Question 1

The nurse checks a patient's casted right leg resting upon a pillow and finds that the cast appears too tight.What should the nurse do?

Accepted Answer

The nurse should notify the RN.A serious complication of a cast being too tight is compartment syndrome.The physician needs to be contacted for orders to cut the cast with a cast cutter to relieve pressure and prevent pressure necrosis of the underlying skin.B.There is no information to support that the patient is in pain.C.There is no information to support that the limb is cool.D.The limb should be elevated or supported with pillows.

Question 2

The nurse is collecting data from a patient suspected of developing a fat embolus from a fracture of the right femur.Which manifestations should the nurse expect? (Select all that apply.)

Accepted Answer

The earliest manifestation of fat emboli syndrome (FES)is altered mental status from a low arterial oxygen level.The patient then experiences tachycardia,tachypnea,fever,high blood pressure,severe respiratory distress,and petechiae.B.E.F.These are not manifestations of fat emboli.

Question 3

The nurse reinforces medication teaching provided to a patient with rheumatoid arthritis.Which medication should the patient identify as helpful to control the symptoms of the health problem?

Accepted Answer

Ibuprofen (an NSAID)blocks activity of the enzyme cyclooxygenase,which makes prostaglandins that produce inflammation,fever,and pain found in rheumatoid arthritis.A.Digoxin is a cardiac medication.C.Morphine is an opioid which may not help reduce inflammation.D.Penicillin is an antibiotic,used to treat bacterial infections.

Question 4

An 87-year-old female with a history of osteoarthritis reports an average generalized pain score of 4 on a 0-to-10 scale while using acetaminophen prn.Which response about this pain level should the nurse make to the patient?

Accepted Answer

Acetaminophen can be helpful in reducing pain associated with osteoarthritis,so the nurse should assess whether the patient is satisfied with the current level of pain control.A.Calcium supplementation is not related to pain control.B.D.These statements miss the opportunity to assess whether the patient is both comfortable and functional with the current pain management.

Question 5

A patient who has a displaced mid-shaft fracture of the left femur and is in balanced suspension skeletal traction with 35 pounds of weights is experiencing calf pain with right foot dorsiflexion.Which action should the nurse take?

Accepted Answer

Calf pain on dorsiflexion can indicate a thrombophlebitis (Homan's sign).The RN should be informed.B.The nurse should not take the time now to check the traction setup.C.Traction weight cannot be reduced without a physician's order.D.The patient should not be encouraged to exercise the limb now since a thrombophlebitis might be present.

Question 6

The nurse is reinforcing teaching provided to a patient for carpal tunnel syndrome treatment.Which patient statement indicates a correct understanding of the teaching?

Accepted Answer

The wrist is rested to reduce inflammation,and a wrist splint may be prescribed to do this.A.B.D.Bedrest,an arm sling,and hand exercises are not indicated for treatment of this syndrome.

Question 7

The nurse is reinforcing teaching provided to a patient who is postmenopausal,has lost 2 inches of height,and has osteoporosis.Which patient statement indicates correct understanding of the purpose of calcium supplements?

Accepted Answer

If serum calcium falls below normal levels,the parathyroid glands stimulate the bone to release calcium into the bloodstream.The result is demineralized bone.Therefore,calcium supplements are used.B.C.D.Calcium is not taken to increase energy levels,decrease serum calcium,or to increase the excretion of calcium.

Question 8

The nurse is contributing to the plan of care for a patient who is scheduled for a below-the-knee amputation.What nursing diagnosis should be recommended for the preoperative plan of care?

Accepted Answer

Patients facing surgery and especially a body image changing surgery such as amputation will experience anxiety.Interventions to aid with this anxiety should be planned.B.C.D.These would be appropriate after surgery has occurred.

Question 9

The nurse reinforces teaching on prevention of osteomyelitis with a patient who has an open fracture of the right leg.Which patient statement indicates that teaching has been effective?

Accepted Answer

Washing hands prior to touching a fracture area is the best way to help prevent osteomyelitis.C.Calcium is related to osteoporosis prevention.B.Keeping the leg immobilized relates to fat emboli reduction.A.Ice is applied to reduce swelling.

Question 10

A patient is diagnosed with osteomyelitis of the right lower leg.What should the nurse expect to be prescribed for this patient's care?

Accepted Answer

Long-term antibiotic therapy (4-6 weeks)is the treatment of choice for patients with osteomyelitis.A.Anticoagulant therapy is prescribed for a thromboembolism.B.Casting is indicated for a fracture.C.Fasciotomy may be indicated to treat compartment syndrome.

Question 11

The nurse is reviewing data collected during the health history for a patient with osteoporosis.What should the nurse identify as a risk factor for osteoporosis development?

Accepted Answer

A risk factor for osteoporosis is excessive caffeine intake or alcohol.A.B.D.Antacids,walking,and dairy intake are not risk factors for the development of osteoporosis.

Question 12

A patient is completing instructions about complications that can occur from osteoporosis.Which complication should the patient state as evidence that teaching has been effective?

Accepted Answer

Osteoporotic bone may cause a pathological fracture in which the hip breaks before the fall.For other patients,a fall can cause a hip or other fracture.B.C.D.Bone overgrowth,spurs,or increases in bone density are not complications of osteoporosis.

Question 13

A patient 48 hours after surgery for a fractured femoral shaft is experiencing mental confusion,tachycardia,tachypnea,and dyspnea.The patient's blood pressure is elevated and petechiae are present on the chest.After reporting the findings to the RN what should the nurse do while awaiting the physician's specific orders? (Select all that apply.)

Accepted Answer

The patient is likely experiencing a fat emboli.The patient should be placed in a high Fowler's position to aid breathing,diagnostic tests will be done,and the patient is kept on bedrest to reduce oxygenation needs and clot movement.Oxygen may be started per agency policy to aid in respiration.E.Limb should not be moved to prevent further release of fat.

Question 14

The nurse is caring for a patient in traction.Which actions are appropriate when caring for this patient? (Select all that apply.)

Accepted Answer

Weights are to hang unobstructed.Assistance should be used to pull the patient up in bed to protect the health care worker from injury.C.D.E.Weights should never touch the floor or be removed or lifted.

Question 15

The nurse is contributing to the plan of care for a patient who has a bone fracture that is splintered and has shattered into numerous fragments.Which term should the nurse use to document this type of fracture?

Accepted Answer

A bone splintered or shattered into numerous fragments is a comminuted fracture that often occurs in crushing injuries.A.Impacted describes a bone that is forcibly pushed together,resulting in bone being pushed into bone.B.Avulsion describes a piece of bone that is torn away from the main bone while still attached to a ligament or tendon.C.Greenstick describes a bone that is bent and fractures on the outer arc of the bend.

Question 16

The nurse is contributing to the plan of care for a patient recovering from total hip replacement.Which exercises should the nurse recommend to help prevent deep vein thrombosis (DVT)formation? (Select all that apply.)

Accepted Answer

Because most DVTs occur in the lower extremities,leg exercises are started in the immediate postoperative period and include heel pumping,foot circles,and SLRs.The patient also performs quadriceps-setting exercises (quad sets).B.D.Deep knee bends and toe touches are not standard postoperative exercises and would be restricted in a patient with a total hip replacement due to restricted hip flexion.

Question 17

The nurse is caring for a patient with gout.Which laboratory value should the nurse review which indicates that the treatment plan is effective?

Accepted Answer

The diagnosis of gout is based on an elevated serum uric acid level which is a waste product resulting from the breakdown of proteins.Urate crystals,formed because of excessive uric acid buildup,are deposited in joints and other connective tissues,causing severe inflammation.B.C.D.Creatinine,blood urea nitrogen,and lipoprotein levels are not used in the diagnosis or treatment of gout.

Question 18

A patient asks the difference between osteoarthritis and rheumatoid arthritis.What manifestations should the nurse explain are characteristic of rheumatoid arthritis? (Select all that apply.)

Accepted Answer

Rheumatoid arthritis is a systemic autoimmune disease with morning stiffness,low-grade fever,and organ involvement.B.Heberden's nodes are seen in osteoarthritis.D.Pain increases with activity in osteoarthritis.

Question 19

The nurse is reinforcing teaching on positioning for a patient after a right total knee replacement.Which patient statement indicates a correct understanding of the teaching?

Accepted Answer

The patient lies supine with pillow under right knee if a continuous passive motion (CPM)machine is not used after a total knee replacement.A.B.D.The patient recovering from a total knee replacement does not need to be placed in the prone,side lying,or supine position with pillows between the legs.

Question 20

A patient with a fractured pelvis and a left acetabular fracture is prescribed bedrest.When the patient asks to toilet,which measure would be appropriate?

Accepted Answer

The nurse should ask the patient to lift straight up using a trapeze mounted above the bed and slide a bedpan underneath from the right side to avoid the left fracture.A.The patient is on bedrest so a bedside commode is not appropriate.B.The patient should not be turned.C.The patient should be instructed to use the trapeze and not attempt to push self up using the bed.

Quiz 46: Nursing Care of Patients With Musculoskeletal and Connective Tissue Disorders