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Flashcards in Musculoskeletal Deck (150)
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91

When preparing the client in a short leg cast for discharge, which data indicate that the
client needs further teaching?
1. “I need to keep my leg elevated on two pillows for the first 24 hours.”
2. “I should apply ice packs for one (1) hour and remove them for one (1) hour.”
3. “I need to contact the health-care provider if I have any numbness or pale toenails.”
4. “I can put a coat hanger down the cast to scratch gently if I have severe itching.”

4. Clients should be taught that putting
objects down the cast to scratch an itch can
cause breaks in skin integrity that may become
infected.

92

Which psychosocial client problem would be most likely in a client with an external
fixator device?
1. Ineffective coping.
2. Alteration in body image.
3. Grieving.
4. Social isolation.

2. Many clients with an external fixator have
alterations in body image because of the
large bulky frame that makes dressing difficult
and because of the scarring that occurs
from the trauma and treatment. The length
of healing is prolonged, so returning to the
client’s normal routine is delayed.

93

A client recovering from a total hip replacement has developed a deep vein thrombosis.
The health-care provider has ordered a continuous infusion of heparin, an anticoagulant,
to infuse at 1200 units per hour. The bag comes with 20,000 unit of heparin
in 500 mL of 0.9% normal saline. At what rate should the nurse set the pump?______

30 mL per hour. Divide the amount of heparin
by the volume of fluid to get the concentration.
Divide the dose ordered by the concentration for
the amount of milliliters per hour to set the pump.
20000/500 =40 units of heparin per 1 mL
1200/40 = 30 mL per hour

94

When conducting rounds at change of shift, the nurse assesses the client with a fractured
humerus. Which data would warrant immediate intervention by the nurse?
1. Capillary refill time of that arm is less than three (3) seconds.
2. Pain relieved by the patient-controlled anesthesia machine.
3. Edema under the dressing that caused the nails to be white.
4. Warm and dry skin on the fingers distally to the elastic bandage.

3. Cool, white nails indicate impaired circulation
to the arm from edema. Without
immediate intervention, the client could
develop compartment syndrome.

95

The client with a right open fractured elbow has a long arm cast and is complaining of
unrelenting severe pain and feeling as if the fingers are asleep. Which complication
should the nurse suspect that the client is experiencing?
1. Fat embolism.
2. Compartment syndrome.
3. Pressure ulcer under cast.
4. Surgical incision infection.

2. These are the classic signs/symptoms of
compartment syndrome.

96

The elderly client is admitted to the hospital for severe back pain. Which data should
the nurse assess first during the admission assessment?
1. The client’s use of herbs.
2. The client’s current pain level.
3. The client’s sexual orientation.
4. The client’s ability to care for self.

2. Pain assessment and management are
the most important issues if the client is
breathing and has circulation. Lack of pain
management decreases the attention of the
client during the admission process. Pain is
called the fifth vital sign.

97

25. Which information should the nurse teach the client regarding sports injuries?
1. Apply heat intermittently for the first 48 hours.
2. An injury is not serious if the extremity can be moved.
3. Only return to health-care provider if the foot becomes cold.
4. Keep the injury immobilized and elevated for 24 to 48 hours.

4. The leg should be iced, elevated, and
immobilized for 48 hours.

98

The emergency department nurse is caring for a client with a compound fracture of
the right ulna. Which interventions should the nurse implement? List in order of
priority.
1. Apply a sterile, normal, saline-soaked gauze to the arm.
2. Send the client to radiology for an x-ray of the arm.
3. Assess the fingers of the client’s right hand.
4. Stabilize the arm at the wrist and the elbow.
5. Administer a tetanus toxoid injection.

The order should be 4, 1, 3, 2, 5.
4. The nurse first should stabilize the arm to
prevent further injury.
1. A compound fracture is one in which the
bone protrudes through the skin. The
nurse should apply sterile, saline-soaked
gauze to protect the area from the intrusion
of bacteria.
3. The nurse should assess the client’s circulation
to the part distal to the injury. This is
done after the first two interventions because
life-threatening complications could
occur if stabilization and protection from
infection are not addressed first.
2. An x-ray will be needed to determine the
extent of the injury.
5. A tetanus toxoid injection should be
administered, but this can be done last.

99



A 54-year-old patient admitted with cellulitis and probable osteomyelitis received an injection of radioisotope at 9:00 AM before a bone scan. The nurse should plan to send the patient for the bone scan at what time?

A. 9:30 PM
B. 10:00 AM
C. 11:00 AM
D. 1:00 PM







C. 11:00 AM

A technician usually administers a calculated dose of a radioisotope 2 hours before a bone scan. If the patient was injected at 9:00 AM, the procedure should be done at 11:00 AM. 10:00 AM would be too early; 1:00 PM and 9:30 PM would be too late.

100

A 50-year-old patient is reporting a sore shoulder after raking the yard. The nurse should suspect which problem?

A. Bursitis
B. Fasciitis
C. Sprained ligament
D. Achilles tendonitis

A. Bursitis

Bursitis is common in adults over age 40 and with repetitive motion, such as raking. Plantar fasciitis frequently occurs as a stabbing pain at the heel caused by straining the ligament that supports the arch. Achilles tendonitis is an inflammation of the tendon that attaches the calf muscle to the heel bone, not the shoulder, and causes pain with walking or running. A sprained ligament occurs when a ligament is stretched or torn from a direct injury or sudden twisting of the joint, not repetitive motion.

101

An 82-year-old patient is frustrated by her flabby belly and rigid hips. What should the nurse tell the patient about these frustrations?

A. "You should go on a diet and exercise more to feel better about yourself." Incorrect
B. "Something must be wrong with you because you should not have these problems."
C. "You have arthritis and need to go on nonsteroidal antiinflammatory drugs (NSAIDs)."
D. "Decreased muscle mass and strength and increased hip rigidity are normal changes of aging."


D. "Decreased muscle mass and strength and increased hip rigidity are normal changes of aging."

The musculoskeletal system's normal changes of aging include decreased muscle mass and strength; increased rigidity in the hips, neck, shoulders, back, and knees; decreased fine motor dexterity; and slowed reaction times. Going on a diet and exercising will help but not stop these changes. Telling the patient "Something must be wrong with you..." will not be helpful to the patient's frustrations.

102

When working with patients, the nurse knows that patients have the most difficulties with diarthrodial joints. Which joints are included in this group of joints (select all that apply)?

A. Hinge joint of the knee
B. Ligaments joining the vertebrae
C. Fibrous connective tissue of the skull
D. Ball and socket joint of the shoulder or hip
E. Cartilaginous connective tissue of the pubis joint

A. D.

The diarthrodial joints include the hinge joint of the knee and elbow, the ball and socket joint of the shoulder and hip, the pivot joint of the radioulnar joint, and the condyloid, saddle, and gliding joints of the wrist and hand. The ligaments and cartilaginous connective tissue joining the vertebrae and pubis joint and the fibrous connective tissue of the skull are synarthrotic joints.

103

In reviewing bone remodeling, what should the nurse know about the involvement of bone cells?

A. Osteoclasts add canaliculi.
B. Osteoblasts deposit new bone.
C. Osteocytes are mature bone cells.
D. Osteons create a dense bone structure.

B. Osteoblasts deposit new bone.

Bone remodeling is achieved when osteoclasts remove old bone and osteoblasts deposit new bone. Osteocytes are mature bone cells, and osteons or Haversian systems create a dense bone structure, but these are not involved with bone remodeling.

104

The nurse is performing a musculoskeletal assessment of an 81-year-old female patient whose mobility has been progressively decreasing in recent months. How should the nurse best assess the patient's range of motion (ROM) in the affected leg?

A. Observe the patient's unassisted ROM in the affected leg.
B. Perform passive ROM, asking the patient to report any pain.
C. Ask the patient to lift progressive weights with the affected leg.
D. Move both of the patient's legs from a supine position to full flexion.

A. Observe the patient's unassisted ROM in the affected leg.

Passive ROM should be performed with extreme caution and may be best avoided when assessing older patients. Observing the patient's active ROM is more accurate and safe than asking the patient to lift weights with her legs.

105

A female patient with a long-standing history of rheumatoid arthritis has sought care because of increasing stiffness in her right knee that has culminated in complete fixation of the joint. The nurse would document the presence of which problem?

A. Atrophy
B. Ankylosis
C. Crepitation
D. Contracture

B. Ankylosis

Ankylosis is stiffness or fixation of a joint, whereas contracture is reduced movement as a consequence of fibrosis of soft tissue (muscles, ligaments, or tendons). Atrophy is a flabby appearance of muscle leading to decreased function and tone. Crepitation is a grating or crackling sound that accompanies movement.

106

Musculoskeletal assessment is an important component of care for patients on what type of long-term therapy?

A. Corticosteroids
B. β-Adrenergic blockers
C. Antiplatelet aggregators
D. Calcium-channel blockers

A. Corticosteroids
Corticosteroids are associated with avascular necrosis and decreased bone and muscle mass. β-blockers, calcium-channel blockers, and antiplatelet aggregators are not commonly associated with damage to the musculoskeletal system.

107

A 54-year-old patient is about to have a bone scan. In teaching the patient about this procedure, the nurse should include what information?

A. Two additional follow-up scans will be required. Incorrect
B. There will be only mild pain associated with the procedure.
C. The procedure takes approximately 15 to 30 minutes to complete.
D. The patient will be asked to drink increased fluids after the procedure.

D. The patient will be asked to drink increased fluids after the procedure.

Patients are asked to drink increased fluids after a bone scan to aid in excretion of the radioisotope, if not contraindicated by another condition. No follow-up scans and no pain are associated with bone scans that take 1 hour of lying supine.

108

While completing an admission history for a 73-year-old man with osteoarthritis admitted for knee arthroplasty, the nurse asks about the patient's perception of the reason for admission. The nurse expects the patient to relate which response to this question?

A. Recent knee trauma
B. Debilitating joint pain
C. Repeated knee infections
D. Onset of "frozen" knee joint

B. Debilitating joint pain

The most common reason for knee arthroplasty is debilitating joint pain despite attempts to manage it with exercise and drug therapy. Recent knee trauma, repeated knee infections, and onset of "frozen" knee joint are not primary indicators for a knee arthroplasty.

109

The nurse is caring for a patient with osteoarthritis who is about to undergo total left knee arthroplasty. The nurse assesses the patient carefully to be sure that there is no evidence of what in the preoperative period?

A. Pain Incorrect
B. Left knee stiffness
C. Left knee infection
D. Left knee instability

C. Left knee infection

It is critical that the patient be free of infection before a total knee arthroplasty. An infection in the joint could lead to even greater pain and joint instability, requiring extensive surgery. For this reason, the nurse monitors the patient for signs of infection, such as redness, swelling, fever, and elevated white blood cell count. Pain, knee stiffness, or instability may be present with osteoarthritis.

110

The nurse formulates a nursing diagnosis of impaired physical mobility related to decreased muscle strength for a 78-year-old patient following left total knee replacement. What would be an appropriate nursing intervention for this patient?

A. Promote vitamin C and calcium intake in the diet. Incorrect
B. Provide passive range of motion to all of the joints q4hr.
C. Encourage isometric quadriceps-setting exercises at least qid.
D. Keep the left leg in extension and abduction to prevent contractures.

C. Encourage isometric quadriceps-setting exercises at least qid.

Emphasis is placed on postoperative exercise of the affected leg, with isometric quadriceps setting beginning on the first day after surgery along with a continuous passive motion (CPM) machine. Vitamin C and calcium do not improve muscle strength, but they will facilitate healing. The patient should be able to do active range of motion to all joints. Keeping the leg in one position (extension and abduction) potentially will result in contractures.

111

The patient is brought to the emergency department after a car accident and has a femur fracture. What nursing intervention should the nurse implement to prevent a fat embolus in this patient?

A. Administer enoxaparin (Lovenox).
B. Provide range-of-motion exercises.
C. Apply sequential compression boots.
D. Immobilize the fracture preoperatively.

D. Immobilize the fracture preoperatively.

To prevent fat emboli, the nurse immobilizes the long bone to reduce movement of the fractured bone ends and decrease the risk of a fat embolus from the bone before surgical reduction. Enoxaparin is used to prevent blood clots not fat emboli. Range of motion and compression boots will not prevent a fat embolus in this patient.

112

An injured soldier had an amputation of his left leg and is reporting shooting pain and heaviness in the area of his missing leg. What would be the best response by the nurse for this patient?

A. Use mirror therapy.
B. Give opioid analgesics.
C. Rebandage the residual limb.
D. Show the patient the leg is gone.

A. Use mirror therapy.

Mirror therapy has been shown to reduce phantom limb pain in some patients. Opioid analgesics, rebandaging the residual limb, and showing the patient that the leg is gone will not decrease phantom limb pain.

113

The patient had a lumbar spine arthrodesis. What should the nurse include in discharge teaching (select all that apply)?

A. Do not smoke cigarettes.
B. You should not walk for 3 weeks.
C. You must wear your brace at all times.
D. You may drive as soon as you feel like it.
E. Do not bend your spine until your follow-up appointment.

A. Do not smoke cigarettes.
E. Do not bend your spine until your follow-up appointment.

After a spinal fusion, the patient should not smoke cigarettes as nonunion tends to occur more often with smokers. Preventing pressure by not bending or twisting the spine or lifting more than 10 pounds will facilitate healing. The amount of time that is needed will be determined by the surgeon at follow-up appointments, but healing usually takes 6 to 9 months. An important aspect of healing is progressively increasing walking, which increases circulation of nutrients and oxygen for healing. If a brace is ordered to protect the surgical area, the surgeon will order how often the patient should wear it. Driving is not done until the surgeon allows it and the patient is no longer taking opioids for pain.

114

The nurse is completing a neurovascular assessment on the patient with a tibial fracture and a cast. The feet are pulseless, pale, and cool. The patient says they are numb. What should the nurse suspect is occurring?

A. Paresthesia
B. Pitting edema
C. Poor venous return
D. Compartment syndrome

D. Compartment syndrome

The nurse should suspect compartment syndrome with one or more of the following six Ps: paresthesia, pallor, pulselessness, pain distal to the injury and unrelieved with opioids, pressure increases in the compartment, and paralysis. Although paresthesia and poor venous return are evident, these are just some of the manifestations of compartment syndrome.

115

A 21-year-old female soccer player has injured her anterior crucial ligament (ACL) and is having reconstructive surgery. The nurse knows that the patient will need more teaching when the patient makes which statement?

A. "I probably won't be able to play soccer for 6 to 8 months."
B. "They will have me do range of motion with my knee soon after surgery."
C. "I can't wait to get this done now so I can play soccer for the next tournament."
D. "I will need to wear an immobilizer and progressively bear weight on my knee."

C. "I can't wait to get this done now so I can play soccer for the next tournament."

When the athlete has ACL reconstructive surgery, the patient does not understand the severity when planning to be back to playing soccer soon, as safe return will not occur for 6 to 8 months after initial range of motion, immobilization, and progressive weight bearing with physical therapy occurs.


116

This morning a 21-year-old male patient had a long leg cast applied and wants to get up and try out his crutches before dinner. The nurse will not allow this. What is the best rationale that the nurse should give the patient for this decision?

A. The cast is not dry yet, and it may be damaged while using crutches.
B. The nurse does not have anyone available to accompany the patient.
C. Rest, ice, compression, and elevation are in process to decrease pain.
D. Excess edema and other problems are prevented when the leg is elevated for 24 hours.

D. Excess edema and other problems are prevented when the leg is elevated for 24 hours.

For the first 24 hours after a lower extremity cast is applied, the leg will be elevated on pillows above the heart level to avoid excessive edema and compartment syndrome. The cast will also be drying during this 24-hour period. RICE is used for soft tissue injuries, not with long leg casts.



117

The patient had frostbite on the distal areas of the toes on both feet. The patient is scheduled for amputation of the damaged tissue. Which assessment finding or diagnostic study is the most objective indicator for locating the level of the patient's injury?

A. Arteriography showing blood vessels
B. Peripheral pulse assessment bilaterally
C. Patches of black, indurated, and cold tissue
D. Bilateral pale and cool skin below the ankles

A. Arteriography showing blood vessels

Arteriography is the most objective study to determine viable tissue for salvage based on perfusion because actual blood flow through the tissues is observed in real time. It is considered the gold standard for evaluating arterial perfusion. Bilateral peripheral pulse assessment, areas of black, indurated, and cold tissue, and bilateral pale and cool skin all identify the lack of tissue perfusion, but not the specific area where tissue perfusion stops and amputation needs to occur.

118


The nurse is completing discharge teaching with an 80-year-old male patient who underwent right total hip arthroplasty. The nurse identifies a need for further instruction if the patient states the need to

A. avoid crossing his legs.
B. use a toilet elevator on toilet seat.
C. notify future caregivers about the prosthesis.
D. maintain hip in adduction and internal rotation.

D. maintain hip in adduction and internal rotation.

The patient should not force hip into adduction or force hip into internal rotation as these movements could displace the hip replacement. Avoiding crossing the legs, using a toilet elevator on a toilet seat, and notifying future caregivers about the prosthesis indicate understanding of discharge teaching.

119

The nurse is caring for a 75-year-old woman who underwent left total knee arthroplasty and has a new order to be "up in chair today before noon." What action should the nurse take to protect the knee joint while carrying out the order?

A. Administer a dose of prescribed analgesic before completing the order.
B. Ask the physical therapist for a walker to limit weight bearing while getting out of bed.
C. Keep the continuous passive motion machine in place while lifting the patient from bed to chair.
D. Put on a knee immobilizer before moving the patient out of bed and keep the surgical leg elevated while sitting.

D. Put on a knee immobilizer before moving the patient out of bed and keep the surgical leg elevated while sitting.

The nurse should apply a knee immobilizer for stability before assisting the patient to get out of bed. This is a standard measure to protect the knee during movement following surgery. Although an analgesic should be given before the patient gets up in the chair for the first time, it will not protect the knee joint. Full weight bearing is begun before discharge, so a walker will not be used if the patient did not need one before the surgery. The CPM machine is not kept in place while the patient is getting up to the chair.

120

The nurse is caring for a 76-year-old man who has undergone left knee arthroplasty with prosthetic replacement of the knee joint to relieve the pain of severe osteoarthritis. Postoperatively the nurse expects what to be included in the care of the affected leg?

A. Progressive leg exercises to obtain 90-degree flexion
B. Early ambulation with full weight bearing on the left leg
C. Bed rest for 3 days with the left leg immobilized in extension
D. Immobilization of the left knee in 30-degree flexion for 2 weeks to prevent dislocation

A. Progressive leg exercises to obtain 90-degree flexion

Although early ambulation is not done, the patient is encouraged to engage in progressive leg exercises until 90-degree flexion is possible. Because this is painful after surgery, the patient requires good pain management and often the use of a CPM machine. The patient's knee is unlikely to dislocate.