Honan-Chapter 41: Nursing Management: Patients With Musculoskeletal Disorders

Which assessment finding may indicate to the nurse an acute peripheral neurovascular dysfunction for the patient recovering from surgery of the foot? A. Pale skin, atrophy of the limb, with capillary refill of 2 seconds B. Absence of feeling, capillary refill of 4 to 5 seconds, and cool skin C. Atrophy of limb, increased motion, and thickened toe nails D. Pale skin, weakness in motion, and loss of toe hairs

B. Absence of feeling, capillary refill of 4 to 5 seconds, and cool skin RATIONALE Delayed capillary refill, pale cool skin, paresthesia, and weakness are associated with acute neurovascular dysfuntion. Atrophy of a limb, thickened toe nails, and loss of toe hairs are associated with chronic ischemia.

Which assessment finding would the nurse expect to find in a patient diagnosed with acute osteomyelitis? A. Leukopenia and localized bone pain B. Leukocytosis and elevated sedimentation (SED) rate C. Leukopenia and elevated fever D. Petechiae over the chest and abnormal arterial blood gas (ABG) results

B. Leukocytosis and elevated sedimentation (SED) rate RATIONALE Leukocytosis or elevated white blood cells and increased sedimentation rate are seen in acute osteomyelitis.

The nurse is educating a client on home care following removal of a ganglion cyst from the right wrist. Which statement by the client demonstrates that the nurse's teaching has been effective? A. "I will leave the dressing on until I follow up with my doctor as scheduled." B. "If my hand becomes numb and cool I will elevate it above my heart." C. "I will notify my doctor if I develop redness and purulent drainage for 2 days." D. "If my pain is not relieved I will use a heat pack and take some more medication."

A. "I will leave the dressing on until I follow up with my doctor as scheduled." RATIONALE The first dressing is changed by the surgeon at a scheduled follow-up appointment. If the hand becomes cool and numb, the client needs to call the surgeon as soon as possible. The surgeon should be notified immediately if redness and purulent drainage develop. Medication should only be used as prescribed. The use of heat may increase swelling, which may increase pain.

The nurse is caring for a 35-year-old man diagnosed with a back strain. What would be a priority point of discussion with this patient? A. Avoid lifting heavy weights without assistance. B. Focus on using back muscles during lifting. C. Lift objects while holding the object away from the body. D. Tighten the abdominal muscles and lock the knees during the lifting of an object.

A. Avoid lifting heavy weights without assistance. RATIONALE The nurse will instruct the patient on the safe and correct way to lift objects, using the strong quadriceps muscles of the thighs, with minimal use of the weak back muscles. To prevent recurrence of acute low back pain, the nurse may instruct the patient to avoid lifting excessive weights without help. The patient should be informed to place the feet a hip-width apart to provide a wide base of support, the person should bend the knees, tighten the abdominal muscles, and lift the object close to the body with a smooth motion, avoiding twisting and jerking.

During a routine physical examination of a client, the nurse observes a flexion deformity of the promixal interphalangeal (PIP) joint of two toes on the right foot. How would the nurse document this finding? A. Hammer toe B. Mallet toe C. Hallux valgus D. Bunion

A. Hammer toe RATIONALE Hammer toe is a flexion deformity of the proximal interphalangeal (PIP) joint and may involve several toes. Mallet toe is a flexion deformity of the distal interphalangeal joint (DIP), and also can affect several toes. Hallux valgus, also called a bunion, is a deformity of the great (large) toe at its metatarsophalangeal joint.

A client is diagnosed with osteoporosis. Which statements should the nurse include when teaching the client about the disease? Select all that apply. A. Osteoporosis is common in females after menopause. B. Osteoporosis is a degenerative disease characterized by an increase in bone density. C. Osteoporosis can increase the risk for fractures. D. The recommended daily calcium dose should be taken as a single dose, and the patient should be instructed not to lie down for 30 minutes. E. Weight-bearing exercise should be avoided. F. The patient's T score is at least 2.5 SD below the young adult mean value on the BMD scan.

A. Osteoporosis is common in females after menopause. C. Osteoporosis can increase the risk for fractures. F. The patient's T score is at least 2.5 SD below the young adult mean value on the BMD scan. RATIONALE It is estimated that one in two women over the age of 50 years will suffer a fracture due to osteoporosis. Characteristics of osteoporosis include a reduction of bone density. The bones become progressively porous, brittle, and fragile; they fracture easily under stresses that would not break normal bone. The calcium dose should be split and not taken as a single dose. Bone formation is enhanced by the stress of weight and muscle activity. Resistance and impact exercises are most beneficial in developing and maintaining bone mass. Osteoporosis is present when the T-score is at least 2.5 SD below the young adult mean value on BMD scan (NIH, 2015).

What places the patient at risk for impaired wound healing after surgery for a primary bone cancer? Select all that apply. A. Radiation therapy B. Prealbumin level is 28 mg/dL C. Weight loss of 18% over the previous 3 months D. Anorexia E. Satisfactory vitamin C levels

A. Radiation therapy C. Weight loss of 18% over the previous 3 months D. Anorexia RATIONALE The purpose of radiation therapy is to disrupt cell mitosis and has lasting effects on wound healing. A normal prealbumin level is 19 to 38 mg/dL. An unintentional weight loss of 10% of usual body weight in three months is a risk factor for malnutrition. Anorexia is associated with inadequate nutrition that is necessary for healing. Vitamin C contributes to the body's resistance to infection and increases wound tensile strength.

A nurse is caring for a client with eczema. Which medication would be prescribed when an allergy is a factor causing the skin disorder? A. Dexamethasone B. Chlorpheniramine C. Dicloxacillin D. Bupivacaine

B. Chlorpheniramine RATIONALE Antihistamines such as chlorpheniramine are frequently prescribed when an allergy is a factor in causing a skin disorder. Antihistamines relieve itching and shorten the duration of allergic reaction. Corticosteroids such as dexamethasone are used to relieve inflammatory or allergic symptoms. Antibiotics such as dicloxacillin are used to treat infectious disorders. Local anesthetics such as bupivacaine are used to relieve minor skin pain and itching.

A 25-year-old woman experienced an open fracture of the right fibula with major soft tissue damage of her lower leg in a motor vehicle accident. Surgical reduction and fixation of the fibula were performed with débridement of nonviable tissue and drain placement in the damaged soft tissue. Which complication is this patient at risk for? A. Osteoporosis B. Osteomyelitis C. Fat emboli D.Compartment syndrome

B. Osteomyelitis RATIONALE Osteomyelitis is an acute or chronic infection of the bone or bone marrow. This patient is at risk for this bone infection because of direct contamination with an open fracture, and direct bone contamination from the Open Reduction and Internal Fixation (ORIF) of the right fibula fracture.

A 67-year-old woman with a history of osteoarthritis has been admitted to the postsurgical unit from the PACU following a bunionectomy. Which of the following nursing actions should the nurse integrate into this patient's immediate care? A. Maintain the patient's foot in a dependent position. B. Apply ice to the affected foot on a schedule of 1 hour on and 1 hour off. C. Keep the patient's foot elevated above the level of her heart. D. Change the patient's surgical dressing and irrigate the surgical site every 6 hours.

C. Keep the patient's foot elevated above the level of her heart. RATIONALE Post bunionectomy, the patient may have intense throbbing pain at the operative site, requiring liberal doses of analgesic medication. The foot is elevated to the level of the heart to decrease edema and pain. The application of ice for a 1-hour period is likely to cause skin breakdown. It is unnecessary to perform frequent irrigation or dressing changes.

The nurse is caring for a patient with a bone tumor. The nurse provides education that teaches the patient to implement measures to reduce the risk of pathologic fractures. What intervention will assist the patient in fracture prevention? A. Teaching the patient to achieve maximum weight-bearing capabilities B. Maintaining strict bed rest C. Supporting the affected extremity with external supports (splints) D. Limiting the patient's reliance on assistive devices

C. Supporting the affected extremity with external supports (splints) RATIONALE During nursing care, the affected extremities must be supported and handled gently. External supports (splints) may be used for additional protection. Prolonged bed rest is not therapeutic and leads to loss of function and muscle atrophy. Assistive devices should be used to strengthen the unaffected extremities. Weight-bearing must be undertaken cautiously.