Musculoskeletal Flashcards
An older man is seen in the outpatient clinic for treatment of an acute attack of gout. Which of the following nursing interventions is MOST beneficial in decreasing the client’s pain during ambulation?
1. Perform passive range-of-motion exercises before walking. 2. Encourage partial weight bearing while ambulating. 3. Immobilize the extremity between activities. 4. Restrict the amount of time and the distance the man walks.
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Strategy: All answers are implementations. Determine the outcome of each answer choice. Is it desired?
(1) would aggravate pain
(2) correct—would relieve weight, pressure, and stress on affected leg, may use walker
(3) would increase stiffness
(4) immobility would aggravate pain and inflammation
A client returns to his room following a myelogram. The nursing care plan should include which of the following?
1. Encourage oral fluid intake. 2. Maintain the prone position for 12 hours. 3. Encourage the client to ambulate after the procedure. 4. Evaluate the client's distal pulses on the affected side.
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Strategy: Answers are a mix of assessments and implementations. Is the assessment appropriate? No. Determine the outcome of the implementations.
(1) correct—implementation; fluids should be encouraged to facilitate dye excretion and to maintain normal spinal fluid
(2) implementation; clients are not placed in the prone position
(3) implementation; bed rest is maintained for several hours after the test
(4) assessment; an extremity was not used for injection of the dye
The nurse in the outpatient clinic instructs a client diagnosed with a sprained right ankle to walk with a cane. What behavior, if demonstrated by the client, indicates to the nurse that teaching is effective?
1. The client advances the cane 18 inches in front of the foot with each step. 2. The client holds the cane in the left hand. 3. The client advances the right leg, then the left leg, and then the cane. 4. The client holds the cane with elbows flexed 60°.
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Strategy: “Teaching is effective” indicates a correct behavior.
(1) should advance cane 6–10 inches with body weight on both legs
(2) correct—should hold cane on strong side, widens base of support, reduces stress on affected side
(3) should advance cane, weaker leg, stronger leg
(4) should flex no more than 30°
The nurse cares for a child several hours after the application of a hip spica cast. The patient turns on the call light and complains of pain in the left foot. Which of the following actions should the nurse take FIRST?
1. Elevate the left leg on two pillows. 2. Palpate the cast for warmth and wetness. 3. Administer pain medication as ordered. 4. Check the blanching sign on both feet.
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Strategy: Answers are a mix of assessments and implementations. Does this situation require assessment? Yes.
(1) implementation; done to prevent swelling and venous congestion, not helpful to reduce pain due to circulatory impairment
(2) assessment; not helpful to reduce pain due to circulatory impairment, should not palpate wet cast, would result in depressions causing pressure
(3) implementation; pain important diagnostic symptom, should not be suppressed or masked
(4) correct—assessment; pain main symptom of circulatory impairment from cast; pressing nail of great toe indicates circulatory function, compare speed with which color returns with result on the opposite side; sluggish return indicates circulatory impairment, too rapid return indicates venous congestion
A brace is ordered for a young teen with scoliosis. The nurse determines teaching is effective if the client makes which of the following statements?
1. "I will have my parents put bed-boards on my bed." 2. "I should decrease my caloric intake." 3. "I should only take showers." 4. "I will hold on the rail when going down the stairs."
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Strategy: All answers are implementations. Determine the outcome of each answer choice. Is it desired?
(1) bed-boards maintain proper vertebral alignment but can’t correct lateral curvature of scoliosis
(2) diet should be high-calorie due to age of child and growth requirements; diet doesn’t affect curvature of the spine
(3) either tub bathing or a shower is permitted
(4) correct—prevents falls, should also avoid slippery surfaces
The nurse cares for a patient recovering from abdominal surgery. During ambulation, the patient complains about a dull ache in the left leg. Which of the following actions should the nurse take FIRST?
1. Place the patient on bedrest with extremity elevated. 2. Place a pillow under the patient’s knee. 3. Encourage patient to ambulate more frequently. 4. Obtain thigh-high compression stockings.
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Strategy: All answers are implementations. Determine the outcome of each answer choice. Is it desired?
(1) correct—promotes venous return and decreases venous pressure, relieving pain and edema
(2) obstructs venous flow, increasing chance for thrombus formation
(3) can cause pulmonary emboli, should be on bedrest 5 to 7 days
(4) used to prevent deep vein thrombosis, should be on bedrest initially
The nurse assists a patient from the bed to the chair for the first time after a right total hip replacement. It is MOST important for the nurse to take which of the following actions?
1. Assist the patient to stand on the right leg and pivot to a low soft chair, keeping her hips straight. 2. Assist the patient to stand on the left leg and pivot to a straight-backed chair, flexing her hips slightly. 3. Ask the patient to bear weight equally on both legs, bend at the waist, and sit in a low soft chair. 4. Assist the patient to stand on both legs and take a few steps to a straight-backed chair.
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Strategy: All answers are implementations. Determine the outcome of each answer choice. Is it desired?
(1) should not bear weight on affected side, dislocation may occur
(2) correct—prevents dislocation
(3) no weightbearing on affected leg, dislocation may occur
(4) no weightbearing on affected leg, dislocation may occur
The nurse cares for a client diagnosed with rheumatoid arthritis. The plan of care should include which of the following?
1. Cold packs, immobilization, and hand splints. 2. Maintain flexion of the joints and proper body mechanics. 3. Analgesics, physical therapy, and a soft mattress on the bed. 4. Heat, range-of-motion exercises, and weight reduction.
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Strategy: Answers are implementations. Determine the outcome of each answer choice. Is it desired?
(1) treatment for acute strain or fracture
(2) joints need extension and rotation in addition to flexion to maintain full range of motion
(3) medications used are anti-inflammatory in addition to analgesics, a firm mattress should be used
(4) correct—goal is to prevent contractures and minimize deformity with a balance of rest and activity
The nurse cares for a client diagnosed with rheumatoid arthritis. The plan of care should include which of the following?
1. Cold packs, immobilization, and hand splints. 2. Maintain flexion of the joints and proper body mechanics. 3. Analgesics, physical therapy, and a soft mattress on the bed. 4. Heat, range-of-motion exercises, and weight reduction.
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Strategy: Answers are implementations. Determine the outcome of each answer choice. Is it desired?
(1) treatment for acute strain or fracture
(2) joints need extension and rotation in addition to flexion to maintain full range of motion
(3) medications used are anti-inflammatory in addition to analgesics, a firm mattress should be used
(4) correct—goal is to prevent contractures and minimize deformity with a balance of rest and activity
Which of the following activities documented by the recreational therapist following a community reorientation outing for a client with paraplegia indicates to the nurse the client’s readiness for discharge?
1. The client states that he enjoyed being outside the hospital environment. 2. The client participated in a structured team sport by keeping score. 3. The client independently ordered his meal and fed himself. 4. The client is independent in transfers and wheelchair mobility.
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Strategy: Think Maslow.
(1) psychosocial, speaks to his psychosocial status, but is not an indication for discharge
(2) psychosocial, addresses social skills, but is not an indication for discharge
(3) physical, not pertinent for a paraplegic
(4) correct—physical, these skills are requisite for discharge
The nurse in the outpatient clinic teaches a young adult with a sprained right ankle to walk with a cane. While teaching the client to use the cane, how should the nurse be positioned?
1. Standing on the client's left side and slightly behind the client. 2. Standing on the client's right with one hand on the client's waist. 3. Standing directly in front of the woman with both hands on the client's arms. 4. Standing in front of the client on the right side.
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Strategy: All answers are implementations. Determine the outcome of each answer. Is it desired?
(1) correct—stand slightly behind patient on strong side
(2) incorrect positioning
(3) use a gait belt to assist patient, don’t place hands on patient’s arms
(4) stand slightly behind patient on strong side
