Chapter 40 Musculoskeletal Care Modalities :A Guide to Common Questions and
Answers
A 91-year-old patient is slated for orthopedic surgery and the nurse is integrated gerontologic considerations
into the patients plan of care. What intervention is most justified in the care of this patient?
A) Administration of prophylactic antibiotics
B) Total parenteral nutrition (TPN)
C) Use of a pressure-relieving mattress
D) Use of a Foley catheter until discharge - ansC) Use of a pressure-relieving mattress
Older adults have a heightened risk of skin breakdown; use of a pressure-reducing mattress addresses this risk.
Older adults do not necessarily need TPN and the Foley catheter should be discontinued as soon as possible to
prevent urinary tract infections. Prophylactic antibiotics are not a standard infection prevention measure.
A nurse is admitting a patient to the unit who presented with a lower extremity fracture. What signs and
symptoms would suggest to the nurse that the patient may have a peroneal nerve injury?
A) Numbness and burning of the foot
B) Pallor to the dorsal surface of the foot
C) Visible cyanosis in the toes D) Inadequate capillary refill to the toes - ansA) Numbness and burning of the
foot
Peroneal nerve injury may result in numbness, tingling, and burning in the feet. Cyanosis, pallor, and decreased
capillary refill are signs of inadequate circulation.
A nurse is assessing a patient who is receiving traction. The nurses assessment confirms that the patient is able
to perform plantar flexion. What conclusion can the nurse draw from this finding?
A) The leg that was assessed is free from DVT.
B) The patients tibial nerve is functional.
C) Circulation to the distal extremity is adequate.
D) The patient does not have peripheral neurovascular dysfunction. - ansB) The patients tibial nerve is
functional.
,Plantar flexion demonstrates function of the tibial nerve. It does not demonstrate the absence of DVT and does
not allow the nurse to ascertain adequate circulation. The nurse must perform more assessments on more sites
in order to determine an absence of peripheral neurovascular dysfunction.
A nurse is assessing the neurovascular status of a patient who has had a leg cast recently applied. The nurse is
unable to palpate the patients dorsalis pedis or posterior tibial pulse and the patients foot is pale. What is the
nurses most appropriate action?
A) Warm the patients foot and determine whether circulation improves.
B) Reposition the patient with the affected foot dependent.
C) Reassess the patients neurovascular status in 15 minutes.
D) Promptly inform the primary care provider. - ansD) Promptly inform the primary care provider.
Signs of neurovascular dysfunction warrant immediate medical follow-up. It would be unsafe to delay.
Warming the foot or repositioning the patient may be of some benefit, but the care provider should be
informed first.
A nurse is caring for a patient in skeletal traction. In order to prevent bony fragments from moving against one
another, the nurse should caution the patient against which of the following actions?
A) Shifting ones weight in bed
B) Bearing down while having a bowel movement
C) Turning from side to side
D) Coughing without splinting - ansC) Turning from side to side
To prevent bony fragments from moving against one another, the patient should not turn from side to side;
however, the patient may shift position slightly with assistance. Bearing down and coughing do not pose a
threat to bone union.
A nurse is caring for a patient receiving skeletal traction. Due to the patients severe limits on mobility, the
nurse has identified a risk for atelectasis or pneumonia. What intervention should the nurse provide in order to
prevent these complications?
, A) Perform chest physiotherapy once per shift and as needed.
B) Teach the patient to perform deep breathing and coughing exercises.
C) Administer prophylactic antibiotics as ordered.
D) Administer nebulized bronchodilators and corticosteroids as ordered. - ansB) Teach the patient to perform
deep breathing and coughing exercises.
To prevent these complications, the nurse should educate the patient about performing deep-breathing and
coughing exercises to aid in fully expanding the lungs and clearing pulmonary secretions. Antibiotics,
bronchodilators, and steroids are not used on a preventative basis and chest physiotherapy is unnecessary and
implausible for a patient in traction.
A nurse is caring for a patient who has a leg cast. The nurse observes that the patient uses a pencil to scratch
the skin under the edge of the cast. How should the nurse respond to this observation?
A) Allow the patient to continue to scratch inside the cast with a pencil but encourage him to be cautious.
B) Give the patient a sterile tongue depressor to use for scratching instead of the pencil.
C) Encourage the patient to avoid scratching, and obtain an order for an antihistamine if severe itching persists.
D) Obtain an order for a sedative, such as lorazepam (Ativan), to prevent the patient from scratching. - ansC)
Encourage the patient to avoid scratching, and obtain an order for an antihistamine if severe itching persists.
Scratching should be discouraged because of the risk for skin breakdown or damage to the cast. Most patients
can be discouraged from scratching if given a mild antihistamine, such as diphenhydramine, to relieve itching.
Benzodiazepines would not be given for this purpose.
A nurse is caring for a patient who has had a plaster arm cast applied. Immediately postapplication, the nurse
should provide what teaching to the patient?
A) The cast will feel cool to touch for the first 30 minutes.
B) The cast should be wrapped snuggly with a towel until the patient gets home.
C) The cast should be supported on a board while drying.
D) The cast will only have full strength when dry. - ansD) The cast will only have full strength when dry.
Answers
A 91-year-old patient is slated for orthopedic surgery and the nurse is integrated gerontologic considerations
into the patients plan of care. What intervention is most justified in the care of this patient?
A) Administration of prophylactic antibiotics
B) Total parenteral nutrition (TPN)
C) Use of a pressure-relieving mattress
D) Use of a Foley catheter until discharge - ansC) Use of a pressure-relieving mattress
Older adults have a heightened risk of skin breakdown; use of a pressure-reducing mattress addresses this risk.
Older adults do not necessarily need TPN and the Foley catheter should be discontinued as soon as possible to
prevent urinary tract infections. Prophylactic antibiotics are not a standard infection prevention measure.
A nurse is admitting a patient to the unit who presented with a lower extremity fracture. What signs and
symptoms would suggest to the nurse that the patient may have a peroneal nerve injury?
A) Numbness and burning of the foot
B) Pallor to the dorsal surface of the foot
C) Visible cyanosis in the toes D) Inadequate capillary refill to the toes - ansA) Numbness and burning of the
foot
Peroneal nerve injury may result in numbness, tingling, and burning in the feet. Cyanosis, pallor, and decreased
capillary refill are signs of inadequate circulation.
A nurse is assessing a patient who is receiving traction. The nurses assessment confirms that the patient is able
to perform plantar flexion. What conclusion can the nurse draw from this finding?
A) The leg that was assessed is free from DVT.
B) The patients tibial nerve is functional.
C) Circulation to the distal extremity is adequate.
D) The patient does not have peripheral neurovascular dysfunction. - ansB) The patients tibial nerve is
functional.
,Plantar flexion demonstrates function of the tibial nerve. It does not demonstrate the absence of DVT and does
not allow the nurse to ascertain adequate circulation. The nurse must perform more assessments on more sites
in order to determine an absence of peripheral neurovascular dysfunction.
A nurse is assessing the neurovascular status of a patient who has had a leg cast recently applied. The nurse is
unable to palpate the patients dorsalis pedis or posterior tibial pulse and the patients foot is pale. What is the
nurses most appropriate action?
A) Warm the patients foot and determine whether circulation improves.
B) Reposition the patient with the affected foot dependent.
C) Reassess the patients neurovascular status in 15 minutes.
D) Promptly inform the primary care provider. - ansD) Promptly inform the primary care provider.
Signs of neurovascular dysfunction warrant immediate medical follow-up. It would be unsafe to delay.
Warming the foot or repositioning the patient may be of some benefit, but the care provider should be
informed first.
A nurse is caring for a patient in skeletal traction. In order to prevent bony fragments from moving against one
another, the nurse should caution the patient against which of the following actions?
A) Shifting ones weight in bed
B) Bearing down while having a bowel movement
C) Turning from side to side
D) Coughing without splinting - ansC) Turning from side to side
To prevent bony fragments from moving against one another, the patient should not turn from side to side;
however, the patient may shift position slightly with assistance. Bearing down and coughing do not pose a
threat to bone union.
A nurse is caring for a patient receiving skeletal traction. Due to the patients severe limits on mobility, the
nurse has identified a risk for atelectasis or pneumonia. What intervention should the nurse provide in order to
prevent these complications?
, A) Perform chest physiotherapy once per shift and as needed.
B) Teach the patient to perform deep breathing and coughing exercises.
C) Administer prophylactic antibiotics as ordered.
D) Administer nebulized bronchodilators and corticosteroids as ordered. - ansB) Teach the patient to perform
deep breathing and coughing exercises.
To prevent these complications, the nurse should educate the patient about performing deep-breathing and
coughing exercises to aid in fully expanding the lungs and clearing pulmonary secretions. Antibiotics,
bronchodilators, and steroids are not used on a preventative basis and chest physiotherapy is unnecessary and
implausible for a patient in traction.
A nurse is caring for a patient who has a leg cast. The nurse observes that the patient uses a pencil to scratch
the skin under the edge of the cast. How should the nurse respond to this observation?
A) Allow the patient to continue to scratch inside the cast with a pencil but encourage him to be cautious.
B) Give the patient a sterile tongue depressor to use for scratching instead of the pencil.
C) Encourage the patient to avoid scratching, and obtain an order for an antihistamine if severe itching persists.
D) Obtain an order for a sedative, such as lorazepam (Ativan), to prevent the patient from scratching. - ansC)
Encourage the patient to avoid scratching, and obtain an order for an antihistamine if severe itching persists.
Scratching should be discouraged because of the risk for skin breakdown or damage to the cast. Most patients
can be discouraged from scratching if given a mild antihistamine, such as diphenhydramine, to relieve itching.
Benzodiazepines would not be given for this purpose.
A nurse is caring for a patient who has had a plaster arm cast applied. Immediately postapplication, the nurse
should provide what teaching to the patient?
A) The cast will feel cool to touch for the first 30 minutes.
B) The cast should be wrapped snuggly with a towel until the patient gets home.
C) The cast should be supported on a board while drying.
D) The cast will only have full strength when dry. - ansD) The cast will only have full strength when dry.
