Musculoskeletal connective tissue

A patient experiences a fracture of the lower leg and undergoes a closed reduction and placement of a fiberglass cast. The patient is 65 years old and has a medical 30-year history of diabetes mellitus. Which condition does the nurse recognize as a possible complication for this patient? 1. Delay or absence of healing 2. Malalignment of healed bones 3. Development of bone infection 4. Impaired mobility function

ANS: 1 Feedback 1 The possibility of non-union (delayed or absence of healing) is a higher risk for some patients. Contributing factors are age and diseases that alter the healing process, such as diabetes mellitus. 2 Malunion (malalignment of healed bones) is a non-union modality, which is most common in fractures that require internal fixation because of multiple bone pieces and fragments. 3 With a closed reduction and placement of a cast, the risk for bone infection is low. 4 Impaired mobility function is not an expected outcome for most bone fractures.

A patient who has a displaced midshaft fracture of the left femur is in balanced suspension skeletal traction with 35 pounds of weight. The patient reports calf pain with right foot dorsiflexion. Which action does the nurse take? 1. Notify the RN. 2. Check the traction setup. 3. Reduce by 5 pounds of weight. 4. Encourage dorsiflexion more frequently.

ANS: 1 1 Calf pain on dorsiflexion can indicate a thrombophlebitis (Homan's sign) and is indicative of a deep vein thrombosis (DVT). The RN should be informed. 2 The nurse should not take the time now to check the traction setup. 3 Traction weight cannot be reduced without a physician's order. 4 The patient should not be encouraged to exercise the limb now since a venous thromboembolitic complication might be present.

The nurse is providing care for a patient with external fixation for a fracture involving severe bone damage. Which is the most important focus for the nurse during care of this patient? 1. Monitoring pin and wound sites for signs of infection 2. Helping the patient achieve a desired level of mobility 3. Being aware that the patient may experience issues with body image 4. Providing a caring and supportive attitude during a challenging time

ANS: 1 1 External fixation allows visualization and care for soft tissue injuries and holds bone pieces in place with the insertion of a pin through the skin and into the bone. Both conditions need to be monitored regularly for signs of infection. This is the most important care performed by the nurse. 2 The nurse is aware of the patient's desired level of mobility and can assist with meeting this goal. However, this is not the most important nursing care for this patient. 3 The external fixation device is intimidating in appearance and may result in issues related to body image. The nurse can assist with this issue; however, it is not the most important nursing care for this patient. 4 Providing a caring and supportive attitude is always an important nursing intervention. It especially important with a patient who has a challenging, and possibly prolonged, healing process. However, this is not the most important nursing care for this patient.

A patient experiences a fracture of the lower leg and undergoes a closed reduction and placement of a fiberglass cast. The patient is 65 years old and has a medical 30-year history of diabetes mellitus. Which condition does the nurse recognize as a possible complication for this patient? 1. Delay or absence of healing 2. Malalignment of healed bones 3. Development of bone infection 4. Impaired mobility function

ANS: 1 1 The possibility of non-union (delayed or absence of healing) is a higher risk for some patients. Contributing factors are age and diseases that alter the healing process, such as diabetes mellitus. 2 Malunion (malalignment of healed bones) is a non-union modality, which is most common in fractures that require internal fixation because of multiple bone pieces and fragments. 3 With a closed reduction and placement of a cast, the risk for bone infection is low. 4 Impaired mobility function is not an expected outcome for most bone fractures.

The home-care nurse is attending to a patient with osteomyelitis in a lower extremity from a traumatic bone fracture. The patient has an open wound that is infected. Which observation prompts the nurse to provide additional information to the patient and family? 1. Clean technique is used when the dressing is changed. 2. Hand hygiene is performed correctly and appropriately. 3. Possible side effects of antibiotics are understood. 4. Children and pets are kept away from the wound.

ANS: 1 1 When a patient has osteomyelitis, sterile dressing changes are always used, even in the home environment. Osteomyelitis is difficult to treat and preventing additional infections is important. Additional teaching is required. 2 Additional teaching is not required when the nurse validates that hand hygiene is performed correctly and at the appropriate times (before and after providing care). 3 Additional teaching is not required if the patient and family understand the side effects of antibiotics. 4 Because of the virulence of the infection, the difficulty of resolving the infection, and the possibility of transmitting the infection to others, pets and children are kept away from the wound. No additional teaching is required.

The nurse is collecting data from a patient suspected of developing a fat embolus from a fracture of the right femur. Which manifestations does the nurse expect? (Select all that apply.) 1. Petechiae 2. Migraine 3. Tachycardia 4. Mental confusion 5. Numbness in the right leg

ANS: 1, 3, 4 1. The earliest manifestation of fat emboli syndrome (FES) is altered mental status from a low arterial oxygen level. The patient then experiences tachycardia, tachypnea, fever, high blood pressure, severe respiratory distress, and petechiae. 2. A migraine is not indicative of FES. 3. The earliest manifestation of FES is altered mental status from a low arterial oxygen level. The patient then experiences tachycardia, tachypnea, fever, high blood pressure, severe respiratory distress, and petechiae. 4. The earliest manifestation of FES is altered mental status from a low arterial oxygen level. The patient then experiences tachycardia, tachypnea, fever, high blood pressure, severe respiratory distress, and petechiae. 5. Numbness in the right leg is not indicative of FES.

A patient asks the difference between osteoarthritis and RA. Which manifestations does the nurse explain are characteristic of RA? (Select all that apply.) 1. Low-grade fever 2. Heberden's nodes 3. Autoimmune disease 4. Pain increasing by activity 5. Early morning stiffness

ANS: 1, 3, 5 1. RA is a systemic autoimmune disease with morning stiffness and low-grade fever. 2. Heberden's nodes are seen in osteoarthritis. 3. RA is a systemic autoimmune disease with morning stiffness and low-grade fever. 4. Pain increases with activity in osteoarthritis. 5. RA is a systemic autoimmune disease with morning stiffness and low-grade fever.

The nurse is helping a patient understand all of the functions of the skeleton. Which function is incorrect? 1. It protects organs and tissues from mechanical injury. 2. It is the main system responsible for body movement. 3. Long, flat, and irregular bones store blood-forming tissue. 4. The entire system is responsible for the storage of excess calcium.

ANS: 2

A patient with gout has been instructed on the prescribed medication allopurinol (Zyloprim). Which patient statement indicates understanding of the action of this medication? 1. "It excretes proteins." 2. "It blocks formation of uric acid." 3. "It increases formation of purines." 4. "It increases metabolism of purines."

ANS: 2 Feedback 1 Allopurinol (Zyloprim) does not excrete proteins or increase the formation or metabolism of purines. 2 Allopurinol (Zyloprim) decreases uric acid production. 3 Allopurinol (Zyloprim) does not excrete proteins or increase the formation or metabolism of purines. 4 Allopurinol (Zyloprim) does not excrete proteins or increase the formation or metabolism of purines.

The nurse is preparing for a home visit to a patient after surgery for a compound fracture. Which specific care does the nurse anticipate for this patient? 1. Monitoring circulatory status 2. Changing wound dressings 3. Checking skin integrity 4. Validating immobilization

ANS: 2 Feedback 1 Routine care for any patient following a fracture is to perform circulatory status. 2 Specific care for a patient following a compound fracture is to perform wound care. The patient with an open wound is likely to be in a splint and have an elastic bandage around the fracture location. This type of immobilization makes it possible to monitor and care for a wound. 3 Routine care for any patient following a fracture is to check for skin integrity. 4 Routine care for any patient following a fracture is to validate immobilization regardless of the type used.

The nurse is providing care for a patient being treated after a complicated femur fracture. The nurse has noticed drowsiness, tachycardia, and a low-grade fever. Which additional manifestation alerts the nurse to the possibility of a fat emboli? 1. Respiratory rate of 20 breaths/min 2. Presence of a petechial rash on chest and neck 3. An oxygen saturation level of 92 percent on room air 4. Verbal complaints of nausea with vomiting

ANS: 2 1 A respiratory rate of 20 breaths/min is within normal range. 2 The presence of petechial rash is one of the classic manifestations of a fat emboli; the rash can appear on the chest, neck, axilla, and conjunctiva. 3 An oxygen saturation level of 92 percent on room air is not necessarily an indication of a fat emboli. 4 Verbal complaints of nausea with vomiting can be caused by multiple problems; however, it is not alone indicative of a fat emboli.

A patient with gout has been instructed on the prescribed medication allopurinol (Zyloprim). Which patient statement indicates understanding of the action of this medication? 1. "It excretes proteins." 2. "It blocks formation of uric acid." 3. "It increases formation of purines." 4. "It increases metabolism of purines."

ANS: 2 1 Allopurinol (Zyloprim) does not excrete proteins or increase the formation or metabolism of purines. 2 Allopurinol (Zyloprim) decreases uric acid production. 3 Allopurinol (Zyloprim) does not excrete proteins or increase the formation or metabolism of purines. 4 Allopurinol (Zyloprim) does not excrete proteins or increase the formation or metabolism of purines.

The nurse is assisting with patients on an orthopedic unit. Which is an important factor to remember when caring for patients after a total hip replacement? 1. Side-lying position is permitted with a pillow between the legs. 2. A triangular pillow is used between the legs to avoid adduction. 3. Sitting in a bedside chair is permitted if the legs are elevated. 4. Place three pillows between the legs, one distal and three proximal.

ANS: 2 1 If a patient is permitted to be in a side-lying position, the legs must be abducted by more than one pillow, which is inadequate to prevent hip dislocation. 2 After a total hip replacement, a triangular pillow is used between the legs to avoid adduction. 3 When sitting in a bedside chair, overflexion of the hips is prevented by using a higher chair; the lower legs are not elevated. 4 Three pillows can be used to maintain abduction; however, one pillow is placed proximal and two are placed distal.

The nurse is preparing for a home visit to a patient after surgery for a compound fracture. Which specific care does the nurse anticipate for this patient? 1. Monitoring circulatory status 2. Changing wound dressings 3. Checking skin integrity 4. Validating immobilization

ANS: 2 1 Routine care for any patient following a fracture is to perform circulatory status. 2 Specific care for a patient following a compound fracture is to perform wound care. The patient with an open wound is likely to be in a splint and have an elastic bandage around the fracture location. This type of immobilization makes it possible to monitor and care for a wound. 3 Routine care for any patient following a fracture is to check for skin integrity. 4 Routine care for any patient following a fracture is to validate immobilization regardless of the type used.

An older adult patient is postoperative for a total hip joint replacement. Which nursing care is inappropriate for this patient on the day of surgery? 1. Assisted out of bed the evening of surgery 2. Provided with an elevated toilet seat 3. Medicated with oral pain medications 4. Prescribed weight-bearing is maintained

ANS: 3 Feedback 1 Patients with a total hip replacement will get out of bed either the evening of the surgery or in the morning after surgery. 2 An elevated toilet seat is needed to prevent the patient from hyper-flexing the new joint. 3 Initially, pain is managed by epidural analgesia, patient-controlled analgesia, or IV analgesia. Oral analgesics are most likely introduced after the first postoperative day. 4 The health care provider (HCP) will prescribe the amount of weight-bearing that is acceptable for the patient receiving a total hip replacement.

The nurse is contributing to the plan of care for a patient who has an upper extremity amputation. Which factor does the nurse keep in mind about this type of amputation being more debilitating than a lower extremity amputation? 1. The upper extremity is more visible. 2. Prosthetic fitting is easier for the leg. 3. The upper extremity is more specialized. 4. There is greater blood supply to the upper extremity.

ANS: 3 Feedback 1 Upper extremity amputations are not more debilitating because the upper extremity is more visible. 2 Upper extremity amputations are not more debilitating because the prosthetic fitting is easier for the leg. 3 Upper extremity amputations are usually more significant than are lower extremity amputations as the arms and hands are necessary for performing activities of daily living. 4 Upper extremity amputations are not more debilitating because of a greater blood supply to the upper extremities.

The nurse is assisting with the preparation of materials for a health fair aimed at promoting health in women. Which reason does the nurse recognize as a probable cause of an increase in the incidence of osteoporosis? 1. More adults are lactose intolerant. 2. Adults tend to be more sedentary. 3. The ages of adults have increased. 4. There is an increased number of smokers.

ANS: 3 1 Increased incidence of osteoporosis is not related to an increase of adults who are lactose intolerant. 2 The most likely cause of an increase in the incidence of osteoporosis may or may not be related to sedentary lifestyle. 3 The population in the United State is increasing in age due to longevity related to better health care and disease management. Osteoporosis is a disease connected to aging. 4 The number of smokers may or may not have increased. Patient education is readily available about the health risks related to smoking.

The nurse is providing care for a patient following an open reduction of a compound fracture. Which neurologic finding does the nurse report immediately to the HCP or registered nurse (RN)? 1. The foot on the surgical limb is cool to touch. 2. Surgical pain is reported at 8 on a 0-to-10 scale. 3. There exists numbness and tingling sensations. 4. There are decreased pulses and a dusky color on the surgical limb.

ANS: 3 1 The foot on the surgical limb should be warm to touch. However, this is a circulatory issue and not a neurologic finding. 2 After any surgical procedure, it is expected for the patient to report a high level of pain; however, this is not a neurologic finding. 3 When a patient reports the presence of numbness and tingling sensations, it is indicative of a neurologic manifestation. This finding needs to be reported immediately to the HCP or RN. 4 Decreased pulses and dusky color of the surgical limb are indications of circulatory problems. The question specifically asks for neurologic findings.

The nurse is assisting with the care of a patient with rheumatoid arthritis (RA). The nurse must remember in which way RA care is different from osteoarthritis care. Which nursing care does the nurse specifically provide for the patient with RA? 1. Exercise is poorly tolerated and frequent rest is needed. 2. Acutely inflamed joints will respond best to heat therapy. 3. It is essential to monitor all body systems for effects of the disease. 4. Injury and age are the greatest contributors to disease development.

ANS: 3 1 The patient with RA will maintain a higher level of functioning with exercise and physical activity, which is balanced with rest periods. 2 With RA, inflamed joints will respond best to ice therapy. Heat applications and hot showers will alleviate stiffness. 3 When a patient has RA, all body systems can be affected. The nurse needs to carefully watch for changes to blood vessels, nerves, kidneys, pericardium, lungs, and subcutaneous tissue. RA is a disease of the connective tissue. 4 Injury and age are actually the greatest contributors to osteoarthritis.

The nurse is contributing to the plan of care for a patient who has an upper extremity amputation. Which factor does the nurse keep in mind about this type of amputation being more debilitating than a lower extremity amputation? 1. The upper extremity is more visible. 2. Prosthetic fitting is easier for the leg. 3. The upper extremity is more specialized. 4. There is greater blood supply to the upper extremity.

ANS: 3 1 Upper extremity amputations are not more debilitating because the upper extremity is more visible. 2 Upper extremity amputations are not more debilitating because the prosthetic fitting is easier for the leg. 3 Upper extremity amputations are usually more significant than are lower extremity amputations as the arms and hands are necessary for performing activities of daily living. 4 Upper extremity amputations are not more debilitating because of a greater blood supply to the upper extremities.

The nurse is preparing material for a presentation about the musculoskeletal system. Which information is inaccurate in regard to the functioning of this system? 1. Voluntary muscles require nerve impulses to contract. 2. A continuous supply of blood is needed from the circulatory system. 3. Joint articulations are maintained by moisture from the lymph system. 4. Adequate oxygenation is supplied by respiratory system functioning.

ANS: 3 1 Voluntary muscles do require nerve impulses to contract and create movement. 2 A continuous supply of blood to maintain muscle health and promote functionality is needed from the circulatory system. 3 Joint articulations are not maintained by moisture from the lymph system; joint capsules are lined with membranes that create synovial fluid. 4 Oxygen is needed for muscle function, which is supplied by the respiratory system.

The nurse is providing care for a patient who experienced a closed reduction to a fracture of the ulna. Which manifestation does the nurse recognize as an early symptom of acute compartment syndrome? 1. Paralysis of the affected limb 2. Lack of a distal pulse 3. Pallor with extremity warmth 4. Poikilothermia of the arm

ANS: 3 1 With compartment syndrome, paralysis is a late manifestation. 2 With compartment syndrome, the absence of a pulse is a late and ominous manifestation. 3 Pallor is an early manifestation of compartment syndrome; however, there may, at this time, be warmth or redness over the area. 4 Poikilothermia is indicative of suppressed circulation. The manifestation is coolness of the extremity. The term indicates that the limb is the same temperature as the environment.

An older adult patient is postoperative for a total hip joint replacement. Which nursing care is inappropriate for this patient on the day of surgery? 1. Assisted out of bed the evening of surgery 2. Provided with an elevated toilet seat 3. Medicated with oral pain medications 4. Prescribed weight-bearing is maintained

ANS: 3 Patients with a total hip replacement will get out of bed either the evening of the surgery or in the morning after surgery. An elevated toilet seat is needed to prevent the patient from hyper-flexing the new joint. Initially, pain is managed by epidural analgesia, patient-controlled analgesia, or IV analgesia. Oral analgesics are most likely introduced after the first postoperative day. The health care provider (HCP) will prescribe the amount of weight-bearing that is acceptable for the patient receiving a total hip replacement.

The nurse is providing care for a patient who is scheduled for joint replacement the next day. Which patient care goals are appropriate at this time? 1. Teach postoperative exercises. 2. Ask if a consent form was signed. 3. Explain the use of assistive devices. 4. Manage preoperative pain.

ANS: 4 Feedback 1 The day before surgery is not the best time to be teaching postoperative exercises. This activity should occur earlier along with some preoperative strengthening exercises. 2 The nurse can check the patient's medical record and confirm the presence of a signed surgery consent form. 3 Explanation of the use of assistive devices will most likely be provided as each device is introduced to the patient during recovery. The day before is not appropriate. 4 Patients requiring total joint replacement are likely to be in severe preoperative pain. Management of pain is an important patient goal.

The nurse is providing care for a patient who is scheduled for joint replacement the next day. Which patient care goals are appropriate at this time? 1. Teach postoperative exercises. 2. Ask if a consent form was signed. 3. Explain the use of assistive devices. 4. Manage preoperative pain.

ANS: 4 Feedback 1 The day before surgery is not the best time to be teaching postoperative exercises. This activity should occur earlier along with some preoperative strengthening exercises. 2 The nurse can check the patient's medical record and confirm the presence of a signed surgery consent form. 3 Explanation of the use of assistive devices will most likely be provided as each device is introduced to the patient during recovery. The day before is not appropriate. 4 Patients requiring total joint replacement are likely to be in severe preoperative pain. Management of pain is an important patient goal.

The nurse is assisting with the care of patients who have had joint replacement surgery. Which action is unnecessary for the patient after a total knee replacement (TKR)? 1. Monitor for excessive bleeding. 2. Check for indications of a DVT. 3. Ambulate as prescribed by HCP. 4. Maintain proper joint alignment.

ANS: 4 1 As with any surgery, the patient with a TKR is monitored for excessive bleeding. 2 Patients with total joint replacements need to be monitored for the formation of DVTs. 3 Patients with a TKR are frequently gotten out of bed and/or ambulated for a short distance the evening of surgery or the next morning. 4 Unlike the patient with a total hip replacement, the TKR does not require maintenance of specific joint alignment.

A patient is being prepared for a prosthesis following surgery for an amputation. Which information will the nurse provide to the client regarding the use of a prosthesis? 1. Manual massage will help shape the end of the residual limb. 2. A prosthesis will not be fitted until the surgery site is healed. 3. A shrinker sock is worn with the prosthesis to prevent sores. 4. Skin inspection is performed each time the sock is removed.

ANS: 4 1 Manual massage is not specific enough to assure the correct preparation of the residual limb for a prosthesis. 2 A temporary prosthesis is often worn until swelling subsides. 3 A shrinker sock is commonly worn to reduce swelling and help shape the limb for the prosthesis. The sock is worn with and without the prosthesis. 4 It is essential that the residual limb be checked for infections and skin integrity each time the shrinker sock is removed. Neurovascular checks are performed at the same time.

The nurse is providing care for a patient after an above-the-knee amputation because of ischemia related to diabetes mellitus complications. Which nursing care is essential for promoting ambulation? 1. Building upper body strength 2. Promoting coordination exercises 3. Maintaining residual limb elevation 4. Lying on the abdomen as prescribed

ANS: 4 1 The patient may need upper body strength for moving about or for using crutches when a prosthesis is not worn. However, this action does not involve essential nursing care to promote ambulation. 2 Coordination may be helpful, but it is not part of the essential nursing care for promoting ambulation. 3 It is important to avoid the formation of hip contractures from flexing the hip for long periods of time. Sitting and the elevation of the residual limb are the most common offenders. Once contractures develop, ambulating with a prosthesis is impossible. 4 The client will need to lie supine for 30 minutes at least four times a day. This activity will likely be prescribed by the HCP or physical therapist. Hip contractures must be avoided if ambulation is to be accomplished.