Management Quiz 1: Musculoskeletal Problems

The charge nurse assigns the nursing care of a patient who has just returned from open carpal tunnel release surgery to an experienced LPN, who will perform under the supervision of an RN. Which instructions would the RN provide for the LPN? (Select All that Apply) 1. Check the patient's VS Q 15 minutes in the first hour. 2. Check the dressing for drainage and tightness 3. Elevate the patient's hand above the heart 4. The patient will no longer need pain medication 5. Check the neurovascular status of the fingers every hour. 6. Instruct the patient to perform range of motion on the affected wrist.

1, 2, 3, 5 Hand movements are restricted for 4-6 weeks after surgery. Raising the hand above the heart reduces swelling. This is often done for several days.

The nurse is preparing to teach a patient with a new dx of osteoporosis about strategies to prevent falls. Which teaching points should the nurse be sure to include? (Select All that Apply) 1. Wear a hip protector when ambulating 2. Remove throw rugs and other obstacles at home 3. Exercise to help build your strength 4. Expect a few bumps and bruises when you go home 5. Rest when you are tired. 6. Avoid consuming three or more alcoholic drinks per day.

1, 2, 3, 5 The hip protector can prevent fractures if the patient falls. Women should not consume more than 1 drink per day, and Men should not consume more than 2 drinks per day.

The emergency department nurse receives a call about a patient with a traumatic finger amputation. What instructions does the nurse provide to the patient's wife? (Select All That Apply) 1. Wrap the completely severed finger in a dry sterile gauze (if available) or a clean cloth. 2. Put the finger in a watertight, sealed plastic bag 3. Place the bag directly on ice 4. Elevate the affected extremity above the patient's heart. 5. Examine the amputation site and apply direct pressure with layers of dry gauze 6. After performing these steps, call 911 and check the patient for breathing.

1, 2, 4, 5 Want to call 911 and assess breathing FIRST. Place the bag with the finger in it in ice water, not directly on ice. 1 part ice and 3 parts water. Avoid contact between the finger and water to prevent tissue damage.

The nurse is preparing a discussion of musculoskeletal health maintenance for a group of older adults. Which key points would the nurse be sure to include? (Select All That Apply) 1. Be aware of and consume foods rich in calcium and vitamin D 2. Wear hats and long sleeves to avoid sun exposure at all times 3. Consider exercise with low impact to avoid risk for injury. 4. If you smoke, consider a smoking cessation program 5. Excessive alcohol intake can interfere with vitamins and nutrients for bone growth. 6. Weight baring activities decrease the risk for osteoporosis.

1, 3, 4, 5, 6 Tobacco slows the healing of musculoskeletal injuries. Alcohol can decrease vitamins and nutrients needed for bone growth and strength.

The nurse is caring for a patient who had a DEXA scan and is not prescribed Ca+ with Vitamin D BID. The patient asks the nurse the purpose of this drug. What is the nurse's best response? (Select All That Apply) 1. When your Ca+ and Vitamin D levels are low, your risk for osteoporosis and osteomalacia increases. 2. When your Vitamin D level is high, your bones release calcium to keep your blood calcium level in the normal range. 3. When your blood calcium is low, calcium is released from your bones increasing your risk for fractures 4. When blood calcium is normal, long bones are formed increasing a person's height. 5. The extra calcium and vitamin D will help protect your bones from damage such as fractures. 6. You can also get extra vitamin D by increasing your intake of beef and pork sources.

1, 3, 5 Vitamin D and metabolites are produced in the body to promote Calcium and Phosphorus absorption from the small intestine.

The nurse is working with UAP to provide care for 6 patients. At the beginning of the shift, the nurse carefully tells the UAP what patient interventions and tasks he or she is expected to perform. Which "Four C's" guide the nurse's communication with the UAP? (Select All that Apply) 1. Clear 2. Comprehensive 3. Concise 4. Credible 5. Correct 6. Complete

1, 3, 5, 6 Clear, concise, correct, and complete are the 4 C's of communication.

The nurse is caring for a postoperative patient with a hip replacement. Which patient care actions can be delegated to the experienced UAP? (Select All That Apply) 1. Inspect heels and other bony prominences every 8 hours. 2. Turn and reposition the patient every 2 hours 3. Assure that the patient's heels are elevated off the bed. 4. Assess the patient's calf regions for redness and swelling 5. Check VS and oxygen saturation via pulse oximetry 6. Assess for pain and administer pain medication

2, 3, 5 An experienced UAP would know to assure the patient's heels are elevated off the bed.

During assessment of a patient with fractures of the medial ulna and radius, the nurse finds all of these data. Which assessment finding should the nurse report to the HCP immediately? A. The patient reports pressure and pain B. The cast is in place and is dry and intact. C. The skin is pink and warm to the touch. D. The patient can move all the fingers and thumb

A. All the other options are good observations.

The nurse delegates the measurement of VS to an UAP. Osteomyelitis has been dx in a patient. Which VS value would the nurse instruct the UAP to report immediately for this patient? A. Temperature of 101*F B. BP of 136/80 C. HR of 96 bpm D. RR of 24 breaths/minute

A. An elevated temperature means infection and inflammation. This patient needs IV antibiotics.

A patient who underwent a right above the knee amputation 4 days ago also has a dx of depression. Which order would the nurse clarify with the HCP? A. Give fluoxetine 40mg once a day B. Administer acetaminophen with codeine 1 or 2 tablets every 4 hours as needed C. Assist the patient to the bedside chair every shift. D. Reinforce the dressing to the right residual limb as needed.

A. Doses of fluoxetine, which is used to treat depression, greater than 20mg should be given in two divided doses, not once a day.

When receiving discharge instructions, a patient with osteoporosis makes all of these statements. Which statement indicates to the nurse that the patient needs additional teaching? A. I take my ibuprofen every morning as soon as I get up B. My daughter removed all of the throw rugs in my home C. My husband helps me every afternoon with range of motion exercises D. I rest in my reclining chair every day for at least an hour.

A. Ibuprofen can cause abdominal discomfort or ulceration of the GI tract. It should be taken with meals or milk.

The nurse is supervising a new graduate RN caring for a patient with a fracture of the right ankle who is at risk for complications of immobility. For which action should the supervising nurse intervene? A. Encourage the patient to go from lying to a standing position B. Administering pain medication before the patient begins exercises C. Explaining to the patient and family the purpose of the exercise program D. Reminding the patient about the correct use of crutches.

A. Moving from a lying to standing position does not allow the patient to establish balance.

A patient is scheduled for endoscopic carpal tunnel release surgery in the morning. What would the nurse be sure to teach the patient? A. Pain and numbness are expected to be experienced for several days to weeks. B. Immediately after surgery, the patient will no longer need assistance C. After surgery, the dressing will be large, and there will be lots of drainage. D. The patient's pain and paresthesia will no longer be present

A. Postoperative pain and numbness occur for a longer period of time with Carpal tunnel release surgeries.

A patient with a right above the knee amputation asks the nurse why he has phantom limb pain. What is the nurse's best response? A. Phantom limb pain is not explained or predicted by any one theory B. Phantom limb pain occurs because your body thinks your leg is still present C. Phantom limb pain will not interfere with your ADLs D. Phantom limb pain is not real pain but is remembered pain.

A. Three theories are being researched with a regard to phantom limb pain. The peripheral nervous system, the central nervous system, and the psychological theory all are playing key roles in explaining phantom limb pain.

The charge nurse is assigning the nursing care of a patient who had a left below the knee amputation 1 day ago to an experienced LPN, who will function under an RN's supervision. What will the RN tell the LPN is the major focus for the patient's care today? A. To attain pain control over phantom pain B. To monitor for signs of sufficient tissue perfusion C. To assist the patient to ambulate as soon as possible D. To elevate the residual limb when the patient is supine

B.

The nurse is preparing a patient who had carpal tunnel release surgery for discharge. Which information is important to provide for this patient? A. The surgical procedure is a cure for CTS B. Do not life any heavy objects C. Frequent doses of pain medication will no longer be necessary D. The HCP should be notified immediately if there is any pain or discomfort.

B.

A patient has a fractured femur. Which finding would the nurse instruct the UAP to report Immediately? A. The patient reports pain B. The patient appears to be confused C. The patient's BP is 136/88 D. The patient voided using the bedpan.

B. Fat embolism syndrome is a serious complication that often results from fractures of long bones. The earliest manifestation is altered mental status caused by low arterial oxygen level.

The ED nurse should question which HCP order when providing care for an older adult with a fracture of the left ulna? A. Get XRs of the left forearm B. Give meperidine IM for pain C. Monitor VS every hour D. Elevate left arm on pillows.

B. Meperidine should not be used because of its toxic metabolites that can cause seizures and other adverse drug events, esp. in the older population

The nurse's assessment reveals all of these data when a patient with Paget Disease is admitted to the acute care unit. Which finding should the nurse notify the HCP about first? A. There is a bowing of both legs, and the knees are asymmetrical B. The base of the skull is invaginated (platybasia) C. The patient is only 5 ft tall and weighs 120lbs D. The skull is soft, thick, and larger than normal.

B. Platybasia (basilar skull invagination) causes brainstem manifestations that threaten life.

The nurse is providing care for a patient with a rotator cuff tear. What treatment does the nurse expect the HCP will prescribe first for this patient? A. Arthroscopic repair of the rotator cuff tear B. Elimination of movements in the affected shoulder C. Conservative therapies such as NSAIDs and PT D. Pendulum exercises that start slow and progress over 2 weeks.

C.

The charge nurse observes an LPN assigned to provide all of these interventions for a patient with Paget Disease. Which actions requires that the charge nurse intervene? A. Administering 600mg of ibuprofen to the patient B. Encouraging the patient to perform exercises recommended by the PT C. Applying ice and gentle massage to the patient's lower extremities D. Reminding the patient to drink mink and eat cottage cheese.

C. Apply heat, not ice, to reduce the patient's pain.

The nurse is teaching an older patient about risks for fractures and osteoporosis. Which dx test should the nurse teach about when the goal is to establish the patient's bone strength and determine if osteoporosis is present? A. CT scan B. MRI scan C. DEXA scan D. Joint XRs

C. Testing bone density is the only way to determine how strong the bone is. DEXA scans the hips and spine.

The nurse observes the UAP performing all of these interventions for a patient with carpal tunnel syndrome. Which action requires the nurse to intervene immediately? A. Arranging the patient's lunch tray and cutting his meat B. Providing warm water and assisting the patient with his bath C. Replacing the patient's splint in hyperextension position D. Reminding the patient not to life heavy objects.

C. The immobilization is placed either in the neutral position or in slight extension. The UAP can remind the patient of elements of their care plans such as avoiding heavy lifting.

After the nurse receives change of shift report, which patient should be assessed first? A. A 42 year old patient with CTS who reports pain B. A 64 year old patient with osteoporosis awaiting discharge C. A 28 year old patient with a fracture who reports the cast is too tight D. A 56 year old patient with a left leg amputation who reports phantom pain

C. The patient with the tight cast is at risk for circulation impairment and peripheral nerve damage.

The nurse is caring for a patient with carpal tunnel syndrome who has been admitted for surgery. Which intervention should be delegated to the UAP? A. Initiating placement of a splint for immobilization during the day B. Assessing the patient's wrist and hand for discoloration and brittle nails C. Assisting the patient with daily self care measures such as bathing and eating D. Testing the patient for painful tingling in the four digits of the hand.

C. UAP's can help with ADLs. Placing a splint for the first time is done under the scope of the physical therapist.

A patient with a fractured fibula is receiving skeletal traction and has skeletal pins in place. What would the nurse instruct the UAP to report immediately? A. The patient wants to change position in bed. B. There is a small amount of clear fluid at the pin sites C. The traction weights are resting on the floor D. The patient reports pain and muscle spasm.

C. When weights are resting on the floor, they are not exerting pulling force to provide reduction and alignment or to prevent muscle spasm. The weights should always be hanging freely.

The nurse is caring for a patient with osteoporosis who is at increased risk for falls. Which intervention should the nurse delegate to the UAP? A. Identifying environmental factors that increase risk for falls B. Monitoring gait, balance, and fatigue level when ambulating C. Collaborating with the PT to provide the patient a walker D. Assisting the patient with ambulation to the bath room and in the halls.

D. Assisting with ADLs is within the UAP scope of practice

The nurse is preparing a patient for an MRI. Which action can the nurse delegate to the experienced UAP? A. Teach the patient what to expect during the test. B. Instruct the patient to remove metal objects including zippers C. Witness that the patient has signed the consent forms D. Check and record pre procedure VS

D. Checking and recording VS is under the scope of the UAP. The UAP can remind the patient to remove metal objects, but not instruct first.

The RN is mentoring a student nurse who is caring for a patient with CTS of the right hand with neuro checks ordered every 2 hours. For which action by the student nurse must the RN intervene? A. Student nurse checks the patient's radial pulse every 2 hours B. Student nurse checks for sensation in the patient's right hand C. Student nurse assesses color, temperature, and pain in right wrist and hand D. Student nurse instructs the a patient to avoid movement because of the pain.

D. Pain is included in the assessment of neurovascular checks. Movement is only restricted with heavy objects 4-6 weeks after surgery.

The charge nurse is making assignments for the day shift. Which patient should be assigned to the nurse who was floated from the PACU for the day? A. A 35 year old patient with osteomyelitis who needs teaching before hyperbaric oxygen therapy. B. A 62 year old patient with osteomalacia who is being discharged to a long term care facility C. A 68 year old patient with osteoporosis given a new orthotic device whose knowledge of its use must be assessed. D. A 72 year old patient with Paget disease who has just returned from surgery for total knee replacement.

D. The PACU nurse is very familiar with the assessment skills necessary to monitor a patient who just underwent surgery.

During morning care, a patient with a below the knee amputation asks the UAP about protheses. How will the nurse instruct the UAP to respond? A. You should get a prosthesis so that you can walk again. B. Wait and ask your doctor that question the next time he comes in. C. It's too soon to be worrying about getting a prosthesis. D. Ill ask the nurse to come in and discuss this with you.

D. The patient is indicating an interest in learning, which the RN can do, without the doctor.