Musculoskeletal Disorders

An elderly client who is having difficulty using a walker tells the nurse, "I don't care what the doctor says; I'm not going to use that thing!" Which response by the nurse is best? 1. "You say that you don't like using the walker; is there any particular reason why?" 2. "You have the right to refuse any treatment intervention your doctor prescribes." 3. "You don't have to use it if you don't want to." 4. "I'll phone your physician and let him explain the reason why you need to use it."

1. "You say that you don't like using the walker; is there any particular reason why?" RATIONALES: Option 1 lets the client know that his concern was heard and asks for more information so that the nurse can further assess the situation. The client does have the right to refuse treatment, but he should be given thorough instruction so that he can make an informed decision. Telling the client that he doesn't need to use the walker encourages unsafe behavior, which places the client at risk for falls. The nurse can explain the importance of using the walker and problem-solve with the client without notifying the physician.

A client with muscle weakness and an abnormal gait is being evaluated for muscular dystrophy. Which test or finding confirms muscular dystrophy? 1. Electromyography 2. Muscle biopsy 3. Family history of muscular dystrophy 3. Gram stain of muscle tissue

2. Muscle biopsy RATIONALE: A muscle biopsy showing fat and connective tissue deposits confirms the diagnosis of muscular dystrophy. Electromyography commonly shows short, weak bursts of electrical activity in affected muscles; however, it isn't a conclusive test for muscular dystrophy. A family history of muscular dystrophy only suggests the disorder. A Gram stain of muscle tissue is inconclusive.

A client is hospitalized for open reduction of a fractured femur. During the postoperative assessment, the nurse notes that the client is restless and she observes petechiae on the client's chest. Which nursing action is indicated first? 1. Elevate the affected extremity. 2. Contact the nursing supervisor. 3. Administer oxygen. 4. Contact the physician.

3. Administer oxygen. RATIONALE: The client is demonstrating clinical manifestations consistent with a fatty embolus. Administering oxygen is the top priority. Elevating the extremity won't alter the client's condition. Notifying the nursing supervisor may be indicated by facility policy after other immediate actions have been taken. The nurse should contact the physician after administering oxygen.

Which nursing intervention is essential in caring for a client with compartment syndrome? 1. Keeping the affected extremity below the level of the heart 2. Wrapping the affected extremity with a compression dressing to help decrease the swelling 3. Removing all external sources of pressure, such as clothing and jewelry 4. Starting an I.V. line in the affected extremity in anticipation of venogram studies

3. Removing all external sources of pressure, such as clothing and jewelry RATIONALE: Nursing measures should include removing all clothing, jewelry, and external forms of pressure (such as dressings or casts) to prevent constriction and additional tissue compromise. The extremity should be maintained at the heart lever (further elevation may increase circulatory compromise, whereas a dependent position may increase edema). A compression wrap, which increases tissue pressure, could further damage the affected extremity. There is no indication that diagnostic studies would require I.V. access in the affected extremity.

A middle-age client recovering from major back surgery must wear a back brace and walk with a cane after experiencing leg weakness. During routine care, the client tells a nurse, "I'm sorry I had this operation. Before surgery I didn't look like I had a problem, but now I do." Which response by the nurse is appropriate? 1. "People often suffer setbacks before they improve." 2. "Maybe you should consult with your attorney." 3. "I'm not sure why you went through with the surgery, you were told of the risks." 4. "You sound concerned about your appearance. In what way are you worse off than before?"

4. "You sound concerned about your appearance. In what way are you worse off than before?" RATIONALES: Option 4 encourages the client to express her feelings about her change in body image. Option 1 minimizes the client's concerns and is condescending. It's inappropriate for the nurse to suggest that the client consult with her attorney. Option 3 is an unprofessional response that minimizes the client's decision-making ability.

A client is preparing for discharge from the hospital after undergoing an above-the-knee amputation. Which instructions should the nurse include in the teaching plan for this client? Select all that apply: 1. Massage the stump away from the suture line. 2. Avoid using heat application to ease pain. 3. Report twitching, spasms, or phantom limb pain immediately. 4. Avoid exposing the skin around the stump to excessive perspiration. 5. Be sure to perform the prescribed exercises. 6. Rub the stump with a dry washcloth for 4 minutes three times per day if the stump is sensitive to touch.

4. Avoid exposing the skin around the stump to excessive perspiration. 5. Be sure to perform the prescribed exercises. 6. Rub the stump with a dry washcloth for 4 minutes three times per day if the stump is sensitive to touch. RATIONALES: The nurse should advise the client to avoid exposing the skin around the stump to excessive perspiration, which can be irritating. She should tell him to perform prescribed exercises to help minimize complications. In addition, the nurse should tell the client that if the stump is sensitive to touch, he should rub the stump with a dry washcloth for 4 minutes three times per day. The nurse should tell the client to massage the stump toward — not away from — the suture line to mobilize the scar and to prevent its adherence to bone. The client may experience twitching, spasms, or phantom limb pain while his muscles adjust to the amputation. This is a normal reaction and doesn't need to be reported. The nurse should advise the client that he can ease these symptoms with heat, massage, or gentle pressure.

The nurse monitors a client receiving enoxaparin (Lovenox), 30 mg subQ b.i.d after hip replacement surgery. Which adverse reaction is the client most likely to experience? 1. Anaphylactic shock 2. Hypersensitivity 3. Bronchospasm 4. Bleeding

4. Bleeding RATIONALES: Bleeding is the most common adverse reaction associated with enoxaparin. The drug isn't known to induce anaphylactic shock or bronchospasm, and hypersensitivity reactions are rare.