MUSCULOSKELETAL QUESTIONS

-Doctor's Order: Demerol 50 mg IVP q 6 hr prn pain -Available: Demerol 75 mg/ 1.3mL. -How many mL will you administer? -Round to the nearest hundredths.

-0.87mL

-Order: Amoxicillin 0.25 g p.o. every 8 hours. -Available: Amoxicillin 125mg tablets. -How many tablets will the nurse give per dose?

-2 tabs

As charge nurse you assign the nursing care of a patient who has just returned from open carpal tunnel release surgery to an experienced LPN, who will perform under the supervision of an RN. Which instructions would you provide for the LPN? (Select all that apply.) -A. Check the patient's vital signs every 15 minutes in the first hour. -B. Check the dressing for drainage and tightness. -C. Elevate the patient's hand above the heart. -D. The patient will no longer need pain medication. -E. Check the neurovascular status of the fingers every hour.

-A, B, C, E. -Check the patient's vital signs every 15 minutes in the first hour. -Check the dressing for drainage and tightness. -Elevate the patient's hand above the heart. -Check the neurovascular status of the fingers every hour.

Which are true about Lyme disease? Select all that apply. -A. If untreated, the disease moves through three stages. -B. Early stage symptoms may include a red macule or papule at the site of the tick bite, a characteristic bullseye rash with round rings around the center, headache, neck stiffness, pain, fever, chills, malaise, nausea, vomiting, and sore throat. -C. Cardiac and neurologic symptoms occur mid-stage, followed by arthritis and joint problems. -D. Nephrotic syndromes occur in the later stages.

-A, B, C.

When discussing physical activities with the client who has just undergone a right total hip replacement, which instruction should the nurse provide? -A. "Limit hip flexion to 90 degrees." -B. "Perform rotation exercises each day." -C. "Intermittently cross and uncross your legs several times each day." -D. "Avoid weight bearing until the hip is completely healed."

-A. "Limit hip flexion to 90 degrees."

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

-A. "Phantom limb pain is not explained or predicted by any one theory."

While taking the health history of a patient with severe painful osteoarthritis, the nurse would expect the patient to report which of the following? -A. A gradual onset of the disease, with involvement of weight-bearing joints -B. A sudden onset of the disease, with involvement of all joints -C. No complaints of morning stiffness -D. Joint pain that is not affected by exercise

-A. A gradual onset of the disease, with involvement of weight-bearing joints

What is important assessment information to obtain from a patient with a fractured hip? -A. Circulation and sensation distal to the fracture -B. Amount of swelling around the fracture site -C. Degree of bone healing that has occurred -D. Amount of pain that the fracture and healing are causing

-A. Circulation and sensation distal to the fracture

The clinic nurse is caring for a patient diagnosed with osteoarthritis. The patient tells the nurse, "I am having trouble getting in and out of my bathtub." Which intervention should the clinic nurse implement first? -A. Determine whether the patient has grab bars in the bathroom. -B. Encourage the patient to take a shower instead of a bath. -C. Initiate a referral for a physical therapist for the patient. -D. Discuss whether the patient takes NSAIDS.

-A. Determine whether the patient has grab bars in the bathroom.

For a patient with severe painful osteoarthritis, a regimen of heat, massage, and exercise will: -A. Help relax muscles and relieve pain and stiffness -B. Restore range of motion previously lost -C. Prevent the inflammatory process -D. Help the client cope with pain effectively

-A. Help relax muscles and relieve pain and stiffness

What evaluation is important in the preoperative nursing assessment of a client with a severely herniated lumbar disc? -A. Movement and sensation in the lower extremities -B. Leg pain that radiates to both lower extremities -C. Reflexes in the upper extremities -D. Pupillary reaction to light

-A. Movement and sensation in the lower extremities

A patient is confined to bed with a fracture of the left femur. He begins receiving subcutaneous heparin injections. What is the purpose of this medication? -A. To prevent thrombophlebitis and pulmonary emboli associated with immobility -B. To promote vascular perfusion by preventing formation of micro-emboli in the left leg -C. To prevent venous stasis, which promotes vascular complications associated with immobility -D. To decrease the incidence of fat emboli associated with long bone fractures

-A. To prevent thrombophlebitis and pulmonary emboli associated with immobility

-The nurse is assessing a patient who had a fractured femur repaired with an external fixator device. Which assessment findings would cause the nurse concern regarding the development of compartment syndrome? Select all that apply. -A. Decrease in pulse rate in affected leg -B. Paresthesia distal to area of injury -C. Toes on affected leg cool to touch and edematous -D. Complaints that pins are hurting -E. Complaints of leg pain unrelieved by analgesics or repositioning -F. Patient angry and calling loudly to the nurse every 10 mins

-B, C, E. -Paresthesia distal to area of injury -Toes on affected leg cool to touch and edematous -Complaints of leg pain unrelieved by analgesics or repositioning

An older adult client has fallen in her home and is brought to the emergency department by ambulance with a suspected fractured hip. X-rays confirm a fracture of the left femoral neck. When planning assessments during the client's presurgical care, the nurse should be aware of the client's heightened risk of what complication? -A. Osteomyelitis -B. Avascular necrosis -C. Phantom pain -D. Septicemia

-B. Avascular necrosis

The postoperative nursing care plan for a patient who has had a right leg amputation includes: -A. Applying ice packs to the residual limb for 72 hours -B. Having the patient lie on his or her abdomen for 30 minutes 3-4 times/day -C. Wrapping the residual limb with Ace bandages from proximal to distal ends -D. Managing client's pain with anti-inflammatory medications

-B. Having the patient lie on his or her abdomen for 30 minutes 3-4 times/day

During a health screening event, which assessment finding in a white, 61-yr-old woman would alert the nurse to the possible presence of osteoporosis? -A. Presence of bowed legs -B. Measurable loss of height -C. Poor appetite and aversion to dairy products -D. Development of unstable, wide-gait ambulation

-B. Measurable loss of height

After a lumbar laminectomy, a patient continues to complain of the same low back pain that he had before surgery. The nurse knows that this finding is caused by what problem -A. Failure of the surgeon to remove the client's herniated disc -B. Swelling in the operative area that compresses adjacent structures -C. Twisting of the patient's spine when he turns from side to side -D. Limitation of movement resulting from spinal fusion

-B. Swelling in the operative area that compresses adjacent structures.

A patient has a fractured femur. Which finding would you instruct the nursing assistant to report immediately? -A. The patient complains of pain. -B. The patient appears confused. -C. The patient's blood pressure is 136/88 mm Hg. -D. The patient voided using the bedpan.

-B. The patient appears confused.

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

-B. To monitor for signs of sufficient tissue perfusion

A client with rheumatoid arthritis informs the nurse that since he has been in remission and not having any symptoms, he doesn't need to take his medication any longer. What is the best response by the nurse? -A. "If you don't take your medication, you will become very ill." -B. "Be sure to let the physician know after you stop your medications." -C. "It is important that you continue to take your medication to avoid an acute exacerbation." -D. "As long as you are not having symptoms, you can take a medication vacation."

-C. "It is important that you continue to take your medication to avoid an acute exacerbation."

The nurse receives report from the licensed practical nurse about care provided to patients on the orthopedic surgical unit. It is most important for the nurse to follow up on which statement? -A. "The patient who had a spinal fusion 12 hours ago has hypoactive bowel sounds and is not passing flatus." -B. "The patient who had cervical spine surgery 2 days ago wants to wear her soft cervical collar when out of bed." -C. "The patient who had spinal surgery 3 hours ago is complaining of a headache and has clear drainage on the dressing." -D. "The patient who had a laminectomy 24 hours ago is using patient-controlled analgesia with morphine for pain management."

-C. "The patient who had spinal surgery 3 hours ago is complaining of a headache and has clear drainage on the dressing."

A patient has a long leg plaster cast applied. What nursing actions are implemented while the cast is still wet? -A. Use only the fingertips when moving the cast -B. Keep the patient and cast covered with blankets -C. Support the cast on plastic-covered pillows -D. Place a heat lamp directly over the cast

-C. Support the cast on plastic-covered pillows.

As charge nurse you are making assignments for the day shift. Which patient would you assign to the nurse who was pulled from the postanesthesia care unit (PACU) for the day? -A. A 35-year-old patient with osteomyelitis who needs teaching before hyperbaric oxygen therapy -B. A 62-year-old patient with osteomalacia who is being discharged to a long-term care facility -C. A 68-year-old with osteoporosis given a new orthotic device whose knowledge of use of this device must be assessed -D. A 72-year-old with Paget disease who has just returned from surgery for total knee replacement

-D. A 72-year-old with Paget disease who has just returned from surgery for total knee replacement

You are initiating a nursing care plan for a patient with osteoporosis. All of these nursing interventions apply to the nursing diagnosis risk for falls. Which intervention should you delegate to the UAP? -A. Identifying environmental factors that increase risk for falls. -B. Monitoring gait, balance, and fatigue levels with ambulation. -C. Collaborating with the physical therapist to provide the patient with a walker. -D. Assisting the patient with ambulation to the bathroom and in the halls.

-D. Assisting the patient with ambulation to the bathroom and in the halls.

A patient has a fractured hip and is currently in Buck's traction before surgery. How is the counter-attraction in Buck's traction achieved? -A. By applying a 10-pound counterweight at the knee -B. By placing shock blocks under the head of the bed -C. By elevating the knee gatch and elevating the head of the bed about 30 degrees -D. By elevating the foot of the bed frame and allowing the weights to hang freely

-D. By elevating the foot of the bed frame and allowing the weights to hang freely

A client arrives at the clinic with reports of pain in the left great toe. The nurse assesses a swollen, warm, erythematous left great toe. What disorder will the nurse relate the client symptoms to? -A. Rheumatoid arthritis -B. Osteoarthritis -C. Fibromyalgia -D. Gout

-D. Gout

A patient who had surgery on the right elbow has no right radial pulse and the fingers are cold, the patient reports tingling, and she cannot move the finger of her right hand. Which intervention should the nurse implement first? -A. Document the findings in the patient's chart. -B. Elevate the patient's right hand. -C. Assess the radial pulse with the Doppler. -D. Notify the patient's healthcare provider.

-D. Notify the patient's healthcare provider.

A patient is being treated with Buck's traction. What are important nursing interventions for this patient? -A. Remove the traction boot every 6hrs to provide skin care -B. Check and clean the pin sites at least three times daily -C. Check the area around the hip where the traction is applied -D. Verify that weights are in the amounts ordered and are hanging freely

-D. Verify that weights are in the amounts ordered and are hanging freely

After you receive the change-of-shift report, which patient should you assess first? -A. A 42-year-old with CTS complaining of pain -B. A 64-year-old with osteoporosis awaiting discharge -C. A 28-year-old with a fracture complaining that the cast is tight -D. A 56-year-old with a left leg amputation complaining of phantom pain

C. A 28-year-old with a fracture complaining that the cast is tight