Musculoskeletal System I Updated

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Which primary manifestation is associated with bursitis? 1 Swelling 2 Painless joints 3 Tingling sensation 4 Altered neurovascular status

Swelling Bursitis is the inflammation in the closed sacs lined with synovial membrane that contain synovial fluid and are located between tendons and bones near the joints. The swelling is the primary manifestation of bursitis. Bursitis is characterized by painful joints and a warm sensation, but not a tingling sensation. The manifestation of altered neurovascular status may appear later in acute soft tissue injury.

The nurse provides discharge instructions to a patient who has undergone total hip arthroplasty. Which statement by the patient indicates understanding of the instructions? 1 "I'll walk at least two miles a day after I get home." 2 "I may get back to work as soon as I feel that I'm able." 3 "I have to do the physical therapy exercises several times a day." 4 "I should take frequent bike rides to increase my activity and joint flexibility."

"I have to do the physical therapy exercises several times a day." After hip arthroplasty (replacement), the patient must perform specially designed exercises to help regain muscle strength. Care must be taken to prevent dislocation of the prosthesis and to prevent fatigue during the recovery period. Walking two miles per day and taking bike rides would put too much physical stress on the patient. Slow but steady progress will indicate when the patient's activity tolerance level is such that he or she may return to work.

What is the most useful initial nursing action for a patient who sustains a joint sprain? 1 Seeking a prescription for a prophylactic antibiotic 2 Administering an over-the-counter analgesic 3 Applying ice compresses to the injured area 4 Providing the patient with instructions about weight bearing

Applying ice compresses to the injured area Ice application is the most useful intervention after a sprain. Cold compression produces hypothermia of the affected area, facilitating vasoconstriction and reducing the perception and transmission of nerve pain impulses. Antibiotic prophylaxis is administered for an open fracture or external extremity injury. Analgesics such as aspirin can be administered after the cold compress. Patient instructions should be provided after the extent of the injury is determined and initial interventions performed. Text Reference - p. 1507

A patient underwent osteotomy a few days ago. Which postoperative nursing action is suitable for the patient at this time? 1 Perform neurovascular assessment. 2 Administer intramuscular antibiotics. 3 Refrain from moving the affected joint. 4 Encourage sitting, standing, and walking.

1 Neurovascular assessment should be performed to assess nerve function and circulatory status. Intramuscular antibiotics are administered during the initial acute injury period, not after several days. The patient needs to be monitored for any limitations of movement or activity related to turning, positioning, and extremity support. Splints are used above and below the fractured site initially to reduce range of motion that might result in further complications. So, sitting, standing, and walking should be discouraged. Text Reference - p. 1535

Musculoskeletal assessment is an important component of care for patients on what type of long-term therapy? 1 Corticosteroids 2 B-adrenergic blockers 3 Antiplatelet aggregators 4 Calcium-channel blockers

1 Corticosteroids Corticosteroids are associated with avascular necrosis and decreased bone and muscle mass. B-blockers, calcium-channel blockers, and antiplatelet aggregators commonly are not associated with damage to the musculoskeletal system. Text Reference - p. 1495

A nurse is assessing a fracture of a patient's hand. Which phenomenon would the nurse note as the bone fragments rub against each other? 1 Crepitation 2 Reabsorption 3 Proliferation 4 Subluxation

1 Crepitation Crepitation is the grating sensation and sound produced when broken bone fragments rub against one another. Reabsorption is the loss of bone mass due to a loss of calcium resulting in porous, weak bones. Proliferation is reproduction or multiplication of similar forms, usually referring to increases of cells. Subluxation is a partial or incomplete dislocation or displacement of a bone from its normal position. Text Reference - p. 1500

A patient had a surgical procedure on the left knee one day ago with the insertion of a hemovac for drainage. What is the role of the nurse in postoperative management? Select all that apply. 1 Monitoring vital signs 2 Performing neurovascular assessments 3 Instructing the patient to restrict water intake 4 Measuring the volume of drainage 5 Retrieving blood from the joint space

1 Monitoring vital signs 2 Performing neurovascular assessments 4 Measuring the volume of drainage In general, postoperative nursing care and management are directed toward monitoring vital signs. Frequent neurovascular assessments of the affected extremity are necessary to detect early and subtle neurovascular changes. Closely monitor any limitations of movement. Pain and discomfort can be minimized through proper alignment and positioning. Carefully observe dressings or casts for any signs of bleeding or drainage. Report any significant increase in the size of the drainage area. If a wound drainage system is in place, as in this case, regularly measure the volume of drainage and assess the patency of the system, using aseptic technique to avoid contamination. The patient's water intake is not restricted. The patient may receive an auto transfusion of blood. However, the retrieval of blood from the joint space is done by the specialists.

The nurse is providing postprocedural care for a patient that has undergone an arthrocentesis. The patient's synovial fluid is whitish yellow in color and has uric acid crystals. Which treatment strategy would be most beneficial for this patient? 1 Infusing lactated Ringer's solution 2 Administering antigout medications 3 Administering antidiabetic medications 4 Infusing intravenous calcium supplements

2 Administering antigout medications Presence of whitish yellow synovial fluid with uric acid crystals in the synovial fluid indicates that the patient has gout; therefore, administering antigout medication will be most beneficial for the patient. Lactated Ringer's solution helps to maintain fluid and electrolyte balance but does not reduce symptoms of gout. Antidiabetic medications reduce blood glucose levels, but do not eliminate uric acid from the body and do not decrease symptoms of gout. Intravenous calcium supplements prevent osteoporosis but do not alleviate symptoms of gout. Text Reference - p. 1503

The nurse is providing postoperative care to a patient who underwent surgical repair of a fractured hip two days ago. Which assessment finding indicates the need for immediate nursing action and intervention? 1 Pain at the surgical site 2 Sudden shortness of breath 3 Serosanguineous wound drainage 4 Limited range of motion of the affected leg

2 Sudden shortness of breath The sudden onset of shortness of breath could be an indication of fat embolism syndrome, a potentially fatal complication of long bone fractures. Pain at the surgical site, serosanguineous wound drainage, and limited range of motion of the affected leg are all expected findings in a patient who has just undergone repair of a fractured hip. Text Reference - p. 1523

The registered nurse is teaching the student nurse about the common sites for synovectomy. Which understanding about the surgical site by the student nurse indicates effective learning? Select all that apply. 1 Hip joint 2 Knee joint 3 Wrist joint 4 Finger joint 5 Elbow joint

3, 4, 5 Common sites for a synovectomy are the wrist, fingers, and elbow joints. Synovectomy is performed to relieve pain and improve range of motion. The hip and knee joints are not common sites for synovectomy. Hip arthroplasty and hip resurfacing are usually performed at the hip joint. Knee arthroplasty is performed at the knee joint to replace the knee joint and chronic knee pain can be relieved with an osteotomy. Text Reference - p. 1534

The nurse is completing a neurovascular assessment on the patient with a tibial fracture and a cast. The feet are pulseless, pale, and cool. The patient says they are numb. What should the nurse suspect is occurring? 1 Paresthesia 2 Pitting edema 3 Poor venous return 4 Compartment syndrome

4 Compartment syndrome The nurse should suspect compartment syndrome with one or more of the following six Ps: paresthesia, pallor, pulselessness, pain distal to the injury and unrelieved with opioids, pressure increases in the compartment, and paralysis. Although paresthesia and poor venous return are evident, these are just some of the manifestations of compartment syndrome. Pitting edema is not evident. Text Reference - p. 1522

A patient reports knee pain while walking. The nurse observes that the patient's knee joint is inflamed. The nurse suspects that which pathologic condition caused the patient's symptoms? 1 Tetany 2 Bursitis 3 Lordosis 4 Scoliosis

Correct2 Bursitis

The nurse is caring for a patient who exhibits increased flexion in the hip and knee to clear the foot from the floor. The patient also exhibits footdrop, and the foot slaps down and along the walking surface. Which condition does the nurse suspect based on these findings? 1 Pes planus 2 Spastic gait 3 Short-leg gait 4 Steppage gait

Correct4 Steppage gait

A patient will undergo electromyography. What information should the nurse give to the patient? Select all that apply 1 Small-gauge needles are inserted into certain muscles. 2 This test can be carried out at the bedside. 3 There may be some discomfort because of the needles. 4 It is useful in identifying any lower motor neuron dysfunction or primary muscle diseases. 5 There may be severe bleeding and pain, and local anesthesia may be given.

Correct 1 Small-gauge needles are inserted into certain muscles. Correct 3 There may be some discomfort because of the needles. Correct 4 It is useful in identifying any lower motor neuron dysfunction or primary muscle diseases. Electromyography helps to evaluate electrical potential associated with skeletal muscle contraction. Small-gauge needles are inserted into certain muscles. Needle probes are attached to leads that feed information to an electromyogram (EMG) machine. Recordings of electrical activity of the muscle are traced on audio transmitter and on oscilloscope and recording paper. There may be some discomfort because of the needles. It is useful in identifying any lower motor neuron dysfunction or primary muscle diseases. The procedure is usually done in an EMG laboratory while the patient lies supine on a special table. It is not performed at the bedside. There is no major bleeding, and it is not performed under anesthesia. Text Reference - p. 1503

The patient is brought to the emergency department after a car accident and has a femur fracture. What nursing intervention should the nurse implement to prevent a fat embolus in this patient? 1 Administer enoxaparin 2 Provide range of motion exercises 3 Apply sequential compression boots 4 Immobilize the fracture preoperatively

Immobilize the fracture preoperatively To prevent fat emboli, the nurse immobilizes the long bone to reduce movement of the fractured bone ends and decrease the risk of a fat embolus from the bone before surgical reduction. Enoxaparin is used to prevent blood clots, not fat emboli. Range of motion and compression boots will not prevent a fat embolus in this patient.

Which postoperative drug class is used in the pain management of joint surgical procedures? 1 Antibiotics 2 Oral opioids 3 Anticoagulants 4 Corticosteroids

Oral opioids Oral opioids are part of the pharmacologic therapy to manage pain after joint surgical procedures. Antibiotics treat infection after surgery. Anticoagulants treat thromboembolism. Corticosteroids treat fat embolism. Text Reference - p. 1535

The nurse is caring for a patient who has undergone left knee arthroplasty with prosthetic replacement of the knee joint to relieve the pain of severe osteoarthritis. Postoperatively, what does the nurse expect to be included in the care of the affected leg? 1 Progressive leg exercises to obtain 90-degree flexion 2 Early ambulation with full weight bearing on the left leg 3 Bed rest for three days with the left leg immobilized in extension 4 Immobilization of the left knee in 30-degree flexion for two weeks to prevent dislocation

Progressive leg exercises to obtain 90-degree flexion Although early, full weight bearing ambulation is not recommended, the patient is encouraged to engage in progressive leg exercises until 90-degree flexion is possible. Because this is painful after surgery, the patient requires good pain management and often the use of a continuous passive motion (CPM) machine. The patient's knee is unlikely to dislocate. The knee will not be immobilized for two weeks at 30-degree flexion. Text Reference - p. 1535

A nurse is caring for a patient with a fractured femur. The health care provider finds that the patient has fat embolism syndrome. What treatment (or treatments) of fat embolism syndrome should the nurse anticipate for this patient? Select all that apply. 1 Fluid resuscitation 2 Avoidance of coughing 3 Correction of acidosis 4 Fracture immobilization 5 Frequent change in positions

1 Fluid resuscitation 3 Correction of acidosis 4 Fracture immobilization The treatment of fat embolism syndrome is directed toward the management of symptoms. This includes fluid resuscitation to prevent hypovolemic shock, correction of acidosis, and fracture immobilization. The patient should be encouraged to cough and perform deep breathing. The patient should be repositioned as little as possible to prevent dislodgment of fat droplets into the general circulation. Text Reference - p. 1523

A patient is admitted with slight erosion of cartilage in the knee joint. What are the symptoms that the nurse is likely to find in this patient? Select all that apply. 1 Crepitation 2 Deformity 3 Joint stiffness 4 Limited range of motion 5 Complete inability to walk

1,3,4 Cartilage erosion can result in direct contact between ends of two bones. This presents as possible crepitation on movement, joint stiffness, decreased mobility, and limited range of motion. There is pain with motion and/or weight bearing. Deformity and complete inability occur in severe and chronic cases, not in slight erosion of cartilage. STUDY TIP: In the first pass through the exam, answer what you know and skip what you do not know. Answering the questions you are sure of increases your confidence and saves time. This is buying you time to devote to the questions with which you have more difficulty. Text Reference - p. 26

A nurse is examining a patient who is in a body jacket brace. The patient states that the brace is applied too tightly. What findings in the patient may indicate that the brace is too tightly applied? Select all that apply. 1 Burning sensation 2 Abdominal pain 3 Guarding and rigidity 4 Increased abdominal pressure 5 Nausea and vomiting

2, 3, 4 After application of the body jacket brace, it is important to assess the patient for the development of superior mesenteric artery syndrome (cast syndrome). This condition occurs if the brace is applied too tightly, compressing the superior mesenteric artery against the duodenum. The patient generally complains of abdominal pain, abdominal pressure, nausea, and vomiting. Burning sensations, guarding, and rigidity may not be found in cast syndrome; these symptoms are more prominent if an intraabdominal disorder is present. Text Reference - p. 1516

A patient is brought to the emergency department after an accident with injury to the right leg. A radiograph of the right femur shows a fracture. What should the nurse note during the peripheral vascular assessment? Select all that apply. 1 Pain 2 Color 3 Edema 4 Motor function 5 Capillary refill

2, 3, 5 In cases related to fractures, peripheral vascular assessment should be done. This consists of assessment of color, temperature, capillary refill, peripheral pulses, and edema. Assessment of motor function and pain is included in the peripheral neurologic assessment. Text Reference - p. 1517

Which discharge instructions would a nurse give to a patient with a cast? Select all that apply. 1 Use talcum powder under the cast as needed. 2 Keep the extremity elevated as much as possible. 3 Take pain medications only when the pain is unbearable. 4 Report a fever or a foul odor coming from beneath the cast. 5 Report itching under the cast that could indicate an infection. 6 Keep the extremity in a dependent position as much as possible.

2, 4 A fever or a foul odor coming from beneath the cast may indicate an infection and requires immediate attention. No product such as talcum powder, cornstarch, or lotion should be put down a cast to relieve itching, because this may increase the risk of infection. If pain is present, the patient should take pain medication before reaching an unbearable level. Itching under the cast is normal and does not need to be reported to the primary health care provider, but the patient must be advised to avoid scratching, because breaks in the skin under the cast can easily become infected. The extremity should be elevated as much as possible to prevent edema. Keeping the extremity elevated, not dependent, decreases edema. Text Reference - p. 1520

A nurse provides postoperative instructions to a patient who underwent reconstructive surgery for an anterior crucial ligament (ACL) injury. Which statement made by the patient indicates the need for further teaching? 1 "I should do range-of-motion (ROM) exercises." 2 "My knees should be kept immobilized while healing." 3 "It is not likely that my physical functioning will ever return to normal." 4 "Progressive weight-bearing may be critical for healing."

3 Reconstructive therapy involves the removal of a torn anterior cruciate ligament tissue and its replacement with an allograft tissue. The patient's physical functioning may return to normal in six to eight months. ROM exercises are encouraged soon after the surgery to prevent complications related to prolonged immobilization. The knee is placed in a brace or immobilized after surgery. Progressive weight-bearing is determined by the degree of surgical repair. Text Reference - p. 1511

A patient has been admitted with edema in the right knee and is unable to bear weight on the right leg after a fall. The nurse is preparing the patient for a right knee aspiration. Which bore needle will be used for aspiration in this patient? 1 24-gauge 2 22-gauge 3 20-gauge 4 18-gauge

4 18-gauge For aspirating fluid from the knee cavity, a large bore needle is required. In this scenario, 18-gauge or wider bore needle should be used. 24-, 22-, and 20-gauge needles have small bores not appropriate for aspirating fluids and, therefore, should not be used. Text Reference - p. 1499

Which type of adult is at an increased risk for carpel tunnel syndrome (CTS)? 1 Male with asthma 2 Male with glaucoma 3 Female with asthma 4 Female with diabetes mellitus

4 Female with diabetes mellitus Patients with diabetes mellitus have greater incidence of CTS. Women have smaller carpel tunnels compared to men and are more prone to develop CTS. Men and women with asthma as well as men with glaucoma are at a lesser risk for CTS. Text Reference - p. 1509

A patient with osteoarthritis is preparing for a total left-knee arthroplasty. The nurse assesses the patient carefully to be sure that there is no evidence of which sign in the preoperative period? 1 Immobility 2 Pain 3 Inflammation 4 Infection

4 Infection It is critical that the patient be free of infection before a total knee arthroplasty. An infection in the joint could lead to even greater pain and joint instability, requiring extensive surgery. For this reason, the nurse monitors the patient for signs of infection, such as redness, swelling, fever, and increased white blood cell count. Pain, immobility, and inflammation are common findings in the patient with osteoarthritis and would not be contraindications to surgery. Text Reference - p. 1535

A patient with severe osteoarthritis of the left knee has undergone left-knee arthroplasty with prosthetic replacement of the knee joint. After surgery, the nurse expects to include which intervention? 1 Active range of motion every hour 2 Strict bedrest for 24 hours 3 Total knee immobilization for 72 hours 4 Physical therapy to achieve full knee flexion

4 Physical therapy to achieve full knee flexion The patient is encouraged to engage in progressive leg exercises until 90-degree flexion is possible. Because this is painful after surgery, the patient requires good pain management and, often, the use of a continuous passive motion (CPM) machine. Hourly range of motion is not necessary, because the patient will already have CPM. Bed rest is not indicated because of the risk of clot formation postoperatively. Knee immobilization should be used when transferring out of bed, but should not be left on. Text Reference - p. 1535

After assessing the muscle strength of a patient, the nurse scores it as 1 on the Muscle Strength Scale. What does the score mean? 1 No detection of muscular contraction 2 A barely detectable flicker or trace of contraction with observation or palpation 3 Active movement of the body part with elimination of gravity 4 Active movement against gravity only and not against resistance

A barely detectable flicker or trace of contraction with observation or palpation On the Muscle Strength Scale, grade 1 means that there is a barely detectable flicker or trace of contraction with observation or palpation in the patient. A grade 0 means no detection of muscular contraction. A grade 2 indicates active movement of body part with elimination of gravity. A grade 3 means active movement against gravity only and not against resistance. Text Reference - p. 1498

What is the best intervention to prevent infection in a patient who has sustained an acute knee injury and has an open wound? 1 Applying an ice pack 2 Administer analgesics 3 Administering tetanus prophylaxis 4 Immobilizing the affected extremity

Administering tetanus prophylaxis Tetanus prophylaxis is administered when the patient has an open wound and an increased risk of infection. Application of ice may help relieve pain. Analgesics may help to relieve pain. Immobilizing the extremity helps in providing comfort. Text Reference - p. 1513

What is a key benefit associated with strengthening exercises? 1 Reduction of pain 2 Prevention of falls 3 Elimination of infection 4 Building of bone density

Building of bone density Strengthening exercises that involve working against resistance help to build bone density. Balancing exercises may help in prevention of falls. Pain reduction is not associated with these exercises. Strength exercises do not cure or treat infections. Text Reference - p. 1507

What are the closed sacs lined with synovial membrane that contain a small amount of synovial fluid that are located at sites of friction in the joints? 1 Bursae 2 Menisci 3 Rotator cuff 4 Carpal tunnel

Bursae Bursae are the closed sacs lined with synovial membrane containing a small amount of synovial fluid. These are located at sites of friction, such as between tendons and bones, and near the joints. The crescent-shaped pieces of fibrocartilage in the knee, located at the sites of friction are menisci. The rotator cuff is the complex of four shoulder muscles, the supraspinatus, infraspinatus, teres minor, and subscapularis muscles. The tunnel formed by ligaments and bones is the carpal tunnel. Text Reference - p. 1511

A patient is hospitalized with severe injuries to the ligament surrounding the hip joint. Which syndrome can the patient develop if the articular surface of the joint is completely separated? 1 Overuse syndrome 2 Impingement syndrome 3 Carpal tunnel syndrome 4 Compartment syndrome

Compartment syndrome Severe injuries to the ligament surrounding the hip joint may result in compartment syndrome if the articular surface of the joint is completely separated. Overuse syndrome results from repetitive movements and awkward postures. Impingement syndrome is the entrapment of soft tissue structures under the coracoacromial arch of the shoulder. Carpal tunnel syndrome may be caused by median nerve compression; the median nerve enters the hand through the carpal tunnel's narrow confines. Text Reference - p. 1508

A patient states, "I twisted my ankle while walking." Which assessment finding make the nurse suspect that the injury is a third degree sprain? 1 Swelling around the ankle 2 Redness of the skin around the ankle 3 Pain on movement of the ankle 4 Muscle gap on palpation of the skin around the ankle

Correct4 Muscle gap on palpation of the skin around the ankle

A middle-aged patient is reporting a sore shoulder after raking the yard. The nurse should suspect which problem? 1 Bursitis 2 Fasciitis 3 Sprained ligament 4 Achilles tendonitis

Correct1 Bursitis Bursitis is common in adults over age 40 and with repetitive motion, such as raking. Plantar fasciitis frequently occurs as a stabbing pain at the heel caused by straining the ligament that supports the arch. A sprained ligament occurs when a ligament is stretched or torn from a direct injury or sudden twisting of the joint, not repetitive motion. Achilles tendonitis is an inflammation of the tendon that attaches the calf muscle to the heel bone, not the shoulder, and it causes pain with walking or running. Text Reference - p. 1493

Which type of fracture is most common in older adults? 1 Hip fracture 2 Colles' fracture 3 Pelvic fracture 4 Fracture of the humerus

Correct1 Hip fracture Hip fractures are most common in older adults, with 90 percent of these fractures occurring as a result of a fall. Colles' fracture is a fracture of the distal radius and is one of the most common fractures in adults. Pelvic fractures range from benign to life threatening, depending on the mechanism of injury and associated vascular insult. Only a small percentage of all fractures are pelvic fractures. This type of injury is associated with a high mortality rate. Fractures of the humerus involve the shaft of the humerus, and are common among young and middle-aged adults. Text Reference - p. 1525

A patient will undergo a computed tomography (CT) scan of the knee joint. What nursing interventions should the nurse perform to prepare the patient for the procedure? Select all that apply. 1 Inform the patient that procedure is painless. 2 Ensure that the patient is shaved completely. 3 Administer local anesthesia and obtain a blood sample. 4 Inform the patient of the importance of remaining still during the procedure. 5 If a contrast medium is being used, verify that patient does not have shellfish allergy.

Correct1 Inform the patient that procedure is painless. Correct4 Inform the patient of the importance of remaining still during the procedure. Correct5 If a contrast medium is being used, verify that patient does not have shellfish allergy.

A patient presents with severe shoulder pain. Which techniques should the nurse use for assessing this patient? Select all that apply. 1 Inspection 2 Percussion 3 Palpation 4 Arthroscopy 5 Obtain health history

Correct1 Inspection Correct3 Palpation Correct5 Obtain health history While assessing a patient with a musculoskeletal complaint, inspection assists the nurse to note any wound or deformity. Palpation helps the nurse to assess the muscles and bones and also feel for crepitation. It is important to obtain a proper health history to know the severity and causative factors. Percussion is a technique used to assess the abdomen and not musculoskeletal system. Arthroscopy is not a nursing assessment; it is a procedure to view the inner surface of a joint cavity and is done only when indicated. Text Reference - p. 1497

A nurse evaluates a patient who reports twisting an ankle while walking down steps. Besides edema, which symptoms would most likely be observed if a nondisplaced simple fracture were present? 1 Numbness, coolness, and loss of pulse 2 Loss of sensation, redness, and warmth 3 Coolness, redness, and inability to bear weight 4 Redness, warmth, and inability to use the affected part

Correct4 Redness, warmth, and inability to use the affected part Common signs of a fracture include edema, redness, warmth, inability to bear weight or use the affected joint, and pain at the site of injury. Coolness, tingling, numbness, and loss of pulses are signs of a vascular problem or may reflect a complication of a more complex fracture. Text Reference - p. 1512

The nurse finds that a patient has frequent, audible crackling sounds and grating upon joint movement. Which condition does the nurse suspect based on these findings? 1 Scoliosis 2 Crepitation 3 Contracture 4 Festinating gait

Crepitation Crepitation is associated with fracture, dislocation, temporomandibular joint dysfunction, and osteoarthritis. It manifests as frequent, audible crackling sounds with palpable grating during movement. Scoliosis is the asymmetric elevation of shoulders, scapulae, and iliac crests with lateral spine curvature. It is often a congenital condition or occurs due to fracture or dislocation. Contracture is the resistance to movement of a muscle or a joint as a result of fibrosis of the supporting soft tissues. Festinating gait is a condition where the neck, trunk, and knees flex but the body is rigid while walking. Text Reference - p. 1500

The nurse is caring for a patient with a fracture who has a Buck's traction boot in place. Which complication is prevented by the use of the boot? 1 Muscle spasms 2 Posttraumatic arthritis 3 Intraarticular adhesions 4 Extraarticular adhesions

Muscle spasms Traction devices apply a pulling force on a fractured extremity in order to realign the bone. A Buck's traction boot is a type of skin traction used to immobilize a fracture, prevent hip flexion contractures, and reduce muscle spasms. Continuous passive motions (CPM) decrease the incidence of posttraumatic arthritis. CPM is used for various joints, such as the knee and shoulder, to prevent intraarticular and extraarticular adhesions. Text Reference - p. 1514

Redness, warmth, and inability to use the affected part Common signs of a fracture include edema, redness, warmth, inability to bear weight or use the affected joint, and pain at the site of injury. Coolness, tingling, numbness, and loss of pulses are signs of a vascular problem or may reflect a complication of a more complex fracture. Text Reference - p. 1512

A patient is found to have a partially dislocated shoulder. How should the nurse document this finding? 1 Fracture 2 Rupture 3 Subluxation 4 Misalignment

Subluxation Subluxation, also known as dislocation, may be assessed by means of palpation of the space between the head of the bone and the cavity where it is normally located. Subluxation results in partial loss of function and intense pain. A subluxation is not a fracture—there is no break in bone integrity—but a subluxation is treated similarly to a fracture. With subluxation, there is no rupture in the integrity of the bone. Subluxation may be described as a misalignment, but this is not an accurate term. Text Reference - p. 1507

The nurse is assisting the radiologist while doing magnetic resonance imaging (MRI) for a patient. Which action of the nurse would be helpful to the patient during the test? 1 The nurse allows the patient to drink coffee. 2 The nurse allows the patient to listen to music. 3 The nurse allows the patient to wear a hearing aid. 4 The nurse allows the patient to keep credit cards in the pocket.

The nurse allows the patient to listen to music. MRI produces loud noises, so the patient can be allowed to listen to music or use earplugs during the test. Coffee is not allowed to be drunk during the test, because it may alter the test results. MRI is contraindicated in the patient who is wearing hearing aids, because it may absorb the radio and magnetic waves and cause adverse effects. The patient should not have metallic objects like credit cards and jewelry, because they may absorb magnetic waves that decrease the image quality.

When teaching a group of athletes about reducing the risk of sprains and strains before vigorous exercise, what instructions should the nurse include? 1 Warm up before exercise. 2 Rest before exercise. 3 Avoid vigorous exercise. 4 Rest after exercise

Warm up before exercise. Warming up muscles before exercising and vigorous activity, followed by stretching, may significantly reduce the risk of sprains and strains. Resting before vigorous exercise may cause sprains and strains. In this group of athletes, vigorous exercise can be done, but it should be done after appropriate warming up. Resting after the exercise does not affect the risk of strains and sprains. Text Reference - p. 1507

A patient with a history of falls is suspected of having a fracture in the radius of the right hand. Which diagnostic test should the nurse anticipate to assess the fracture? 1 Magnetic resonance imaging (MRI) 2 X-ray 3 Computed tomography (CT) scan 4 Diskogram

X-ray X- ray is the preliminary diagnostic test for diagnosing fractures. CT scan and MRI are advanced tests to analyze the condition of various other organs and body parts. Diskogram involves x-ray of cervical or lumbar intervertebral disc after injection of contrast media into nucleus pulposus. It helps in visualization of intervertebral disc abnormalities. It does not aid in assessing the fracture in the radius of the right hand. Text Reference - p. 1499

A patient with carpal tunnel syndrome (CTS) reports being awakened at night due to tingling and numbness in the hands. Which activity should the nurse instruct the patient to perform to relieve the symptoms? 1 "Shake your hands." 2 "Wash your hands with water." 3 "Apply cold packs to your hands." 4 "Apply warm, moist heat to your hands."

"Shake your hands" Shaking the hands often relieves CTS symptoms. Washing hands with water will not relieve the symptoms. Cold application is performed to promote healing of sprains. Warm, moist heat is applied 24 to 48 hours after a sprain injury. Text Reference - p. 1509

1 "Shake your hands." Shaking the hands often relieves CTS symptoms. Washing hands with water will not relieve the symptoms. Cold application is performed to promote healing of sprains. Warm, moist heat is applied 24 to 48 hours after a sprain injury. Text Reference - p. 1509

What is a meniscus injury? 1 Injury to fibrocartilage of the knee 2 Injury to the ligament by deceleration forces 3 Injury resulting in tearing or stretching of a ligament 4 Injury within the muscle or tendinoligamentous structures

1 A meniscus injury refers to injury to the fibrocartilage of the knee that is characterized by popping, clicking, and tearing sensations with effusion and swelling. The traumatic tearing of ligaments by excessive deceleration forces together with pivoting or rotating positions of the knee or leg is an anterior cruciate ligament tear. Tearing or stretching of ligaments as a result of excessive inversion, eversion, shearing, or torque applied to a joint is described as ligament injury. Injury to the muscle or tendinoligamentous structures around the shoulder is called a rotator cuff tear. Text Reference - p. 1506

Which movement helps to turn the sole of the foot outward away from the midline of the body? 1 Eversion 2 Extension 3 Abduction 4 Dorsiflexion

1 Eversion Eversion is the turning of the sole outward away from the midline of the body. Extension is the straightening of the joints that increases the angle between two bones. Abduction is the movement of a part away from the midline of the body. Dorsiflexion is the flexion of the ankle and toes towards the shin. Text Reference - p. 1498

A nurse is taking care of a patient with a cast on the right leg maintained in external traction. However, during the routine examination, the nurse finds that the patient has compartment syndrome. What measures should a nurse take in the management of this patient? Select all that apply. 1 Cut the cast in half. 2 Remove or loosen any bandage. 3 Elevate the affected limb above heart level. 4 Apply cold compresses to the leg. 5 Reduce external traction weight

1,2,5 If the patient has compartment syndrome, the cast should be split in half. If there are any bandages, they should be removed or loosened to remove the pressure. A reduction in traction weight may also decrease external circumferential pressures. Elevation of the extremity may lower venous pressure and slow arterial perfusion. Therefore the extremity should not be elevated above heart level. The application of cold compresses may result in vasoconstriction and exacerbate compartment syndrome. Text Reference - p. 1522

A patient reports pain and inflammation of the knee. The nurse flexes the knee by 15 to 30 degrees and also pulls the tibia forward while keeping the femur stable. The nurse feels a soft forward motion of the tibia with an indistinct endpoint. What diagnosis does the nurse anticipate? 1 Bursitis 2 Rotator cuff injury 3 Carpal tunnel syndrome 4 Anterior cruciate ligament injury

Anterior cruciate ligament injury The knee with an anterior cruciate ligament tear may produce a positive Lachman's test. This test involves flexing the knee by 15 to 30 degrees and pulling the tibia forward, keeping the femur stable. It is considered positive with forward motion of the tibia with a soft feeling and indistinct endpoint. This test is not performed to assess bursitis. A rotator cuff injury may be examined by a drop arm test. Carpel tunnel syndrome may be examined by positive results for Tinel's sign and Phalen's sign. Text Reference - p. 1511

Which surgery is considered to be the most appropriate in a patient with osteoarthritis and complete loss of function in the knee joint? 1 Osteotomy 2 Arthrodesis 3 Arthroplasty 4 Synovectomy

Arthroplasty A patient with osteoarthritis with a complete loss of function in the knee joint needs an arthroplasty to replace the joint. Osteotomy is a surgical procedure in which a part of the bone is sliced to change alignment, correcting deformity and relieving chronic pain. Arthrodesis is the surgical fusion of a joint and is performed only when the joint is severely infected or if reconstructive surgery fails. Synovectomy is used as a prophylactic measure and as a palliative treatment for rheumatoid arthritis (RA) Text Reference - p. 1534

A patient reports a clicking, popping, and locking sensation with knee instability and tests positive when performing McMurray's test. Which condition can occur in the patient, if this is left untreated? 1 Bursitis 2 Avascular necrosis 3 Quadriceps atrophy 4 Pathologic fracture

Correct3 Quadriceps atrophy A clicking, popping, and locking sensation with knee instability along with a positive McMurray's test indicate a meniscus injury. If untreated for a prolonged period, the meniscus injury may result in quadriceps atrophy due to disuse of the muscle. Bursitis is inflammation of the bursae and is not due to a meniscus injury. Avascular necrosis results from a lack of blood flow to the bones and does not occur due to untreated meniscus injury. A pathologic fracture is not associated with the prolonged lack of treatment of meniscus injury. Text Reference - p. 1511

A patient is found to have a partially dislocated shoulder. How should the nurse document this finding? 1 Fracture 2 Rupture 3 Subluxation 4 Misalignment

Correct3 Subluxation Subluxation, also known as dislocation, may be assessed by means of palpation of the space between the head of the bone and the cavity where it is normally located. Subluxation results in partial loss of function and intense pain. A subluxation is not a fracture—there is no break in bone integrity—but a subluxation is treated similarly to a fracture. With subluxation, there is no rupture in the integrity of the bone. Subluxation may be described as a misalignment, but this is not an accurate term. Text Reference - p. 1507

A patient admitted with cellulitis and probable osteomyelitis received an injection of radioisotope at 9:00 AM before a bone scan. At what time should the nurse plan to send the patient for the bone scan? 1 9:30 PM 2 10:00 AM 3 11:00 AM 4 1:00 PM AM

Correct3 11:00 AM

As part of a wellness program, the nurse recommends balancing exercises. What should the nurse explain as the primary benefit of the exercises? 1 To prevent falls 2 To build bone density 3 To build muscle strength 4 To maintain normal blood pressure

Correct1 To prevent falls Balancing exercises help to prevent falling. Bone density is not built by balancing exercises. Strengthening exercises may help build bone density and muscle strength. Balancing exercises may not help in maintaining normal blood pressure. Text Reference - p. 1507

A nurse applies an elastic bandage to a patient's knee and provides discharge instructions after teaching the patient how to reapply the bandage. Which statement made by the patient indicates the need for further teaching? 1 "I will wrap it tightly but ensure that there is no numbness." 2 "I will wrap it starting from distal to proximal end." 3 "I will leave it in place for prolonged periods." 4 "I will leave it in place for 30 minutes and then remove it for 15 minutes."

Correct2 "I will wrap it starting from distal to proximal end."

The nurse is performing a physical examination on a patient who is suffering from extreme pain in the right knee as well as weakness in the right leg. What should the nurse consider when performing palpation? Select all that apply. 1 Palpate only the affected region. 2 Palpate the muscles as well as joints. 3 Rub your hands together before palpating. 4 Palpate from above to below (cephalopedal direction). 5 Do not palpate the knee region, because it will cause discomfort for the patient.

Correct2 Palpate the muscles as well as joints. Correct3 Rub your hands together before palpating. Correct4 Palpate from above to below (cephalopedal direction). When palpating, it is important that the nurse palpates the muscles as well as the joints to allow for evaluation of skin temperature, local tenderness, swelling, and crepitation. Rubbing the hands together before performing palpation prevents muscle spasm. Spasm can interfere with the identification of essential landmarks or soft tissue structures. When palpating, the nurse should palpate the affected area as well as the neighboring area. It is necessary to palpate from above to below so that no part is missed. Palpation of the affected joint is important, and, therefore, palpating the knee is important. Text Reference - p. 1497

A nurse is taking the health history of a patient with a backache. What are the questions that should be included in the health history related to this condition? Select all that apply. 1 Did you lift a heavy object? 2 Describe your usual daily activities. 3 Did you have any unsafe sexual activity? 4 Do you have any vision problems? 5 Do you find it difficult to perform your daily activities?

Did you lift a heavy object? Describe your usual daily activities. Do you find it difficult to perform your daily activities? The nurse should ask if the patient tried lifting any heavy object. The nurse should record the patient's daily activities and ask if the patient experiences any discomfort in performing them. This gives an idea of the severity of the ailment. Vision problems do not have a direct bearing on backache. Having unsafe sexual activity exposes the person to various serious, sexually transmitted infections (STIs) but does not affect the musculoskeletal system. Text Reference - p. 1495

Which type of fracture is most common in older adults? 1 Hip fracture 2 Colles' fracture 3 Pelvic fracture 4 Fracture of the humerus

Hip fracture Hip fractures are most common in older adults, with 90 percent of these fractures occurring as a result of a fall. Colles' fracture is a fracture of the distal radius and is one of the most common fractures in adults. Pelvic fractures range from benign to life threatening, depending on the mechanism of injury and associated vascular insult. Only a small percentage of all fractures are pelvic fractures. This type of injury is associated with a high mortality rate. Fractures of the humerus involve the shaft of the humerus, and are common among young and middle-aged adults. Text Reference - p. 1525

Which statement given by the nurse indicates need for further teaching about a safe home environment for the patient who has undergone an orthopedic surgery? 1 The home environment should be free of any electrical cords on the floor. 2 Home assistance should be discouraged to promote independent living skills. 3 The floor should have scatter rugs removed for the free movement of the patient 4 Door frames should be wide enough for free movement of the patient with a walker.

Home assistance should be discouraged to promote independent living skills. A patient who has undergone orthopedic surgery will require assistance for a few weeks after the surgery. The patient will need help performing simple daily activities such as tying shoes. The home environment should be free of any electric cords on the floor to prevent accidents from electric shock. Scatter rugs should be removed to prevent falls. Door frames should be wide enough for the free movement of a patient with a walker so that there is no dislocation of the operated joint during the movement.

After a motor vehicle crash, a patient has a dislocated right hip joint, and the bone is exposed in the right thigh. What type of fracture should the nurse document? Select all that apply. 1 Open 2 Comminuted 3 Closed 4 Displaced 5 Greenstick

In this case, the bone is exposed, and therefore it is an open fracture. Comminuted fractures have two or more fragments of bones. Fractures can be classified as displaced or nondisplaced. In a displaced fracture, the two ends of the broken bone are separated from one another and are out of their normal positions. This fracture is not a closed one, because the fractured bone is exposed through soft tissue injury. Greenstick fracture is a type of fracture in which the periosteum is intact across the fracture and the bone is still in alignment. Text Reference - p. 1511

A patient will undergo a computed tomography (CT) scan of the knee joint. What nursing interventions should the nurse perform to prepare the patient for the procedure? Select all that apply. 1 Inform the patient that procedure is painless. 2 Ensure that the patient is shaved completely. 3 Administer local anesthesia and obtain a blood sample. 4 Inform the patient of the importance of remaining still during the procedure 5 If a contrast medium is being used, verify that patient does not have shellfish allergy.

Inform the patient that procedure is painless Inform the patient of the importance of remaining still during the procedure If a contrast medium is being used, verify that patient does not have shellfish allergy. While preparing a patient for a CT scan, the nurse should inform the patient that the procedure is painless, and it is important to remain still during the procedure. If a contrast medium is being used, verify that the patient does not have a shellfish allergy. There is no need to shave the patient, because the procedure does not involve any invasive techniques. For a CT scan, local anesthesia and blood samples are not needed, because it is a noninvasive procedure. Test-Taking Tip: Look for answers that focus on the client or are directed toward feelings. Text Reference - p. 1501

A nurse is taking a patient's health history related to musculoskeletal system. What are the common symptoms of musculoskeletal impairments? Select all that apply. 1 Stiffness 2 Weakness 3 Changes in pigmentation 4 Joint crepitation 5 Redness and blisters

Stiffness Weakness Joint crepitation Stiffness and loss of range of motion are very commonly seen symptoms in musculoskeletal impairments. Weakness is also a common symptom. Joint crepitation is also seen in such disorders. Redness and blisters are not common symptoms seen in musculoskeletal impairments. Redness and blisters are associated with burns and infections. Similarly, a change in pigmentation is not a common symptom. It is usually a result of hormonal changes, aging, or other dermatologic conditions. Text Reference - p. 1494

The nurse is completing discharge teaching with a patient who has undergone total knee arthroplasty. Which statement would indicate the need for additional teaching? 1 "I should continue physical therapy as prescribed." 2 "I will increase intake of vitamins and minerals." 3 "I will report pain or swelling to the health care provider." 4 "I should expect that my knee may change shape."

"I should expect that my knee may change shape." The patient should report a change in the shape of the knee, which could signal the onset of complications. Reporting pain or swelling, continuing physical therapy, and supplementing vitamins and minerals are all correct. Test-Taking Tip: Avoid looking for an answer pattern or code. There may be times when four or five consecutive questions have the same letter or number for the correct answer. Text Reference - p. 1535

The registered nurse is teaching a student nurse about the postoperative management care for a patient who has undergone knee arthroplasty. Which statement given by the student nurse is most important for knee arthroplasty? 1 "I will assess the vital signs of the patient." 2 "I will assess the respiratory rate of the patient." 3 "I will restrict the patient from doing active flexion exercises initially." 4 "I will emphasize isometric quadriceps exercises on the first postoperative day."

"I will emphasize isometric quadriceps exercises on the first postoperative day." Emphasizing isometric quadriceps on the first postoperative day is particular to knee arthroplasty. Assessment of vital signs is a general precautionary method after any surgery. Assessment of the respiratory rate checks for any airway complications following surgery. Restricting the patient from doing active flexion exercises initially is appropriate but is not as high a priority as isometric exercises Text Reference - p. 1534

The nurse is grading a muscle-strength test on the patient and obtains a score of 4/5. What best describes this score? 1 Active movement against gravity and some resistance 2 Active movement of body part with elimination of gravity 3 Active movement against full resistance without evident fatigue 4 Active movement against gravity only and not against resistance

1 A score of 4/5 means active movement against gravity with some resistance. Active movement of a body part with elimination of gravity is a score of 2/5. A score of 5/5 means active movement against full resistance without evident fatigue, and a score of 3/5 reveals active movement against gravity and not against resistance. Text Reference - p. 1576

1 Bursae Bursae are the closed sacs lined with synovial membrane containing a small amount of synovial fluid. These are located at sites of friction, such as between tendons and bones, and near the joints. The crescent-shaped pieces of fibrocartilage in the knee, located at the sites of friction are menisci. The rotator cuff is the complex of four shoulder muscles, the supraspinatus, infraspinatus, teres minor, and subscapularis muscles. The tunnel formed by ligaments and bones is the carpal tunnel. Text Reference - p. 1511

A coal miner with a history of rheumatoid arthritis reports pain, swelling, and a limited range of motion in the knee joints. What diagnosis does the nurse suspect? 1 Bursitis 2 Shin splints 3 Rotator cuff tear 4 Impingement syndrome

1 Bursitis Bursitis is the inflammation of the bursae located near the joints. Rheumatoid arthritis causes inflammation in the joints, resulting in friction between joint surfaces. The repetitive kneeling involved in occupations such as coal mining may result in bursitis. A shin splint are is inflammation along the anterior aspect of the calf due to periostitis. A rotator cuff tear is a muscle tear around the shoulder joint. Impingement syndrome is also a shoulder injury. Text Reference - p. 1511

The registered nurse teaches a student nurse about care of a patient with a fracture of the humerus, compartment syndrome, and a plaster cast in place. The student nurse provides discharge education to the patient. Which statement made by the student nurse needs correction? 1 "Elevate the extremity above the heart level." 2 "Use a hair dryer on a low setting to dry the cast thoroughly." 3 "Control the itching sensation by using a hair dryer on a cool setting at the site of itching." 4 "Avoid covering the cast with plastic for extended periods of time."

1 Elevation of the extremity above the heart level is contraindicated for patients with compartment syndrome, which is a painful condition that occurs when the pressure within the muscle increases to dangerous levels. If the cast gets wet by mistake, it should be dried thoroughly using a hair dryer on the low setting. Itching is a common sensation experienced by patients and can be controlled by using a hair dryer on the cool setting instead of using hard objects to scratch the area. The patient should not cover the cast with plastic for prolonged periods. Text Reference - p. 1520

The nurse plans care for a patient who has a fractured femur. During the 48 to 72 hours after the fracture the nurse should monitor the patient for the development of: 1 Fat emboli 2 Renal calculi 3 Muscle atrophy 4 Bone demineralization

1 Fat emboli Pressure on the bone marrow or an increase in catecholamines (related to stress) can mobilize fatty acids and the development of fat globules in the bloodstream. These fat globules travel to the lung and become lodged, causing the pulmonary symptoms. Renal calculi, muscle atrophy, and bone demineralization are potential complications of immobility; however, they would develop much later than 72 hours after the fracture. Text Reference - p. 1523

A patient arrives in the emergency department after sustaining a fall. The initial assessment reveals that the left leg is shorter than the right and externally rotated. What condition should the nurse suspect? 1 Fractured hip 2 Fractured pelvis 3 Nondisplaced fractured femur 4 Fractured tibia/fibula

1 Fractured hip Older adults, especially women, are at high risk for fracture. One classic sign of a fractured hip is a leg that is shorter than the opposite one and abnormally rotated (internally or externally). A fractured hip is accompanied by pain and possibly neurovascular changes. A leg that is shorter than the other one and externally rotated is not a sign of a fractured pelvic, femur, or tibia/fibula. Text Reference - p. 1525

A patient has undergone amputation just below the level of the elbow in the right upper limb. The patient states that there is still the sensation of pain in the missing portion one day after surgery. What should the nurse inform the patient? 1 It is normal to feel this way. 2 You are having illusions. 3 You are experiencing delusions. 4 You are having hallucinations.

1 It is normal to feel this way. After an amputation, the patient may still feel the presence of the amputated part. The nurse should explain to the patient that it is normal to feel this way. This phenomenon, termed phantom limb sensation, occurs in many amputees. Such a sensation is not illusion, delusion, or hallucination. Text Reference - p. 1533

A patient with an injury to the ankle joint has an elastic bandage in place. The patient reports numbness in the area of the ankle. What should the nurse conclude related to the elastic bandage? 1 It is wrapped too tightly. 2 It was wrapped from proximal to distal end. 3 It is being used during physical activity. 4 It was left in place for 30 minutes and then removed for 15 minutes

1 It is wrapped too tightly Applying an elastic bandage too tightly may compromise the blood circulation in the area, causing numbness. The prescribed method of wrapping elastic bandage is to start from the proximal end and progress towards the distal end. An appropriately applied elastic bandage can be left in place during athletic activity. The elastic bandage should be wrapped for 30 minutes and then removed for 15 minutes to avoid irritating the damaged area. Text Reference - p. 1507

Which activities may precipitate bursitis? 1 Kneeling repeatedly 2 Lifting heavy weights 3 Using a keyboard frequently 4 Sitting with crossed legs for a short time

1 Kneeling repeatedly Bursitis is the inflammation of the bursae. Common precipitating activities include repetitive kneeling or running in worn-out shoes. Activities such as lifting heavy objects and the frequent use of a computer keyboard can cause cumulative trauma disorder. Bursitis is also precipitated by sitting with crossed legs for prolonged time periods, but not for a short time. Text Reference - p. 1511

A newborn baby has sustained an uncomplicated midshaft fracture of the femur. In how many weeks will the fracture heal? Record your answer as a whole number. 1 3 weeks 2 7 weeks 3 10 weeks 4 20 weeks

1 Many factors influence fracture healing, including displacement, the site of the fracture, the blood supply to the area, and any immobilization and internal fixation devices (e.g., screws, pins). Healing time for fractures increases with age. An uncomplicated midshaft fracture of the femur heals in 3 weeks in a newborn and in 20 weeks in an adult. Text Reference - p. 1513

Which joint surgery involves removing a slice of bone? 1 Osteotomy 2 Arthroplasty 3 Synovectomy 4 Debridement

1 Osteotomy is the removal of a slice of bone to change the alignment of the joint and to improve weight-bearing capacity. Arthroplasty is the reconstruction or replacement of a joint to relieve pain, improve or maintain a range of motion, and correct deformity. Synovectomy is the removal of synovial membrane. It is used as a prophylactic measure and as a palliative treatment for rheumatoid arthritis (RA). Debridement is the removal of degenerative debris such as loose bodies, osteophytes, joint debris, and degenerated menisci from a joint. Text Reference - p. 1534

Which drug is monitored via measurement of prothrombin time in patients who undergo orthopedic surgeries? 1 Warfarin 2 Enoxaparin 3 Rivaroxaban 4 Fondaparinux

1 Prothrombin time is measured daily, starting on the day of the surgery, when a patient is taking warfarin. Low-molecular-weight heparin drugs such as enoxaparin, rivaroxaban, and fondaparinux do not require prothrombin time testing on a daily basis. Text Reference - p. 1536

The nurse reviews a test result of a patient with bursitis and notes bursal wall thickening that interferes with normal joint function. Which treatment does the nurse anticipate will be prescribed to this patient? 1 Surgical excision of bursae 2 Aspiration of the bursal fluid 3 Administering a corticosteroid through the intraarticular route 4 Administering an oral nonsteroidal antiinflammatory drug (NSAID)

1 Surgical excision of bursae The thickening of bursal walls may interfere with normal joint function and may require surgical excision. Aspirating bursal fluid, administration of NSAIDs, and intraarticular injections of corticosteroids may not be beneficial in this situation. Text Reference - p. 1511

Which primary manifestation is associated with bursitis? 1 Swelling 2 Painless joints 3 Tingling sensation 4 Altered neurovascular status

1 Swelling Bursitis is the inflammation in the closed sacs lined with synovial membrane that contain synovial fluid and are located between tendons and bones near the joints. The swelling is the primary manifestation of bursitis. Bursitis is characterized by painful joints and a warm sensation, but not a tingling sensation. The manifestation of altered neurovascular status may appear later in acute soft tissue injury. Text Reference - p. 1511

A patient scheduled for an arthrocentesis is anxious about the procedure. What information should the nurse give to the patient to alleviate anxiety? Select all that apply. 1 This procedure is performed to obtain samples of synovial fluid or to remove excess fluid from the joint cavity. 2 The procedure is performed under local anesthesia. 3 This procedure can be performed at the bedside or in an examination room. 4 There are serious complications, such as respiratory distress, related to the procedure. 5 This procedure is performed to visualize and examine interior of the joint cavity.

1 This procedure is performed to obtain samples of synovial fluid or to remove excess fluid from the joint cavity. Correct2 The procedure is performed under local anesthesia. Correct3 This procedure can be performed at the bedside or in an examination room. The nurse should explain to the patient that arthrocentesis involves an incision or puncture of the joint capsule to obtain samples of synovial fluid or remove excess fluid from within the joint cavity. Local anesthesia and aseptic preparation are used before the needle is inserted into the joint and fluid is aspirated. It is useful in the diagnosis of joint inflammation, infection, meniscal tears, and subtle fractures. The procedure is usually done at the bedside or in an examination room. Respiratory distress is not a complication of this procedure, because local anesthesia is given. The interior of the joint cavity is visualized and examined during arthroscopy and not during arthrocentesis. Text Reference - p. 1502

1 To prevent falls Balancing exercises help to prevent falling. Bone density is not built by balancing exercises. Strengthening exercises may help build bone density and muscle strength. Balancing exercises may not help in maintaining normal blood pressure. Text Reference - p. 1507

The nurse provides instructions to a patient with osteomyelitis who is scheduled for a bone scan. Which statement made by the patient indicates a need for further teaching or clarification? 1 "Before the test, I should refrain from voiding." 2 "The test is noninvasive; I should not have pain during the procedure." 3 "The test will take about an hour; I should remain in a supine position during the procedure." 4 "Two hours before the test, I will receive an injection of radioisotope."

1 "Before the test, I should refrain from voiding." A bone scan is a radiographic technique that helps diagnose malignant lesions in the bone. When explaining the procedure, the nurse should instruct the patient to empty the bladder before the test, because it prevents discomfort in the patient. A bone scan is a noninvasive procedure; the patient should not experience pain during the test. The nurse should instruct the patient to lie in the supine position during the test, because it helps to clearly visualize the organs under examination. Because a bone scan is a radiographic technique, the patient will receive an injection of radioisotope two hours before the test for clear imaging. Text Reference - p. 1501

What instructions should be given to a patient with a cast to prevent edema and skin breakdown? Select all that apply. 1 Elevate the affected limb above heart level during the first 48 hours. 2 Apply ice on the fracture site during the first 24 hours. 3 Cover the cast with plastic for prolonged periods. 4 Remove the padding of the cast after going home. 5 Exercise joints above and below the cast.

1 ,2, 5 Regardless of the type of cast material, a cast can interfere with circulation and nerve function if edema occurs after the application of the cast. Therefore, it is important to teach the patient and caregivers about measures to prevent edema. Elevating the limb above heart level and applying ice in the initial phase (24 to 48 hours) help in preventing edema. The patient should also be encouraged to exercise the joints above and below the cast. Pulling out the cast padding, inserting foreign objects into the cast to scratch an itch, and covering the cast with plastic may predispose patients to skin breakdown and infections. Therefore they should be advised to abstain from doing such things. Text Reference - p. 1520

A patient is scheduled for a technetium [Tc]-99m bone scan. What nursing interventions are appropriate for the patient? Select all that apply. 1 Ensure that patient's bladder is emptied before scan. 2 Explain to the patient that blood sample will be obtained in the test. 3 Explain to the patient that radioisotope is given 2 hours before the procedure. 4 Explain to the patient that it will be painless, because general anesthesia will be administered. 5 Increase fluid intake after the examination.

1 ,3, 5 A bone scan involves injecting a radioisotope (usually technetium [Tc]-99m) that is absorbed by the bone. A uniform uptake of the isotope is normal. The patient should empty the bladder before the procedure. The nurse should explain to the patient that radioisotope is given two hours before procedure. The patient should be informed that the procedure requires one hour while the patient lies supine and that no pain or harm will result from isotopes. Fluid intake should be increased after the examination to help elimination of the radioisotope through urine. No blood sample is needed, and anesthesia is not administered during this test. Text Reference - p. 1501

A patient is experiencing osteoarthritis. Which finding on the x-ray report of a patient experiencing osteoarthritis indicates that the patient is developing a permanent limitation of motion? 1 Joint-space narrowing 2 Dislocation of the joint 3 Increased synovial fluid 4 A thickened synovial membrane

1 Joint-space narrowing The x-ray for a patient diagnosed with osteoarthritis with permanent limitation of motion would show joint-space narrowing. Dislocation of the joint occurs with fractures. Increased synovial fluid indicates the presence of infection or inflammation in the joint. A thickened synovial membrane would be seen with degenerative joint diseases. Text Reference - p. 1534

A patient with a fracture of the right tibia is scheduled for application of a cast. What is the correct order of applying the materials, from inside to outside? 1. Place padding over the stockinette. 2. Immerse plaster of Paris in warm water. 3. Cover the affected part with a stockinette. 4. Wrap plaster of Paris around the affected part.

1 Cover the affected part with a stockinette. 2 Place padding over the stockinette. 3 Immerse plaster of Paris in warm water. 4 Wrap plaster of Paris around the affected part. To apply a cast on an extremity, first cover the affected part with a stockinette that is cut longer than the extremity. Then place padding over the stockinette, with the bony prominences given extra padding. If the casting material used is plaster of Paris, it is usually immersed in warm water before being wrapped and molded around the affected part. The number of layers of plaster bandage and the technique of application determine the strength of the cast. The plaster sets within 15 minutes. Text Reference - p. 1520

When treating a patient with compartment syndrome, what measures should the nurse consider to be contraindicated? Select all that apply. 1 Elevation of the limb above heart level. 2 Bivalving of the bandage. 3 Application of cold compresses. 4 Reduction in traction weight. 5 Bandage removal.

1 Elevation of the limb above heart level. 3 Application of cold compresses Elevation of the extremity may lower venous pressure and slow arterial perfusion. Therefore the extremity should not be elevated above heart level in case of compartment syndrome. Similarly, the application of cold compresses may result in vasoconstriction and exacerbate compartment syndrome. It may also be necessary to remove or loosen the bandage and split the cast in half (bivalving). A reduction in traction weight may also decrease external circumferential pressures. Text Reference - p. 1522

The nurse is performing a musculoskeletal assessment of an older adult patient whose mobility has been decreasing progressively in recent months. How should the nurse best assess the patient's range of motion (ROM) in the affected leg? 1 Observe the patient's unassisted ROM in the affected leg 2 Perform passive ROM, asking the patient to report any pain 3 Ask the patient to lift progressive weights with the affected leg 4 Move both of the patient's legs from a supine position to full flexion

1 Observe the patient's unassisted ROM in the affected leg Passive ROM should be performed with extreme caution, and may be best avoided when assessing older patients. Observing the patient's active ROM is more accurate and safer than asking the patient to lift weights with her legs. Text Reference - p. 1497

A patient experiences a compound fracture. What assessment findings does the nurse expect? Select all that apply. 1 Soft tissue injury 2 The absence of soft tissue injury 3 The bone is splintered and bent 4 The skin is intact 5 The skin is broken, exposing the bone

1 Soft tissue injury 5 The skin is broken, exposing the bone In compound fractures, the soft tissue is injured, and the skin is broken, exposing the bone. In nondisplaced greenstick fractures, an incomplete fracture occurs, in which the bone is splintered on one side and bent on the other side. The skin is not broken and remains intact in simple fractures.

When teaching a group of young adults, what general measures should a nurse teach to prevent injuries? Select all that apply. 1 Use seat belts regularly. 2 Avoid drunken driving. 3 Drive slower than the posted speed limit. 4 Use safety equipment at work. 5 Use protective athletic equipment. 6 While driving, talk on the phone only if the call is important

1 Use seat belts regularly. 2 Avoid drunken driving. 4 Use safety equipment at work. 5 Use protective athletic equipment. A nurse plays a pivotal role in teaching patients to take appropriate measures to prevent injuries. Some of these measures include regularly using seat belts; avoiding drunken driving, using protective athletic equipment (helmets and knee, wrist, and elbow pads), and using safety equipment at work. Obeying the speed limit is sufficient; the nurse does not need to teach that people should always drive slower than the speed limit. The teaching should encourage people not to use the phone at all while driving; if an important call must be made, the driver should find a safe place to stop before making it.

A patient is admitted to the hospital with Boutonnière deformity. What are the signs and symptoms that the nurse is likely to find during assessment? Select all that apply. 1 Flexion of proximal interphalangeal joint 2 Hyperextension of the distal interphalangeal joint 3 Flexion of the metacarpophalangeal joint 4 Fingers drift to ulnar side of forearm 5 Partial dislocation of finger joints

1, 2 Boutonnière deformity is the deformity of rheumatoid and psoriatic arthritis caused by the rupture of the extensor tendons over the fingers. It is characterized by the flexion of the proximal interphalangeal (PIP) joint and hyperextension of the distal interphalangeal (DIP) joints of the fingers. Flexion of the metacarpophalangeal joint occurs in swan neck deformity. Ulnar drift refers to the deformity of rheumatoid arthritis due to tendon contracture. Dislocation of the finger joints does not happen in Boutonnière deformity. Text Reference - p. 1500

When attending a patient who has undergone hip replacement surgery, what interventions should a nurse perform to prevent thromboembolism? Select all that apply. 1 Administer a prophylactic anticoagulant drug, such as warfarin. 2 Administer low-molecular-weight heparin, such as enoxaparin. 3 Apply compression gradient stockings. 4 Avoid moving toes of the affected extremities. 5 Perform range-of-motion exercises on the affected extremity.

1, 2, 3 Because of the high risk of venous thromboembolism in the orthopedic surgical patient, prophylactic anticoagulant drugs, such as warfarin, or low-molecular-weight heparin, such as enoxaparin, may be prescribed. In addition to wearing compression gradient stockings, the patient should move (dorsiflex and plantar flex) the toes of the affected extremity against resistance and perform range-of-motion exercises on the unaffected lower extremities. Text Reference - p. 1527

A patient presents with festinating gait. What are the signs and symptoms while ambulating that a nurse should expect in this patient? Select all that apply. 1 While walking, the neck, trunk, and knees flex while the body is rigid. 2 Patient displays delayed start with short, quick, shuffling steps. 3 Speed may increase as if patient is unable to stop. 4 The patient is unable to walk for more than two steps at a time. 5 The patient is unable to walk in a straight line and walks diagonally

1, 2, 3 Festinating gait is a neurogenic disorder characterized by flexion of the neck, trunk, and knees during walking while the body is rigid. There may be a delayed start with short, quick, shuffling steps, and speed may increase as if the patient is unable to stop (festination). The patient can walk in a straight line and for more than two to three steps at a time. Text Reference - p. 1500

A patient has a mandibular fracture from an accident, and there is prominent swelling around it. What are the important nutritional measures that need to be followed in the postoperative stages? Select all that apply. 1 Include liquid protein supplements. 2 Give prune juice to drink. 3 Administer bulk-forming laxatives. 4 Give a low-carbohydrate, high-bulk diet. 5 Instruct the patient to chew food properly.

1, 2, 3 Ingestion of sufficient nutrients poses a challenge because the diet must be liquid. The patient easily tires of sucking through a straw or laboriously using a spoon. Liquid protein supplements may be helpful for improving the nutritional status. The low-bulk, high-carbohydrate diet and the intake of air through the straw can create problems related to constipation and flatus. Prune juice and bulk-forming laxatives may help to ward off these problems. The constraint of the diet to only liquids usually results in a low-bulk, high-carbohydrate diet. Chewing is not applicable here, because the diet must be liquid with any form of mandibular immobilization. Text Reference - p. 1530

A patient with a fracture of the femur is to be placed in Buck's traction. How should the nurse explain the functions of Buck's traction to the patient? Select all that apply. 1 It immobilizes the fracture. 2 It prevents hip flexion contractures. 3 It reduces muscle spasms. 4 It reduces injury-related edema. 5 It helps in union of the fractured bone.

1, 2, 3 Traction is the application of a pulling force to an injured or diseased part of the body, often an extremity. A Buck's traction boot is a type of skin traction used to immobilize the fracture, prevent hip flexion contractures, and reduce muscle spasms. The traction does not reduce edema or directly help in union of the fractured bone. However, it indirectly helps the process of union of the fractured bone by keeping the limb aligned and reducing spasms and contractures. Text Reference - p. 1514

A nurse is attending a patient who has sustained a fracture of the femur. What interventions should the nurse perform to ensure a healthy diet for optimal healing of the injured tissues? Select all that apply. 1 Include 1g/kg of protein daily. 2 Increase calcium-rich foods in the diet. 3 Decrease magnesium- and phosphorus-rich foods. 4 Include foods rich in vitamins C and D. 5 Decrease the intake of foods rich in B vitamins.

1, 2, 4 Include 1g/kg of protein daily. Increase calcium-rich foods in the diet. Include foods rich in vitamins C and D. Proper nutrition is an essential component of the healing process in injured tissue. An adequate energy source is needed to promote muscle strength and tone, build endurance, and provide energy for ambulation and maintaining a proper gait. The patient's dietary requirements must include adequate protein, usually 1 g/kg of body weight. The calcium intake should be increased, because immobility and bone healing increase calcium needs. Intake of vitamins C and D should be increased, because these are necessary for optimal soft tissue and bone healing. Magnesium and phosphorus are also necessary for the healing process, and their intake should be increased. B vitamins also aid in the healing of soft tissues and bones. Text Reference - p. 1517

A patient is scheduled for magnetic resonance imaging (MRI). What nursing interventions should the nurse perform to prepare the patient for the procedure? Select all that apply. 1 Offer ear plugs or music. 2 Inform the patient to remain still throughout the procedure. 3 Ensure that the patient is shaved completely and also catheterize the patient. 4 Ensure that patient is not wearing metal such as zippers or jewelry. 5 Explain that the machine will make loud tapping noises intermittently, and there is no cause for alarm.

1, 2, 4, 5 The nurse should inform the patient that the procedure is painless. Offer ear plugs or music to listen to so that the patient will be relaxed during the procedure. Inform the patient to remain still throughout procedure. The patient should have no metal on the clothing. Explain to the patient that the machine will make loud tapping noises intermittently, and there is no cause for alarm. Inform patients who are claustrophobic that they may experience symptoms during examination. Administer an antianxiety agent if indicated and ordered. The procedure is noninvasive, so the patient need not be shaved or catheterized. Text Reference - p. 1501

A nurse is caring for a patient with carpal tunnel syndrome who is advised to undergo surgical repair either by open release surgery or by endoscopic carpal tunnel release surgery. What possible advantages of an endoscopic approach over an open release approach should the nurse explain to the patient? Select all that apply. 1 An endoscopic approach may allow faster recovery. 2 An endoscopic approach does not require rigorous wound care. 3 An endoscopic approach may lead to less postoperative discomfort. 4 An endoscopic approach, unlike an open approach, requires only local anesthesia. 5 An endoscopic approach, unlike an open approach, will shift the surgery to an outpatient setting.

1, 3 Carpal tunnel release is recommended in patients whose symptoms last for more than six months. This may be done either by open release or by endoscopic release approaches. However, an endoscopic approach may have the advantages of faster recovery and less postoperative discomfort when compared with open release. The patient should be instructed about wound care and appropriate assessments to be performed at home for both approaches. Both of these techniques can be used in an outpatient setting and under local anesthesia. Text Reference - p. 1509

A patient will undergo electromyography. What information should the nurse give to the patient? Select all that apply. 1 Small-gauge needles are inserted into certain muscles. 2 This test can be carried out at the bedside. 3 There may be some discomfort because of the needles. 4 It is useful in identifying any lower motor neuron dysfunction or primary muscle diseases. 5 There may be severe bleeding and pain, and local anesthesia may be given.

1, 3, 4 Small-gauge needles are inserted into certain muscles. There may be some discomfort because of the needles. It is useful in identifying any lower motor neuron dysfunction or primary muscle diseases Electromyography helps to evaluate electrical potential associated with skeletal muscle contraction. Small-gauge needles are inserted into certain muscles. Needle probes are attached to leads that feed information to an electromyogram (EMG) machine. Recordings of electrical activity of the muscle are traced on audio transmitter and on oscilloscope and recording paper. There may be some discomfort because of the needles. It is useful in identifying any lower motor neuron dysfunction or primary muscle diseases. The procedure is usually done in an EMG laboratory while the patient lies supine on a special table. It is not performed at the bedside. There is no major bleeding, and it is not performed under anesthesia.

A patient is scheduled for a somatosensory evoked potential (SSEP). What information should the nurse provide the patient? Select all that apply. 1 Transcutaneous or percutaneous electrodes are applied to the skin. 2 This test analyzes and determines the strength of the bones. 3 The test measures nerve conduction along the pathways not accessible by electromyogram (EMG). 4 The procedure is similar to EMG but does not involve needles. 5 The electrodes are pierced in the superficial layer on the skin under anesthesia, so it is not painful.

1, 3, 4 The SSEP test helps to evaluate evoked potential of muscle contractions. Transcutaneous or percutaneous electrodes are applied to the skin and help identify neuropathy and myopathy. It is useful in identifying subtle dysfunction of lower motor neuron and primary muscle disease. It measures nerve conduction along pathways not accessible by EMG. The procedure is similar to EMG but does not involve needles. The test does not determine the strength of bones; strength of bones is determined by bone mass density measurements. In SSEP, the electrodes are not pierced into the skin under anesthesia; the electrodes are placed on the skin. Text Reference - p. 1503

A nurse is taking the health history of a patient with severe pain in the right knee and lower right extremity. What are the important questions related to the dietary behavior of the patient that the nurse should ask about? Select all that apply. 1 What is your usual daily intake of food? 2 Do you like to eat out? 3 Do you have difficulties preparing your food? 4 Do you consume any calcium or vitamin D supplements? 5 Do you face any digestive problem after the consumption of some specific food?

1, 3, 4 What is your usual daily intake of food? Do you have difficulties preparing your food? Do you consume any calcium or vitamin D supplements? When assessing a patient with musculoskeletal problems, probing about nutrition is important. It is important to know the patient's daily diet, as it helps to understand whether the patient is getting enough nutrition. Asking whether the patient has difficulty preparing food helps to understand severity of the pain. Knowing if the patient has been taking dietary supplements also helps in assessing the patient. Asking the patient about eating out does not help in analyzing the cause of or effect of severe pain in the right knee and lower right extremity. Allergy or sensitivity to certain foods does not help in assessing the musculoskeletal system directly. Text Reference - p. 1496

A patient presents with pain in the wrist joint radiating up the entire arm. What should the nurse ask the patient while taking the health history? Select all that apply. 1 Nature of work 2 Food preference 3 Safety practices followed at work 4 Mechanism of injury if any 5 Respiratory function

1, 3, 4 Nature of work Safety practices followed at work Mechanism of injury if any The nature of work helps in knowing about potential injuries in the workplace. The safety practices at work also aid the nurse in assessing the severity of the condition. Knowing how the injury exactly occurred is an important factor that enables the nurse to determine the cause and severity of the injury. Food preferences affect the general health and nutritional status but do not specifically lead to wrist joint problems. Respiratory functioning is an important component of overall general health but is not specifically related to this scenario involving the musculoskeletal problem. Text Reference - p. 1496

A patient is suspected of having fat emboli after a fractured hip. What assessment data gathered by the nurse are indicative of this condition? Select all that apply. 1 Decreased platelet count 2 Increased hematocrit 3 Prolonged prothrombin time 4 Pulmonary infiltration on chest radiograph 5 Increased partial pressure of arterial oxygen

1, 3, 4 This patient's signs and symptoms indicate that the patient has a condition called acute respiratory distress syndrome, caused by fat emboli. Petechiae located around the neck, the anterior chest wall, the axillae, the buccal membrane, and the conjunctivae of the eyes helps distinguish fat emboli from other problems. Results of blood tests show decreased platelet count and prolonged prothrombin time. A chest radiograph may reveal areas of pulmonary infiltrate or multiple areas of consolidation. The partial pressure of arterial oxygen (PaO2) and hematocrit are decreased. Text Reference - p. 1523

The nurse provides education to an athlete about how to avoid sprains and strains. Which suggestion is appropriate for the nurse to include? Select all that apply. 1 "Perform balancing exercises." 2 "Use a cane while walking." 3 "Perform strengthening exercises." 4 "Take an analgesic before exercising." 5 "Perform muscle warming up exercises before vigorous activities."

1, 3, 5 "Perform balancing exercises." "Perform strengthening exercises." "Perform muscle warming up exercises before vigorous activities." Balance exercises help in preventing falls. Strengthening exercises help in building up muscle strength and bone density. Performing warm-up exercises before any vigorous activity reduces the risk of sprains and strains. A cane can assist in walking but does not reduce sprains or strains. Taking analgesics before exercise in the absence of injury or pain may be unnecessary. Text Reference - p. 1507

The nurse is instructed to apply a swathe to a patient. What is true about a swathe? Select all that apply. 1 It is used for shoulder dislocations. 2 It is used for hip dislocations. 3 It encircles the trunk and humerus. 4 It encircles the trunk and femur. 5 It may be used after surgical repairs.

1, 3, 5 A swathe is a type of immobilizer used to prevent glenohumeral movement. It encircles the trunk and humerus as an additional binder and is often used after surgical repairs or shoulder dislocations. It is not used for hip dislocations and is not used to encircle the trunk and femur. Text Reference - p. 1524

1, 3, 5 Obtain health history While assessing a patient with a musculoskeletal complaint, inspection assists the nurse to note any wound or deformity. Palpation helps the nurse to assess the muscles and bones and also feel for crepitation. It is important to obtain a proper health history to know the severity and causative factors. Percussion is a technique used to assess the abdomen and not musculoskeletal system. Arthroscopy is not a nursing assessment; it is a procedure to view the inner surface of a joint cavity and is done only when indicated. Text Reference - p. 1497

A nurse is caring for a patient who has undergone a knee joint replacement. What measures should a nurse take to prevent constipation of the patient in the postoperative period? Select all that apply. 1 Advise the patient to drink more than 2500 mL/day of fluids. 2 Instruct the patient to drink cold fluids. 3 Advise the patient to eat more fruits and vegetables. 4 Advise the patient to maintain complete bed rest until recovery. 5 Use stool softeners and laxatives as advised.

1, 3, 5 Patients often have reduced mobility after a fracture, which may result in constipation. The nurse should implement appropriate measures, such as high fluid intake (more than 2500 mL/day unless contraindicated) and a diet high in bulk and roughage (fruits and vegetables) to prevent constipation. If these measures fail to maintain normal bowel pattern, then laxatives and stool softeners can be used. Constipation can be relieved by drinking warm fluids, not cold ones. Physical activity also helps in bowel activity, so the patient should ambulate as early as the indications and provider prescriptions allow. Text Reference - p. 1519

A nurse has applied Buck's traction to a patient who has sustained a fractured femur. What are the main purposes of this type of traction? Select all that apply. 1 Reduce muscle spasms 2 Reduce the risk of a fat embolism 3 Repair the fracture without surgery 4 Immobilize and stabilize the fracture 5 Reduce the amount of analgesics required 6 Allow the nursing staff to care for the patient more easily

1, 4 Buck's traction, a type of skin traction, is used to stabilize and immobilize a fractured femur. This type of traction decreases the risk for further injury until surgery can be performed and can also ease painful muscle spasms. Secondarily, Buck's traction may reduce the risk of a fat embolism. Buck's traction may be used long-term until the patient is able to undergo surgery, but this is not the preferred treatment. Once muscle spasms have been relieved after the application of Buck's traction, the patient may require less pain medication. Buck's traction does not necessarily allow the nursing staff to care for the patient more easily. Text Reference - p. 1514

A patient is admitted to the hospital with an open fracture. What should the nurse do to prevent infection of the fracture wound in this patient? Select all that apply. 1 Administer prophylactic antibiotics. 2 Assess the neurovascular status of the limb. 3 Ensure airway, breathing, and circulation. 4 Administer tetanus and diphtheria prophylaxis. 5 Immobilize the affected extremity in the position found.

1, 4 It is very important to administer tetanus prophylaxis, diphtheria prophylaxis, and prophylactic antibiotics to a patient with open fractures to prevent any infections. Open fractures are predisposed to be contaminated, and therefore patients are exposed to higher risk of infections. Other measures, including assessing the neurovascular status of the limb; ensuring airway, breathing, and circulation; and immobilizing the affected limb in the position found, are also important, but these activities do not help in preventing infection of the open fracture wound. Text Reference - p. 1522

When working with patients, the nurse knows that patients have the most difficulties with diarthrodial joints. Which joints are included in the group of diarthrodial joints? Select all that apply. 1 Hinge joint of the knee 2 Ligaments joining the vertebrae 3 Fibrous connective tissue of the skull 4 Ball and socket joint of the shoulder or hip 5 Cartilaginous connective tissue of the pubis joint

1, 4 The diarthrodial joints include the hinge joint of the knee and elbow, the ball and socket joint of the shoulder and hip, the pivot joint of the radioulnar joint, and the candyloid, saddle and gliding joints of the wrist and hand. The ligaments and cartilaginous connective tissue joining the vertebrae and pubis joint and the fibrous connective tissue of the skull are synarthrotic joints. Text Reference - p. 1491

A patient experiences inflammation and pain in the muscles, tendons, and nerves of the neck and spine due to repetitive strain injury (RSI). What ergonomic instructions should the nurse provide to the patient? Select all that apply. 1 "Take hourly stretch breaks while working at your desk." 2 "Perform strengthening and conditioning exercises regularly." 3 "Apply moist, warm, heat to the affected area regularly." 4 "Keep your hips and knees flexed to 90 degrees with the feet flat while sitting." 5 "Keep your wrist straight when typing and keep the top of the computer monitor level with your forehead."

1, 4, 5 Ergonomic considerations for patients include taking hourly stretch breaks, keeping the hips and knees flexed at 90 degrees, keeping the feet flat on the floor to reduce strain on the soft tissue, keeping the wrist straight when typing, and keeping the top of the computer monitor even with the forehead to reduce strain of muscles and ligaments. Strengthening and conditioning exercises may reduce sprain and strain risk. Warm, moist heat application is used to help patients with a sprain after 48 hours of injury. Text Reference - p. 1509

A nurse is performing a musculoskeletal assessment on a patient. What are the findings that denote a normal musculoskeletal system? Select all that apply. 1 Muscle strength of 5 2 No eruptions on the joints 3 No pigmentation on the joints 4 No joint swelling, deformity, or crepitation 5 Full range of motion of all joints without pain or laxity 6 No tenderness on palpation of spine, joints, or muscles

1, 4, 5, 6 The components of a normal musculoskeletal system include muscle strength of 5, no joint swelling, deformity, or crepitation, a full range of motion of all joints without pain or laxity, and no tenderness on palpation of spine, joints, or muscles. Eruptions and pigmentations are characteristics of a skin assessment and are not included in musculoskeletal assessment. Text Reference - p. 1499

The patient had a lumbar spine arthrodesis. What should the nurse include in discharge teaching? Select all that apply. 1 Do not smoke cigarettes. 2 You should not walk for three weeks. 3 You must wear your brace at all times. 4 You may drive as soon as you feel like it. 5 Do not bend your spine until your follow-up appointment.

1, 5 Do not smoke cigarettes. Do not bend your spine until your follow-up appointment. After a spinal fusion, the patient should not smoke cigarettes, because nonunion tends to occur more often with smokers. Preventing pressure by not bending or twisting the spine or lifting more than 10 pounds will facilitate healing over time. The amount of time that is needed will be determined by the health care provider at follow-up appointments, but healing usually takes six to nine months. An important aspect of healing is progressively increasing walking, which increases circulation of nutrients and oxygen for healing. If a brace is prescribed to protect the surgical area, the health care provider will prescribe how often the patient should wear it. Driving is not done until the health care provider allows it and the patient is no longer taking opioids for pain. Text Reference - p. 1534

A patient with a nonunion of the tibia receives repair via an external fixation. What signs in the patient may indicate infection around the fixator pins? Select all that apply. 1 Pain at the pin site 2 Exudate from the pin site 3 Pin looseness 4 Edema around the pin 5 Pale skin around the pin

1,2,4 External fixation is often used as an attempt to salvage extremities that otherwise might require amputation. Because the use of an external device is a long-term process, ongoing assessment for pin loosening and infection is critical. Infection is indicated by the presence of pain, exudates, and edema around the pin site. Pin looseness does not indicate infection. In the presence of infection, the skin around the pin site is red (erythematous), not pale. Text Reference - p. 1516

In what order does the nurse recall the steps of the bone healing process to be? 1. Hematoma formation occurs due to bleeding at the ends of the fractured bone. 2. Hematoma converts into granulation tissue. 3. Bone matrix is formed at the fractured parts. Evidence of callus formation can be seen in an x-ray. 4. Remodeling of the new bone takes place when the excess callus is reabsorbed, and trabecular bone is laid down. 5. Callus ossification is sufficient to prevent movement at the fracture site when the bones are gently stressed

1. Hematoma formation occurs due to bleeding at the ends of the fractured bone. 2. Hematoma converts into granulation tissue. 3. Bone matrix is formed at the fractured parts. Evidence of callus formation can be seen in an x-ray. 4. Callus ossification is sufficient to prevent movement at the 5. Remodeling of the new bone takes place when the excess callus is reabsorbed, and trabecular bone is laid down. Bone healing initiates hematoma formation due to bleeding at the fractured ends of the fractured bone. This occurs usually during the first 72 hours after the injury. The products of necrotic tissue get absorbed and hematoma converts into granulation tissue 3 to 14 days after the injury through phagocytosis. Minerals, such as calcium and phosphorus, form an unorganized network at the fractured site and can be observed in an x-ray during the second week of the injury. Callus ossification is sufficient to prevent movement at the fracture site when the bones are gently stressed. Remodeling of the new bone takes place when the excess callus is resorbed, and trabecular bone is laid down. Text Reference - p. 1513

After interacting with a patient, the nurse determines that the patient is at risk for developing musculoskeletal problems. Which statement made by the patient supports the nurse's conclusion? 1 "I try not to sleep flat on my stomach." 2 "I only exercise once in a while." 3 "I try to not take pain killers frequently." 4 "I drink orange juice every day for breakfast."

2 "I only exercise once in a while." The patient who exercises only sporadically has a risk of musculoskeletal problems because sporadic exercise increases the risk of muscle injury and induces muscle necrosis. Refraining from sleeping in the prone position, or flat on the stomach, does not increase the risk of muscle damage. Painkillers, such as nonsteroidal antiinflammatory drugs, cause a risk of bleeding. This prevents the frequent use of painkillers but does not increase the risk of musculoskeletal disorders. Foods rich in vitamin C maintain tissue integrity and prevent muscle damage. Text Reference - p. 1496

A patient with a long-standing history of rheumatoid arthritis has sought care because of increasing stiffness in the right knee that has culminated in complete fixation of the joint. The nurse would document the presence of which problem? 1 Atrophy 2 Ankylosis 3 Crepitation 4 Contracture

2 Ankylosis is stiffness or fixation of a joint, whereas contracture is reduced movement as a consequence of fibrosis of soft tissue (muscles, ligaments, or tendons). Atrophy is a flabby appearance of muscle leading to decreased function and tone. Crepitation is a grating or crackling sound that accompanies movement. Text Reference - p. 1500

What is the duration of hospitalization for hip arthroplasty? 1 One to two days 2 Three to five days 3 Two to four weeks 4 Six to twelve weeks

2 Three to five days The duration of a hospital stay after hip arthroplasty is three to five days, depending on the patient's course and need for physical therapy. The patient would not recover in one or two days. Two to four weeks or six to twelve weeks of hospitalization would be unnecessary. Text Reference - p. 1535

A patient with a history of a cervical injury frequently works at a desk and uses a computer. The patient reports a recurrence of pain and stiffness in the neck. Which action may be the cause of the symptoms? 1 The patient takes hourly stretch breaks. 2 The patient elevates the wrist when typing. 3 The patient keeps the top of the computer monitor even with the forehead. 4 The patient keeps the hips and knees flexed to 90 degrees with feet flat while sitting.

2 The patient with a cervical injury who frequently works at a desk and uses the computer may suffer from a repetitive strain injury from repetitive movements and awkward positions of the wrist. Taking hourly stretch breaks helps in promoting circulation. The computer monitor's top should be kept even with the forehead to keep the neck muscles from straining. The hips and knees should be kept flexed at 90 degrees with the feet flat. Text Reference - p. 1509

Which statement indicates specific postoperative care for a patient who underwent finger joint arthoplasty? 1 "The operated extremity should not be elevated above heart level." 2 "The operated extremity should have a bulky dressing and must be elevated." 3 "The patient's upper extremities should be assessed for neurovascular changes." 4 "Hand exercises should be performed for one to two weeks after discharge."

2 "The operated extremity should have a bulky dressing and must be elevated." During the postoperative care of the finger joint, the extremity should is kept elevated with bulky dressing to increase venous pressure. The operated extremity should be elevated above heart level to prevent edema formation. Assessment of neurovascular changes in both the upper extremities is to compare both the extremities. This is done to obtain accurate assessment of the operated extremity is general postoperative care followed after an orthopedic surgery. The patient is advised to perform hand exercises for at least 10 to12 weeks after discharge. Text Reference - p. 1535

The nurse provides education to a patient that recently underwent acromioplasty about the postoperative plan of care. Which statement made by the patient indicates the need for further teaching? 1 "Physical therapy will start one day after surgery." 2 "Weight lifting will be permitted in 7 to 10 days." 3 "Pendulum exercises will be started one day after surgery." 4 "The shoulder will be immobilized for a short time."

2 Acromioplasty is the surgical removal of the acromion, which relieves rotator cuff compression during the movement. Weight lifting is usually restricted until the patient fully recovers. Physical therapy is initiated from the first postoperative day to facilitate recovery without any complications. Pendulum exercises begin on the first postoperative day. The shoulder is immobilized with a sling for a short time. Text Reference - p. 1510

A patient is at risk for developing a deep vein thrombosis after a knee replacement surgery. Which interventions would reduce the risk of this complication? Select all that apply. 1 Applying heat to the operative site 2 Administrating prophylactic anticoagulant drugs 3 Administrating intermittent positive pressure ventilation 4 Restricting the range of motion of the unaffected lower extremity 5 Encouraging the patient to wear a compression gradient stocking

2 Administrating prophylactic anticoagulant drugs 5 Encouraging the patient to wear a compression gradient stocking To decrease the risk for thromboembolism after knee replacement surgery, a patient is treated with prophylactic anticoagulant drugs. Encouraging the patient to wear a compression gradient stocking will lead to increased venous blood return from the extremities. Heat is applied during the initial postoperative period to decrease swelling. However, heat does not affect the development of a deep vein thrombosis. Intermittent positive pressure ventilation is administered during fat embolism syndrome. Restricting the range of motion of the unaffected lower extremity would result in thromboembolism. Text Reference - p. 1535

The patient is having a musculoskeletal diagnostic test called an electromyogram (EMG). The nurse knows that this test: 1 Evaluates potential of muscle contractions 2 Evaluates electrical potential related to skeletal muscle contraction 3 Records variations in volume and pressure of blood passing through tissues 4 Uses an infrared detector to measure degrees of heat radiating from the skin surface

2 An EMG evaluates electrical potential related to skeletal muscle contraction. To record potential of muscle contractions, a plethysmography is used. A somasosensory evoked potential (SEEP) looks at the ability of muscle contractions. A thermography measures degrees of heat radiating from the skin surface with an infrared detector. Text Reference - p. 1580

A patient admitted with Parkinson's disease fell down the stairs in the hospital. The patient is conscious and states there is severe pain in the calf muscles. What should be the immediate course of action for the nurse? Select all that apply. 1 Apply hot compresses. 2 Apply ice to the painful area. 3 Encourage the patient to mobilize the limb. 4 Elevate the affected limb. 5 Restrain the patient to the bed.

2 Apply ice to the painful area. 4 Elevate the affected limb. If an injury occurs, the immediate care focuses on applying ice compresses to the injured area to reduce pain, muscle spasms, inflammation, and edema. The affected limb should be elevated to mobilize excess fluid from the area and prevent further edema. The nurse should instruct the patient to limit movements of the affected limb. After the acute phase (usually 24 to 48 hours) moist heat may be applied to the affected area to reduce swelling and provide comfort. Restraining the patient to the bed is not related to the management of this injury. Text Reference - p. 1507

In reviewing bone remodeling, what should the nurse know about the involvement of bone cells? 1 Osteoclasts add canaliculi 2 Osteoblasts deposit new bone 3 Osteocytes are mature bone cells 4 Osteons create a dense bone structure

2 Bone remodeling is achieved when osteoclasts remove old bone and osteoblasts deposit new bone. Osteocytes are mature bone cells and osteons or Haversian systems create a dense bone structure, but these are not involved with bone remodeling. Text Reference - p. 1490

The nurse, caring for a patient with cancer, recalls that what diagnostic study uses radioisotope to detect increased metastatic activity? 1 MRI 2 Bone scan 3 Ultrasound 4 Barium swallow

2 Bone scan Of the choices listed, only a bone scan involves the use of a radioisotope to detect increased metastatic activity. Magnetic resonance imaging (MRI), ultrasound, and barium swallow may be used to detect metastasis, but these procedures do not involve the use of radioisotopes. Text Reference - p. 1501

What is impingement syndrome? 1 The tear within the muscle or tendons and ligament structures around the shoulder 2 The entrapment of soft tissue structures under the coracoacromial arch of the shoulder 3 The traumatic tearing of a ligament by deceleration forces, combined with pivoting of the knee 4 The injury to fibrocartilage of the knee characterized by popping, clicking, and tearing sensations

2 Impingement syndrome is the entrapment of soft tissue structures under the coracoacromial arch of shoulder. The tear within the muscle or tendons or ligament structures around the shoulder is a rotator cuff tear. Anterior cruciate ligament injury is the traumatic tearing of the ligament caused by deceleration forces combined with pivoting of the knee. A meniscus injury is an injury to the fibrocartilage of knee characterized by popping, clicking, and tearing sensation. Test-Taking Tip: You have at least a 25 percent chance of selecting the correct response in multiple-choice items. Text Reference - p. 1506

A bandage has been applied on the ankle of a patient for a sprain. The patient states the ankle is swollen, numb, and painful. What is the priority action by the nurse? 1 Have the patient ambulate 2 Loosen the bandage 3 Check for Homan's sign 4 Administer an antibiotic for cellulitis

2 Loosen the bandage The patient's signs and symptoms indicate that the bandage is too tight. In such cases, the bandage can be left in place for 30 minutes and then removed for 15 minutes. However, some elastic wraps are left on during training, athletic, and occupational activities. Although assessing for thrombophlebitis, deep vein thrombosis, and cellulitis can all cause pain and swelling, the differential diagnosis in this instance points to bandage tightness as the likeliest cause. Ambulation will increase the pain and swelling until the bandage is loosened. Text Reference - p. 1507

During a physical assessment, the nurse asks the patient to abduct the elbow joint. How should the nurse instruct the patient? 1 Move your elbow toward the midline of your body. 2 Move your elbow away from the midline of your body. 3 Straighten your elbow to increase the angle between two bones. 4 Bend your elbow to decrease the angle between two bones

2 Move your elbow away from the midline of your body. The nurse should instruct the patient to move the elbow away from the midline of the body. Movement of the elbow toward the midline of body refers to adduction. Flexion refers to the bending of the joint as a result of muscle contraction, resulting in a decreased angle between two bones. Straightening of the elbow that increases the angle between two bones means extension. Text Reference - p. 1498

The nurse is reviewing the medication histories of patients in a health care setting. The nurse determines that which patient has a risk of gait disturbance? 1 A patient taking carbamazepine 2 A patient taking a phenothiazine 3 A patient taking spironolactone 4 A patient taking a corticosteroid

2 Phenothiazines are antipsychotic medications that decrease dopamine levels in the brain and may cause gait disturbance in the patient; therefore, Patient B has a risk of gait disturbance. Anticonvulsant medications such as carbamazepine cause demineralization of bones, resulting in osteomalacia. Patient A has a risk of osteomalacia, not gait disturbance. Potassium-sparing diuretics such as spironolactone decrease the elimination of potassium through the urine, resulting in hyperkalemia; therefore, Patient C has a risk of muscle cramps and weakness but not gait disturbance. Corticosteroids decrease bone and muscle mass, and increase the risk of avascular necrosis in the patient; therefore, Patient D has a risk of avascular necrosis but not of gait disturbance. Test-Taking Tip: Chart/exhibit items present a situation and ask a question. A variety of objective and subjective information is presented about the client in formats, such as the medical record (e.g., laboratory test results, results of diagnostic procedures, progress notes, health care provider orders, medication administration record, health history), physical assessment data, and assistant/patient interactions. After analyzing the information presented, the test taker answers the question. These questions usually reflect the analyzing level of cognitive thinking. Text Reference - p. 1495

The nurse teaches a student nurse about traction. Which statement made by the student nurse reflects effective learning? 1 "Traction prevents active and passive exercise." 2 "Traction provides immobilization to the fractured joint." 3 "Traction decreases the joint space before a major joint reconstruction." 4 "Skeletal traction is typically used for shorter time periods than skin traction."

2 Traction is the application of a pulling force to an injured or diseased part of the body or an extremity. Traction is used to immobilize a joint or part of the body in order to promote joint stabilization and prevent soft tissue damage. Traction promotes active and passive exercise in order to prevent muscle spasms, which may further complicate the fracture. Traction helps to increase space in the joint before major joint reconstruction. Skin Traction is typically used for short periods of time, while skeletal traction is typically used for longer periods. Text Reference - p. 1514

During a physical assessment, the nurse asks the patient to perform inversion movement of the foot. What instruction should the nurse give to the patient? 1 Flex your ankle and toes toward the shin. 2 Turn the sole inward toward the midline of the body. 3 Turn the sole outward away from the midline of the body. 4 Flex your ankle and toes toward the plantar surface of the foot.

2 Turn the sole inward toward the midline of the body. To perform inversion movements of the foot, the nurse should instruct the patient to turn the sole inward toward the midline of the body. Flexion of the ankle and toes toward the shin is called dorsiflexion. Turning the sole outward away from the midline of the body is called eversion, and flexion of ankle and toes toward the plantar surface of the foot is called plantar flexion. Text Reference - p. 1498

A patient with a fracture of the humerus is advised to have a cast made of synthetic material. How should the nurse explain the benefits of casts made of synthetic materials, compared with plaster casts? Select all that apply. 1 Synthetic casts are of a heavier weight. 2 Synthetic casts are stronger. 3 Synthetic casts are permeable to water. 4 Synthetic casts provide for early weight bearing. 5 Synthetic casts can be easily molded to fit the torso or extremity.

2 Synthetic casts are stronger. 4 Synthetic casts provide for early weight bearing. 5 Synthetic casts can be easily molded to fit the torso or extremity. Casts made of synthetic materials are being used more than plaster casts because they are stronger and provide for early weight bearing. The synthetic casting materials (thermolabile plastic, thermoplastic resins, polyurethane, and fiberglass) are activated by submersion in cool or tepid water. Then they are molded to fit the torso or extremity. Synthetic casts are not heavy—in fact, they are lightweight and they are water-resistant.

Which instructions should the nurse include when teaching a patient about endurance exercise? Select all that apply. 1 "Do them without wearing shoes." 2 "Start at a low level of effort." 3 "Start with warming up the muscles." 4 "Gradually progress to a moderate level." 5 "In addition to the exercises, change your diet to increase body weight."

2, 3, 4 Endurance exercise should begin at a low level of effort. Warming up before exercise is a general rule for all the type of exercises. Endurance exercises should progress gradually to a moderate level. The patient should wear shoes while performing endurance exercises. Dietary changes to increase weight are not needed with endurance exercises. Text Reference - p. 1507

The nurse is caring for a patient with a fractured femur. Which nursing action(s) by the nurse is the priority? Select all that apply. 1 Resting the extremity. 2 Elevating the extremity. 3 Providing analgesia as necessary. 4 Compressing the involved extremity. 5 Applying ice compresses to the injured area. 6 Stopping the activity and limiting movement.

2, 3, 4, 5, 6 There are five interventions performed for an acute injury. Stopping the activity and limiting movement, applying ice compresses to the injured area, compressing the involved extremity, elevating the extremity, and providing analgesia as necessary. Resting the extremity is not included in the immediate care. Text Reference - p. 1585 Page not right. ???

The nurse provides discharge education to a patient who had recently underwent closed reduction therapy for realigning a dislocated hip joint. What instruction is appropriate for the nurse to include in the care plan? Select all that apply. 1 "Take a prophylactic antibiotic." 2 "Restrict strenuous activities." 3 "Return to normal activities gradually." 4 "Apply warm, moist heat to the affected area." 5 "Perform gentle range-of-motion exercises."

2, 3, 5 "Restrict strenuous activities." "Return to normal activities gradually." "Perform gentle range-of-motion exercises." The patient who recently underwent closed reduction therapy for realigning the hip dislocation is advised to restrict strenuous activities that strain the joint. The patient should gradually return to the normal activities. The patient should perform gentle ROM exercises to prevent motion limitations of the joint. Antibiotic prophylaxis is appropriate for patients with open fractures and large tissue defects. The application of warm and moist heat is useful in a strain injury. Text Reference - p. 1508

A patient is scheduled for an arthroscopy. The patient wants to know what an arthroscopy is. What information should the nurse provide to this patient? Select all that apply. 1 Fluid from the joints will be aspirated during this procedure. 2 This procedure allows visualization of the interior portion of the joint capsule. 3 The procedure will be performed under anesthesia. 4 In case of inflammatory joint diseases, intraarticular injections of corticosteroids may be given.

2, 3, 5 Arthroscopy allows for visualization of the interior portion of the joint capsule through a small fiberoptic tube. This procedure is performed under anesthesia. A needle is inserted in the joint, it is distended with fluid or air, and the joint cavity is examined. Fluids from the joints are aspirated by a procedure called arthrocentesis, in which a needle is inserted into the joint cavity, and the synovial fluid is aspirated; however, the procedure does not allow visualization of the joint cavity. Arthroscopy is not done to give corticosteroid injections; intraarticular injections can be given when arthrocentesis is done. Text Reference - p. 1499

A nurse is caring for a patient with reported fracture of the tibia. A plaster cast has been applied to the patient. What interventions are important for the care of the cast during the drying period and immediately thereafter? Select all that apply. 1 Cover the cast with a cloth. 2 Avoid direct pressure on the cast. 3 Handle the cast gently with an open palm. 4 Avoid petaling the cast. 5 Place several strips of tape over the rough edges.

2, 3, 5 Avoid direct pressure on the cast during the drying period. Handle the cast gently with an open palm to avoid denting the cast. The health care provider should place several strips (petals) of tape over the rough areas to ensure a smooth cast edge. A fresh plaster cast should never be covered, because covering it prevents air from circulating; this lack of air circulation allows heat to build up in the cast (which may cause a burn) and may also result in a delay in drying. After drying, the edges may need to be petaled to avoid skin irritation from rough edges and to prevent plaster of Paris debris from falling into the cast and causing irritation or pressure necrosis. Text Reference - p. 1520

A nurse is making note of the elimination pattern of a patient suffering from severe knee pain. What are the points that she should include in the assessment? Select all that apply. 1 How many times in a day do you have to have a bowel movement? Is it satisfactory? 2 Do you need any assistive devices or equipment to achieve a bowel movement? 3 Does your functional ability make it difficult for you to reach the toilet in time? 4 Do you find that problems related to moving your bowels occur after eating a particular food? 5 Do you experience constipation?

2, 3, 5 While assessing the elimination pattern of a patient suffering from knee pain, it is important to know if the patient requires assistive devices or equipment to achieve a bowel movement, because it gives an idea about severity of the ailment. Similarly, knowing if the person has difficulty in reaching the commode in time due to a musculoskeletal ailment suggests the severity of the disorder. The nurse should also understand if the patient experiences constipation related to decreased mobility or to drugs taken for a musculoskeletal problem. The frequency and character of the bowel movements are important parameters in the assessment of the gastrointestinal system of a patient, but not in the musculoskeletal system. Bowel problems related to any specific food do not directly affect the musculoskeletal system. Text Reference - p. 1495

A nurse is taking the health history of a patient with severe lumbar back pain. What are the questions related to sleep-rest patterns that the nurse should ask this patient? Select all that apply. 1 Do you sleep often during the day? 2 Do you require frequent position changes at night? 3 Do you wake up at night because of pain? 4 Do you have disturbed sleep at night due to frequent urination? 5 Do you use complementary and alternative therapies to help you sleep at night? 6 Do you experience any difficulty sleeping because of a musculoskeletal problem?

2, 3, 5, 6 When assessing a patient with musculoskeletal problems, it is extremely important to ask questions related to sleep-rest pattern. Questions relating to whether the patient requires frequent position changes during sleep and whether the patient wakes due to pain help in understanding the severity of the pain. Knowing whether the patient is taking any complementary and alternative therapy is also important in assessment. Sleeping during the day and frequency of urination are not related to musculoskeletal problems directly. Text Reference - p. 1495

What questions should the nurse ask a patient with severe back pain in the lumbar region when taking the health history? Select all that apply. 1 Have you been vaccinated against hepatitis? 2 Does your work involve lifting any heavy objects? 3 Has this pain affected your social or professional life? 4 Have you taken any high-dose antibiotic recently? 5 Do you consume any dietary supplements like calcium or vitamin D? 6 Do you require frequent change of position while you are sleeping because of the pain?

2, 3, 5, 6 2 Does your work involve lifting any heavy objects? 3 Has this pain affected your social or professional life? 5 Do you consume any dietary supplements like calcium or vitamin D? 6 Do you require frequent change of position while you are sleeping because of the pain? Lifting heavy objects can lead to back pain; therefore, it is important to know whether the patient's work involves lifting heavy objects. Knowing if the pain has affected the patient's social and professional life helps to determine the severity of the problem. Knowing if the patient is taking dietary supplements like calcium and Vitamin D helps to understand how the patient is treating self and also helps in planning future interventions for the patient. Similarly, knowing if the patient has frequent changes in position while asleep helps to understand the severity of the complaint. Vaccination against hepatitis is not connected to back pain. Similarly, antibiotic therapy is not relevant in the back pain assessment. Text Reference - p. 1495

A patient with a fracture of the right tibia has been advised to use a cane. What instructions should the nurse give to this patient? Select all that apply. 1 Hold the cane in the right hand. 2 Hold the cane in the left hand. 3 Advance the right leg first. 4 Advance the left leg first. 5 Advance the right leg last. 6 Advance the left leg last.

2, 3, 6 The decision to use assistive devices is made by the health care provider depending on the needs and lifestyle of patient. Use of these devices varies. When a cane is used, the affected limb is advanced along with or after the cane, and the unaffected limb is advanced last. The cane is held in the hand opposite the affected limb. In this case, the right leg is affected, and therefore the cane should be held in the left hand, the right leg should be advanced first, and the left leg should be advanced last. Text Reference - p. 1521

A patient has been admitted to the hospital for a scheduled knee arthroplasty. What should a nurse do in the preoperative management of this patient? Select all that apply. 1 Assess muscle strength in the lower limbs. 2 Assess muscle strength in the upper limbs. 3 Assess joint function of the lower limbs. 4 Assess joint function of the upper limbs. 5 Assess pain sensation in the lower limbs. 6 Assess pain sensation in the upper limbs.

2, 4 If lower extremity surgery is planned, the nurse should assess upper extremity muscle strength and joint function to determine the type of assistive devices needed postoperatively for ambulation and activities of daily living. Therefore, in this case, the assessment of muscle strength and joint function of the upper limbs is required. Assessment of pain sensation is not important. Text Reference - p. 1535

A patient fell from a 20-foot height onto the right elbow. The radiograph revealed a fracture in the middle third of the right humerus, with sharp edges. What are the structures that may be at risk of damage due to the sharp edges of broken bone in this patient? Select all that apply. 1 Axillary nerve 2 Radial nerve 3 Brachial plexus 4 Brachial artery 5 Ulnar nerve

2, 4 The radial nerve is present in the axillary groove of the humerus, and the brachial artery is located on the anterior aspect of the humerus. Therefore the radial nerve and brachial artery are likely to be damaged by the sharp edges of fractured bone margins of the humerus. The axillary nerve and brachial plexus are present in the axilla. Therefore they are unlikely to be damaged. The ulnar nerve is usually unaffected by bone fractures, owing to the presence of muscles and soft tissues. Text Reference - p. 1524

An occupational health nurse is conducting an awareness program to prevent limb amputations. When explaining the risk of amputation, which population group would the nurse indicate as at high risk for amputation? Select all that apply. 1 Patients with ulcerative colitis 2 Patients with diabetes mellitus 3 Patients with myasthenia gravis 4 Patients with chronic osteomyelitis 5 Patients with peripheral vascular disease

2, 4, 5 2 Patients with diabetes mellitus 4 Patients with chronic osteomyelitis 5 Patients with peripheral vascular disease Patients with diabetes mellitus, chronic osteomyelitis, or peripheral vascular disease are predisposed to increased risk of amputation. Controlling these diseases can eliminate or delay the need for amputation. Ulcerative colitis and myasthenia gravis do not lead to gangrene in the limbs or to amputation. Text Reference - p. 1531

What measures should a nurse take to prevent muscle spasms in cases of musculoskeletal injuries? Select all that apply. 1 Massage the muscle spasms. 2 Align the affected extremity appropriately. 3 Use thermotherapy on the affected extremity. 4 Place the affected extremity in a comfortable position. 5 Provide isometric muscle strengthening exercises.

2,, 3, 4 Muscle spasms are caused by involuntary muscle contraction after fracture, strain, or nerve injury. These may displace a nondisplaced fracture or prevent it from healing spontaneously. Therefore it is important to take measures to prevent muscle spasms. The affected extremity should be aligned appropriately. Thermotherapy may reduce muscle spasm. The extremity should be placed in a comfortable position. Massaging a muscle spasm may stimulate muscle tissue contraction, further increasing pain and spasm. Therefore it is not advisable to massage spasms. An isometric muscle-strengthening exercise regimen will not prevent muscle spasms in this injured patient. Text Reference - p. 1521

A nurse is interviewing a patient to assess the risk for developing musculoskeletal impairments. What are the conditions that increase the patient's risk of developing a musculoskeletal ailment? Select all that apply. 1 Patient has a history of hyperlipidemia and has been on lovastatin for a long time. 2 Patient has a history of premenopausal amenorrhea and is taking oral contraceptives. 3 Patient has renal disease and has been taking a potassium-depleting diuretic for a long time. 4 Patient suffers from hypertension and has been on treatment with amlodipine for a long time. 5 Patient has a seizure disorder and has been taking antiseizure medications for a long time

2,3,5 It is important to question the patient regarding prescription, drugs, herbal products, and nutritional supplements, because these can have potential side effects on the musculoskeletal system. Episodes of premenopausal amenorrhea can contribute to the development of osteoporosis; even hormonal therapy has adverse effects on the musculoskeletal system. Potassium-depleting diuretics may cause muscle cramps and weakness. Antiseizure medications can increase the risk of osteomalacia; phenothiazines are associated with gait disturbances; corticosteroids increase the risk of avascular necrosis and decreased bone and muscle mass. Lovastatin and amlodipine are not associated with major musculoskeletal disorders. Text Reference - p. 1494

A patient is being treated for a vertebral injury. After the application of a body brace jacket, the patient reports abdominal pain and pressure, nausea, and vomiting. What is the nurse's priority assessment? 1 Assess vital signs and compare the quality of the pulses bilaterally. 2 Assess for temperature elevation and other signs of infection. 3 Assess the abdomen for decreased bowel sounds through a window in the brace. 4 Assess for excessive pain with passive stretch of the extremities.

3 The patient is being treated for a vertebral injury with a body brace jacket. Monitoring the abdomen is necessary to observe decreased bowel sounds through a window present in the brace. This symptom occurs if the brace is applied too tightly, compressing the superior mesenteric artery against the duodenum. Monitoring vital signs and comparing pulses help to identify differences in rate or quality but are not the priority. Monitoring for temperature elevation and other signs of infection are important but are not the priority. Monitoring for excessive pain with passive stretching of the affected extremity's muscles, pallor, paresthesia, and late signs of paralysis and pulselessness is done to check for compartment syndrome. Text Reference - p. 1516

A soccer player has injured the anterior crucial ligament (ACL) and is having reconstructive surgery. The nurse knows that the patient will need more teaching when the patient makes which statement? 1 "I probably won't be able to play soccer for six to eight months." 2 "They will have me do range of motion with my knee soon after surgery." 3 "I can't wait to get this done now so I can play soccer for the next tournament." 4 "I will need to wear an immobilizer and progressively bear weight on my knee."

3 "I can't wait to get this done now so I can play soccer for the next tournament." When the athlete has ACL reconstructive surgery, the patient does not understand the severity when the patient mentions planning to be back to playing soccer soon. The patient likely will not be able to play soccer for six to eight months. The patient will be able to do range of motion soon after surgery. Immobilization and progressive weight bearing with physical therapy will occur during rehabilitation. Text Reference - p. 1511

The nurse assists in performing annual well visits for four patients. Which patient is least likely to develop overuse syndrome? 1 A dancer 2 A musician 3 A football player 4 A grocery store cashier

3 A football player Repetitive strain injury (RSI) may result from prolonged force or repetitive movements and awkward postures. The repeated movements strain the tendons, ligaments, and muscles, causing tiny tears. It may result in inflammation, swelling, and pain in the muscles and nerves of the neck, shoulder, forearm, and hand. Persons at risk for RSI include dancers, musicians, grocery clerks, and workers who use power tools that cause vibration. The football player is least likely to develop this condition. Text Reference - p. 1509

Which joint is considered an ideal site for surgical fusions? 1 Hip joint 2 Knee joint 3 Wrist joint 4 Elbow joint

3 Arthrodesis is the surgical fusion of a joint. Common areas of joint fusions are the wrist, ankle, and cervical spine. The hip, knee, and elbow joints are not considered ideal sites for surgical fusion, because fusion of those joints will lead to immobility. Text Reference - p. 1535

A patient with a leg fracture is scheduled for a fasciotomy. What complication is identified to have caused the need for this type of surgery? 1 Infection 2 Fat embolism syndrome 3 Compartment syndrome 4 Venous thromboembolism

3 Compartment syndrome Compartment syndrome is characterized by swelling and increased pressure within a limited space, which presses and compromises the function of the blood vessels, nerves, and/or tendons that run through that compartment. Surgical decompression of soft tissue is done through fasciotomy. The occurrence of infection is greatly reduced with antibiotics in conjunction with aggressive surgical management. Fat embolism syndrome treatment includes fluid resuscitation to prevent hypovolemic shock, correction of acidosis, and replacement of blood loss. Venous thromboembolism can be managed with drug management therapy such as anticoagulants. Text Reference - p. 1522

Which condition does the nurse anticipate if a patient experiences a severe injury to the ligament around the humerus bone? 1 Strain 2 Sprain 3 Dislocation 4 Subluxation

3 Dislocation Severe injury of the ligamentous structures surrounding the humerus is a dislocation. A strain is an excessive stretching of the muscle, its fascial sheath, or a tendon. A sprain generally represents an injury to the ligament structures surrounding a joint. Subluxation is a partial displacement of the joint surface. Text Reference - p. 1508

A patient asks the nurse why an arthrogram has been scheduled. The nurse should reply that this test is designed to identify: 1 Fractures of the bone 2 The risk for osteoporosis 3 Disorders of the cartilage 4 Peripheral vasculature patency

3 Disorders of the cartilage An arthrogram involves the injection of a radiopaque solution into a joint to outline the joint for visualization of cartilage and joint structures. It is useful in diagnosing an arthropathy. An arthrogram may show fractures, but this is not its primary purpose. An arthrogram will not show bone abnormalities such as osteoporosis. The test does not show vasculature structures or abnormalities. Text Reference - p. 1499

During the nursing musculoskeletal assessment, the nurse assesses the joint movements. On the nurse's instruction, the patient flexes the ankle and toes toward the shin. As what should the nurse record this movement? 1 Inversion 2 Eversion 3 Dorsiflexion 4 Plantar flexion

3 Dorsiflexion Flexion of the ankle and toes toward the shin is called dorsiflexion. Eversion refers to turning of the sole outward away from midline of body. Inversion means turning of the sole inward toward the midline of body. Plantar flexion means flexion of the ankle and toes toward the plantar surface of the foot. Text Reference - p. 1498

Which is a common site of bursitis? 1 Back 2 Thighs 3 Elbows 4 Abdomen

3 Elbows Bursitis is the inflammation of the bursae. These are located at sites of friction such as between tendons and bones and near the joints. The most common sites of bursitis occurrence include the elbows, shoulders, and greater trochanters of the hip. The back, thighs, and abdomen are less likely to be affected. Text Reference - p. 1511

A nurse is caring for a patient who has just sustained a hip fracture. Which nursing action should be performed first? 1 Administering pain medication 2 Preparing for immediate surgery 3 Immobilizing the affected extremity 4 Placing the injured extremity in traction

3 Immobilizing the affected extremity The priority of emergency management for a fractured hip is immobilizing the affected extremity, because movement could cause further damage and more extensive internal bleeding and worsen the patient's pain. Administering pain medication, preparing the patient for immediate surgery, and placing the injured extremity in traction are secondary nursing interventions that require further direction from the primary health care provider. Text Reference - p. 1525

The nurse is caring for a patient with osteoarthritis who is about to undergo total left knee arthroplasty. The nurse assesses the patient carefully to be sure that there is no evidence of what in the preoperative period? 1 Chronic pain 2 Left knee stiffness 3 Left knee infection 4 Left knee instability

3 Left knee infection It is critical that the patient be free of infection before a total knee arthroplasty. An infection in the joint could lead to even greater pain and joint instability, requiring extensive surgery. For this reason, the nurse monitors the patient for signs of infection, such as redness, swelling, fever, and elevated white blood cell count. Chronic pain, knee stiffness, or instability may be present with osteoarthritis and is not a reason to postpone arthroplasty. Text Reference - p. 1535

A patient has presented with an unstable wrist fracture. What kind of cast is best for this patient? 1 Posterior splint 2 Short arm cast 3 Long arm cast 4 Sugar-tong splint

3 Long arm cast The long arm cast is commonly used for stable forearm or elbow fractures and unstable wrist fractures. It is similar to the short arm cast but extends to the proximal humerus, restricting motion at the wrist and the elbow. The sugar-tong posterior splint accommodates post injury swelling in the fractured extremity. A short arm cast is used for stable wrist fractures. The sugar-tong splint is typically used for acute wrist injuries or injuries that may result in significant swelling. Text Reference - p. 1515

A patient with a cast for a fractured radius reports, "My fingers feel numb." Which action is the highest priority for the nurse? 1 Elevating the arm on two pillows 2 Notifying the primary health care provider 3 Performing a thorough neurovascular assessment 4 Reassuring the patient that this is a normal response

3 Numbness distal to a casted extremity is an indication of decreased circulation, nerve compression, and possibly compartment syndrome. The nurse should perform a full neurovascular assessment to determine the extent of the problem. After the nurse has performed the assessment, the arm may be elevated on two pillows while the primary health care provider is notified. Numbness in the fingers of the casted arm is not a normal response. Text Reference - p. 1518

3 Quadriceps atrophy A clicking, popping, and locking sensation with knee instability along with a positive McMurray's test indicate a meniscus injury. If untreated for a prolonged period, the meniscus injury may result in quadriceps atrophy due to disuse of the muscle. Bursitis is inflammation of the bursae and is not due to a meniscus injury. Avascular necrosis results from a lack of blood flow to the bones and does not occur due to untreated meniscus injury. A pathologic fracture is not associated with the prolonged lack of treatment of meniscus injury. Text Reference - p. 1511

The nurse suspects that a patient is experiencing a fat embolism after sustaining a femur fracture. What clinical manifestations does the nurse expect? 1 Tachypnea, tachycardia, shortness of breath, and paresthesia 2 Paresthesia, bradycardia, bradypnea, petechial rash on the chest and neck 3 Tachypnea, tachycardia, shortness of breath, petechial rash on the chest and neck 4 Bradypnea, bradycardia, shortness of breath, petechial rash on the chest and neck

3 Tachypnea, tachycardia, shortness of breath, petechial rash on the chest and neck A fat embolism may occur in a patient who has had a fracture of a large bone such as a femur or hip. The classic symptoms of a fat embolism include tachypnea, tachycardia, shortness of breath, and petechial rash on the chest and neck. Tachypnea, tachycardia, shortness of breath, and paresthesias; paresthesias, bradycardia, bradypnea, and petechial rash; and bradypnea, bradycardia, shortness of breath, and petechial rash are not directly characteristic of a pulmonary embolism. Text Reference - p. 1523

What is carpel tunnel syndrome (CTS)? 1 The tear within the muscle or tendinoligamentous structures around the shoulder 2 The entrapment of soft tissue structures under the coracoacromial arch of the shoulder 3 The compression of the median nerve that enters the hand through the narrow confines of the carpal tunnel 4 The injury to fibrocartilage of knee, characterized by popping, clicking, tearing sensation, effusion, and swelling

3 The compression of the median nerve that enters the hand through the narrow confines of the carpal tunnel CTS involves the compression of the median nerve, which enters the hand through the narrow confines of the carpal tunnel. A rotator cuff tear is a tear within the muscle or tendinoligamentous structures around shoulder. The entrapment of soft tissue structures under the coracoacromial arch of the shoulder is impingement syndrome. The injury to fibrocartilage of the knee, characterized by popping, clicking, tearing sensation, effusion, and swelling, is a meniscus injury. Text Reference - p. 1509

Which condition can be prevented with anticoagulant drugs in a patient who underwent orthopedic surgery? 1 Fat embolism 2 Bone infection 3 Thromboembolism 4 Compartment syndrome

3 Thromboembolism can be prevented with anticoagulant drugs. These drugs diminish hypercoagulability. Antibiotics reduce bone infection. Corticosteroids treat fat embolism. Proper management techniques and surgery can relieve compartment syndrome. Text Reference - p. 1535

Which is an example of a gliding joint? 1 Wrist 2 Shoulder 3 Between carpal bones 4 Carpometacarpal of thumb

3 Between carpal bones The joint between carpal bones is a gliding joint because the bones move over the surface of each other. The wrist joint is a condyloid joint capable of flexion, extension, abduction, adduction and circumduction. The shoulder joint is a ball and socket joint also capable of flexion, extension, adduction, abduction and circumduction. The carpometacarpal joint of the thumb is a saddle joint which allows thumb-finger opposition along with flexion, extension, adduction, abduction and circumduction. Text Reference - p. 1492

The nurse is caring for a patient with a dislocated hip. The nurse knows that this type of injury is associated most commonly with: 1 Fall from a high place 2 Osteoporosis of the hip 3 Motor vehicle collisions 4 Pathologic fractures of the hip

3 Motor vehicle collisions The hip is the most common dislocation of the lower extremity and generally is associated with motor vehicle collisions. Falls from a high place generally result in a fracture. Osteoporosis of the hip joint is more likely to result in a fracture and not dislocation. Pathologic fractures secondary to a history of cancer are not associated with hip dislocations. Text Reference - p. 1586

Which postoperative care, given by the nurse to the patient after a total hip replacement surgery, indicates an effective intervention? 1 Allowing the patient to sit on chairs without arms 2 Allowing the patient to cross legs at the knees or ankles 3 Allowing the patient to use a pillow between the legs for the first six weeks after surgery 4 Allowing the patient to perform daily activities such as putting on shoes and socks

3 Allowing the patient to use a pillow between the legs for the first six weeks after surgery The nurse should allow the patient to use a pillow between the legs for the first six weeks after surgery. It should be used when lying on the nonoperative side or when in a supine position to maintain the joint in abduction and prevent dislocation of the new joint. Sitting on chairs without arms will lead to a sudden flexing of the body more than 90°, resulting in destabilization of the prosthesis. Crossing of the legs at the knees or ankles affects healing of the soft tissue of the hip joint, leading to predisposition of the joint. Performing daily activities such as putting on shoes and socks that require flexing the body more than 90°, will lead to damage of the soft tissue. Therefore, it should be avoided till at least six weeks after the surgery. Text Reference - p. 1526

Which postoperative care should be included in the nursing care plan of a patient who had surgery on the wrist? 1 Maintaining the strength in the affected extremity 2 Focusing on the patient's communication and adequate nutrition 3 An occupational therapist assisting the patient to perform hand exercises 4 Providing pain management techniques, including epidural or intrathecal analgesia

3 An occupational therapist assisting the patient to perform hand exercises

A patient is brought to the hospital with bloodstains on clothing and active bleeding from the nose, with deformity of the right arm. Prioritize the initial interventions to be done in this case. 1. Check for respiratory rate. 2. Check for pulse rate. 3. Check if there is blood in the mouth. 4. Assess the neurovascular status of the right arm.

3 Check if there is blood in the mouth. 1 Check for respiratory rate. 2 Check for pulse rate. 4 Assess the neurovascular status of the right arm. Emergency management of any injury involves assessment of air way (A), breathing (B), and circulation (C), in that order. Therefore for this patient the attending nurse should first check for any blood in the mouth blocking the airway, then check for respiratory effort to see if the patient is breathing, then check for a pulse to see if circulation of blood is normal, and then assess the neurovascular status of the affected limb (in this case, the right arm). Text Reference - p. 1529

A patient has presented with an unstable wrist fracture. What kind of cast is best for this patient? 1 Posterior splint 2 Short arm cast 3 Long arm cast 4 Sugar-tong splint

When assessing muscle strength of a patient, the nurse finds out that the patient can perform active movement against gravity and some resistance. Which grade will the nurse give this patient? 1) 2 2) 3 3) 4 4) 5

3) 4 A grade 4 means active movement against gravity and some resistance. Grade 2 means active movement of the body part with elimination of gravity. A grade 3 refers to active movement against gravity only and not against resistance. Grade 5 means active movement against full resistance without evident fatigue (normal muscle strength). Text Reference - p. 1498

A patient has an injury to the eye. On examination, the nurse finds a brown tissue on the surface of the ocular globe and a teardrop-shaped pupil. What should the nurse do next? Select all that apply. 1 Assess for the function of cranial nerves. 2 Send the patient for a computed tomography (CT) scan. 3 Stop further examination of the eye. 4 Place a protective shield over the eye. 5 Put antibiotic eyedrops in the eye.

3, 4 The presence of brown tissue (iris or ciliary body) on the surface of the globe, extrusion of vitreous humor, and an eccentric or teardrop-shaped pupil indicate rupture of the globe. When such an injury is suspected, it is important to stop the examination and place a protective shield over the involved eye. Assessment of the function of the cranial nerves and sending the patient for a CT scan are done in the case of any facial fractures, but they aren't directly related to the eye assessment. Because this is a case of globe rupture, antibiotic eyedrops should be given only per the prescription of an ophthalmologist. Text Reference - p. 1529

A nurse is completing the discharge sheet for a patient with hip fracture, who has been treated by insertion of a prosthesis using a posterior approach. What instructions should be given to this patient before discharge? Select all that apply. 1 An adaptive device is not necessary for putting on shoes. 2 Use low toilet seats and chairs without arms. 3 Place a chair inside the tub and remain seated while washing. 4 Keep the hip in a neutral, straight position when sitting or lying. 5 Inform the dentist about the prosthesis before any dental work.

3,4,5 For a patient who had a hip fracture and has been treated by insertion of a prosthesis using a posterior approach, it is important to teach him or her and the caregiver about the measures to prevent dislocation. Certain measures, such as placing a chair in the tub and remaining seated while washing and keeping the hip in a neutral and straight position when sitting, lying, or walking prevents dislocation. The patient should be advised to inform his or her dentist about the prosthesis before any dental work, so that prophylactic antibiotics can be given if indicated. Many positions and daily activities predispose the patient to the dislocation of the prosthesis. Some of these activities include putting on one's own shoes and socks without using adaptive devices; crossing the legs or feet while seated; assuming the side-lying position incorrectly; standing up or sitting down while the body is flexed more than 90 degrees relative to the chair; and sitting on low seats, especially low toilet seats. It is also important to sit in chairs with arms, because these help the patient to rise to a standing position. Text Reference - p. 1527

A patient will undergo debridement of the shoulder joint. After the nurse explains the procedure, the patient asks the nurse what will be removed from the joint. How should the nurse answer? Select all that apply. 1 Synovial membrane 2 A wedge of bone 3 Joint debris 4 Degenerated menisci 5 Osteophytes

3,4,5 The procedure of debridement involves removing from a joint any devitalized tissue, such as loose bodies, joint debris, degenerated menisci, and osteophytes. This procedure is usually performed on the knee or the shoulder using a fiber optic arthroscope. Removal of synovial membrane is called synovectomy. The removal of a wedge of bone is called osteotomy. Text Reference - p. 1534

The nurse is completing discharge teaching with an older adult patient who underwent right total hip arthroplasty. The nurse identifies a need for further instruction if the patient states the need to: 1 Avoid crossing his legs 2 Use a toilet elevator on toilet seat 3 Notify future caregivers about the prosthesis 4 Maintain hip in adduction and internal rotation

4 The patient should not force the hip into adduction, or force the hip into internal rotation, because these movements could displace the hip replacement. Avoiding crossing the legs, using a toilet elevator on a toilet seat, and notifying future caregivers about the prosthesis indicate understanding of discharge teaching. Text Reference - p. 1536

A registered nurse is teaching the student nurse about hand surgery. Which statement made by the student nurse about the primary outcome of the surgery indicates a need for further teaching? 1 "To strengthen the hand joint" 2 "To restore the ability to grasp" 3 "To restore the stability of the hand" 4 "To correct the deformity of the hand"

4 "To correct the deformity of the hand" Correcting the deformity of the hand is not a primary objective of the hand surgery. The primary objective of a hand surgery is to restore strength. Finger arthroplasty aims to improve the ability of the hand to grasp in order to improve its functional ability. Stability of the hand is restored by hand surgery. Text Reference - p. 1535

The nurse is caring for a patient with pain in the posterior leg, initially when walking and later at rest. What does the nurse suspect based on these symptoms? 1 Atrophy 2 Ankylosis 3 Antalgic gait 4 Achilles tendonitis

4 Achilles tendonitis Achilles tendonitis occurs due to cumulative stress on the Achilles tendon resulting in inflammation. Initially the patient experiences pain in the posterior leg while running or walking and later it is felt even at rest. Atrophy occurs due to muscle denervation, contracture, and prolonged disuse. It results in a flabby appearance of the muscle with decreased function and tone. Ankylosis occurs due to chronic joint inflammation and destruction. It results in stiffness and fixation of a joint. Antalgic gait occurs due to trauma or other disorders. There is pain in the lower extremity on bearing weight. It results in shortened strides with little weight bearing on the affected side. Text Reference - p. 1500

A patient experiences a traumatic tear of ligament caused by an excessive deceleration force combined with rotation of the limb. What diagnosis does the nurse suspect? 1 Ligament injury 2 Meniscus injury 3 Rotator cuff tear 4 Anterior cruciate ligament tear

4 Anterior cruciate ligament tear An anterior cruciate ligament tear is the traumatic tearing of the ligament by excessive deceleration forces together with pivoting or rotating positions of the knee. Ligament injury can be described as traumatic tearing and stretching of a ligament as a result of excessive torque applied to the joint. Meniscus injury to the fibrocartilage of the knee is characterized by popping, clicking, tearing sensation, effusion, and swelling. A rotator cuff tear is a tear within muscle or tendinoligamentous structures around the shoulder. Text Reference - p. 1506

The nurse reviews the plan of care for the initial management of a patient with an injured ankle ligament. Which item listed on the care plan requires attention? 1 Apply ice to the ankle. 2 Limit movement of the ankle. 3 Keep the affected ankle elevated. 4 Apply warm, moist heat to the ankle.

4 Apply warm, moist heat to the ankle.

The nurse reviews test reports of a violin player who reports weakness, pain, numbness, and impaired sensation in the upper extremities. What should the nurse infer from the findings? 1 Shin splints 2 Impingement syndrome 3 Repetitive strain injury (RSI) 4 Carpal tunnel syndrome (CTS)

4 Carpal tunnel syndrome (CTS) The clinical findings indicate CTS. Tinel's sign is elicited by tapping over the median nerve as it passes through the carpal tunnel in the wrist. Phalen's sign can be elicited by allowing the wrists to fall freely into maximum flexion and maintaining this position for more than 60 seconds. The positive responses for both include a tingling sensation in the median nerve distribution over the hand associated with CTS. Shin splints are inflammation along the anterior aspect of the calves from periostitis. Impingement syndrome is the entrapment of soft tissue structures under the coracoacromial arch of the shoulder. RSI is caused by the repeated movements that strain the tendons, ligaments, and muscles. Text Reference - p. 1509

A patient with a long leg cast reports pain in the toes. The nurse discovers that the toes are pale and cool to the touch with intact pulses and minimal neuropathy. The findings indicate that the patient may be experiencing: 1 A pressure ulcer 2 Osteomyelitis 3 A fat embolism 4 Compartment syndrome

4 Compartment syndrome is the progressive compromise of neurovascular function of tissue in a confined space such as a cast. It may also result from circumferential inflammation around an extremity. The earliest sign is paresthesias, followed by pain, pressure resulting from edema, pallor, paralysis, and absence of pulse. (Absence of the peripheral pulse is a late and ominous sign.) A pressure ulcer is caused by decreased circulation due to pressure, tissue hypoxia, and destruction. Osteomyelitis is an infectious process within the bone. A fat embolism is an acute event in which fat globules released into circulation obstruct pulmonary circulation. It is seen with fractures of long bones such as the femur. Text Reference - p. 1522

The nurse reviews the results of a magnetic resonance image (MRI) study that was performed on a patient with a severe shoulder injury. Which MRI finding has the potential risk of dislocation? 1 Tearing of the ligaments around the shoulder joint 2 Mild tears within the muscles around the shoulder joint 3 Severe tearing within the muscles around the shoulder joint 4 Deformation injury to the humerus around the shoulder joint

4 Deformation injury to the humerus around the shoulder joint The patient with a dislocation may have deformation injury to the humerus around the shoulder joint. Tearing of ligaments in the shoulder may not indicate a dislocation. Mild tears in the shoulder muscles may not indicate dislocation. Severe tearing in the shoulder muscles may not indicate dislocation. Text Reference - p. 1508

A nurse evaluates a patient who reports twisting an ankle while walking down steps. Besides edema, which symptoms would most likely be observed if a non-displaced simple fracture were present? 1 Numbness, coolness, and loss of pulse 2 Loss of sensation, redness, and warmth 3 Coolness, redness, and inability to bear weight 4 Redness, warmth, and inability to use the affected part

4 Redness, warmth, and inability to use the affected part Common signs of a fracture include edema, redness, warmth, inability to bear weight or use the affected joint, and pain at the site of injury. Coolness, tingling, numbness, and loss of pulses are signs of a vascular problem or may reflect a complication of a more complex fracture. Text Reference - p. 1512

A nurse is taking the health history of a patient suffering from severe knee pain. Which question related to the sexuality-reproductive pattern are important in this scenario for assessment? 1 What are your sexual preferences? 2 How many sexual partners do you have? 3 Which method of contraception do you use? 4 Do you face any sexual concerns related to your mobility?

4 Do you face any sexual concerns related to your mobility? In a patient suffering from knee pain, few questions related to sexual pattern should be asked. Knowing whether the patient experiences any sexual concerns due to knee pain gives an indication of the severity of the complaint. The patient's sexual preferences, number of sexual partners, and method of contraception are important in assessing a patient for sexually transmitted infection (STI), but not for musculoskeletal system. Text Reference - p. 1495

The nurse formulates a nursing diagnosis of impaired physical mobility related to decreased muscle strength for a patient who has undergone a total knee replacement. What is an appropriate nursing intervention for this patient? 1 Maintain the leg in an abducted position while supine 2 Weight-bear as tolerated 3 Increase calcium intake to 400 mg daily 4 Encourage isometric exercises every six hours

4 Encourage isometric exercises every six hours Great emphasis is placed on postoperative exercise of the affected leg, with isometric quadriceps setting beginning on the day after surgery. The leg does not need to stay in an abducted position, which would be used following hip replacement surgery. The patient should not bear weight on the extremity until instructed to do so by the health care provider. Calcium supplementation will not impact physical mobility. Text Reference - p. 1535

Which type of surgical repair is performed during hemiarthroplasty? 1 Reshaping of the femoral head 2 Repair with internal fixation devices 3 Replacement of both femur and acetabulum 4 Replacement of part of the femur with prosthesis

4 Hemiarthroplasty is a surgical replacement of part of a joint. Replacement of part of the femur with a prosthesis is known as hemiarthroplasty. Reshaping of the femoral head is done during hip resurfacingin which the femoral head is reshaped rather than replaced. Repair of the joints with internal fixation is done through devices such as pins, plates, and intramedullary rods that are inserted into the joint to attain the correct bone alignment. The replacement of both femur and acetabulum is performed during a total hip arthroplasty. Text Reference - p. 1534

4 Immobilize the fracture preoperatively To prevent fat emboli, the nurse immobilizes the long bone to reduce movement of the fractured bone ends and decrease the risk of a fat embolus from the bone before surgical reduction. Enoxaparin is used to prevent blood clots, not fat emboli. Range of motion and compression boots will not prevent a fat embolus in this patient. Text Reference - p. 1523

A patient with an extensive tear of the muscles around the shoulder underwent acromioplasty. Which postoperative activity may result in arthrofibrosis? 1 Lifting weights after six months 2 Beginning physical therapy on the first postoperative day 3 Performing pendulum exercises on the first postoperative day 4 Keeping the shoulder immobilized for prolonged periods after surgery

4 Keeping the shoulder immobilized for prolonged periods after surgery

A patient sustains a severe hip injury with dislocation in the posterior direction. Joint aspiration reveals hemarthrosis. What condition does the nurse suspect? 1 Bursitis 2 Arthrofibrosis 3 Avascular necrosis 4 Intraarticular fracture

4 Severe injury may result from posterior hip dislocation due to damage to the ligament structure around the joint. The presence of hemarthrosis indicates an intraarticular fracture and bleeding into the joint space. Bursitis is the inflammation of closed sae bursae. Arthrofibrosis is the "freezing" of the shoulder after prolonged immobilization after surgery. Avascular necrosis is associated with inadequate blood supply, resulting in bone cell death. Text Reference - p. 1508

The nurse is providing discharge education to a patient with a fiberglass cast. What should the nurse be sure to include with the education? 1 It must not get wet 2 It has to be replaced every one to two weeks 3 The fiberglass is heavier than a plaster cast 4 Skin irritation is more common than with a plaster cast

4 Skin irritation is more common than with a plaster cast

An older adult patient states, "I am frustrated by my flabby belly and rigid hips." What is the best response by the nurse? 1 "You should go on a diet and exercise more to feel better about yourself." 2 "Something must be wrong with you because you should not have these problems." 3 "You have arthritis and need to go on nonsteroidal antiinflammatory drugs (NSAIDs)." 4 "Decreased muscle mass and strength, and increased hip rigidity are normal changes of aging."

4 The musculoskeletal system's normal changes of aging include decreased muscle mass and strength, increased rigidity in the hips, neck, shoulders, back, and knees, decreased fine motor dexterity, and slowed reaction times. Going on a diet and exercising will help, but will not stop these changes. Telling the patient "Something must be wrong with you" will not be helpful to the patient's frustrations. The patient does not have arthritis or need NSAIDs. Text Reference - p. 1494

A patient status post right total knee arthroplasty has a prescription to get out of bed to the chair. Which action would the nurse take to protect the knee joint while carrying out the prescription? 1 Use a walker and two-person transfer technique. 2 Transfer the patient to the chair using a mechanical lift. 3 Ask the physical therapist to assist to limit weight bearing while the patient gets out of bed. 4 Ensure a knee immobilizer is in place and elevate the leg while sitting.

4 The nurse should apply a knee immobilizer for stability before helping the patient out of bed. This is a standard measure to protect the knee during movement after surgery. A mechanical lift would not be necessary, because the patient can fully weight bear on the unaffected leg. A walker and assistance from the physical therapist may be considered, but the priority action would be to stabilize the knee and elevate it while sitting. Text Reference - p. 1535

On return from surgery, the patient is wearing intermittent sequential compression stockings that the patient does not want to keep on. How should the nurse explain their necessity to the patient while on bed rest? 1 The stockings keep the legs warm while the patient is not moving much. 2 The stockings maintain the blood flow to the legs while the patient is on bed rest. 3 The stockings keep the blood pressure down while the patient is stressed after surgery. 4 The stockings provide compression of the veins to keep the blood moving back to the heart

4 The stockings provide compression of the veins to keep the blood moving back to the heart. Intermittent sequential compression stockings provide compression of the veins while the patient is not using skeletal muscles to compress the veins, which keeps the blood moving back to the heart and prevents blood pooling in the legs that could cause deep vein thrombosis. The warmth is not important. Blood flow to the legs is not maintained. Blood pressure is not decreased with the use of intermittent sequential compression stockings.

A patient is suffering from inflammation in the joints of fingers, wrists, feet, and ankles that results in painful deformity, especially in the knees. Which type of surgery is indicated as a palliative treatment for this patient? 1 Osteotomy 2 Arthrodesis 3 Arthroplasty 4 Synovectomy

4 The symptoms of inflammation in the joints of fingers, wrists, feet, and ankles, along with painful deformity in the knees, indicate a surgical synovectomy to remove damaged, inflamed synovial membranes. Osteotomy has proven ineffective in patients with inflammatory joint disease. Arthrodesis is the fusion of a joint when joint replacement surgery fails. Arthroplasty is the reconstruction or replacement of a joint. Text Reference - p. 1534

A patient with a fracture of the femur has the extremity in skeletal traction and is encouraged to use an overhead trapeze apparatus. The nurse explains that the primary purpose of the overhead trapeze is: 1 To assist with leg exercises 2 To enhance breathing and lung expansion 3 To promote circulation throughout the body 4 To facilitate independent movement while the patient is in bed

4 To facilitate independent movement while the patient is in bed An overhead trapeze will facilitate independent movement in bed. It also maintains range of motion of the upper extremities and strengthens the biceps. Assisting with stump exercises, enhancing breathing and lung expansion, and promoting circulation throughout the body are secondary benefits to using an overhead trapeze but are not the primary purpose. Text Reference - p. 1526

The nurse is caring for a patient who underwent left total knee arthroplasty and has a new prescription to be "up in the chair today before noon." What action should the nurse take to protect the knee joint while carrying out the prescription? 1 Administer a dose of prescribed analgesic before completing the prescription. 2 Ask the physical therapist for a walker to limit weight bearing while getting out of bed. 3 Keep the continuous passive motion machine (CPM) in place while lifting the patient from bed to chair. 4 Put on a knee immobilizer before moving the patient in and out of bed and keep the surgical leg elevated while sitting.

4 Put on a knee immobilizer before moving the patient in and out of bed and keep the surgical leg elevated while sitting. Put on a knee immobilizer before moving the patient in and out of bed and keep the surgical leg elevated while sitting. The nurse should apply a knee immobilizer for stability before assisting the patient to get out of bed. This is a standard measure to protect the knee during movement following surgery. Although an analgesic should be given before the patient gets up in the chair for the first time, it will not protect the knee joint. Full weight bearing is begun before discharge, so a walker will not be used if the patient did not need one before the surgery. The CPM machine is not kept in place while the patient is getting up to the chair. Text Reference - p. 1535

Which condition in a patient indicates that he or she is an ideal candidate for an osteotomy? 1 Synovitis 2 Osteoarthritis 3 Rheumatoid arthritis 4 Ankylosing spondylitis

Ankylosing spondylitis An osteotomy involves removing a wedge or slice of bone to change alignment and to shift weight bearing, correcting a deformity. A patient with ankylosing spondylitis may benefit the most from an osteotomy, because it corrects the deformity in the patient. Synovitis is the inflammation of the synovial membrane and is corrected through synovectomy. Osteoarthritis and rheumatoid arthritis are inflammatory disorders and are not treated with osteotomy. Text Reference - p. 1534

The nurse is performing a physical examination on a patient with sciatica. Which statements are correct for the straight-leg-raising test? Select all that apply. 1 The patient should lie prone for the test. 2 The patient is instructed to actively raise his or her legs to 60 degrees. 3 The test is positive if the patient complains of pain along the distribution of the sciatic nerve. 4 A positive test indicates nerve root irritation from intervertebral disc prolapse and herniation. 5 The nerve root at the level of L4-5 or L5-S1 may be involved.

Correct3 The test is positive if the patient complains of pain along the distribution of the sciatic nerve. Correct4 A positive test indicates nerve root irritation from intervertebral disc prolapse and herniation. Correct5 The nerve root at the level of L4-5 or L5-S1 may be involved. The straight-leg-raising test is performed on a patient with sciatica or leg pain. The test is positive if the patient complains of pain along the distribution of the sciatic nerve when the leg is raised to 60 degrees or less. A positive test indicates nerve root irritation from intervertebral disc prolapse and herniation; usually, the nerve root at the level of L4-5 or L5-S1 is involved. The test is conducted with the patient in supine position. The nurse passively raises the patient's legs 60 degrees or less. Text Reference - p. 1498

The nurse interacts with a patient who has arrived at the hospital for a scheduled electromyogram. The nurse concludes that that the test will need to be rescheduled based on what patient statement? 1 "I drank apple juice last night." 2 "I have been taking antibiotics for one week." 3 "I have had knee pain since early this morning." 4 "I drank two cups of coffee this morning."

Correct4 "I drank two cups of coffee this morning."

Correct4 Carpal tunnel syndrome (CTS) The clinical findings indicate CTS. Tinel's sign is elicited by tapping over the median nerve as it passes through the carpal tunnel in the wrist. Phalen's sign can be elicited by allowing the wrists to fall freely into maximum flexion and maintaining this position for more than 60 seconds. The positive responses for both include a tingling sensation in the median nerve distribution over the hand associated with CTS. Shin splints are inflammation along the anterior aspect of the calves from periostitis. Impingement syndrome is the entrapment of soft tissue structures under the coracoacromial arch of the shoulder. RSI is caused by the repeated movements that strain the tendons, ligaments, and muscles. Text Reference - p. 1509

A patient tests positive for Lachman's test and is unable to perform physical activities due to pain in the knees. What coexisting condition may be diagnosed, as per the nurse's suspicion? 1 Bursitis 2 Fracture 3 Rotator cuff injury 4 Collateral ligament injuries

Correct4 Collateral ligament injuries A positive Lachman's test may indicate an anterior cruciate ligament (ACL) tear in the knee. The coexisting condition that might be diagnosed includes collateral ligament injuries. Bursitis involves the inflammation of the bursae. Fracture is the disruption in bone structure's continuity. Rotator cuff injury causes disruption of shoulder joint movement.

A patient is hospitalized with severe bleeding in the leg. An x-ray of the leg reveals that the periosteum is intact across the fracture and that the bone is still in alignment. What type of fracture does the patient have? 1 Oblique fracture 2 Pathologic fracture 3 Greenstick fracture 4 Comminuted fracture

Greenstick fracture A nondisplacement fracture in which the periosteum is intact across the fracture and the bone is still in alignment is classified as a greenstick fracture. In an oblique fracture, the line of the fracture extends in an oblique direction. A pathologic fracture is a spontaneous fracture at the site of a bone disease. Displaced fractures are usually comminuted fractures in which there are more than two bone fragments with the smaller fragments floating or oblique. Text Reference - p. 1512

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