Chapter 33: Care of Patients with Musculoskeletal and Connective Tissue Disorders My Nursing Test Banks

Chapter 33: Care of Patients with Musculoskeletal and Connective Tissue Disorders

MULTIPLE CHOICE

1. A patient has come to the ambulatory care clinic with a sprain. The nurse correctly differentiates a grade 2 sprain from a grade 3 sprain with the assessment of:

a.

pain.

b.

swelling.

c.

bleeding into the joint.

d.

minor loss of function.

ANS: D

The minor loss of function is the differentiating factor. Pain, swelling, and bleeding into the joint are true of both grade 2 and grade 3 sprains. A grade 3 sprain has loss of function of the joint.

DIF: Cognitive Level: Application REF: 734 OBJ: 1 (theory)

TOP: Sprains: Grade 2 KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

2. An older adult has fallen and sprained his ankle in a local park. The correct initial management of the injury will include which action?

a.

Elevating the foot to reduce swelling

b.

Applying ice to delay swelling

c.

Administering aspirin to combat pain

d.

Having the person ambulate to test for ability to bear weight

ANS: A

Elevation is the initial intervention as it can be done immediately. Applying ice and medicating for pain will follow quickly.

DIF: Cognitive Level: Comprehension REF: 734 OBJ: 1 (theory)

TOP: Sprain: First Aid KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

3. When the clinic nurse starts to take the air cast off the grade 2 sprain, the patient asks why it is being removed as he still has pain. The nurse explains that the cast is removed because:

a.

the cast will interfere with adequate circulation.

b.

the cast will increase the edema.

c.

long-term immobilization can cause permanent disability.

d.

another heavier cast will be applied.

ANS: C

Lengthy immobilization can lead to permanent disability. Casts and splints are left on only until the joint is strengthened.

DIF: Cognitive Level: Comprehension REF: 734 OBJ: 1 (theory)

TOP: Splinted Sprain: Complications KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

4. The nurse recognizes a need for further instruction about application of ice to a sprain when the patient says:

a.

I know this ice will reduce the swelling.

b.

I will keep the ice on this knee for the rest of the day.

c.

I will use the ice as you have directed for 24 hours.

d.

I can elevate my leg and use ice to reduce swelling.

ANS: B

Ice should be applied for 20 minutes of each hour for the first 24 hours.

DIF: Cognitive Level: Application REF: 734 OBJ: 1 (theory)

TOP: Ice: Duration of Application KEY: Nursing Process Step: Evaluation

MSC: NCLEX: Health Promotion and Maintenance

5. The industrial nurse examines an employee who states that his right shoulder hurts when he abducts it and points with one finger to the spot at the point of his shoulder that is painful. He mentions that he won a racquetball tournament yesterday. The nurse suspects the employee is suffering from:

a.

rotator cuff tear.

b.

bursitis.

c.

dislocation.

d.

subluxation.

ANS: B

Bursitis occurs after overuse, with pain in the joint on activity with no erythema and little, if any, swelling. Dislocations are very painful and the pain is spread all over the shoulder. The shoulder also looks misshapen in a dislocation. Rotator cuff tear would prevent the patient from abducting his shoulder.

DIF: Cognitive Level: Analysis REF: 736 OBJ: 1 (theory)

TOP: Bursitis: Signs and Symptoms KEY: Nursing Process Step: Assessment

MSC: NCLEX: Health Promotion and Maintenance

6. The patient, who is a legal secretary, asks the nurse how she can avoid developing carpal tunnel syndrome. The nurse suggests:

a.

exercising the wrist with repetitive flexion movements.

b.

wrapping the wrists with elastic bandages.

c.

acquiring a pad to support wrists while typing.

d.

applying warm compresses to wrists every evening.

ANS: C

Elevating the wrist with a firm support eliminates the need to keep the wrists flexed for long periods of time. This wrist support will help prevent carpal tunnel syndrome.

DIF: Cognitive Level: Application REF: 736 OBJ: 1 (theory)

TOP: Carpal Tunnel Syndrome: Prevention

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

7. The nurse explains that carpal tunnel syndrome is caused when the carpal tunnel compresses the:

a.

radial artery.

b.

brachial artery.

c.

median nerve.

d.

ulnar nerve.

ANS: C

When the median nerve is compressed by the carpal tunnel to the point that numbness, pain, and tingling occur, the result is carpal tunnel syndrome.

DIF: Cognitive Level: Knowledge REF: 736 OBJ: 1 (theory)

TOP: Carpal Tunnel Syndrome: Pathophysiology

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

8. The patient with mild discomfort from carpal tunnel syndrome delightedly reports amazing relief from taking a daily dose of vitamin:

a.

A.

b.

B6.

c.

B12.

d.

C.

ANS: B

Vitamin B6 has been found helpful in relieving the pain of carpal tunnel syndrome.

DIF: Cognitive Level: Knowledge REF: 736 OBJ: 1 (theory)

TOP: Carpal Tunnel Syndrome: Alternate Remedy

KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance

9. The assessment made by the nurse caring for a patient just returned from surgery following a surgical decompression of the carpal tunnel that would require immediate remedy is:

a.

fingers swollen and warm.

b.

complaint of pain.

c.

capillary refill of 8 seconds.

d.

fingers rosy.

ANS: C

A capillary refill of over 5 seconds is an indication of diminished perfusion. Pain and swelling are to be expected.

DIF: Cognitive Level: Application REF: 736 OBJ: 1 (theory)

TOP: Nerve Decompression: Aftercare KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

10. An 80-year-old man falls and suffers a compound fracture of the femur. The most appropriate immediate action is to:

a.

help position him flat on his back.

b.

place a tourniquet on the leg.

c.

splint the leg as it is.

d.

carefully straighten the leg.

ANS: C

Any fracture, even a compound one, should be immobilized in position to avoid further injury to the soft tissue attached to the bones. Any other initial action may cause further injury.

DIF: Cognitive Level: Application REF: 737 OBJ: 2 (theory)

TOP: Fracture: First Aid Splinting KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

11. The nurse explains that the major advantage of the external fixation device is that the patient:

a.

will heal more quickly.

b.

can bear weight right away.

c.

has greater freedom of movement.

d.

experiences less pain.

ANS: C

The external device for fracture reduction allows greater freedom of movement, decreasing the problems of immobility. Healing time and pain are the same as with any other fracture reduction method.

DIF: Cognitive Level: Comprehension REF: 738 OBJ: 3 (theory)

TOP: External Fixation Device: Advantages

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

12. The patient in a long arm cast (from below the shoulder to the wrist, with a 90-degree elbow flexion) complains of a burning sensation over the elbow. The nurses initial intervention should be:

a.

elevate the casted arm on pillows.

b.

check to see if the cast is properly supported.

c.

notify the charge nurse of developing pressure ulcer.

d.

cut a window in the cast.

ANS: B

The initial intervention should be to assess for adequate support to the cast, then elevate the limb for 30 minutes. If the pain has not diminished, document the intervention and notify the charge nurse.

DIF: Cognitive Level: Analysis REF: 739 OBJ: 2 (clinical)

TOP: Cast Care: Pain KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

13. The nurse is performing an assessment on the patient who is in bilateral Bucks traction. Which finding indicates the need to reposition the patient?

a.

Heels are not touching the surface of the mattress.

b.

Elastic bandages need to be rewrapped.

c.

Patients feet are against the footboard.

d.

Weights are hanging free.

ANS: C

When the patients feet are against the footboard, the traction is ineffective. The heels should be off the surface of the mattress to reduce the threat of pressure ulcer. The weights should be hanging free.

DIF: Cognitive Level: Application REF: 740 OBJ: 5 (theory)

TOP: Bucks Traction KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

14. A patient in Russells traction with a Pearson attachment for a fracture of the tibia complains of intense pain at the fracture site. The nurse assesses a temperature of 102 F and increased swelling at the fracture site. These assessment findings suggest:

a.

osteomyelitis.

b.

fat embolism.

c.

traction misalignment.

d.

nonunion of the fracture.

ANS: A

Osteomyelitis is a bacterial infection of the bone. The causative organism is most often Staphylococcus aureus, which enters the bloodstream from a distant focus of infection, such as a boil or furuncle, or from an open wound, as in an open (compound) fracture. It is usually found in the tibia or fibula, in vertebrae, or at the site of a prosthesis. Osteomyelitis has a sudden onset with severe pain and marked tenderness at the site, high fever with chills, swelling of adjacent soft parts, headache, and malaise.

DIF: Cognitive Level: Application REF: 741 OBJ: 5 (theory)

TOP: Osteomyelitis: Complications KEY: Nursing Process Step: Assessment

MSC: NCLEX: Health Promotion and Maintenance

15. While the nurse is giving morning care to a patient who sustained a fractured pelvis and bilateral fractures of the femur in a motorcycle accident yesterday, the patient complains of shortness of breath and is audibly wheezing. An assessment of the oxygen saturation reveals 76%. The initial intervention by the nurse should be to:

a.

alert the code team.

b.

inform the charge nurse.

c.

give oxygen at 4 to 5 L/min.

d.

raise patient to high Fowlers position.

ANS: D

Raising the patient to high Fowlers position is the best initial intervention as it can be done immediately. There is no need to notify the code team, and 5 L/min of oxygen is too much. Informing the charge nurse and giving oxygen at 2 to 3 L/min can be done when the patient has been made more comfortable.

DIF: Cognitive Level: Application REF: 741 OBJ: 2 (clinical)

TOP: Fracture Complication: Fat Embolus

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

16. The nurse instructing a patient with rheumatic arthritis about the prescribed exercise program includes that the exercises should be:

a.

done every day 3 to 10 times for every joint.

b.

done even if inflammation is present.

c.

continued past the point of pain.

d.

doubled the next day if one day is missed.

ANS: A

Exercises are essential to preserve joint function and should be done every day 3 to 10 times per joint. Exercises should be omitted if there is inflammation present and should not be taken past the point of pain, or made up the next day.

DIF: Cognitive Level: Comprehension REF: 753 OBJ: 9 (theory)

TOP: Rheumatoid Arthritis: Exercises KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

17. A patient with osteoporosis calls the nurse in the doctors office to report that she has forgotten to take her weekly bisphosphonate (alendronate [Fosamax]) for 2 days past the weekly time. The nurse should advise the patient to:

a.

take the dose now with 8 ounces of water.

b.

take two doses 3 days apart.

c.

skip this week and pick up the schedule next week.

d.

take 2 tablets now with a snack.

ANS: C

If 2 or more days have passed since the regular dose time, this weeks dose should be skipped and the weekly schedule should be picked up next week.

DIF: Cognitive Level: Application REF: 756 OBJ: 8 (theory)

TOP: Osteoporosis: Treatment KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

18. When caring for a patient who has an abductor wedge in place following a total hip replacement, the nurse should assess for:

a.

muscle spasms.

b.

alteration in peripheral circulation.

c.

compression fracture.

d.

appropriateness of the size of the wedge.

ANS: B

Pressure from the abductor wedge can interrupt arterial blood supply and compress the peroneal nerve.

DIF: Cognitive Level: Application REF: 750 OBJ: 7 (theory)

TOP: Care of a Total Hip Replacement KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

MULTIPLE RESPONSE

19. A patient has come to the emergency department. A dislocation is suspected. An x-ray has been ordered. Before confirmation by x-ray, the dislocation diagnosis is supported by which manifestations? (Select all that apply.)

a.

History of forceful injury

b.

Purple-black hematoma over joint

c.

Severe pain, aggravated by motion

d.

Muscle spasm

e.

Abnormal appearance of joint

ANS: A, C, D, E

A dislocation will be evidenced by severe pain aggravated by motion, muscle spasm, and an abnormal-appearing joint after the history of a forceful injury. A hematoma, if it forms, will not be evident for a few hours.

DIF: Cognitive Level: Comprehension REF: 735 OBJ: 1 (theory)

TOP: Dislocation: Signs and Symptoms KEY: Nursing Process Step: Planning

MSC: NCLEX: Health Promotion and Maintenance

20. The nurse understands that all soft tissue injuries require the nurse to assist with or instruct about: (Select all that apply.)

a.

bed rest.

b.

pain control.

c.

immobilization.

d.

activity restrictions.

e.

prevention of recurrence.

ANS: B, C, D, E

All options listed are part of the care to a patient with a soft tissue injury except bed rest. Bed rest is not warranted with this type of injury.

DIF: Cognitive Level: Comprehension REF: 734-735 OBJ: 1 (theory)

TOP: Soft Tissue Injury: General Care KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

21. The nurse lists the advantages of fiberglass casts, which include that this type of cast: (Select all that apply.)

a.

is lighter.

b.

allows weight bearing in 30 minutes.

c.

is cheaper.

d.

dries quickly.

e.

is easily molded to body part.

f.

has a smooth surface that does not abrade skin.

ANS: A, B, D

Fiberglass casts are lighter and dry quickly, allowing weight bearing in as little as 30 minutes. Fiberglass casts are very expensive and do not lend themselves to molding to body parts. The surface is very rough and often abrades the skin.

DIF: Cognitive Level: Analysis REF: 739 OBJ: 3 (theory)

TOP: Fiberglass Casts: Advantages KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

22. The patient is returning to the unit with a wet long leg cast. To prevent damage to the wet cast, the nurse should: (Select all that apply.)

a.

determine the cast material.

b.

prop the casted limb on a footboard to elevate it until the cast is dry.

c.

support the cast with the palms of the hands rather than holding it with the fingers.

d.

assess heat generated from the drying cast.

e.

explain that the cast has dried when it acquires a grayish color.

ANS: A, C, D

Determining the cast material will inform the nurse of how quickly the cast can be expected to dry. The cast should be supported with the palms of the hands rather than holding it with the fingers. The heat of the drying cast should be evaluated to prevent skin irritation.

DIF: Cognitive Level: Application REF: 739 OBJ: 3 (theory)

TOP: Cast Care: Wet Cast KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

23. The nurse instructs a patient going home with a short arm synthetic cast to: (Select all that apply.)

a.

cover the cast with a plastic bag when taking a shower.

b.

blow warm air into the cast to relieve itching.

c.

observe skin at the edge of the cast for irritation or injury.

d.

check circulation and sensation in the fingers frequently.

e.

move and flex the fingers to stimulate circulation.

ANS: A, C, D, E

All options listed are important teaching points for cast care except blowing warm air into the cast. If itching occurs, cool air will be most helpful.

DIF: Cognitive Level: Comprehension REF: 739 OBJ: 1 (clinical)

TOP: Cast Care: Discharge Instruction KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

24. The probability of compartment syndrome in a patient with a side arm cast and traction is considered when the nurse assesses: (Select all that apply.)

a.

warm, rosy fingers.

b.

complaint of pain in hand and fingers.

c.

edema of fingers.

d.

weak radial pulse.

e.

tingling and numbness.

ANS: B, C, D, E

Warm, rosy fingers would be assessed as a sign of adequate perfusion.

DIF: Cognitive Level: Comprehension REF: 742 OBJ: 4 (theory)

TOP: Cast Complication: Compartment Syndrome

KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

COMPLETION

25. The nurse explains that the C in the acronym RICE for sprain treatment stands for _______.

ANS:

compression

RICE stands for Rest, Ice, Compression, and Elevation.

DIF: Cognitive Level: Knowledge REF: 734 OBJ: 1 (theory)

TOP: Sprain Treatment: Acronym KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

26. The nurse uses a visual aid to show the difference between a complete dislocation and a partial dislocation, which is also called a(n) __________.

ANS:

subluxation

A subluxation is a partial dislocation.

DIF: Cognitive Level: Comprehension REF: 735 OBJ: 1 (theory)

TOP: Subluxation: Definition KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

MATCHING

Match the fracture type to the description that characterizes it.

a.

Complete fracture

b.

Comminuted fracture

c.

Closed fracture

d.

Compound fracture

e.

Greenstick fracture

27. Bone is partially broken and partially bent

28. Fracture that has not broken through skin

29. Fracture bone end protruding through skin

30. Bone that is in two distinct pieces

31. Bone shattered in more than two pieces

27. ANS: E DIF: Cognitive Level: Knowledge REF: 737

OBJ: 2 (theory) TOP: Fractures: Types

KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance

28. ANS: C DIF: Cognitive Level: Knowledge REF: 737

OBJ: 2 (theory) TOP: Fractures: Types

KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance

29. ANS: D DIF: Cognitive Level: Knowledge REF: 737

OBJ: 2 (theory) TOP: Fractures: Types

KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance

30. ANS: A DIF: Cognitive Level: Knowledge REF: 737

OBJ: 2 (theory) TOP: Fractures: Types

KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance

31. ANS: B DIF: Cognitive Level: Knowledge REF: 737

OBJ: 2 (theory) TOP: Fractures: Types

KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance

Match the type of fracture stabilization with the characteristics that best describe it. (The options can be used once, more than once, or not at all.)

a.

Closed reduction

b.

Open reduction

c.

Internal fixation

d.

External fixation

32. Reduction of fracture through surgical incision

33. Metal appliances are used to stabilize pieces of fracture

34. Reduction of fracture and fixation to device that maintains alignment

35. Used with infected fractures that do not heal properly

36. Manual reduction and manipulation of bones into alignment

37. Used with older adults when brittle bones do not heal quickly

32. ANS: B DIF: Cognitive Level: Comprehension REF: 738

OBJ: 3 (theory) TOP: Fracture Reduction Methods: Characteristics

KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance

33. ANS: C DIF: Cognitive Level: Comprehension REF: 738

OBJ: 3 (theory) TOP: Fracture Reduction Methods: Characteristics

KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance

34. ANS: D DIF: Cognitive Level: Comprehension REF: 738

OBJ: 3 (theory) TOP: Fracture Reduction Methods: Characteristics

KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance

35. ANS: D DIF: Cognitive Level: Comprehension REF: 738

OBJ: 3 (theory) TOP: Fracture Reduction Methods: Characteristics

KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance

36. ANS: A DIF: Cognitive Level: Comprehension REF: 738

OBJ: 3 (theory) TOP: Fracture Reduction Methods: Characteristics

KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance

37. ANS: C DIF: Cognitive Level: Comprehension REF: 738

OBJ: 3 (theory) TOP: Fracture Reduction Methods: Characteristics

KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance

Place the steps of the process of fracture healing in proper order.

a.

Medullary canal is reconstructed.

b.

Mature bone cells form ossification.

c.

Callus is formed.

d.

Granulation tissue is formed.

e.

Hematoma is formed between broken ends of bone.

38. Step 1

39. Step 2

40. Step 3

41. Step 4

42. Step 5

38. ANS: E DIF: Cognitive Level: Analysis REF: 738

OBJ: 2 (theory) TOP: Fracture Healing: Process

KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance

39. ANS: D DIF: Cognitive Level: Analysis REF: 738

OBJ: 2 (theory) TOP: Fracture Healing: Process

KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance

40. ANS: C DIF: Cognitive Level: Analysis REF: 738

OBJ: 2 (theory) TOP: Fracture Healing: Process

KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance

41. ANS: B DIF: Cognitive Level: Analysis REF: 738

OBJ: 2 (theory) TOP: Fracture Healing: Process

KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance

42. ANS: A DIF: Cognitive Level: Analysis REF: 738

OBJ: 2 (theory) TOP: Fracture Healing: Process

KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance

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