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