Chapter 46. Nursing Care of Patients With
Musculoskeletal and Connective Tissue
Disorders
A patient 48 hours after surgery for a fractured femoral shaft is experiencing mental confusion,
tachycardia, tachypnea, and dyspnea. The patients blood pressure is elevated and petechiae
are present on the chest. After reporting the findings to the RN what should the nurse do while
awaiting the physicians specific orders? (Select all that apply.)
a. Administer oxygen.
b. Prepare patient for arterial blood gas tests.
c. Prepare patient for chest x-ray or lung scan.
d. Maintain bedrest and keep movement to a minimum.
e. Ask patient to move affected limb to see if pain is worse.
f. Place patient in high Fowlers position or raise the head of the bed. - ANS: Administer oxygen.
Prepare patient for arterial blood gas tests.
Prepare patient for chest x-ray or lung scan.
Maintain bed rest and keep movement to a minimum.
Place patient in high Fowler's position or raise the head of the bed.
The patient is likely experiencing a fat emboli. The patient should be placed in a high Fowler's
position to aid breathing, diagnostic tests will be done, and the patient is kept on bed rest to
reduce oxygenation needs and clot movement. Oxygen may be started per agency policy to aid
in respiration. E. Limb should not be moved to prevent further release of fat.
A patient asks the difference between osteoarthritis and rheumatoid arthritis. What
manifestations should the nurse explain are characteristic of rheumatoid arthritis? (Select all
that apply.)
a. Low-grade fever
,b. Heberdens nodes
c. Autoimmune disease
d. Activity increases pain
e. Early morning stiffness
f. Involvement of other major organs - ANS:Low-grade fever
Autoimmune disease
Early morning stiffness
Involvement of other major organs
Rheumatoid arthritis is a systemic autoimmune disease with morning stiffness, low-grade fever,
and organ involvement. B. Heberdens nodes are seen in osteoarthritis. D. Pain increases with
activity in osteoarthritis.
A patient has an open reduction of a radial fracture and is casted. Several hours after the
operation, the patient reports a throbbing pain in the arm. What nursing action is essential for
the nurse to take?
a. Reposition arm.
b. Perform neurovascular checks.
c. Administer analgesics as ordered.
d. Notify the physician immediately. - ANS: Perform neurovascular checks.
The nurse should begin with data collection to determine what the next action to take. For this
patient the nurse should perform neurovascular checks. A. The arm might need to be positioned
however this should not be done until a neurovascular check is completed. C. Administering
pain medication might be indicted however should not be done until a pain assessment is
completed. D. The nurse needs to determine the patients neurovascular status before notifying
the physician.
A patient in the ambulatory clinic is diagnosed with a muscle strain. What actions should the
nurse instruct the patient to do to treat this injury? (Select all that apply.)
, a. Rest the limb.
b. Elevate the limb.
c. Apply heat for 1 hour.
d. Apply ice to the area.
e. Wrap with an elastic bandage. - ANS: Rest the limb.
Elevate the limb.
Apply ice to the area.
Wrap with an elastic bandage.
RICE is an acronym for rest, ice, compression, and elevation which is the therapy for strain
injuries. Immediately after a strain, the injured area should be rested to protect it. Ice should be
applied to decrease pain, swelling, and inflammation. Applying an elastic bandage for
compression and elevating the affected area provide support and minimize swelling. C. After
inflammation subsides, heat application (15 to 30 minutes four times a day) brings increased
blood flow to the injured area for healing. Heat should not be immediately applied for 1 hour.
A patient is completing instructions about complications that can occur from osteoporosis.
Which complication should the patient state as evidence that teaching has been effective?
a. Hip fracture.
b. Overgrowth of bone.
c. Bone spur formation.
d. Increased bone density. - ANS: Hip fracture.
Osteoporotic bone may cause a pathological fracture in which the hip breaks before the fall. For
other patients, a fall can cause a hip or other fracture. B. C. D. Bone overgrowth, spurs, or
increases in bone density are not complications of osteoporosis.
A patient is diagnosed with osteomyelitis of the right lower leg. What should the nurse expect to
be prescribed for this patients care?
Musculoskeletal and Connective Tissue
Disorders
A patient 48 hours after surgery for a fractured femoral shaft is experiencing mental confusion,
tachycardia, tachypnea, and dyspnea. The patients blood pressure is elevated and petechiae
are present on the chest. After reporting the findings to the RN what should the nurse do while
awaiting the physicians specific orders? (Select all that apply.)
a. Administer oxygen.
b. Prepare patient for arterial blood gas tests.
c. Prepare patient for chest x-ray or lung scan.
d. Maintain bedrest and keep movement to a minimum.
e. Ask patient to move affected limb to see if pain is worse.
f. Place patient in high Fowlers position or raise the head of the bed. - ANS: Administer oxygen.
Prepare patient for arterial blood gas tests.
Prepare patient for chest x-ray or lung scan.
Maintain bed rest and keep movement to a minimum.
Place patient in high Fowler's position or raise the head of the bed.
The patient is likely experiencing a fat emboli. The patient should be placed in a high Fowler's
position to aid breathing, diagnostic tests will be done, and the patient is kept on bed rest to
reduce oxygenation needs and clot movement. Oxygen may be started per agency policy to aid
in respiration. E. Limb should not be moved to prevent further release of fat.
A patient asks the difference between osteoarthritis and rheumatoid arthritis. What
manifestations should the nurse explain are characteristic of rheumatoid arthritis? (Select all
that apply.)
a. Low-grade fever
,b. Heberdens nodes
c. Autoimmune disease
d. Activity increases pain
e. Early morning stiffness
f. Involvement of other major organs - ANS:Low-grade fever
Autoimmune disease
Early morning stiffness
Involvement of other major organs
Rheumatoid arthritis is a systemic autoimmune disease with morning stiffness, low-grade fever,
and organ involvement. B. Heberdens nodes are seen in osteoarthritis. D. Pain increases with
activity in osteoarthritis.
A patient has an open reduction of a radial fracture and is casted. Several hours after the
operation, the patient reports a throbbing pain in the arm. What nursing action is essential for
the nurse to take?
a. Reposition arm.
b. Perform neurovascular checks.
c. Administer analgesics as ordered.
d. Notify the physician immediately. - ANS: Perform neurovascular checks.
The nurse should begin with data collection to determine what the next action to take. For this
patient the nurse should perform neurovascular checks. A. The arm might need to be positioned
however this should not be done until a neurovascular check is completed. C. Administering
pain medication might be indicted however should not be done until a pain assessment is
completed. D. The nurse needs to determine the patients neurovascular status before notifying
the physician.
A patient in the ambulatory clinic is diagnosed with a muscle strain. What actions should the
nurse instruct the patient to do to treat this injury? (Select all that apply.)
, a. Rest the limb.
b. Elevate the limb.
c. Apply heat for 1 hour.
d. Apply ice to the area.
e. Wrap with an elastic bandage. - ANS: Rest the limb.
Elevate the limb.
Apply ice to the area.
Wrap with an elastic bandage.
RICE is an acronym for rest, ice, compression, and elevation which is the therapy for strain
injuries. Immediately after a strain, the injured area should be rested to protect it. Ice should be
applied to decrease pain, swelling, and inflammation. Applying an elastic bandage for
compression and elevating the affected area provide support and minimize swelling. C. After
inflammation subsides, heat application (15 to 30 minutes four times a day) brings increased
blood flow to the injured area for healing. Heat should not be immediately applied for 1 hour.
A patient is completing instructions about complications that can occur from osteoporosis.
Which complication should the patient state as evidence that teaching has been effective?
a. Hip fracture.
b. Overgrowth of bone.
c. Bone spur formation.
d. Increased bone density. - ANS: Hip fracture.
Osteoporotic bone may cause a pathological fracture in which the hip breaks before the fall. For
other patients, a fall can cause a hip or other fracture. B. C. D. Bone overgrowth, spurs, or
increases in bone density are not complications of osteoporosis.
A patient is diagnosed with osteomyelitis of the right lower leg. What should the nurse expect to
be prescribed for this patients care?
