Deck 64: Nursing Management: Musculoskeletal Problems

Question 1

A patient with a herniated intravertebral disk undergoes a laminectomy and diskectomy. Following the surgery, the nurse should position the patient on the side by

A) elevating the head of the bed 30 degrees and having the patient extend the legs while turning to the side.
B) turning the patient's head and shoulders and then the hips, keeping the patient centered in the bed.
C) having the patient turn by grasping the side rails and pulling the shoulders over.
D) placing a pillow between the patient's legs and turning the entire body as a unit.

Answer 1

placing a pillow between the patient's legs and turning the entire body as a unit.

Question 2

When evaluating the effectiveness of treatment for a patient who is being treated for Paget's disease with calcitonin (Cibacalcin) and ibandronate (Boniva), the nurse will ask the patient about

A) weight loss.
B) skeletal pain.
C) decreased appetite.
D) frequent cough.

Answer 2

skeletal pain.

Question 3

Which statement by a patient who is scheduled for an above-the-knee amputation for treatment of an osteogenic sarcoma of the right tibia indicates that patient teaching is needed?

A) "I wish that I did not have to have chemotherapy after this surgery."
B) "I do not mind the surgery because it will finally cure the cancer."
C) "I know that I will need lots of physical therapy after surgery."
D) "I will use the patient-controlled analgesia to help control my pain level after surgery."

Answer 3

"I do not mind the surgery because it will finally cure the cancer."

Question 4

The nurse identifies a nursing diagnosis of pain related to muscle spasms for a patient with acute low back pain associated with acute lumbosacral strain. An appropriate nursing intervention for this problem is to teach the patient to

A) twist gently from side to side to maintain range-of-motion in the spine.
B) place a small pillow under the upper back to flex the lumbar spine gently.
C) keep the head elevated slightly and flex the knees when resting in bed.
D) avoid the use of cold because it will exacerbate the muscle spasms.

Question 5

After teaching a patient with a bunion about how to prevent further problems, the nurse will determine that more teaching is needed if the patient says,

A) "I will wear soft slippers whenever possible."
B) "I will throw away my high heel shoes."
C) "I will use the bunion pad to relieve the pain."
D) "I will take ibuprofen (Motrin) when I need it."

Question 6

A patient whose work involves loading and unloading boxes has a history of chronic back pain. Which statement after the nurse has taught the patient about correct body mechanics indicates that the teaching has been effective?

A) "I plan to start doing sit-ups and leg lifts to strengthen the muscles of my back."
B) "I will try to sleep with my hips and knees extended to prevent back strain."
C) "I can tell my boss that I need to change to a job where I can work at a desk."
D) "I will keep my back straight when I need to lift anything higher than my waist."

Question 7

A 20-year-old patient with a 6-year history of muscular dystrophy is hospitalized with a respiratory tract infection. Which nursing action will be included in the plan of care?

A) Logroll the patient every 1 to 2 hours.
B) Teach the patient about the muscle biopsy procedure.
C) Provide the patient with a pureed diet.
D) Assist the patient with active range-of-motion (ROM) exercises.

Question 8

A patient is receiving gentamicin (Garamycin) 80 mg IV twice daily for acute osteomyelitis. Which action should the nurse take before administering the gentamicin?

A) Obtain the patient's oral temperature.
B) Review the patient's BUN and creatinine levels.
C) Ask the patient about any nausea.
D) Change the wet-to-dry dressing.

Question 9

When planning care for a patient who will be treated with 2 days of bed rest for low back pain, which intervention will the nurse include?

A) Telling the patient about the importance of a high fiber and fluid intake
B) Instructing the patient to avoid positioning the knee in the flexed position
C) Educating the patient that continuous heat application will reduce pain
D) Teaching the patient that the prone position will help relieve back pain

Question 10

The nurse determines that teaching regarding diet for a patient with osteoporosis has been successful when the patient selects which of these meals as having the highest amount of calcium?

A) Sardine sandwich on whole wheat bread, one cup of fruit yogurt, and one cup of skim milk
B) Two-egg omelet with American cheese, one slice of whole-wheat toast, and a half grapefruit
C) Ham and Swiss cheese sandwich on whole-wheat bread, steamed broccoli, and an apple
D) Chicken stir-fry with bok choy, onions, and snap peas and one cup of steamed brown rice

Question 11

A patient has chronic osteomyelitis of the left femur, which is being managed at home with self-administration of IV antibiotics. On a home visit, the nurse identifies the nursing diagnosis of ineffective therapeutic regimen management when the nurse finds that the patient

A) is unable to plantar-flex the foot on the affected side.
B) uses crutches to avoid weight bearing on the affected leg.
C) takes and records the oral temperature twice a day.
D) is irritable and frustrated with the length of treatment required.

Question 12

An assessment finding that alerts the nurse to the presence of osteoporosis in a middle-aged patient is

A) the presence of bowed legs.
B) measurable loss of height.
C) an aversion to dairy products.
D) statements about frequent falls.

Question 13

Which of these nursing actions included in the care of a patient after laminectomy can the nurse delegate to an experienced nursing assistant?

A) Evaluation of the effectiveness of the PCA
B) Monitoring plantar and dorsiflexion of the feet
C) Logrolling the patient from side to side every 2 hours
D) Determining the patient's readiness to ambulate

Question 14

A patient with an open fracture of the left tibia and soft tissue damage underwent a surgical reduction and fixation of the tibia with debridement of nonviable tissue and drain placement. When assessing the patient during the postoperative period, the nurse will be most concerned about

A) fever with chills and night sweats.
B) light yellow drainage from the wound.
C) pain on movement of the affected limb.
D) muscle spasms around the affected bone.

Question 15

A patient is being discharged after 2 weeks of IV antibiotic therapy for acute osteomyelitis in the left leg. Which information will be included in the discharge teaching?

A) The reason for taking oral antibiotics for 7 to 10 days after discharge
B) The need for daily aerobic exercise to help maintain muscle strength
C) How to monitor and care for the long-term IV catheter site
D) How to apply warm packs safely to the leg to reduce pain

Question 16

Following a laminectomy with a spinal fusion, a patient reports numbness and tingling of the right lower leg. The first action indicated by the nurse is to

A) report the patient's complaint to the surgeon.
B) check the vital signs for indications of hemorrhage.
C) turn the patient to the side to relieve pressure on the operative area.
D) check the chart for preoperative neuromuscular assessment data.

Question 17

A 58-year-old woman who has been menopausal for 5 years is diagnosed with osteoporosis following densitometry testing. The woman has been concerned about her risk for osteoporosis because her mother has the condition. In teaching the woman about her osteoporosis, the nurse explains that

A) with a family history of osteoporosis, there is no way to prevent or slow gradual bone resorption.
B) estrogen replacement therapy must be started to prevent rapid progression of her osteoporosis.
C) even with a family history of osteoporosis, the calcium loss from bones can be slowed by increased calcium intake and exercise.
D) continuous, low-dose corticosteroid treatment is effective in stopping the course of osteoporosis.

Question 18

A patient is hospitalized for initiation of regional antibiotic perfusion for acute osteomyelitis of the right femur. Which intervention will be included in the plan of care?

A) Frequent weight-bearing exercise
B) Immobilization of the right leg
C) Avoid administration of NSAIDs
D) Support right leg in a flexed position

Question 19

When administering alendronate (Fosamax) to a patient, the nurse will first

A) administer the ordered calcium carbonate.
B) be sure the patient has recently eaten.
C) assist the patient to sit up at the bedside.
D) ask about any leg cramps or hot flashes.