Muscoluskeletal Answers key

1. B. Systemic lupus erythematosus ( SLE) is characterized by alternating periods of remissions and exarcerbations. Normal symptoms of SLE include microscopic hematuria, that the patient would not see. Therefore, if the patient reports hematuria, it should be considered a serious complication

2. B. People with seasonal affective disorder report a craving for, and increased consumption of, carbohydrates, weight gain, fatigue and irritability during the winter months. A reversal of these symptoms occurs in the spring and summer, with elation, increased social activity, decreased appetite and weight loss occurring

3. D. The axilla should not rest on the crutches. Such pressure may cause discomfort and nerve damage. The weight of the body should be borne by the hands. The girl needs further instruction in this area

4. D. Diazepam ( Valium) is prescribed for a patient with low back pain to decrease muscle spasms

5. A. A patient with a spinal cord transection has no movement or feeling below the level of the injury

6. D. Capillary refill greater than two seconds indicates vascular compromise or pressure from the immobilizing device

7. B. Protamine sulfate is the antidote for heparin toxicity and overdose

8. C. Massaging the patient’s back and buttocks frequently promotes skin integrity and should be included in the care of a patient in traction

9. D. Bowel retraining is established by providing a consistent time for evacuation each day

10. D. Tapazole is used to decrease iodine use and inhibit the synthesis of thyroid hormones. Therefore, metabolic activity will be decreased if the treatment is effective

11. A. Multiple diapers can be sued prior to surgery to effectively separate the child’s legs and hold the legs in an abducted, externally rotated position

12. A. Alteration in skin integrity is the priority nursing diagnosis. Skin excoriation can occur if the leather and plastic pads of the brace touch the child’s skin. The brace can be worn over a tee shirt

13. A. Nutritional counseling for weight reduction may be necessary to eliminate excessive strain on the joints of a patient with osteoarthritis.

14. C. This statement indicates a need for further teaching. The child should have sensation while the cast is in place. Observation such as pain, swelling, discoloration of the exposed portions, lack of pulsation and warmth and the inability to move the exposed part are reported immediately

15. B. Restraints encircle the limbs, placing the patient at risk for circulation being restricted to the distal areas of the extremities. Checking the patients circulation every 15-30 minutes will allow the nurse to adjust the restraints before injury form decreased blood flow occurs. The nurse must document the time of the check and the degree of capillary refill

16. A. The long term goal is to have the patient return to full function in approximately three months

17. B. Because dislocation of a total hip prosthesis is a possible complication of the surgery, the patient’s legs are to be kept away from the middle of the body, or abducted. To ensure that abduction is maintained and the prosthesis does not dislocate, the patient is instructed to keep an abduction pillow between the legs

18. D. The patient should be assisted into the prone position every three to four hours for 20 to 30-minute periods, This is necessary to prevent hip flexion contractures

19. B. Thrombophlebitis is the formation of a clot with inflammation of a vein. Clinical manifestation s are tenderness, redness and warmth. Edema may oir may not occur

20. B. Patients in traction should be assessed for nerve and circulatory disturbances. To check for capillary filling times, the patient’s nail beds are compressed to produce blanching and assessed for return of color

21. A. Following a hip replacement, the patient’s affected hip should be placed in extension, with an abduction wedge between his legs

22. D. Scoliosis is a complex spinal deformity that includes curvature of the spine. It can be congenital but more commonly develops during the growth spurt of early adolescence. To maintain proper body alignment after surgery, the patient should avoid twisting movements that can cause indwelling instruments to twist the spine. Log-rolling is preferred when moving the child.

23. A. Following a lumbar laminectomy, the patient should wear anti-embolism stockings or another anti-embolism device to prevent deep vein thrombosis

24. A. A long-term goal for a 30-year-old man who is unable to return to construction work would be to develop alternate vocational skills

25. The formula for this calculation is as follows

Desired amount x volume = dose

Available amount

75 mcg x 10 ml = dose

x 750 = dose

200

3.75 ml = dose

Muscoluskeletal Questions

Muscoluskeletal

1. A patient reports all of the following symptoms. Which of these symptoms would indicate to the nurse a serious complication of systemic lupus erythematosus?

a. Fatigue c. Joint pain

b. Hematuria d. Oral ulcers

2. Which of the following disorders would a nurse expect to identify when assessing a patient who us experiencing afternoon slumps, carbohydrate craving and weight gain during the fall and winter months that disappear in spring and summer?

a. Major depressive disorder c. Dysthymic disorder

b. Seasonal affective disorder d. Bipolar Disorder

3. A 12-year-old girl has a long leg cast applied to her left leg. She is being instructed in crutch-walking with no weight bearing on her left leg. Which of the following observations indicates that the girl needs further teaching?

a. She is using the three-point gait

b. Her elbows are slightly flexed

c. She places the crutches approximately six to eight inches (15 to 20 cm) in front of her with each step

d. She is supporting her weight on the axillary bars and hand pieces of the crutches

4. Diazepam ( Valium) is prescribed for a patient with low back pain. The desired therapeutic action of valium in this situation is to

a. reduce anxiety levels

b. eliminate pain sensation

c. suppress the inflammatory process

d. lessen muscle spasticity

5. A patient who has a spinal cord transection is in spinal shock. On assessment, the nurse would expect the patient to describe which of the following findings ion the lower extremities?

a. Loss of sensation c. Excessive diaphoresis

b. Complaints of tingling d. Constant tremors

6. A six-year-old child has a short arm cast placed on the right extremity. While assessing the fingers during immediate period after casting, a nurse would report which of the following finding?

a. Mild enema

b. Pain on movement

c. Slight coolness of the cast when touched

d. Capillary refill greater than three seconds

7. Which of the following medications would a nurse have available when administering an injection of heparin sodium to a patient?

a. Naloxone hydrochloride (narcan)

b. Protamine sulfate

c. Phytonadione ( aquaMEPHYTON)

d. Phentolamine mesylate ( Regitine)

8. To promote the skin integrity of a patient who is in Russell’s traction, which of the following measures should be included in the care plan?

a. Having the patient lie on the right side for 20 minutes every two to three hours

b. Placing pillows under the patient’s sacral and scapular areas

c. Massaging the patient’s back and buttocks frequently

d. Applying an antiseptic solution to the patient’s bony prominences after bathing

9. The bowel retraining program for a patient who has had cerebrovascular accident should include which of the following measures?

a. Checking for impaction daily

b. Increasing the intake of milk products

c. Utilizing incontinent pads until control is achieved

d. Establishing a consistent time for elimination

10. A patient who has hyperthyroidism is taking methimazole (Tapazole) and attends the clinic regularly. To evaluate the effectiveness of Tapazole therapy, the nurse should consider which of the following questions?

a. Has the patient’s vision improved?

b. Has the patient’s appetite improved?

c. Has the patient’s need for sleep decreased?

d. Has the patient’s pulse rate decreased?

11. Prior to surgery for correction of congenital hip dysplasia in four-month-old infant, which of the following home care instructions would a nurse include in the teaching plan for the infant’s family?

a. “ Apply double diapers when changing the infant.”

b. “ Perform passive range-of-motion on the lower extremities.”

c. “ Support the legs in an adducted position with pillows during sleep.”

d. “ Avoid placing the infant in upright position.”

12. A 12-year-old child who has been diagnosed with scoliosis is to be treated with a Milwaukee brace. To which of the following nursing diagnoses would a nurse give priority?

a. Skin integrity c. Impaired gas exchange

b. Self-care deficit d. Sleep pattern disturbance

13. Which of the following guidelines should a nurse include in the teaching plan for a patient who has Osteoarthritis?

a. Achieve ideal body weight

b. Increase daily calcium intake to 1500 mg

c. Maintain a high-fiber diet

d. Sleep at least 10 hours each day

14. A six-year-old child who sustained a fracture has a long leg cast applied to the left leg. Which of the following statements, if made by a parent, would indicate the need for further teaching?

a. “ I will call the clinic if my child complains of sudden pain on his foot.”

b. “ I will check the skin temperature of my child’s toes at least once a day.”

c. “ I should not expect my child to have sensation in the toes while the cast is on.”

d. “ I should not let my child put anything inside the cast to relieve itching.”

15. A nurse places a patient in four-point restraints following orders from a physician. Which of the following measures should the nurse in the patient’s care of plan?

a. Socialize with other patients once a shift

b. Check circulation periodically

c. Provide stimulating diversional activities

d. Assess rectal temperature frequently

16. A nurse conducts discharge teaching with a patient who is in cervical traction with a halo apparatus. Which of the following statements indicates that the patient needs further instructions?

a. “ I will need to wear the halo for several months.”

b. “ I should remove the halo when I shower.”

c. “ I plan to take a walk every day.”

d. “ I will continue my previous diet.”

17. A patient who has had a right hip replacement should be instructed to carry out which of the following techniques when turning in bed?

a. Bring both knees to the chest before turning

b. Keep an abductor wedge between the legs

c. Maintain flexion of the affected hip

d. Move the affected leg with the unaffected foot

18. Which of the following nursing measures is appropriate when caring for a patient who has undergone a right, above-the-knee amputation?

a. Ambulating the patient in the hallway with crutches

b. Placing the patient in a chair during waking hours

c. Keeping the patient’s stump elevated on a pillow

d. Encouraging the patient to lie prone in bed

19. If a patient were to develop thrombophlebitis at an intravenous infusion site, which of the following early findings should the nurse expect to observe?

a. Pallor and swelling

b. Erythema and heat

c. Mottling and coolness

d. Leakage of fluid and numbness

20. Which of the following measures should be included in the care plan of a patient whose left leg is in traction?

a. Checking the feet for the presence of ankle clonus

b. Noting the color of the toenails after applying temporary pressure

c. Assessing the femoral arteries for equality of pulses

d. Precussing the knee for a patellar reflex

21. Following a hip replacement, the patient should have the affected hip placed in which of these positions?

a. Extended, with a wedge between the legs

b. Flexed, with the knee supported on sandbags

c. Elevated, with pillows under the leg from the knee to the ankle

d. Rotated externally, with a trochanter roll in place

22. A 15-year old boy has undergone a spinal instrumentation at the level of T4 to T5 for scoliosis. Because there is an order to maintain strict bed rest, a nurse should use which of the following techniques when repositioning the boy?

a. Assist the patient in pulling himself up with the overhead trapeze bar

b. Turn the patient’s head to one side, then have him reach for the rail to turn

c. Place the bed in Trendelenburg position, then have the boy roll to one side

d. Use an assistant and logroll the patient to the desired side

23. A nurse would assess a patient who has undergone a lumbar laminectomy for which of the following post-surgical complications?

a. Deep vein thrombosis c. Intemittent claudification

b. Urinary frequency d. Flank pain

24. A physician tells a 30-year-old man who had an above the knee amputation that he will not be able to return to his construction work. Which of the following long-term goals would be an appropriate expectation of the man?

a. He will develop alternative vocational skills

b. He will acknowledge his loss

c. He will identify his areas of interest

d. He will engage in occupational therapy

25. A patient with hypothyroidism is to receive levothyroxine sodium ( Synthroid), 75 mcg by IV push. The medication available is labeled 200 ,cg/10ml. Which of the following doses is the correct amount?

a. 5.0 ml b. 3.75ml c. 4.75ml d. 2.5 ml