Chapter 42: Musculoskeletal Disorders - NCLEX REVIEW
The nurse is providing instructions to the client who is being prepared for skeletal traction. Which statement by the client indicates teaching was effective? "Metal pins will go through my skin to the bone." "I will wear a boot with weights attached." "A belt will go around my pelvis and weights will be attached." "The traction can be removed once a day so I can shower
"Metal pins will go through my skin to the bone." In skeletal traction, metal rods or pins are used to apply continuous traction directly to the bone. Weights are used to apply the traction. Casts, external fixators, or splints are used when the traction is discontinued.
The nurse is assessing a client with a musculoskeletal system condition. Which statement indicates to the nurse that the client is experiencing bone pain? "I have soreness and aching like cramps in both of my arms." "The pain feels deep in my legs and keeps me awake at night." "The pain feels tender, hurts, and is worse when I move." "The pain is sharp in my arms but is relieved by not moving."
"The pain feels deep in my legs and keeps me awake at night." Bone pain is deep and dull! Joint pain is worse with movement. Fracture pain is sharp and piercing. Muscle pain is soreness and achy (think working out)
When developing the teaching plan for parents using the Pavlik harness with their child, what should be the nurse's initial step? 1.Assessing the parents' current coping strategies. 2.Determining the parents' knowledge about the device. 3.Providing the parents with written instructions. 4.Giving the parents a list of community resource
2 Assessing the learner's knowledge level is the initial step in any teaching plan to promote the maximum amount of learning. This assessment also provides the nurse with a starting point for teaching. Assessing coping strategies can provide important information to the development of the teaching plan but is not the initial step. Giving parents written instructions or a list of community resources is appropriate once the parents' knowledge level has been determined and teaching has begun.
The mother asks the nurse about using a car seat for her toddler who is in a hip spica cast. The nurse should tell the mother: 1."You can use a seat belt because of the spica cast." 2."You will need a specially designed car seat for your toddler." 3."You can still use the car seat you already have." 4."You'll need to get a special release from the police so that a car seat won't be needed.
2 The toddler in a hip spica cast needs a specially designed car seat. The one that the mother already has will not be appropriate because of the need for the car seat to accommodate the cast and abductor bar
Which should the nurse stress to the parents of an infant in a Pavlik harness for treatment of developmental dysplasia of the hip (DDH)? 1. Put socks on over the foot pieces of the harness to help stabilize the harness. 2. Use lotions or powder on the skin to prevent rubbing of straps. 3. Remove harness during diaper changes for ease of cleaning diaper area. 4. Check under the straps at least two to three times daily for red areas.
4 1. Socks should be put on under the straps to prevent rubbing of the skin. The harness is stable if fitted correctly. 2. Lotions and powders tend to cake and irritate under the straps. Their use is not recommended. 3. The harness is not to be removed except in specific conditions and after instruction on removal and refitting. Diapering is easily done with the harness in place. 4. Checking under straps frequently is suggested to prevent skin breakdown.TEST-TAKING HINT: The test taker can eliminate answer 1 because the question is about skin redness and irritation, not harness fi t.
The nurse is assessing the infant shown in the figure. On observing the client from this angle, the nurse should document that this infant has which of the following? 1.Ortolani's "click. "2.Limited abduction. 3.Galeazzi's sign. 4.Asymmetric gluteal folds
4 This infant with congenital hip dysplasia has asymmetric gluteal folds. The Ortolani "click" occurs when the nurse feels the femur sliding into the acetabulum with a "click." Limited abduction may be observed during an attempt to abduct the infant's thighs. Galeazzi's sign reveals femoral foreshortening and is observed by flexing the thighs.
Which is useful in identifying acute or chronic tears of the joint capsule or supporting ligaments of the knee, shoulder, ankle, hip, or wrist? Meniscography Bone densitometry Arthrography EMG
Arthrography Arthro means joint.
Which cleansing solution is the most effective for use in completing pin site care? Betadine Chlorhexidine Hydrogen peroxide Alcohol
Chlorhexidine
The nurse is monitoring a patient who sustained a fracture of the left hip. The nurse should be aware that which kind of shock can be a complication of this type of injury? Cardiogenic Hypovolemic Neurogenic Septic
Hypovolemic INCREASE FLUIDS!!
A nurse is caring for a client who has suffered a hip fracture and who will require an extended hospital stay. The nurse should ensure that the client does what action to prevent common complications associated with a hip fracture? Avoid requesting analgesia unless pain becomes unbearable. Use supplementary oxygen when transferring or mobilizing. Increase fluid intake and perform prescribed foot exercises. Remain on bed rest for 14 days or until instructed by the orthopedic surgeon.
Increase fluid intake and perform prescribed foot exercises. Increasing fluid and foot exercises prevents DVT (The fluid dilutes the clots)
The nurse is caring for a client with a spica cast. What is the nurse's priority intervention? Keep the cast clean and dry. Position the client on the affected side. Promote elimination with a regular bedpan. Keep the legs in abduction.
Keep the cast clean and dry. Keeping the cast clean and dry around the perineal opening is a priority. A spica cast has a built-in abduction bar. The client should be positioned on the unaffected side every 2 hours and prone twice a day. A fracture bedpan is easier to use for the client with a spica cast.
Which device is designed specifically to initially support and immobilize a body part in a desired position until swelling subsides? Brace Continuous passive motion (CPM) device Splint Trapeze
Splint Explanation: A splint may be applied to a fractured extremity initially until swelling subsides. A brace is an externally applied device to support a body part, control movement, and prevent injury. A CPM device is an instrument that moves a body part to promote healing and circulation. A trapeze is an overhead device to promote client mobility in bed.
The nurse is planning discharge instructions for the client with osteomyelitis. What instructions should the nurse include in the discharge teaching? a) "You will receive IV antibiotics for 3 to 6 weeks." b) "Use your continuous passive motion machine (CPM) 2 hours each day." c) "You need to perform weight-bearing exercises twice a week." d) "You need to limit the amount of protein and calcium in your diet."
a) "You will receive IV antibiotics for 3 to 6 weeks." Explanation: Treatment of osteomyelitis requires IV antibiotics for 3 to 6 weeks. pg.1148
The client presents to the emergency department with fever, chills, restlessness, and limited movement of a fractured jaw. The nurse interprets these findings as indicating which of the following complications? a) Osteomyelitis b) Avascular necrosis c) Fat embolism d) Compartment syndrome
a) Osteomyelitis Explanation: Clinical manifestations of osteomyelitis include signs and symptoms of sepsis and localized infection. pg.1148
A client is diagnosed with osteomyelitis. This is most commonly caused by which of the following? a) Staphylococcus aureus b) Psuedomonas aeruginosa c) Escherichia coli d) Proteus vulgaris
a) Staphylococcus aureus Explanation: Staphylococcus aureus causes over 50% of bone infections. Other organisms include Proteus vulgaris and Pseudomonas aeruginosa, as well as E. coli. pg.1148
A patient with chronic osteomyelitis has undergone 6 weeks of antibiotic therapy. There is no improvement in the wound appearance. What action would the nurse anticipate to promote healing? a) Surgical debridement b) Vitamin supplements c) Wound irrigation d) Wound packing
a) Surgical debridement Explanation: In chronic osteomyelitis, surgical debridement is used when the wound fails to respond to antibiotic therapy. Wound packing, vitamin supplements, and wound irrigation are not the standard of care when treating chronic osteomyelitis. pg.1149
A nurse is planning discharge teaching regarding exercise for a client at risk for osteoporosis. Which of the following exercises would be appropriate? a) Walking b) Yoga c) Bicycling d) Swimming
a) Walking Explanation: Weight-bearing exercises should be incorporated into the client's lifestyle activities. pg.1141
A client with diabetes punctured his foot with a broken acorn in the yard. Within a week, the client developed osteomyelitis of the foot. The client was admitted for IV antibiotic therapy. How long does the nurse anticipate the client will receive IV antibiotics? a) 7 to 10 days b) 3 to 6 weeks c) 6 months d) 3 months
b) 3 to 6 weeks Explanation: Identification of the causative organism to initiate appropriate and ongoing antibiotic therapy for infection control. IV antibiotic therapy is administered for 3 to 6 weeks. Oral antibiotics then follow for as long as 3 months. pg.1148
A client is admitted with acute osteomyelitis that developed after an open fracture of the right femur. When planning this client's care, the nurse should anticipate which measure? a) Instructing the client to ambulate twice daily b) Administering large doses of I.V. antibiotics as ordered c) Withholding all oral intake d) Administering large doses of oral antibiotics as ordered
b) Administering large doses of I.V. antibiotics as ordered Explanation: Treatment of acute osteomyelitis includes large doses of I.V. antibiotics (after blood cultures identify the infecting organism). Surgical drainage may be indicated, and the affected bone is immobilized. The client usually requires I.V. fluids to maintain hydration, but oral intake isn't necessarily prohibited. pg.1148
A patient stepped on an acorn while walking barefoot in the backyard and developed an infection progressing to osteomyelitis. What microorganism does the nurse understand is most often the cause of the development of osteomyelitis? a) Proteus b) Staphylococcus aureus c) Salmonella d) Pseudomonas
b) Staphylococcus aureus Explanation: More than 50% of bone infections are caused by Staphylococcus aureus and increasingly of the variety that is methicillin resistant (i.e., methicillin-resistant Staphylococcus aureus [MRSA]) (Miller & Kaplan, 2009). Other pathogens include the gram-positive organisms streptococci and enterococci, followed by gram-negative bacteria, including pseudomonas. pg.1148
The client diagnosed with osteosarcoma is scheduled for a surgical amputation. Which nursing diagnosis would be a priority for this client compared with other surgical clients? a) Impaired physical mobility b) Risk for infection c) Disturbed body image d) Inadequate nutrition
c) Disturbed body image Explanation: Amputation of a body part can result in disturbances in body image. pg.1153
Which assessment findings would the nurse expect in a client diagnosed with osteomyelitis? a) Pruritus and uremic frost b) Petechiae over the chest and abnormal ABGs c) Leukocytosis and localized bone pain d) Thrombocytopenia and ecchymosis
c) Leukocytosis and localized bone pain Explanation: Clinical manifestations of osteomyelitis include signs and symptoms of sepsis and localized infection. pg.1148
Which of the following would the nurse use to determine that a client is exhibiting signs and symptoms of chronic osteomyelitis? a) Rapid pulse b) Tenderness over the affected area c) Persistent draining sinus d) High fever
c) Persistent draining sinus Explanation: Persistent draining sinus indicates a chronic infection in a client with osteomyelitis. High fever, rapid pulse, and tenderness or pain over the affected area is evidence of an acute infection. pg.1148
The nurse is preparing a client for a surgical procedure that will allow visualization of the extent of joint damage of the knee for a client with rheumatoid arthritis and also obtain a sample of synovial fluid. What procedure will the nurse prepare the client for? a) Arthroplasty b) Open reduction c) Needle aspiration d) Arthroscopy
d) Arthroscopy Explanation: Arthroscopic examination may be carried out to visualize the extent of joint damage as well as to obtain a sample of synovial fluid. An open reduction would be used for the treatment of a fracture. Needle aspiration will not allow visualization of the joint damage but will allow obtaining the sample of synovial fluid. Arthroplasty is the restructure of the joint surface after diagnosis is made. pg.1100
In chronic osteomyelitis, antibiotics are adjunctive therapy in which of the following situations? a) Wound irrigation b) Vitamin supplements c) Wound packing d) Surgical debridement
d) Surgical debridement Explanation: In chronic osteomyelitis, antibiotics are adjunctive therapy to surgical debridement. pg.1148