Lewis Chapter 66: Musculoskeletal Conditions TEST BANK Flashcards
The nurse is caring for a patient who is hospitalized for initiation of regional antibiotic
irrigation for acute osteomyelitis of the right femur. Which of the following interventions
should be included in the plan of care?
a. Immobilization of the right leg
b. Frequent weight-bearing exercise
c. Avoiding administration of nonsteroidal anti-inflammatory drugs (NSAIDs)
d. Support of the right leg in a flexed position
ANS: A
Immobilization of the affected leg helps decrease pain and reduce the risk for pathological
fractures. Weight-bearing exercise increases the risk for pathological fractures. NSAIDs are
frequently prescribed to treat pain. Flexion of the affected limb is avoided to prevent
contractures.
The nurse is preparing a patient for discharge to receive prolonged IV antibiotic therapy for
acute osteomyelitis in the left leg. Which of the following information should be included in
the discharge teaching?
a. How to apply warm packs safely to the leg to reduce pain.
b. How to monitor and care for the long-term IV catheter site.
c. The need for daily aerobic exercise to help maintain muscle strength.
d. The reason for taking oral antibiotics for 7–10 days after discharge.
ANS: B
The patient will be on IV antibiotics for several months, and the patient will need to recognize
signs of infection at the IV site and how to care for the catheter during daily activities such as
bathing. IV antibiotics rather than oral antibiotics are used for acute osteomyelitis. Patients are
instructed to avoid exercise and heat application because these will increase swelling and the
risk for spreading infection
The home care nurse is caring for a patient who has persistent osteomyelitis of the left femur
who is being managed at home with administration of IV antibiotics. Which of the following findings would indicate to the nurse that a nursing diagnosis of ineffective health maintenance is appropriate for this patient?
a. Takes and records the oral temperature twice a day.
b. Is unable to plantar flex the foot on the affected side.
c. Uses crutches to avoid weight bearing on the affected leg.
d. Is irritable and frustrated with the length of treatment required
ANS: B
Foot drop is an indication that the foot is not being supported in a neutral position by a splint.
Using crutches and monitoring the oral temperature are appropriate self-care activities.
Frustration with the length of treatment is not an indicator of ineffective health maintenance of
the osteomyelitis.
Which of the following statements by a patient with osteosarcoma of the right tibia who is
scheduled for an above-the-knee amputation indicates that patient teaching is needed?
a. “I did not have this bone cancer until my leg broke a week ago.”
b. “I wish that I did not have to have chemotherapy after this surgery.”
c. “I know that I will need to participate in physical therapy after surgery.”
d. “I will use the patient-controlled analgesia (PCA) to control postoperative pain.”
ANS: A
Ewing’s sarcoma may be diagnosed following a fracture, but it is not caused by the injury. The
other patient statements indicate that patient teaching has been effective.
The nurse is caring for a patient with pes planus. Which of the following actions should the nurse expect to provide symptom relief for this patient?
a. The administration of a corticosteroid
b. The use of longitudinal arch supports
c. Passive manual stretching of the PIP joint
d. Casting of the affected foot
ANS: B
Symptoms of pes planus are usually relieved by use of resilient longitudinal arch supports.
Casting of the affected foot, passive manual stretching of the PIP joint, and the administration of a corticosteroid are not part of the treatment for pes planus.
The nurse is caring for a patient who has muscle spasms and acute low back pain. Which of
the following actions is most appropriate to teach the patient to promote comfort?
a. Avoid the use of cold because it will exacerbate the muscle spasms.
b. Keep both feet flat on the floor when prolonged standing is required.
c. Keep the hips and knees flexed when resting in bed.
d. Twist gently from side to side to maintain range of motion in the spine.
ANS: C
Resting with the hips and knees flexed will reduce the strain on the back and decrease muscle spasms. Twisting from side to side will increase tension on the lumbar area. A pillow placed under the upper back will cause strain on the lumbar spine. Alternate application of cold and heat should be used to decrease pain.
The nurse is teaching a patient with persistent back pain, whose work involves lifting, about
proper body mechanics. Which of the following patient statements indicates that the teaching
has been effective?
a. “I plan to start doing exercises 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.”
ANS: A
Exercises can help to strengthen the muscles that support the back. Flexion of the hips and
knees places less strain on the back. Modifications in the way the patient lifts boxes is needed as well as reminding that sitting for prolonged periods can aggravate back pain. The patient should not lift above the level of the elbows.
The nurse is caring for a patient who underwent a laminectomy and discectomy for a
herniated intervertebral disc. Following the surgery, which of the following actions should the nurse implement when positioning the patient on their side?
a. Instruct the patient to move their legs before turning the rest of the body.
b. Have the patient turn by grasping the side rails and pulling the shoulders over.
c. Place a pillow between the patient’s legs and turn the entire body as a unit.
d. Turn the patient’s head and shoulders first, followed by the hips, legs, and feet.
ANS: C
The spine should be kept in correct alignment after laminectomy. The other positions will
create misalignment of the spine.
The nurse is teaching a patient with a bunion how to prevent further deformity. Which of the
following patient statements indicates that more teaching is required?
a. “I will throw away my high heel shoes.”
b. “I will use the bunion pad to relieve the pain.”
c. “I will need to wear open sandals at all times.”
d. “I will take ibuprofen when I need it.”
ANS: C
The patient can wear shoes that have a wide forefoot. The other patient statements indicate
that the teaching has been effective.
The nurse is caring for an older female adult patient who has a family history of osteoporosis
and is diagnosed with osteopenia following densitometry testing. Which of the following
explanations should the nurse provide when teaching the patient about osteoporosis?
a. Estrogen replacement therapy must be started to prevent rapid progression to
osteoporosis.
b. Continuous, low-dose corticosteroid treatment is effective in stopping the course of
osteoporosis.
c. With a family history of osteoporosis, there is no way to prevent or slow gradual
bone resorption.
d. Calcium loss from bones can be slowed by increasing calcium intake and weight-bearing exercise.
ANS: D
Progression of osteoporosis can be slowed by increasing calcium intake and weight-bearing
exercise. Estrogen replacement therapy does help prevent osteoporosis, but it is not the only
treatment and is not appropriate for some patients. Corticosteroid therapy increases the risk for osteoporosis.
Which of the following assessment findings should alert the nurse to the presence of
osteoporosis in an older adult patient?
a. Measurable loss of height
b. Presence of bowed legs
c. Aversion to dairy products
d. Statements about frequent falls
ANS: A
Osteoporosis occurring in the vertebrae produces a gradual loss of height. Bowed legs are associated with osteomalacia. Low intake of dairy products is a risk factor for osteoporosis,
but it does not indicate that osteoporosis is present. Frequent falls increase the risk for
fractures but are not an indicator of osteoporosis.
Which of the following menu choices by a patient with osteoporosis indicates that the nurse’s teaching about appropriate diet has been effective?
a. Pancakes with syrup and bacon
b. Whole wheat toast and fruit jelly
c. Two-egg omelet and a half grapefruit
d. Oatmeal with skim milk and fruit yogurt
ANS: D
Skim milk and yogurt are high in calcium. The other choices do not contain any high calcium
foods.
The nurse is caring for a patient who has Paget’s disease and is prescribed salmon calcitonin
and acetaminophen. Which of the following assessment information will the nurse obtain to
evaluate the effectiveness of these medications?
a. Pain level
b. Oral intake
c. Daily weight
d. Grip strength
ANS: A
Bone pain is one of the common early manifestations of Paget’s disease, and the nurse should assess the pain level to determine whether the treatment is effective. The other information will also be collected by the nurse, but will not be used in evaluating the effectiveness of the therapy.
The nurse is caring for a patient who has acute osteomyelitis and is receiving tobramycin 80
mg IV twice daily. Which of the following actions should the nurse take before administering
the gentamicin?
a. Ask the patient about any nausea.
b. Obtain the patient’s oral temperature.
c. Change the prescribed wet-to-dry dressing.
d. Review the patient’s blood urea nitrogen (BUN) and creatinine levels.
ANS: D
Gentamicin is nephrotoxic and can cause renal failure. Monitoring the patient’s temperature
before gentamicin administration is not necessary. Nausea is not a common adverse effect of IV gentamicin. There is no need to change the dressing before gentamicin administration.
The nurse is caring for a patient who has had a surgical reduction of an open fracture of the
left tibia. Which of the following assessment findings is most important to report to the health care provider?
a. Left leg muscle spasms
b. Serous wound drainage
c. Left leg pain with movement
d. Temperature 38.6°C (101.5°F)
ANS: D
An elevated temperature is suggestive of possible osteomyelitis. The other clinical
manifestations are typical after a repair of an open fracture.
