Chapter 27. Musculoskeletal Care
Multiple Choice
Identify the choice that best completes the statement or answers the question.
1. A 15-year-old football player is diagnosed with a bad sprain. A nurse recognizes that the injury involves
1. Torn ligaments.
2. A fine crack in the anklebone.
3. Injury to a long bone.
4. Damage to cartilage tissue.
2. The potential need for amputation will most likely be discussed as part of the medical and surgical care for
1. A 27-year-old with a comminuted fracture of the left femur from a car accident.
2. A 64-year-old with gangrene of the left foot due to decreased circulation.
3. A 71-year-old with arthritis in both knees.
4. A 54-year-old with a newly developed diabetic foot ulcer.
3. A nurse is providing care for a patient with an Ilizarov frame. The nurse would chart:
1. “Rod, wires, and screw ring intact without evidence of redness or drainage.”
2. “Pedaling performed to outer cast edge.”
3. “Weight suspended at 90 degrees.”
4. “Patient using abduction pillow as instructed.”
4. A motor vehicle accident resulting in a comminuted fracture of the right fibula has left a patient’s right
leg shorter than the left. A nurse identifies that bone lengthening can be stimulated by using
1. Plaster casting.
2. Skin traction.
3. An Ilizarov frame.
4. Internal fixators.
5. A nurse caring for patients on an orthopedic unit should be most concerned by
1. A patient reporting pain at a 2 on a 0 to 10 scale.
2. A patient reporting itching under a plaster cast.
3. Redness and purulent drainage at an external pin site.
4. A patient with a hip replacement ambulating with assistance.
6. While providing care for a patient with skeletal traction to the right leg, a nurse would report which of the
following observations to the physician?
1. The patient turns toward the right to answer the phone.
2. Traction weights hang freely.
3. Traction ropes are not crossing.
4. Purulent drainage is noted at the pin site.
7. A patient with a plaster cast tells the nurse, “This thing itches like crazy, and it is making me nuts.” The
best response by the nurse is:
1. “The cast itches because air is trapped between the cast and your skin.”
2. “Try to ignore that. The cast will be off in a few weeks.”
3. “Sometimes using a hair dryer on the cool setting to blow air down the cast can
relieve itching.”
4. “Itching is a sign of infection. Let me take your temperature.”
, 8. While checking on students who are caring for patients on an orthopedic unit, a nursing instructor would be
most concerned if
1. A student assists a patient with a left hip replacement turn to the left side.
2. A student caring for a patient with a right knee replacement assists with continuous
passive motion (CPM).
3. A student is noted inserting an abduction pillow between the legs of a patient with right hip
replacement.
4. A student uses sterile technique to provide site care to tongs for a patient with
cervical traction.
9. A nurse is assisting in the discharge of a patient who had a right hip replacement. Additional teaching
is necessary if the patient states:
1. “I will need an extender to pick things up from the floor.”
2. “I should keep a wide stance when I walk with my walker.”
3. “I will have to bend way over to tie my shoes.”
4. “I have to keep this special pillow between my legs when I’m sleeping.”
10. A student nurse approaches and asks a nurse to check and make sure the continuous passive motion (CPM)
machine is correct before it is turned on. The most important action by the nurse is to
1. Verify that the sheepskin does not have any folds.
2. Stand at the foot of the bed to inspect the alignment.
3. Check to see whether the CPM machine is plugged in.
4. Ask the patient to rank his or her current level of pain.
11. While caring for a patient who is on a continuous passive motion machine (CPM) after a total knee
replacement, a nurse notices that the patient is grimacing. Pain medication is not due for 2 hours, but the
CPM machine is supposed to continue for another 20 minutes. The best action by the nurse is to
1. Call the physician for additional pain medication.
2. Encourage the patient to bear it for 20 minutes longer.
3. Instruct the patient to tense and then relax his or her leg muscles.
4. Teach the patient relaxation techniques.
12. As a nurse enters the room of a patient who has had an amputation, the nurse notes that the patient is crying.
The best response by the nurse is to
1. Say, “I’m here if you’d like to talk,” while standing close to the patient’s bed.
2. Say, “I’ll leave you alone for a little while,” while leaving the room.
3. Ask, “Is there someone you’d like me to call?” while picking up the phone.
4. Say, “Everyone feels this way at first, but it will get easier,” while patting the
patient’s shoulder.
13. New crutches are the correct size if
1. The top of the crutch is 4 inches above the elbow.
2. The patient’s arms are at 90 degrees when holding the handles.
3. The crutch tips are resting against the outer aspect of the patient’s shoes.
4. Three fingers fit between the axilla and the axillary pad of each crutch.
14. Which of the following patients could successfully use a cane?
1. A 59-year-old with a left below-the-knee amputation
2. A 47-year-old with orders for non-weight-bearing on the left
3. A 69-year-old recovering from a stroke with mild right-sided weakness
4. A 70-year-old who cannot bear full weight on both legs
, 15. A nursing instructor recognizes that teaching has been effective if a student who is providing care for a patient
with right-sided weakness reports:
1. “The top of the cane is level with the iliac crest.”
2. “The patient is holding the cane in the right hand.”
3. “The top of the cane is even with the patient’s hip joint.”
4. “The base of the cane is even with the tip of the patient’s shoe.”
16. A student nurse is providing care for a patient who is returning from the recovery room after a total hip
replacement. During an initial assessment, the student notes serosanguineous drainage on the dressing.
The student should
1. Remove the dressing and assess the wound site.
2. Draw a line around the drainage and write the time, date, and his or her initials on the
dressing.
3. Notify the nursing instructor of the finding.
4. Document the finding in the chart.
17. Which of the following assessments would be most concerning to a nurse caring for a patient who was
recently admitted to the unit after a right knee replacement?
1. Pedal pulses on the operative side are weak compared with those on the nonoperative side.
2. A small amount of serosanguineous drainage is noted on the dressing.
3. The intravenous pump is infusing normal saline at 100 mL/hr.
4. The patient has a Foley catheter that is draining clear yellow urine.
18. A nursing instructor is evaluating elastic bandages applied to the ankle in a skills laboratory. The nursing
instructor recognizes that additional teaching is needed because
1. The wrap has a crisscross pattern across the top of the foot.
2. The wrap progresses down the limb at a 45-degree angle.
3. The wrap comes around the inner ankle and behind the leg.
4. The wrap comes around the outer ankle and then across the top of the foot to the instep.
19. A nurse is caring for a patient with an order for non-weight-bearing to the left leg. Which of the following
would indicate that the patient is using the correct crutch gait?
1. The patient moves one foot and the opposite crutch forward at the same time.
2. The patient moves the first crutch forward and then the opposite foot forward.
3. The patient moves both crutches and the nonaffected foot forward at the same time.
4. The patient moves both crutches forward at the same time and then swings both feet
forward.
20. One indication that a continuous passive motion (CPM) machine was set up incorrectly would be
1. The break in the platform is centered beneath the patient’s knee.
2. The motion of the CPM is causing severe pain.
3. The machine is in line with the patient’s hip.
4. The flexion is set to 80 degrees.
21. A student nurse is caring for a patient who has been diagnosed with a cerebral vascular accident that resulted
in right-sided weakness. In developing a plan of care that focuses on optimizing mobility, collaborative
interventions should involve which of the following health-care team members?
1. Chaplain
2. Social worker
3. Physical therapist
4. Dietitian
Multiple Choice
Identify the choice that best completes the statement or answers the question.
1. A 15-year-old football player is diagnosed with a bad sprain. A nurse recognizes that the injury involves
1. Torn ligaments.
2. A fine crack in the anklebone.
3. Injury to a long bone.
4. Damage to cartilage tissue.
2. The potential need for amputation will most likely be discussed as part of the medical and surgical care for
1. A 27-year-old with a comminuted fracture of the left femur from a car accident.
2. A 64-year-old with gangrene of the left foot due to decreased circulation.
3. A 71-year-old with arthritis in both knees.
4. A 54-year-old with a newly developed diabetic foot ulcer.
3. A nurse is providing care for a patient with an Ilizarov frame. The nurse would chart:
1. “Rod, wires, and screw ring intact without evidence of redness or drainage.”
2. “Pedaling performed to outer cast edge.”
3. “Weight suspended at 90 degrees.”
4. “Patient using abduction pillow as instructed.”
4. A motor vehicle accident resulting in a comminuted fracture of the right fibula has left a patient’s right
leg shorter than the left. A nurse identifies that bone lengthening can be stimulated by using
1. Plaster casting.
2. Skin traction.
3. An Ilizarov frame.
4. Internal fixators.
5. A nurse caring for patients on an orthopedic unit should be most concerned by
1. A patient reporting pain at a 2 on a 0 to 10 scale.
2. A patient reporting itching under a plaster cast.
3. Redness and purulent drainage at an external pin site.
4. A patient with a hip replacement ambulating with assistance.
6. While providing care for a patient with skeletal traction to the right leg, a nurse would report which of the
following observations to the physician?
1. The patient turns toward the right to answer the phone.
2. Traction weights hang freely.
3. Traction ropes are not crossing.
4. Purulent drainage is noted at the pin site.
7. A patient with a plaster cast tells the nurse, “This thing itches like crazy, and it is making me nuts.” The
best response by the nurse is:
1. “The cast itches because air is trapped between the cast and your skin.”
2. “Try to ignore that. The cast will be off in a few weeks.”
3. “Sometimes using a hair dryer on the cool setting to blow air down the cast can
relieve itching.”
4. “Itching is a sign of infection. Let me take your temperature.”
, 8. While checking on students who are caring for patients on an orthopedic unit, a nursing instructor would be
most concerned if
1. A student assists a patient with a left hip replacement turn to the left side.
2. A student caring for a patient with a right knee replacement assists with continuous
passive motion (CPM).
3. A student is noted inserting an abduction pillow between the legs of a patient with right hip
replacement.
4. A student uses sterile technique to provide site care to tongs for a patient with
cervical traction.
9. A nurse is assisting in the discharge of a patient who had a right hip replacement. Additional teaching
is necessary if the patient states:
1. “I will need an extender to pick things up from the floor.”
2. “I should keep a wide stance when I walk with my walker.”
3. “I will have to bend way over to tie my shoes.”
4. “I have to keep this special pillow between my legs when I’m sleeping.”
10. A student nurse approaches and asks a nurse to check and make sure the continuous passive motion (CPM)
machine is correct before it is turned on. The most important action by the nurse is to
1. Verify that the sheepskin does not have any folds.
2. Stand at the foot of the bed to inspect the alignment.
3. Check to see whether the CPM machine is plugged in.
4. Ask the patient to rank his or her current level of pain.
11. While caring for a patient who is on a continuous passive motion machine (CPM) after a total knee
replacement, a nurse notices that the patient is grimacing. Pain medication is not due for 2 hours, but the
CPM machine is supposed to continue for another 20 minutes. The best action by the nurse is to
1. Call the physician for additional pain medication.
2. Encourage the patient to bear it for 20 minutes longer.
3. Instruct the patient to tense and then relax his or her leg muscles.
4. Teach the patient relaxation techniques.
12. As a nurse enters the room of a patient who has had an amputation, the nurse notes that the patient is crying.
The best response by the nurse is to
1. Say, “I’m here if you’d like to talk,” while standing close to the patient’s bed.
2. Say, “I’ll leave you alone for a little while,” while leaving the room.
3. Ask, “Is there someone you’d like me to call?” while picking up the phone.
4. Say, “Everyone feels this way at first, but it will get easier,” while patting the
patient’s shoulder.
13. New crutches are the correct size if
1. The top of the crutch is 4 inches above the elbow.
2. The patient’s arms are at 90 degrees when holding the handles.
3. The crutch tips are resting against the outer aspect of the patient’s shoes.
4. Three fingers fit between the axilla and the axillary pad of each crutch.
14. Which of the following patients could successfully use a cane?
1. A 59-year-old with a left below-the-knee amputation
2. A 47-year-old with orders for non-weight-bearing on the left
3. A 69-year-old recovering from a stroke with mild right-sided weakness
4. A 70-year-old who cannot bear full weight on both legs
, 15. A nursing instructor recognizes that teaching has been effective if a student who is providing care for a patient
with right-sided weakness reports:
1. “The top of the cane is level with the iliac crest.”
2. “The patient is holding the cane in the right hand.”
3. “The top of the cane is even with the patient’s hip joint.”
4. “The base of the cane is even with the tip of the patient’s shoe.”
16. A student nurse is providing care for a patient who is returning from the recovery room after a total hip
replacement. During an initial assessment, the student notes serosanguineous drainage on the dressing.
The student should
1. Remove the dressing and assess the wound site.
2. Draw a line around the drainage and write the time, date, and his or her initials on the
dressing.
3. Notify the nursing instructor of the finding.
4. Document the finding in the chart.
17. Which of the following assessments would be most concerning to a nurse caring for a patient who was
recently admitted to the unit after a right knee replacement?
1. Pedal pulses on the operative side are weak compared with those on the nonoperative side.
2. A small amount of serosanguineous drainage is noted on the dressing.
3. The intravenous pump is infusing normal saline at 100 mL/hr.
4. The patient has a Foley catheter that is draining clear yellow urine.
18. A nursing instructor is evaluating elastic bandages applied to the ankle in a skills laboratory. The nursing
instructor recognizes that additional teaching is needed because
1. The wrap has a crisscross pattern across the top of the foot.
2. The wrap progresses down the limb at a 45-degree angle.
3. The wrap comes around the inner ankle and behind the leg.
4. The wrap comes around the outer ankle and then across the top of the foot to the instep.
19. A nurse is caring for a patient with an order for non-weight-bearing to the left leg. Which of the following
would indicate that the patient is using the correct crutch gait?
1. The patient moves one foot and the opposite crutch forward at the same time.
2. The patient moves the first crutch forward and then the opposite foot forward.
3. The patient moves both crutches and the nonaffected foot forward at the same time.
4. The patient moves both crutches forward at the same time and then swings both feet
forward.
20. One indication that a continuous passive motion (CPM) machine was set up incorrectly would be
1. The break in the platform is centered beneath the patient’s knee.
2. The motion of the CPM is causing severe pain.
3. The machine is in line with the patient’s hip.
4. The flexion is set to 80 degrees.
21. A student nurse is caring for a patient who has been diagnosed with a cerebral vascular accident that resulted
in right-sided weakness. In developing a plan of care that focuses on optimizing mobility, collaborative
interventions should involve which of the following health-care team members?
1. Chaplain
2. Social worker
3. Physical therapist
4. Dietitian
