)Pancakes with syrup and bacon
B)Whole wheat toast and fresh fruit
C)Egg-white omelet and a half grapefruit
D)Oatmeal with skim milk and fruit yogurt

Question 12

An assessment finding for a 55-yr-old patient that alerts the nurse to the presence of osteoporosis is

A)bowed legs.
B)a loss of height.
C)the report of frequent falls.
D)an aversion to dairy products.

Question 13

Which action should the nurse take before administering gentamicin (Garamycin)to a patient with acute osteomyelitis?

A)Ask the patient about any nausea.
B)Obtain the patient's oral temperature.
C)Review the patient's serum creatinine.
D)Change the prescribed wet-to-dry dressing.

Question 14

The nurse instructs a patient who has osteosarcoma of the tibia about a scheduled above-the-knee amputation. Which statement by a patient indicates additional patient teaching is needed?

A)"I will need to participate in physical therapy after surgery."
B)"I wish I did not need to have chemotherapy after this surgery."
C)"I did not have this bone cancer until my leg broke a week ago."
D)"I can use the patient-controlled analgesia (PCA) to manage postoperative pain."

Question 15

The nurse evaluating effectiveness of prescribed calcitonin and ibandronate (Boniva)for a patient with Paget's disease will consider the patient's

A)oral intake.
B)daily weight.
C)grip strength.
D)pain intensity.

Question 16

The nurse will determine more teaching is needed if a patient with discomfort from a bunion says,"I will

A)give away my high-heeled shoes."
B)take ibuprofen (Motrin) if I need it."
C)use the bunion pad to cushion the area."
D)only wear sandals, no closed-toe shoes."

Question 17

After laminectomy with a spinal fusion to treat a herniated disc,a patient reports numbness and tingling of the right lower leg. The first action the nurse should take is to

A)report the patient's complaint to the surgeon.
B)check the chart for preoperative assessment data.
C)check the vital signs for indications of hemorrhage.
D)turn the patient to the left to relieve pressure on the right leg.

Question 18

A patient whose employment requires frequent lifting has a history of chronic back pain. After the nurse has taught the patient about correct body mechanics,which patient statement indicates the teaching has been effective?

A)"I will keep my back straight when I lift above than my waist."
B)"I will begin doing exercises to strengthen and support my back."
C)"I will tell my boss I need a job where I can stay seated at a desk."
D)"I can sleep with my hips and knees extended to prevent back strain."

Question 19

A patient with acute osteomyelitis of the left femur is hospitalized for regional antibiotic irrigation. Which intervention will the nurse include in the initial plan of care?

A)Quadriceps-setting exercises
B)Immobilization of the left leg
C)Positioning the left leg in flexion
D)Assisted weight-bearing ambulation

Question 20

Which nursing action included in the care of a patient after laminectomy can the nurse delegate to experienced unlicensed assistive personnel (UAP)?

A)Check ability to plantar and dorsiflex the foot.
B)Determine the patient's readiness to ambulate.
C)Log roll the patient from side to side every 2 hours.
D)Ask about pain management with the patient-controlled analgesia (PCA).

Question 21

Which information will the nurse include when teaching a patient with acute low back pain ?

A)Sleep in a prone position with the legs extended.
B)Keep the knees straight when leaning forward to pick something up.
C)Expect symptoms of acute low back pain to improve in a few weeks.
D)Avoid activities that require twisting of the back or prolonged sitting.
E)Use ibuprofen (Motrin, Advil) or acetaminophen (Tylenol) to relieve pain.

Question 22

A patient with osteomyelitis is to receive vancomycin (Vancocin)500 mg IV every 6 hours. The vancomycin is diluted in 100 mL of normal saline and needs to be administered over 1 hour. The nurse will set the IV pump for how many milliliters per minute? (Round to the nearest hundredth.)

Question 23

Which actions will the nurse include in the plan of care for a patient with metastatic bone cancer of the left femur ?

A)Monitor serum calcium.
B)Teach about the need for strict bed rest.
C)Discontinue use of sustained-release opioids.
D)Support the left leg when repositioning the patient.
E)Support family and patient as they discuss the prognosis.

Question 24

A nurse who works on the orthopedic unit has just received change-of-shift report. Which patient should the nurse assess first?

A)Patient who reports foot pain after hammertoe surgery
B)Patient who has not voided 10 hours after a laminectomy
C)Patient with low back pain and a positive straight-leg-raise test
D)Patient with osteomyelitis who has a temperature of 100.5° F (38.1° C)

Question 25

In which order will the nurse implement these interprofessional interventions prescribed for a patient admitted with acute osteomyelitis with a temperature of 101.2° F? (Put a comma and a space between each answer choice [A,B,C,D].)

A)Obtain blood cultures from two sites.
B)Administer dose of gentamicin 60 mg IV.
C)Send to radiology for computed tomography (CT) scan of right leg.
D)Administer acetaminophen (Tylenol) now and every 4 hours PRN for fever.