Chapter 43: Care of the Patient with a Musculoskeletal Disorder Flashcards Quizlet PDF

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Chapter 43: Care of the Patient with a Musculoskeletal Disorder Terms in this set (48) 1. What is the movement of an extremity away

ANS: A

from the midline of the body called?

Abduction is movement of an extremity away from the midline of the body.

a. Abduction b. Adduction

PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1339

c. Flexion

OBJ: 6 TOP: Movements KEY: Nursing Process Step: Implementation

d. Extension

2. What is the large, fan-shaped muscle that

ANS: D

covers the anterior chest from the sternum to the

Pectoralis major is the large, fan-shaped muscle that covers the anterior chest

proximal end of the humerus and acts on the joint

and is an adductor muscle, which will cause the shoulder to flex.

of the shoulder to flex, adduct, and rotate? a. Serratus anterior

PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1341, Figure 43-4 OBJ: 4 TOP:

b. Intercostal

Muscle functions

c. Transversus abdominis

KEY: Nursing Process Step: Assessment

d. Pectoralis major

3. What should the nurse instruct the patient

ANS: C

before a magnetic resonance imaging (MRI)

MRI procedures require that the patient remove all metal b

procedure?

become magnetized.

a. Void to completely empty the bladder b. Omit all citrus food for 12 hours before the

PTS: 1 DIF: Cognitive Level: Application REF: Page 1341 OBJ

procedure

examinations

c. Remove all metal, such as jewelry, glasses, and

KEY: Nursing Process Step: Assessment

hair clips d. Wear only cotton garments for the procedure

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4. The nurse instructs the patient who is to have a

ANS: A

unicompartmental knee replacement that a major

Unicompartmental knee arthroplasty is also referred to as partial knee

advantage of this partial knee replacement is that:

replacement in which the worn cartilage is replaced with a plastic disk. It is not

a. the patient will be up and walking 2 to 3 hours

as invasive as a full knee replacement and does not disturb the kneecap so that

after the operation.

the patient can be up and walking in 2 to 3 hours after surgery. It is not

b. the kneecap is completely removed.

recommended for RA patients.

c. the procedure is especially helpful in the

PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1361 OBJ: 13 TOP:

treatment of rheumatoid arthritis.

Unicompartmental knee replacement

d. a small titanium disk replaces the worn

KEY: Nursing Process Step: Implementation

cartilage.

5. A patient who has had a right below the knee

ANS: C

amputation continues to complain of unpleasant sensation in the right foot. What can the nurse

Phantom pain (pain felt in the missing extremity as if it were still present) may

explain about this "phantom pain"?

occur and be frightening to the patient. Phantom pain occurs because the nerve

a. It only exists in the mind.

tracts that register pain in the amputated area continue to send a message to

b. It is a complication following an amputation

the brain (this is normal).

and can be clarified by the surgeon. c. It is related to the severed nerves that are still

PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1394 OBJ: 21 TOP: Phantom pain

sending messages to the brain.

KEY: Nursing Process Step: Implementation

d. It occurs when the person becomes focused on the loss of the limb.

6. The patient that has a bipolar hip replacement

ANS: C

following an intracapsular fracture has an order to

Nursing interventions also involve postoperative maintenance of leg abduction

be turned every 2 hours. The nurse understands

by using an abduction splint for 7 to 10 days to prevent dislocation of the

that the correct nursing intervention is to keep the

prosthesis.

legs: a. together so they do not separate while turning.

PTS: 1 DIF: Cognitive Level: Application REF: Page 1367, Figure 43-13 OBJ: 14

b. flexed to stabilize the prosthesis.

TOP: Maintaining abduction

c. abducted so the prosthesis does not become

KEY: Nursing Process Step: Implementation

dislocated. d. adducted to prevent additional pain for the patient with turning.

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7. A patient has been casted to stabilize a fracture

ANS: C

of the right radius and ulna. The nurse assesses a

The nurse should first elevate the right hand to heart level and notify the charge

capillary refill of 5 seconds and cold fingers of

nurse. Permanent damage can occur in as little time as 6 hours.

the right hand. Which initial intervention should the nurse deploy?

PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1375 OBJ: 19 TOP: Compartment syndrome

a. Notify the charge nurse of a probable

KEY: Nursing Process Step: Implementation

compartment syndrome b. Apply a warm compress to the fingers to relieve swelling c. Elevate the right hand to heart level to maintain arterial pressure d. Cut the cast off to release constriction

8. A patient had an open reduction with internal

ANS: B

fixation (ORIF) for a compound fracture of the left

All of the assessments are within normal limits. A small amount of blood on the

tibia and has been placed in a long leg cast. The

cast is expected and should be monitored.

assessments by the nurse are: left foot warm/pink, pedal pulse weaker than right, capillary refill 3

PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1397 OBJ: 19 TOP: Compound

seconds, and small 1 cm area of blood on cast.

fracture

What should the nurse do?

KEY: Nursing Process Step: Assessment

a. Notify charge nurse of impending compartment syndrome b. Document that all assessments are within normal limits c. Inform charge nurse about probable hemorrhage d. Place warm compresses on left foot

9. When a patient recovering from a fractured

ANS: B

tibia asks what callus formation is, the nurse tells

Callus formation occurs when the osteoblasts continue to lay the network for

her it is:

bone buildup and osteoclasts destroy dead bone.

a. when blood vessels of the bone are compressed.

PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1371 OBJ: 15 TOP: Bone

b. a part of the bone healing process after a

healing

fracture when new bone is being formed

KEY: Nursing Process Step: Implementation

over the fracture site. c. the formation of a clot over the fracture site. d. when the hematoma becomes organized and a fibrin meshwork is formed.

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10. Which patient statement indicates the need for

ANS: B

additional teaching for a patient with rheumatoid

Aspirin or products containing aspirin should be avoided while taking

arthritis who is taking meloxicam (Mobic)?

meloxicam.

a. "I am keeping a daily record of my blood pressure."

PTS: 1 DIF: Cognitive Level: Application REF: Page 1346, Table 43-5 OBJ: 9 TOP:

b. "I take aspirin before I go to bed."

Rheumatoid arthritis KEY: Nursing Process Step: Evaluation

c. "I know I can take meloxicam with or without regard to meals." d. "I weigh every day so I will be aware of any weight gain."

11. What should the nurse include in the plan of

ANS: A

care for a patient following a myelogram?

The patient should be positioned in the semi-Fowler position for 8 hours to

a. Position in a semi-Fowler position for 8 hours to

encourage the dye to stay in the lower spine and to reduce headache.

reduce potential of headache b. Place patient flat on back to compress

PTS: 1 DIF: Cognitive Level: Application REF: Page 1340

puncture site

OBJ: 7 TOP: Myelogram KEY: Nursing Process Step: Implementation

c. Ambulate for brief periods to lessen postmyelogram headache d. Limit fluids to increase absorption of the dye

12. Which finding would delay a computed

ANS: A

tomography (CT) scan?

Allergy to shellfish predicts an allergy to the contrast media used in the CT scan.

a. Patient's allergy to shellfish b. Patient in first trimester of a pregnancy

PTS: 1 DIF: Cognitive Level: Application REF: Page 1342 OBJ: 7 TOP: CT scan KEY:

c. Patient's allergy to milk products

Nursing Process Step: Assessment

d. Patient's gluten intolerance

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13. Forty-eight hours after a patient sustained a

ANS: C

fractured femur in a car accident, the nurse

A pulmonary fat embolism involves the embolization of fat tissue with platelets

assessed a pulse of 110, respirations at 25, and

and circulation of free fatty acids within the pulmonary circulation. Dyspnea,

labored crackles in both lung fields. The nurse

tachypnea, and chest pain are symptomatic of a fat embolus.

immediately reports to the charge nurse the probability of a(n):

PTS: 1 DIF: Cognitive Level: Application REF: Page 1376 OBJ: 17 TOP: Fat

a. impending pneumonia.

embolism

b. atelectasis.

KEY: Nursing Process Step: Assessment

c. fat embolism. d. anxiety attack.

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14. What is the first priority nursing intervention for

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ANS: A

an impending fat embolism?

The airway is always the first priority. If hypoxia is present, the physician will

a. Administer oxygen in a respiratory emergency

order the administration of oxygen. It is important for the nurse to check the liter

b. Increase intravenous fluids

flow of oxygen and educate patients and their families as to safety precautions

c. Position in flat position to ease decreased

necessary when oxygen is administered.

blood pressure d. Cover with warm blanket

PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1377 OBJ: 17 TOP: Fat embolism KEY: Nursing Process Step: Implementation

15. A patient, age 68, has suffered an

ANS: D

intertrochanteric fracture of the right hip. Before

Buck traction is a form of traction used as a temporary measure to provide

surgery, to provide support and comfort, an

support and comfort to a fractured extremity until a more definite treatment is

immobilizing device of a is applied.

initiated.

a. Thomas splint b. Bryant traction

PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1383

c. Russell traction

OBJ: 21 TOP: Fracture KEY: Nursing Process Step: Implementation

d. Buck traction

16. Which foods should the home health nurse

ANS: A

suggest for the patient with osteoporosis to help

To slow the bone loss, a patient with osteoporosis should eat green leafy

slow the disease?

vegetables, foods low in sodium, and also avoid caffeine. Vitamin A does not

a. Leafy green vegetables

help with the absorption of calcium.

b. Foods high in sodium c. Tea and coffee

PTS: 1 DIF: Cognitive Level: Application REF: Page 1357, Patient Teaching OBJ: 11

d. Vitamin A

TOP: Osteoporosis diet KEY: Nursing Process Step: Implementation

17. What should the nurse include in the teaching

ANS: B

plan for a patient who is taking alendronate

Alendronate (Fosamax) should be taken on an empty stomach first thing in the

(Fosamax)?

morning with 6 oz of water, accompanied by no other medication.

a. Take drug with any meal

PTS: 1 DIF: Cognitive Level: Application REF: Page 1356, Table 43-6 OBJ: 8 TOP:

b. Take drug first thing in the morning

Osteoporosis drug

c. Drink at least 5 oz of milk before taking drug

KEY: Nursing Process Step: Planning

d. Take drug with an antacid to avoid heartburn

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18. The patient has been diagnosed as having

ANS: B

gouty arthritis. The patient asks the nurse to

Gout is a metabolic disease resulting from an accumulation of uric acid in the

explain the cause of the inflammation of the great

blood. It is an acute inflammatory condition associated with ineffective

toe. What is the most appropriate nursing

metabolism of purines.

response? a. "You have calcium oxalate deposits that are

PTS: 1 DIF: Cognitive Level: Application REF: Page 1353 OBJ: 8 TOP: Gouty

seen in gouty arthritis."

arthritis

b. "The inflammation is from small accumulations

KEY: Nursing Process Step: Implementation

of uric acid crystals, which are called tophi." c. "The small nodules are not related to the arthritis condition." d. "You have fat deposits that are common with gouty arthritis."

19. When the patient with rheumatoid arthritis

ANS: A

complains about the daily exercise, the nurse

Daily gentle exercises keep the joints from "freezing" and keep the muscles from

encouragingly reminds the patient that exercises:

weakening.

a. keeps the joints from "freezing." b. will ensure better sleep.

PTS: 1 DIF: Cognitive Level: Application REF: Page 1349 OBJ: 8 TOP: Rheumatoid

c. should be vigorous for joint stimulation.

arthritis

d. need not be done daily.

KEY: Nursing Process Step: Assessment

20. The nurse clarifies to a patient who is being

ANS: C

evaluated for possible rheumatoid arthritis that the elevated erythrocyte sedimentation rate

The ESR indicates an increase in the inflammatory reactions in the body.

indicates the presence of: a. immunoglobulin M.

PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1345 OBJ: 8 TOP:

b. abnormal serum protein.

Rheumatoid arthritis

c. increased inflammatory reaction in the body.

KEY: Nursing Process Step: Implementation

d. C-reactive protein.

21. What should the nurse instruct the patient

ANS: C

before the initiation of the antimalarial drug

An eye examination should be completed before starting the drug and an eye

hydroxychloroquine (Plaquenil)?

examination should be done every 6 months while on the drug, because the

a. Get a complete blood count to assess anemia.

drug can damage the retina and lead to blindness.

b. Get a chest x-ray. c. Get an eye examination.

PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1336, Table 43-5 OBJ: 8

d. Take prophylaxis for malaria.

TOP: Gout KEY: Nursing Process Step: Implementation

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22. What should the nurse do when a patient with

ANS: B

osteomyelitis is admitted with an open wound that

The patient with osteomyelitis should be at least in drainage and secretion

is draining?

precaution. The limb should be positioned for maximum comfort and left at rest.

a. Enforce a low calorie diet

These patients are usually on bed rest and require a high-calorie, high-protein

b. Initiate drainage and secretion precautions

diet.

c. Frequently do passive ROM on the elbow d. Ambulate several times daily

PTS: 1 DIF: Cognitive Level: Application REF: Page 1358 OBJ: 19 TOP: Osteomyelitis KEY: Nursing Process Step: Implementation

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23. A 16-year-old male patient presents in the

ANS: A

emergency room with a pathologic fracture of the

Osteogenic sarcoma occurs in young men aged 10 to 25. They are malignant

left femur and complains of pain on weight

bone tumors that can cause a pathologic fracture and they are accompanied by

bearing. These are cardinal indicators of:

pain on weight bearing.

a. osteogenic sarcoma.

Osteochondromas are benign and usually do not cause fractures.

b. osteoporosis. c. rheumatoid arthritis.

PTS: 1 DIF: Cognitive Level: Application REF: Page 1393 OBJ: 20 TOP: Bone tumor

d. osteochondroma.

KEY: Nursing Process Step: Assessment

24. The 14-year-old boy who is scheduled for left

ANS: A

leg amputation says to the nurse, "What in the

The patient's co...