Musculoskeletal Chapter 61, 62, 63

Which action should the nurse take to evaluate the effectiveness of Buck's traction for a patient who has an intracapsular fracture of the right femur? A. Assess for hip pain. B. Check for contractures. C. Palpate peripheral pulses. D. Monitor for hip dislocation.

A Buck's traction is used to reduce painful muscle spasm. Hip contractures and dislocation are unlikely to occur in this situation. The peripheral pulses will be assessed, but this does not help in evaluating the effectiveness of Buck's traction.

A patient with left knee pain is diagnosed with bursitis. What area should the nurse explain is the site of inflammation in bursitis? A. fluid-filled sac found at some joints. B. synovial membrane that lines some joints. c. The connective tissue joining bones within a joint. d. The fibrocartilage that acts as a shock absorber in the knee

A Bursae are fluid-filled sacs that cushion joints and bony prominences. Fibrocartilage is a solid tissue that cushions some joints. Ligaments are connective tissue joining bones within a joint. The synovial membrane lines many joints but is not affected in bursitis.

A patient with severe kyphosis is scheduled for dual-energy x-ray absorptiometry (DXA) testing. Which action should the nurse plan to take? A. Explain the procedure to the patient. B. Start an IV line for contrast injection. C. Give an oral sedative 60 to 90 minutes before the procedure. D. Screen the patient for allergies to shellfish or iodine products.

A DXA testing is painless and noninvasive. No IV access is necessary. Contrast medium is not used. Shellfish or iodine allergies are not a concern with DXA testing. Because the procedure is painless, antianxiety medications are not typically required.

Which action should 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. Instruct the patient to avoid dairy products in the diet. D. Discuss the use of medications such as bisphosphonates.

A Osteomalacia is caused by inadequate intake or absorption of vitamin D. Weight-bearing exercise and bisphosphonate administration may be used for osteoporosis but will not be beneficial for osteomalacia. Because ultraviolet light is needed for the body to synthesize vitamin D, the patient might be taught that 20 minutes a day of sun exposure is beneficial.

A patient has a new order for magnetic resonance imaging (MRI) to evaluate possible left femur osteomyelitis after hip arthroplasty surgery. Which information indicates the nurse should consult with the health care provider before scheduling the MRI? A. The patient has a pacemaker. B. The patient wears a hearing aid. C. The patient is allergic to shellfish. D. The patient uses supplemental oxygen.

A Patients with most permanent pacemakers cannot have an MRI because of the force exerted by the magnetic field on metal objects. Supplemental oxygen can be delivered during the MRI. The patient will need to be instructed to remove the hearing aid before the MRI, but this does not require consultation with the health care provider. Because contrast medium will not be used, shellfish allergy is not a contraindication to MRI.

A patient with a right lower leg fracture will be discharged home with an external fixation device in place. Which statement should the nurse including in discharge teaching? A. "Check and clean the pin insertion sites daily." B. "Remove the external fixator for your shower." C. "Remain on bed rest until bone healing is complete." D. "Take prophylactic antibiotics until the fixator is removed."

A Pin insertion sites should be cleaned daily to decrease risk for infection at the site. An external fixator allows the patient to be out of bed and avoid the risks of prolonged immobility. The device is surgically placed and is not removed until the bone is stable. Prophylactic antibiotics are not routinely given during external fixator use.

What should the occupational health nurse advise a patient whose job involves many hours of typing? A. Obtain a keyboard pad to support the wrist. B. Do stretching exercises before starting work. C. Wrap the wrists with compression bandages every morning. D. Avoid using nonsteroidal antiinflammatory drugs (NSAIDS).

A Repetitive strain injuries caused by prolonged work at a keyboard can be prevented by using a pad to keep the wrists in a straight position. Stretching exercises during the day may be helpful, but these would not be needed before starting work. Use of a compression bandage is not needed, although a splint may be used for carpal tunnel syndrome. NSAIDs are appropriate to decrease swelling.

For a patient who has had right hip arthroplasty, which nursing action can the nurse delegate to experienced unlicensed assistive personnel (UAP)? A. Reposition the patient every 1 to 2 hours. B. Assess for skin irritation on the patient's back. C. Teach the patient quadriceps-setting exercises. D. Determine the patient's pain intensity and tolerance.

A Repositioning of orthopedic patients is within the scope of practice of UAP after they have been trained and evaluated in this skill. The other actions should be done by licensed nursing staff members.

A patient who has had open reduction and internal fixation (ORIF) of a hip fracture tells the nurse he is ready to get out of bed for the first time. Which action should the nurse take? A. Check the patient's prescribed weight-bearing status. B. Use a mechanical lift to transfer the patient to the chair. C. Decrease the pain medication before getting the patient up. D. Have the unlicensed assistive personnel (UAP) transfer the patient.

A The nurse should be familiar with the weight-bearing orders for the patient before attempting the transfer. Mechanical lifts are not typically needed after this surgery. Pain medications should be given because the movement is likely to be painful for the patient. The registered nurse (RN) should supervise the initial transfer to evaluate how well the patient is able to accomplish the transfer.

A patient undergoes left above-the-knee amputation with an immediate prosthetic fitting. What should the nurse do when the patient arrives on the orthopedic unit after surgery? A. Assess the surgical site for hemorrhage. B. Remove the prosthesis and wrap the site. C. Place the patient in a side-lying position. D. Keep the residual limb elevated on a pillow.

A The nurse should monitor for postoperative hemorrhage. The prosthesis will not be removed. To avoid flexion contracture of the hip, the leg will not be elevated on a pillow. Unless contraindicated, the patient will be placed in a prone position for 30 minutes several times a day to prevent hip flexion contracture.

A patient who had open reduction and internal fixation (ORIF) of left lower leg fractures continues to report severe pain in the leg 15 minutes after receiving the prescribed IV morphine. The nurse determines pulses are faintly palpable and the foot is cool to the touch. Which action should the nurse take next? A. Notify the health care provider. B. Assess the incision for redness. C. Reposition the left leg on pillows. D. Check the patient's blood pressure.

A The patient's clinical manifestations suggest compartment syndrome and delay in diagnosis and treatment may lead to severe functional impairment. The data do not suggest problems with blood pressure or infection. Elevation of the leg will decrease arterial flow and further reduce perfusion.

Which finding from analysis of fluid from a patient's right knee arthrocentesis should be of concern to the nurse? A. Cloudy fluid B. Scant thin fluid C. Pale yellow fluid D. Straw-colored fluid

A The presence of purulent (cloudy) fluid suggests a possible joint infection. Normal synovial fluid is scant in amount and pale yellow/straw-colored.

Which action should the nurse include when performing the straight-leg raising test for an ambulatory patient with back pain? A. Lift the patient's leg to a 60-degree angle from the bed. B. Place the patient in the prone position on the exam table. C. Ask the patient to dangle both legs over the edge of the exam table. D. Instruct the patient to elevate the legs and tense the abdominal muscles.

A When performing the straight leg-raising test, nurse passively lifts the patient's legs to a 60-degree angle while the patient is in the supine position. The other actions would not be correct for this test.

Which actions should the nurse include in the plan of care for a patient with metastatic bone cancer of the left femur? (Select all that apply.) A. Monitor serum calcium. B. Teach about the need for strict bed rest. C. Explain the use of sustained-release opioids. D. Support the left leg when repositioning the patient. E. Assist family and patient as they discuss the prognosis.

A, C, D, E The nurse will monitor for hypercalcemia caused by bone decalcification. Support of the leg helps reduce the risk for pathologic fractures. Although the patient may be reluctant to exercise, activity is important to maintain function and avoid complications associated with immobility. Adequate pain medication, including sustained-release and rapid-acting opioids, is needed for the severe pain often associated with bone cancer. The prognosis for metastatic bone cancer is poor, so the patient and family need to be supported as they deal with the reality of the situation.

Which action should the urgent care nurse take for a patient with a possible knee meniscus injury? A. Encourage bed rest for 24 to 48 hours. B. Apply an immobilizer to the affected leg. C. Avoid palpation or movement of the knee. D. Administer intravenous opioids for pain management.

B A knee immobilizer may be used for several days after a meniscus injury to stabilize the knee and minimize pain. Patients are encouraged to ambulate with crutches. The knee is assessed by flexing, internally rotating, and extending the knee (McMurray's test). The pain associated with a meniscus injury will not typically require IV opioid administration. Nonsteroidal antiinflammatory drugs (NSAIDs) are recommended for pain management.

A 60-yr-old patient had open reduction and internal fixation (ORIF) for an open, displaced tibial fracture, What should the nurse identify as the priority patient problem? A. Acute pain B. Risk for infection C. Activity intolerance D. Risk for constipation

B A patient having ORIF is at risk for problems such as wound infection and osteomyelitis. After ORIF, patients typically are mobilized starting the first postoperative day, so the problems caused by immobility are not as likely. Pain management is important, but the most important action is to prevent infection.

The day after a having a right below-the-knee amputation, a patient reports pain in the missing right foot. Which action is most important for the nurse to take? A. Explain the reasons for the pain. B. Administer prescribed analgesics. C. Reposition the patient to assure good alignment. D. Tell the patient that the pain will diminish over time.

B Acute phantom limb sensation is treated as any other type of postoperative pain would be treated. Explanations of the reason for the pain may be given, but the nurse should still medicate the patient.

The nurse should instruct a patient with a nondisplaced fractured left radius that the cast will need to remain in place for what amount of time? A. Two weeks B. At least six weeks C. Until swelling of the wrist has resolved D. Until x-rays show complete bony union

B Bone healing starts immediately after the injury, but because ossification does not begin until 3 weeks after injury, the cast will need to be worn for at least 3 weeks. Complete union may take up to 1 year. Resolution of swelling does not indicate bone healing.

After change-of-shift report, which patient should the nurse assess first? A. Patient with a repaired mandibular fracture who is reporting facial pain. B. Patient with repaired right femoral shaft fracture who reports tightness in the calf. C. Patient with an unrepaired Colles' fracture who has right wrist swelling and deformity. D. Patient with an unrepaired intracapsular left hip fracture whose leg is externally rotated.

B Calf swelling after a femoral shaft fracture suggests possible DVT or compartment syndrome. The nurse should assess the patient rapidly and then notify the health care provider. The other patients have symptoms that are typical for their injuries but do not require immediate intervention.

Which information about a patient with a lumbar vertebral compression fracture should the nurse immediately report to the health care provider? A. Patient declines to be turned due to back pain. B. Patient has been incontinent of urine and stool. C. Patient reports lumbar area tenderness to palpation. D. Patient frequently uses oral corticosteroids to treat asthma.

B Changes in bowel or bladder function indicate possible spinal cord compression and should be reported immediately because surgical intervention may be needed. The other findings are also pertinent but are consistent with the patient's diagnosis and do not require immediate intervention.

The nurse notes crackling sounds and a grating sensation with palpation of an older patient's elbow. How should this finding be documented a. Torticollis b. Crepitation c. Subluxation d. Epicondylitis

B Crackling sounds and a grating sensation that accompany movement are described as crepitus or crepitation. Torticollis is a twisting of the neck to one side, subluxation is a partial dislocation of the joint, and epicondylitis is an inflammation of the elbow causing a dull ache that increases with movement.

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 8 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).

B Difficulty in voiding may indicate damage to the spinal nerves and should be assessed and reported to the surgeon immediately. The information about the other patients is consistent with their diagnoses. The nurse will need to assess them as quickly as possible, but the information about them does not indicate a need for immediate intervention.

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."

B Exercises can help strengthen the muscles that support the back. Flexion of the hips and knees places less strain on the back than keeping these joints extended. Sitting for prolonged periods can aggravate back pain. Modification in the way the patient lifts boxes is needed, but the patient should not lift above the level of the elbows.

Which medication information should the nurse identify as a potential risk to a patient's musculoskeletal system? A. The patient takes a daily multivitamin and calcium supplement. B. The patient has asthma requiring frequent therapy with oral corticosteroids. C. The patient takes hormone replacement therapy (HRT) to prevent "hot flashes." D. The patient has headaches treated with nonsteroidal antiinflammatory drugs (NSAIDs).

B Frequent or chronic corticosteroid use may lead to skeletal problems such as avascular necrosis and osteoporosis. The use of HRT and calcium supplements will help prevent osteoporosis. NSAID use does not increase the risk for musculoskeletal problems.

A patient with acute osteomyelitis of the left femur is hospitalized for regional antibiotic irrigation. Which intervention should 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

B Immobilization of the affected leg helps to decrease pain and reduce the risk for pathologic fracture. Weight-bearing exercise increases the risk for pathologic fractures. Flexion of the affected limb is avoided to prevent contractures.

Which task can the nurse assign to unlicensed assistive personnel (UAP) who are working in the orthopedic clinic? A. Grade leg muscle strength for a patient with back pain. B. Obtain blood sample for uric acid from a patient with gout. C. Perform straight-leg-raise testing for a patient with sciatica. D. Check for knee joint crepitation before arthroscopic surgery

B In clinic setting, drawing blood specimens is a common skill performed by UAP who are trained. The other actions are assessments and require registered nurse (RN)-level judgment and critical thinking.

Which assessment finding for a 55-yr-old patient should alert the nurse to the presence of osteoporosis? A. Bowed legs B. Loss of height C. Report of frequent falls D. Aversion to dairy products

B Osteoporosis occurring in the vertebrae produces a gradual loss of height. Bowed legs are associated with osteomalacia and osteoarthritis. Low intake of dairy products is a risk factor for osteoporosis, but it does not indicate osteoporosis is present. Frequent falls increase the risk for fractures but are not an indicator of osteoporosis.

A patient who is to have no weight bearing on the left leg is learning to use crutches. Which observation by the nurse indicates the patient can safely ambulate independently? A. The patient moves the right crutch with the right leg and then the left crutch with the left leg. B. The patient advances the left leg and both crutches together and then advances the right leg. C. The patient uses the bedside chair to assist in balance as needed when ambulating in the room. D. The patient keeps the padded area of the crutch firmly in the axillary area when ambulating.

B Patients are usually taught to move the crutches and the injured leg forward at the same time and then to move the unaffected leg. If the 2- or 4-point gait is to be used, the crutch and leg on opposite sides move forward, not the crutch and same-side leg.Patients are discouraged from using furniture to assist with ambulation. The patient is taught to place weight on the hands, not in the axilla, to avoid brachial plexus damage.

A tennis player has an arthroscopic repair of a rotator cuff injury performed in same-day surgery. Which information will the nurse include in postoperative teaching? A. "You will not be able to serve a tennis ball again." B. "You will begin work with a physical therapist tomorrow." C. "Keep the shoulder immobilizer on for the first 4 days to minimize pain." D. "The surgeon will use the drop arm test to determine the success of surgery."

B Physical therapy after a rotator cuff repair begins on the first postoperative day to prevent "frozen shoulder." A shoulder immobilizer is used immediately after the surgery, but leaving the arm immobilized for several days would lead to loss of range of motion. The drop arm test is used to test for rotator cuff injury but not after surgery. The patient may be able to return to tennis after rehabilitation.

A patient who arrives at the emergency department with severe left knee pain is diagnosed with a patellar dislocation. What should be the nurse's initial focus for patient teaching? A. Use of a knee immobilizer B. Monitored anesthesia care C. Physical activity restrictions D. Performance of gentle knee flexion

B The first goal of interprofessional management is realignment of the knee to its original anatomic position, which will require anesthesia or monitored anesthesia care, formerly called conscious sedation. Immobilization, gentle range-of-motion exercises, and discussion about activity restrictions will be implemented after the patella is realigned.

Which information should the nurse include in discharge teaching for a patient who has had a repair of a fractured mandible? A. Administration of nasogastric tube feedings B. How and when to cut the immobilizing wires C. The importance of high-fiber foods in the diet D. The use of sterile technique for dressing changes

B The jaw will be wired for stabilization, and the patient should know what emergency situations require the wires to be cut to protect the airway. There are no dressing changes for this procedure. The diet is liquid, and patients are not able to chew high-fiber foods. Initially, the patient may receive nasogastric tube feedings, but by discharge, the patient will swallow liquid through a straw.

Which action should 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)

B The nurse's initial action should be further assessment of related symptoms because cervical nerve root compression will require different treatment than musculoskeletal neck pain. The other actions may also be appropriate, depending on the assessment findings.

Which statement by a patient who has had an above-the-knee amputation indicates the nurse's discharge teaching has been effective? A. "I should elevate my residual limb on a pillow 2 or 3 times a day." B. "I should lie flat on my abdomen for 30 minutes 3 or 4 times a day." C. "I should change the limb sock when it becomes soiled or each week." D. "I should use lotion on the stump to prevent skin drying and cracking."

B The patient lies in the prone position several times daily to prevent flexion contractures of the hip. The limb sock should be changed daily. Lotion should not be used on the stump. The residual limb should not be elevated because this would encourage hip flexion contracture.

Before assisting a patient with ambulation 2 days after total hip arthroplasty, which action is most important for the nurse to take? A. Observe output from the surgical drain. B. Administer prescribed pain medication. C. Instruct the patient about benefits of early ambulation. D. Change the dressing and document the wound appearance.

B The patient should be adequately medicated for pain before any attempt to ambulate. Instructions about the benefits of ambulation may increase the patient's willingness to ambulate but decreasing pain with ambulation is more important. The presence of an incisional drain or timing of dressing change will not affect ambulation.

A patient is being discharged after 1 week of IV antibiotic therapy for acute osteomyelitis in the right leg. Which information should the nurse include 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

B The patient will be taking IV antibiotics for several months. The patient will need to recognize signs of infection at the IV site and know how to care for the catheter during daily activities such as bathing. IV antibiotics rather than oral antibiotics are used for acute osteomyelitis. Patients are instructed to avoid exercise and heat application because these will increase swelling and the risk for spreading infection.

A patient reports shoulder pain when the nurse moves the patient's arm behind the back. Which question should the nurse ask? A. "Are you able to feed yourself without difficulty?" B. "Do you have difficulty when you are putting on a shirt?" C. "Are you able to sleep through the night without waking?" D. "Do you ever have trouble lowering yourself to the toilet?"

B The patient's pain will make it more difficult to accomplish tasks such as putting on a shirt or jacket. This pain should not affect the patient's ability to feed himself or use the toilet because these tasks do not involve moving the arm behind the patient. The arm will not usually be positioned behind the patient during sleeping.

Which action should the nurse take when repositioning the patient who has just had a laminectomy and discectomy? A. Instruct the patient to move the legs before turning the rest of the body. B. Place a pillow between the patient's legs and turn the entire body as a unit. C. Have the patient turn by grasping the side rails and pulling the shoulders over. D. Turn the patient's head and shoulders first, followed by the hips, legs, and feet.

B The spine should be kept in correct alignment after laminectomy. The other positions will create misalignment of the spine.

What action should the nurse complete before administering alendronate (Fosamax) to a patient with osteoporosis? 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.

B To avoid esophageal erosions, the patient taking bisphosphonates should be upright for at least 30 minutes after taking the medication. Fosamax should be taken on an empty stomach, not after taking other medications or eating. Leg cramps and hot flashes are not side effects of bisphosphonates.

A patient with muscular dystrophy is hospitalized with pneumonia. Which nursing action should the nurse include 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.

B Because the goal for the patient with muscular dystrophy is to keep the patient active for as long as possible, assisting the patient to ambulate will be part of the care plan. The patient will not require logrolling. Muscle biopsies are necessary to confirm the diagnosis but are not necessary for a patient who already has a diagnosis. There is no need for genetic testing because the patient already knows the diagnosis.

After being hospitalized for 3 days with a right femur fracture, a patient suddenly develops shortness of breath and tachypnea. The patient tells the nurse, "I feel like I am going to die!" Which action should the nurse take first? A. Stay with the patient and offer reassurance. B. Administer prescribed PRN O2 at 4 L/min. C. Check the patient's legs for swelling or tenderness. D. Notify the health care provider about the symptoms.

B The patient's clinical manifestations and history are consistent with a pulmonary embolism, and the nurse's first action should be to ensure adequate oxygenation. The nurse should offer reassurance to the patient but meeting the physiologic need for O2 is a higher priority. The health care provider should be notified after the O2 is started and pulse oximetry obtained concerning suspected fat embolism or venous thromboembolism.

The nurse is caring for a patient who is using Buck's traction after a hip fracture. Which action can the nurse delegate to experienced unlicensed assistive personnel (UAP)? A. Remove and reapply traction periodically. B. Ensure the weight for the traction is hanging freely. C. Monitor the skin under the traction boot for redness. D. Check for intact sensation and movement in the affected leg.

B UAP can be responsible for maintaining the integrity of the traction after it has been established. The RN should assess the extremity and assure manual traction is maintained if the traction device has to be removed and reapplied. Assessment of skin integrity and circulation should be done by the registered nurse (RN).

Which information in a 67-yr-old woman's health history should alert the nurse to the need for a focused assessment of the musculoskeletal system? A. The patient sprained her ankle at age 13. B. The patient's father died of tuberculosis. C. The patient's mother became shorter with aging. D. The patient takes ibuprofen for occasional headaches.

C A family history of height loss with aging may indicate osteoporosis, and the nurse should perform a more thorough assessment of the patient's current height and other risk factors for osteoporosis. A sprained ankle during adolescence does not place the patient at increased current risk for musculoskeletal problems. A family history of tuberculosis is not a risk factor. Occasional nonsteroidal antiinflammatory drug (NSAID) use does not indicate any increased musculoskeletal risk

A patient arrived at the emergency department after tripping over a rug and falling at home. Which finding should the nurse identify as most important to communicate to the health care provider? A. There is bruising at the shoulder area. B. The patient reports arm and shoulder pain. C. The right arm appears shorter than the left. D. There is decreased shoulder range of motion.

C A shorter limb after a fall indicates a possible dislocation, which is an orthopedic emergency. Bruising, pain, and decreased range of motion should also be reported, but these do not indicate emergent treatment is needed to preserve function.

What should the nurse include when teaching older adults at a community recreation center about ways to prevent fractures? A. Tack down scatter rugs on the floor in the home. B. Expect most falls to happen outside the home in the yard. C. Buy shoes that provide good support and are comfortable to wear. D. Get instruction in range-of-motion exercises from a physical therapist.

C Comfortable shoes with good support will help decrease the risk for falls. Scatter rugs should be eliminated, not just tacked down. Activities of daily living provide range-of-motion exercise; these do not need to be taught by a physical therapist. Falls inside the home are responsible for many injuries.

Which discharge instruction should the emergency department nurse include for a patient with a sprained ankle? A. Keep the ankle loosely wrapped with gauze. B. Apply a heating pad to reduce muscle spasms. C. Use pillows to elevate the ankle above the heart. D. Gently move the ankle through the range of motion.

C Elevation of the leg will reduce swelling and pain. Compression bandages are used to decrease swelling. For the first 24 to 48 hours, cold packs are used to reduce swelling. The ankle should be rested and kept immobile to prevent further swelling or injury.

A patient is receiving IV antibiotics at home to treat chronic osteomyelitis of the left femur. Which statement by the patient should indicate to the nurse the need for additional teaching related to health maintenance? A. "I'm frustrated with this endless treatment!" B. "I will take my oral temperature twice a day." C. "I think my left foot is starting to droop down." D. "I use crutches to avoid weight bearing on the left leg."

C Footdrop is an indication that the foot is not being supported in a neutral position by a splint. Using crutches and monitoring the oral temperature are appropriate self-care activities. Frustration with the length of treatment is not an indicator of ineffective health maintenance of the osteomyelitis.

Which patient statement indicates understanding of the nurse's teaching about a new short-arm synthetic cast? A. "I can remove the cast in 4 weeks using industrial scissors." B. "I should avoid moving my fingers until the cast is removed." C. "I will apply an ice pack to the cast over the fracture site off and on for 24 hours." D. "I can use a cotton-tipped applicator to rub lotion on any dry areas under the cast."

C Ice application for the first 24 hours after a fracture will help reduce swelling and can be placed over the cast. The cast is typically removed in the outpatient setting. The patient should be encouraged to move the joints above and below the cast. Patients should not insert objects inside the cast.

Which information should the nurse include in discharge instructions for a patient with comminuted left forearm fractures and a long-arm cast? A. Keep the left shoulder elevated on a pillow or cushion. B. Avoid nonsteroidal antiinflammatory drugs (NSAIDs). C. Call the health care provider for numbness of the hand. D. Keep the hand immobile to prevent soft tissue swelling.

C Increased swelling or numbness may indicate increased pressure at the injury, and the health care provider should be notified immediately to avoid damage to nerves and other tissues. The patient should be encouraged to move the joints above and below the cast to avoid stiffness. There is no need to elevate the shoulder, although the forearm should be elevated to reduce swelling. NSAIDs are appropriate to treat mild to moderate pain after a fracture.

A patient is being discharged 4 days after hip arthroplasty using the posterior approach. Which patient action requires intervention by the nurse? A. Using crutches with a swing-to gait B. Sitting upright on the edge of the bed C. Leaning over to pull on shoes and socks D. Bending over the sink while brushing teeth

C Leaning over would flex the hip at greater than 90 degrees and predispose the patient to hip dislocation. The other patient actions are appropriate and do not require any immediate action by the nurse to protect the patient.

The nurse instructs a patient who has osteosarcoma of the tibia about a scheduled above-the-knee amputation. Which patient statement indicates to the nurse that additional 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."

C Osteogenic sarcoma may be diagnosed following a fracture, but it is not caused by the injury. The other statements indicate patient teaching has been effective.

When a patient arrives in the emergency department with a facial fracture, which action should the nurse take first? A. Assess for nasal bleeding and pain. B. Apply ice to the face to reduce swelling. C. Use a cervical collar to stabilize the spine. D. Check the patient's alertness and orientation.

C Patients who have facial fractures are at risk for cervical spine injury and should be treated as if they have a cervical spine injury until this is ruled out. The other actions are also necessary, but the most important action is to prevent cervical spine injury.

A patient is admitted to the emergency department with a left femur fracture. Which assessment finding by the nurse is most important to report to the health care provider? A. Bruising of the left thigh B. Reports of severe thigh pain C. Slow capillary refill of the left foot D. Outward pointing toes on the left foot

C Prolonged capillary refill may indicate complications such as compartment syndrome. The other findings are typical with a left femur fracture.

Which 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).

C Repositioning a patient is included in the education and scope of practice of UAP, and experienced UAP will be familiar with how to maintain alignment in the postoperative patient. Evaluation of the effectiveness of pain medications, assessment of neurologic function, and evaluation of a patient's readiness to ambulate after surgery require higher levelnursing education and scope of practice.

What should the nurse include in the teaching plan for ae patient who has acute low back pain and muscle spasms? 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.

C Resting with the head elevated and knees flexed will reduce the strain on the back and decrease muscle spasms. Twisting from side to side will increase tension on the lumbar area. Prolonged standing will cause strain on the lumbar spine, even with both feet flat on the floor. Alternate application of cold and heat should be used to decrease pain.

Which finding in a patient with a Colles' fracture of the left wrist should the nurse identify as most important to communicate immediately to the health care provider? A. The patient reports severe pain. B. Swelling is noted around the wrist. C. Capillary refill to the fingers is slow. D. The wrist has a deformed appearance.

C Swelling, pain, and deformity are common findings with a Colles' fracture. Prolonged capillary refill indicates decreased circulation and risk for ischemia. This is not an expected finding and should be immediately reported.

A patient with a complex pelvic fracture from a motor vehicle crash is on bed rest. Which assessment finding should indicate to the nurse a potential complication of the fracture? A. The patient states the pelvis feels unstable. B. The patient reports pelvic pain with palpation. C. Abdomen is distended, and bowel sounds are absent. C. Ecchymoses are visible across the abdomen and hips.

C The abdominal distention and absent bowel sounds may be due to complications of pelvic fractures such as paralytic ileus or hemorrhage or trauma to the bladder, urethra, or colon. Pelvic instability, abdominal pain with palpation, and abdominal bruising would be expected with this type of injury.

A patient who slipped and fell in the shower at home has a proximal left humerus fracture immobilized with a sling. Which intervention should the nurse include in the plan of care? A. Use surgical net dressing to hang the arm from an IV pole. B. Immobilize the fingers of the left hand with gauze dressings. C. Assess the left axilla and change absorbent dressings as needed. D. Assist the patient in passive range of motion (ROM) for the right arm.

C The axilla can become excoriated when a sling is used to support the arm, and the nurse should check the axilla and apply absorbent dressings to prevent this. A patient with a sling would not have traction applied by hanging. The patient will be encouraged to move the fingers on the injured arm to maintain function and to help decrease swelling. The patient will do active ROM on the uninjured side.

A high school teacher with ulnar drift caused by rheumatoid arthritis (RA) is scheduled for arthroplasty of several joints in the left hand. Which patient statement to the nurse indicates a realistic expectation for the surgery? A. "This procedure will correct the deformities in my fingers." B. "I will not have to do as many hand exercises after the surgery." C. "I will be able to use my fingers with more flexibility to grasp things." D. "My fingers will appear more normal in size and shape after this surgery."

C The goal of hand surgery in RA is to restore function, not to correct for cosmetic deformity or treat the underlying process. Hand exercises will be prescribed after the surgery.

After a motorcycle accident, a patient arrives in the emergency department with severe swelling of the left lower leg. Which action should the nurse take first? a. Elevate the leg on 2 pillows b. Apply a compression bandage. c. Assess leg pulses and sensation. d. Place ice packs on the lower leg

C The initial action by the nurse will be to assess circulation to the leg and observe for any evidence of injury such as fractures or dislocations. After the initial assessment, the other actions may be appropriate based on what is observed during the assessment.

A pedestrian who was hit by a car is admitted to the emergency department with possible right lower leg fractures. What initial action should the nurse take? A. Elevate the right leg. B. Splint the lower leg. C. Assess the pedal pulses. D. Verify tetanus immunization.

C The initial nursing action should be assessment of the neurovascular condition of the injured leg. After assessment, the nurse may need to splint and elevate the leg based on the assessment data.

After the health care provider recommends amputation for a patient who has nonhealing ischemic foot ulcers, the patient tells the nurse that he would rather die than have an amputation. Which response by the nurse is best? A. "You are upset, but you may lose the foot anyway." B. "Many people are able to function with a foot prosthesis." C. "Tell me what you know about your options for treatment." D. "If you do not want an amputation, you do not have to have it."

C The initial nursing action should be to assess the patient's knowledge and feelings about the available options. Discussion of the patient's option to refuse the procedure, seriousness of the condition, or rehabilitation after the procedure may be appropriate after the nurse knows more about the patient's current knowledge and emotional state.

The nurse is caring for a patient who has a pelvic fracture and an external fixation device. How should the nurse perform assessment of pressure areas and provide skin care to the patient's back and sacrum? A. Ask the patient to turn to the side independently. B. Defer back assessment until the patient is ambulatory. C. Have the patient lift the back and buttocks using a trapeze. D. Roll the patient over to the side by pushing on the patient's hips.

C The patient can lift the back slightly off the bed by using a trapeze. The patient may find it very difficult to turn to the side without assistance while in a fixator device. Delaying assessment and skin care may put the patient at risk for an undetected pressure injury. Pushing on the patient's hips may cause additional injury.

Which information obtained during the nurse's assessment may indicate a patient's increased risk for musculoskeletal problems? A. The patient takes a multivitamin daily. B. The patient dislikes fruits and vegetables. C. The patient is 5 ft, 2 in tall and weighs 180 lb. D. The patient prefers whole milk to nonfat milk.

C The patient's height and weight indicates obesity that places stress on weight-bearing joints and predisposes the patient to osteoarthritis. The use of whole milk, avoidance of fruits and vegetables, and use of a daily multivitamin are not risk factors for musculoskeletal problems.

The second day after admission with a fractured pelvis, a patient suddenly develops confusion. Which action should the nurse take first? a. Take the blood pressure. b. Check the O2 saturation. c. Assess patient orientation. d. Observe for facial asymmetry.

C The patient's history and clinical manifestations suggest a fat embolism. The most important assessment is oxygenation. The other actions are also appropriate but will be done after the nurse assesses O2 saturation.

After laminectomy with a spinal fusion to treat a herniated disc, a patient reports numbness and tingling of the right lower leg. What action should the nurse take? A. Elevate the right leg on two pillows. B. Obtain vital signs for indication of hemorrhage. C. Review the preoperative assessment data in the health record. D. Turn the patient to the left to relieve pressure on the right leg.

C The postoperative movement and sensation of the extremities should be unchanged (or improved) from the preoperative assessment. If the numbness and tingling are new, this information should be immediately reported to the surgeon. Numbness and tingling are not symptoms associated with hemorrhage at the site. Turning the patient or elevating the leg will not relieve the numbness.

After completing the health history, how should the nurse begin to assess the musculoskeletal system? A. Feel for the presence of crepitus during joint movement. B. Have the patient move the extremities against resistance. C. Observe the patient's body build and muscle configuration. D. Check active and passive range of motion for the extremities.

C The usual technique in the physical assessment is to begin with inspection. Abnormalities in muscle mass or configuration will allow the nurse to perform a more focused assessment of affected areas. The other assessments are included but are usually done after inspection.

Which information should the nurse include when teaching a patient with acute low back pain? (Select all that apply.) 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.

C, D, E Acute back pain usually starts to improve within 2 weeks. In the meantime, the patient should use medications such as nonsteroidal antiinflammatory drugs (NSAIDs) or acetaminophen to manage pain and avoid activities that stress the back. Sleeping in a prone position and keeping the knees straight when leaning forward will place stress on the back and should be avoided.

Which finding for a 77-yr-old patient seen in the outpatient clinic is the highest priority for further nursing assessment and intervention? A. Symmetric joint swelling of fingers B. Decreased right knee range of motion C. Report of left hip aching when jogging D. History of recent loss of balance and fall

D A history of falls is a safety issue that requires further assessment and development of fall prevention strategies. The other changes may require additional attention but are less urgent.

Which action should the nurse include in the plan of care for a patient who had a cemented right total knee arthroplasty? A. Avoid extension of the right knee beyond 120 degrees. B. Use a compression bandage to keep the right knee flexed. C. Teach about the need to avoid weight bearing for 4 weeks. D. Start progressive knee exercises to obtain 90-degree flexion.

D After knee arthroplasty, active or passive flexion exercises are used to obtain a 90-degree flexion of the knee. The goal for extension of the knee will be 180 degrees. A compression bandage is used to hold the knee in an extended position after surgery. Protected weight bearing is typically not ordered after this procedure.

A patient has had surgical reduction of an open fracture of the right radius. Which assessment findings should the nurse report immediately to the health care provider? A. Serous wound drainage B. Right arm muscle spasms c. Pain with right arm movement d. Temperature 101.4° F (38.6° C)

D An elevated temperature suggests possible osteomyelitis. The other clinical manifestations are typical after a repair of an open fracture.

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. Change the prescribed wet-to-dry dressings. D. Review the patient's serum creatinine results.

D Gentamicin is nephrotoxic and can cause renal failure as reflected in the patient's serum creatinine. Monitoring the patient's temperature before gentamicin administration is not necessary. Nausea is not a common side effect of IV gentamicin. There is no need to change the dressing before gentamicin administration.

A young adult arrives in the emergency department with ankle swelling and severe pain after twisting an ankle playing basketball. Which prescribed action will the nurse implement first? A. Send the patient for ankle x-rays. B. Administer naproxen (Naprosyn). C.Give acetaminophen with codeine. D. Wrap the ankle and apply an ice pack.

D Immediate care after a sprain or strain injury includes application of cold and use of compression to minimize swelling. The other actions should be taken after the ankle is wrapped with a compression bandage and ice is applied.

The nurse finds that a patient can flex the arms when no resistance is applied but is unable to flex against light resistance. How should the nurse document the patient's muscle strength level? a. 0 b. 1 c. 2 d. 3

D Muscle strength of 3 indicates the patient is unable to move against resistance but can move against gravity. Level 1 indicates minimal muscle contraction, level 2 indicates the arm can move when gravity is eliminated, and level 4 indicates active movement with some resistance.

A 54-yr-old woman who recently reached menopause and has a family history of osteoporosis is diagnosed with osteopenia. Which information should the nurse explain to the patient? 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.

D Progression of osteoporosis can be slowed by increasing calcium intake and weight-bearing exercise. Estrogen replacement therapy is no longer routinely given to prevent osteoporosis because of increased risk of heart disease as well as breast and uterine cancer. Corticosteroid therapy increases the risk for osteoporosis.

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

D Skim milk and yogurt are high in calcium. The other choices do not contain any high-calcium foods.

A patient has possible right carpal tunnel syndrome. What symptom should the nurse expect with a positive Tinel's sign? A. Weakness in the right little finger B. Burning in the right elbow and forearm C. Tremor when gripping with the right hand D. Tingling in the right thumb and index finger

D Testing for Tinel's sign will cause tingling in the thumb and first three fingers of the affected hand in patients who have carpal tunnel syndrome. The median nerve does not innervate the right little finger or elbow and forearm. Tremor is not associated with carpal tunnel syndrome.

The nurse notes that a 59-yr-old female patient has lost 1 inch in height over the past 2 years. What diagnostic test should the nurse plan to discuss with the patient? A. Discography studies B. Myelographic testing C. Magnetic resonance imaging (MRI) D. Dual-energy x-ray absorptiometry (DXA)

D The decreased height and the patient's age suggest that the patient may have osteoporosis, and bone density testing is needed. Discography, MRI, and myelography are typically done for patients with current symptoms caused by musculoskeletal dysfunction and are not the initial diagnostic tests for osteoporosis.

Which statement by a patient with discomfort from a bunion indicates to the nurse that more teaching is needed? A. "I will give away my high-heeled shoes." B. "I can take ibuprofen (Motrin) if I need it." C. "I will use the bunion pad to cushion the area." D. "I can only wear sandals, no closed-toe shoes."

D The patient can wear shoes that have a wide forefoot (toe box). The other patient statements indicate the teaching has been effective.

A patient is to be discharged from the hospital 4 days after insertion of a femoral head prosthesis using a posterior approach. Which patient statement to the nurse indicates that additional teaching is needed? a. "I should not cross my legs while sitting." b. "I will use a toilet elevator on the toilet seat." c. "I will have someone else put on my shoes and socks." d. "I can sleep in any position that is comfortable for me."

D The patient needs to sleep in a position that prevents excessive internal rotation or flexion of the hip. The other patient statements indicate the patient has understood the teaching.

A factory line worker has repetitive strain syndrome in the left elbow. What topic should the nurse plan to include in patient teaching? a. Surgical options b. Elbow injections c. Wearing a left wrist splint d. Modifying arm movements

D Treatment for repetitive strain syndrome includes changing the ergonomics of the activity. Elbow injections and surgery are not initial options for this type of injury. A wrist splint might be used for hand or wrist pain.

What should the nurse assess to evaluate the effectiveness of alendronate (Fosamax) therapy for a patient with Paget's disease? A. Oral intake B. Daily weight C. Grip strength D. Pain intensity

D. Bone pain is a common early manifestation of Paget's disease, and the nurse should assess the pain intensity to determine if treatment is effective. The other information will be collected by the nurse but will not be used in evaluating the effectiveness of the therapy.