Chapter 4: Musculoskeletal
The relationship between phosphorus and calcium is best described by which statement?
Calcium and phosphorus share an inverse relationship. When calcium is elevated, phosphorus levels are reduced.
A client with osteoarthritis is refusing to perform her own daily care. Which of the following approaches would be most appropriate to use with this client?
Encourage her to perform as much care as her pain will allow
While teaching the client, which of the following explanation provided by the nurse is the purpose of stump bandaging?
It shrinks and shapes the stump
A nurse is organizing a teaching plan for a patient with gout. What should the nurse caution this patient he is at an increased risk for?
Kidney stones
The office nurse has noted the presence of an increase in lumbar curvature in a 20-year-old female patient. What is this condition known as?
Lordosis Rational: Common deformities include an increase in the curve at the lumbar space region that throws the shoulder back, making the "lordly or kingly" appearance that is known as lordosis. Scoliosis involves the S curvature of the spine. Kyphosis is the rounding of the thoracic spine.
A nurse is talking with an older adult client who has osteoarthritis about joint protection strategies. Which of the following recommendations should the nurse reinforce?
Maintain the recommended body weight
The term that describes a lateral curvature of the spine is:
scoliosis
a break that coils around the bone
spiral fracture
A client has hyperextension of the proximal interphalangeal joint with fixed flexion of the distal interphalangeal joint. Which of the following signs of rheumatoid arthritis does the patient has?
swan neck deformity
This crutch gait would be instructed when non-weight bearing is allowed on both legs:
swing through
A male client with a fractured femur is in Russell's traction. He asks the nurse to help him with back care. Which nursing action is most appropriate?
tell the client to use the trapeze to lift his back off the be
The nurse instructs the patient who is to have a unicompartmental knee replacement that a major advantage of this partial knee replacement is that:
the patient will be up and walking 2-3 hours after the operation. Rational: Unicompartmental knee arthroplasty is also referred to as partial knee replacement in which the worn cartilage is replaced with a plastic disk. It is not as invasive as a full knee replacement and does not disturb the kneecap so that the patient can be up and walking in 2 to 3 hours after surgery. It is not recommended for RA patients.
Nursing care of a client post spine surgery:
turn client as a unit log roll technique
A nurse is reinforcing teaching for the family of a client who is receiving treatment for a spinal cord injury with halo fixation device. Which of the following statements by the nurse is appropriate?
"The purpose of this device is to immobilize the cervical spine."
A nurse is caring for a client who has osteoporosis and is prescribed 70 mg of Alendronate (Fosamax) to take by mouth weekly. The nurse recognizes the need to reinforce teaching with the client when she states:
"I take my Alendronate at the same day every week with an 8 ounce glass of milk."
Two days after a total hip replacement, a patient is being discharged. Which statement indicates that the patient understands the discharge teaching?
"I will ask my husband to tie my shoes for me."
My. Cross, age 51, is suffering from RA. He asks if there is a cure for RA. The most appropriate response is
"No, but new drugs being developed can interfere with the body's reaction to inflammation and better control the disease process."
The client is rushed to surgery where his arm is amputated above the elbow. Postoperatively, the client says, "I know my arm isn't there, but I feel it throbbing." Which response by the nurse would be most accurate?
"You may be experiencing phantom pain from the amputated site."
The 14-year-old boy who is scheduled for left leg amputation says to the nurse, "What in the world am I going to do with only one leg?" What is the nurse's most therapeutic response?
"what are you thinking about right now?" rational: the patient's concern should be acknowledged and the patient encouraged to express feelings.
Which of the following are the main purposes of traction?
- Align and stabilize a fracture - prevent deformities - relieve muscle spasms Rational: Skin and skeletal traction provide alignment and stabilize a fracture. This prevents deformities and relieves muscle spasms by putting muscles under tension until they are fatigued.
What are the vital functions provided by muscle contraction?
- Maintenance of posture - Production of heat - Motion
The nurse has been assigned to care for a postoperative client with total knee replacement. The nurse understands that post-op care for this client includes:
- Monitor incision for drainage and infection - Perform continuous passive motion for 24-48 hours - Patient should avoid bearing weight on affected leg - Prevent patient from dangling leg over the bed
The clinical manifestations of hip fracture include which of the following:
- Severe pain and tenderness - inability to move the leg voluntarily - external rotation of the leg
Which instructions should the nurse include in a teaching plan for a person with gouty arthritis?
- avoid excessive alcohol - maintain rest and immobility while disease is symptomatic - check urine and urine output for possible kidney stones - use bed cradle to support linens Rational: The person with gout should avoid alcohol and food with high purine content, maintain rest and immobility while symptomatic, and check urine and urine output for possible kidney stones.
Pain management for the client with Rheumatoid Arthritis (RA) include:
- cox-2 inhibitor (Celebrex) - nonsteroidal anti-inflammatory drugs (NSAIDs) - physical mobility - salicylates
The characteristics of osteoarthritis that should be included in a teaching plan would include that osteoarthritis:
- will cause the formation of Heberden nodes - results from wear and tear - may affect only one side of the body Rational: Osteoarthritis is a disease caused by wear and tear of the joints, causing the appearance of Heberden nodes on the fingers without marked edema or erythema. The disease may only affect one side of the body and does not cause constitutional symptoms.
Identify the body movements listed:
---
A nurse assigns assistive personnel to apply a footplate to the bed of a client who has his left leg in Buck's traction. The nurse correctly explains that the purpose of this action is to:
Prevents foot drop
The nurse administering the drug colchicine for gout will give 0.5 mg hourly for _____ hours.
12
Which patient is most likely to develop osteoporosis?
57 year old white woman Rational: White women have a higher incidence of osteoporosis than Asian women, followed by African American women and Hispanic women.
A movement of an extremity away from the midline of the body.
Abduction
A movement of an extremity towards the axis of the body.
Adduction
Which statement provides the best explanation about the preventative nature of anti-embolism stockings?
Anti Embolism stockings prevent blood from pooling in the legs
A 56-year-old female patient is being seen for osteoarthritis of the knee in the clinic. What should the nurse recommend when discussing strengthening exercises?
Bicycling Rational: Bicycling or swimming is recommended for osteoarthritis of the hip or knee. Jogging would put undue stress on knee joints. Climbing stairs should be avoided. Walking should be done on level ground, not up or down elevations.
Certain foods may increase the pain associated with gout. Which foods have the highest concentration of purines?
Brain, liver, kidney Rational: Foods high in purines, such as brain, kidney, liver, and heart should be avoided, as well as alcohol.
Which information is critical to include in the discharge plans for a client leaving the hospital in a leg cast?
Cast care, neurovascular checks, and hygiene measures
Nursing interventions to treat musculoskeletal injury may include cold or heat therapy. Cold therapy decreases pain by which of the following actions?
Causes local vasoconstriction and prevent edema or muscle spasm
A nurse is caring for a client in skeletal traction who reports pain at the pin insertion site. Which of the following should be the initial nursing action?
Check the pin site for signs of drainage or inflammation
a broken bone, but is still in alignment, skin remains intact.
Closed, non-displaced fracture
A nurse is caring for a client who has a fractured tibia and is in a cast. Which of the following findings is a manifestation of compartment syndrome?
Decreased capillary refill
A client has been diagnosed with gout and wants to know why colchicine is use in the treatment of gout. Which of the following actions of colchicine explains why it's effective for gout?
Descreases inflammation
The nurse takes into consideration that a healing fracture progresses through several healing stages. Which is the third healing stage?
Development of fibrin meshwork Rational: The healing stages of a fracture start with a clot formation, which leads to a hematoma. The development of a fibrin meshwork, which traps osteoblasts to keep the fracture site firm, vascularization, collagen fibers collect calcium to make the callus.
What is the best physiologic reason for a patient with osteoporosis to maintain a regular exercise regimen?
Promotes bone formation and improves strength
A carpenter is returning to work after being diagnosed and treated for carpal tunnel syndrome. To prevent recurrence, which of the following instructions is best to provide to the carpenter?
Do hand and wrist stretching exercises and take frequent breaks
A patient has been casted to stabilize a fracture of the right radius and ulna. The nurse assesses a capillary refill of 5 seconds and cold fingers of the right hand. Which initial intervention should the nurse deploy?
Elevate the right hand to heart level to maintain arterial pressure Rational: the nurse should first elevate the right hand to heart level and notify the charge nurse. Permanent damage can occur in as little time as 6 hours
A nurse is talking with the client who is about to start taking Alendronate (Fosamax) to treat osteoporosis. When the nurse instructs the client to remain sitting or standing for at least 30 minutes after taking the medication, the client ask why. The nurse should tell the client that this will help prevent:
Esophagitis
The nurse discovering that a patient with a recently placed cast have signs of compartment syndrome knows that treatment of compartment syndrome includes which of the following measures?
Fasciotomy
It is a chronic syndrome of unknown origin that causes pain in the muscles, bones, or joints.
Fibromyalgia
A client with gout is encouraged to increase fluid intake. Which of the following statements best explains why increase fluids are encouraged for gout?
Fluids promote the excretion of uric acid
A condition where there is an accumulation of uric acid in the blood due to a defect in purine metabolism.
Gout
A typical symptom of osteoarthritis. What is this called? (bump on the bone)
Heberden's node
A nurse is collecting a healthy history from a patient with a connective tissue disease. What is the most important inquiry by the nurse?
History of a prior injury to a specific body part.
A patient with osteoarthritis in both knees and shoulders states that she cannot manage her household tasks without pain. Which is the most appropriate nursing diagnosis for this patient?
Impaired physical mobility, related to pain
What should the nurse do when a patient with osteomyelitis is admitted with an open wound that is draining?
Initiate drainage and secretion precautions Rational: The patient with osteomyelitis should be at least in drainage and secretion precaution. The limb should be positioned for maximum comfort and left at rest. These patients are usually on bed rest and require a high-calorie, high-protein diet.
A goal for a client who has difficulty with the physical aspects of feeding herself due to rheumatoid arthritis is to use adaptive devices to enhance her capabilities. The nurse caring for the client should initiate a referral to which of the following members of the interprofessional healthcare team?
Occupational therapist
fragmented bone breaking through the skin
Open compound fracture
The most common form of arthritis:
Osteoarthritis (OA)
The first priority nursing intervention for an impending fat embolism is to administer:
Oxygen (O2)
A nurse is monitoring a client who has a cast on her right ankle following an open reduction and internal fixation procedure. The nurse should monitor for which of the following findings to identify compartment syndrome?
Pain unrelieved by routine medications
A nurse is collecting data from a client following the application of a leg cast for the treatment of a fracture. Which of the following should the nurse expect to find first if the cast is too tight?
Pallor of the toes
What does prolonged bed rest put the older adult at risk for?
Pathologic fractures Rational: Immobilization results in bone resorption, and the bone tissue becomes less dense. Prolonged bed rest puts the patient at risk for pathologic fracture. This is a serious concern for an older adult in terms of regaining mobility.
A nurse is collecting data on a client who has a femur fracture. Which of the following findings is a manifestation of fat embolism syndrome?
Petechiae over the client's chest
A movement of the hand and forearm that causes the palm to face downward and backward.
Pronation
You are performing an educational session with female clients and one asked you "Why are females more prone than males in developing osteoporosis"?
Postmenopausal women are high risk related to loss of female hormone estrogen
What should the nurse stress to a patient who has had a hip replacement and is beginning strengthening exercises for the unaffected leg?
Push foot down against the footboard for a count of five. Rational: The unaffected leg should be strengthened by pushing the foot down against the footboard for a count of five and repeating frequently during the day.
A home health nurse is visiting a patient after a total hip replacement. What should the nurse include when teaching the patient how to protect the new joint?
Put an extension on the toilet seat.
The nurse realizes that a client needs further teachings on the use of crutches when he:
Puts his weight on the axilla when ambulating
A nurse is caring for a patient immediately after total knee replacement surgery. What assessment requires priority?
Quality of pulses in the affected limb.
Rheumatoid arthritis can best be distinguished from osteoarthritis by which of the following
RA is an autoimmune, systemic disease; osteoarthritis is a degenerative disease of the joints
An older adult client on an orthopedic unit has an intracapsular fracture of the right hip following a fall. The client is in Buck's traction and will have hip prosthesis surgery in the morning. The nurse reinforces with the client that this type of traction helps:
Relieve muscle spasms
What should the nurse instruct the patient before a magnetic resonance imaging (MRI) procedure?
Remove all metal, such as jewelry, glasses, and hair clips. Rational: MRI procedures require that the patient remove all metal because it will become magnetized.
A client, with a lower leg amputation, is experiencing edema, so a nursing assistant elevates the client's residual left limb on pillows. What is the most appropriate action by the nurse when observing that the client's leg has been elevated with pillows?
Remove the pillows, raise the foot of the bed, and inform the nursing assistant that the limb should not be elevated on pillows because it could cause a flexion contracture
how is RA distinguished from osteoarthritis?
Rheumatoid arthritis is an autoimmune, systemic disease; osteoarthritis is a degenerative disease of the joints. Rational: RA is thought to be an autoimmune disorder. Degenerative joint disease is also known as osteoarthritis.
A nurse is educating a patient with gout about low-purine diet. Which food choice by the patient would indicate the need for further teaching?
Seafood platter with scallops and mussels
A 20-year-old male client has just had a plaster cast applied to his right forearm following reduction of a closed radius fracture due to an in-line skating accident. The most important for the nurse to check which of the following?
Sensation and movement of the fingers.
Bursitis is defined as inflammation of a bursa, a fibrous sac that is lined with synovial fluid. Your client asks you: "Where are the common sites that bursitis occurs in"? You reply by saying:
Shoulder, elbow, and knee joints
What should the nurse include in the teaching plan for a patient who is taking alendronate (Fosamax)?
Take drug first thing in the morning. Rational: Alendronate (Fosamax) should be taken on an empty stomach first thing in the morning with 6 oz of water, accompanied by no other medication.
Calcium is a mineral found in many foods that can slow bone loss during the aging process. Which food is high in calcium?
Spinach Rational: Spinach and green vegetables, as well as yogurt, are considered calcium-rich foods. Fresh oranges, bananas, and eggs are not good calcium choices.
A movement of the hand and forearm that causes the palm to face upward or forward.
Supination
Client with osteoarthritis may be on bed rest for prolonged periods. Which of the following nursing interventions would be appropriate for these clients?
Turn the client every 2 hours, and encourage coughing and deep breathing exercises
When assessing for Tinel's sign in a patient with possible right-sided carpal tunnel syndrome, the nurse will ask the patient about:
Tingling in the right thumb and fingers
A claw like deformity of the hand, wrist, fingers, and atrophy of the forearm that can happen as a result of compartment syndrome.
Volkmann's contracture
A client asks why a cast can't get wet. Which of the following responses would be the most appropriate?
a wet cast will weaken or be destroyed
What is the neurotransmitter for the skeletal muscle tissue?
acetylcholine
A client has a fiberglass cast on the right arm. Which action should the nurse include in the pain of care?
assessing movement and sensation in the fingers of the right hand
What do connective tissue diseases affect?
bones, ligaments, cartilage, tendons
A nurse is caring for a client with a fractured right hip. Which of the following types of traction should the nurse expect the client to have prior to hip surgery?
buck's traction
How can the nurse best support the wet cast while the physician wraps the arm with rolls of wet plaster?
by using the palms of her hands
The nurse is assessing the client's circulation in the right leg following an injury. Which findings need further action?
capillary refill is longer than 3 secs.
The client tells the nurse that his skin itches terribly beneath the cast. Which nursing action is most appropriate at this time?
collaborate with the physician on prescribing an antipruritic medication
bone breaks into three or more pieces with more than one fracture line
comminuted fracture
A 51 year old professional tennis instructor is newly diagnosed with osteoarthritis. What is the nurse's best explanation to the patient when asked what this diagnosis means?
degeneration of articular cartilage
One month after discharge, a client who had a left total hip replacement calls a clinic reporting acute constant pain in the left groin and hip area and feeling like the left leg is shorter than the right. A nurse advises the client to come to the clinic immediately suspecting:
dislocation of the prosthesis
A fracture that has come out of alignment
displaced fracture
A patient had an open reduction with internal fixation (ORIF) for a compound fracture of the left tibia and has been placed in a long leg cast. The assessments by the nurse are: left foot warm/pink, pedal pulse weaker than right, capillary refill 3 seconds, and small 1 cm area of blood on cast. What should the nurse do?
document that all assessments are within normal limits Rational: all of the assessments are within normal limits. A small amount of blood on the cast is expected and should be monitored.
The doctor orders non-weight bearing with crutches for a client with leg injury. In preparation for the use of crutches, the nurse should instruct the client to:
exercise the triceps, fingers flexor and elbow extensors.
While performing an educational session with a client, which of the following conditions is the primary complication of osteoporosis?
fractures
an incomplete fracture in which the fracture line extends only partially through the bone. A fracture common in children.
greenstick fracture
A nurse is caring for a client who is 2 days postoperative following an above-the-knee amputation. Which of the following is an appropriate nursing intervention for this client at this time?
have the client lie prone several times a day
To promote the safe use of a cane as an assistive device for a client who is recovering from a musculoskeletal injury of the left lower extremity, which of the following instructions should the nurse provide?
hold the cane on the right side
The community health nurse found an elderly female client lying in the snow, unable to move her right leg because of a fracture. What's the nurse first priority?
immobilize the fracture in its present position
A nurse witnesses a client sustain a fall and suspects that the client's leg may be frustrated. Which nursing action is the priority?
immobilize the leg before moving the client
telescoped fracture, one bone fragment is wedged forcibly into another bone fragment.
impacted fracture
A nurse is collecting data from a client who has a left lower arm fracture. Which of the following findings indicates impaired venous return in the affected arm?
increasing edema
A nurse is caring for a client who has a fractured femur. Which of the following techniques should the nurse use when collecting data about the client's circulatory status?
instruct the client to wiggle his toes
When the patient with rheumatoid arthritis complains about the daily exercise, the nurse encouragingly reminds the patient that exercises:
keeps the joints from "freezing" Rational: daily gentle exercises keep the joints from "freezing" and keep the muscles from weakening
The diagnostic procedure that is used to detect abnormalities of the spinal cord or selected areas, such as the cervical or lumbar areas, is called:
myelography
A fracture that runs diagonally
oblique fracture
A nurse is caring for an adolescent client who has a fractured tibia. Following the application of a fiberglass cast, which of the following is the nurse's priority action?
perform a neurovascular check
A movement that causes the bottom of the foot to be directed downward.
plantar flexion
A nurse assigns assistive personnel to apply a footplate to the bed of a client who has his left leg in Buck's traction. The nurse correctly explains that the purpose of this action is to:
prevent foot drop
The nurse explains to a patient who has had a knee replacement that warfarin (Coumadin) is ordered to:
prevent formation of emboli Rational: Warfarin (Coumadin) is a standard postsurgical drug to prevent the formation of emboli.
A patient who had a hip fracture was placed on spica cast. The patient complains of abdominal pain and numerous bouts of vomiting. The physician confirms that the patient is showing signs of cast syndrome. Which position will relieve the signs and symptoms of cast syndrome?
prone
A client who has a compound fracture of the right tibia has had a long-leg fiberglass cast applied. To reinforce teaching for the client on how to observe and manage his casted extremity at home, the nurse should include which of the following instructions?
report any worsening or unrelieved pain
A nurse is administering meperidine 100 mg IM for a client who is admitted with a pelvic fracture. Following the injection, which of the following data is the priority for the nurse to check?
respiratory rate
A nurse is administering meperidine 100 mg IM for a client who is admitted with pelvic fracture. Following the injection, which of the following data is the priority for the nurse to check?
respiratory rate
Which nursing diagnosis has the highest priority after surgery for the open reduction and external fixation of an ankle?
risk of infection
A movement of a bone around its longitudinal axis.
rotation
