Lewis Ch 63 Musculoskeletal Trauma
and Orthopedic Surgery NCLEX
(Answered) 100% Correct. Updated Fall
2024/2025.
A 72-year-old man tells the nurse that he cannot perform most of the physical activities he could do 5
years ago because of overall joint aches and pains. What can the nurse do to assist the patient to prevent
further deconditioning and decrease the risk for developing musculoskeletal problems?
a. Limit weight-bearing exercise to prevent stress on fragile bones and possible hip fractures.
b. Advise the patient to avoid the use of canes and walkers because they increase dependence on
ambulation aids.
c. Advise the patient to increase his activity by more frequently climbing stairs in buildings and other
environments with steps.
d. Discuss use of over-the-counter (OTC) medications to decrease inflammation and pain so that exercise
can be maintained.
d. Almost all older adults have some degree of decreased muscle strength, joint stiffness, and pain with
motion.
The use of mild antiinflammatory agents decreases
inflammation and pain and can help the patient to maintain activity and prevent further deconditioning
but other prescribed drugs and potential abdominal problems must be considered by the patient.
Musculoskeletal problems in the older adult can be prevented with appropriate strategies, especially
exercise. Stair walking can create enough stress
on fragile bones to cause a hip fracture and use of ramps may help to prevent falls. Walkers and canes
should be used as necessary to decrease stress on joints so that activity can be maintained.
2. The nurse teaches individuals that one of the best ways to prevent musculoskeletal injuries during
physical exercise is by doing what?
a. Increase muscle strength with daily isometric exercise.
b. Avoid exercising on concrete or hard pavement surfaces.
c. Perform stretching and warm-up exercises before exercise.
d. Wrap susceptible joints with elastic bandages or adhesive tape before exercise.
2. c. Warm-up exercises "prelengthen" potentially strained tissues by avoiding the quick stretch often
encountered in sports and also increase the temperature of muscle, resulting in increased speed of cell
metabolism, increased speed of nerve impulses, and improved oxygenation of muscle fibers.
Stretching is also thought to improve kinesthetic awareness, lessening the chance of uncoordinated
movement. Muscle strength is not a key factor in soft tissue injuries and taping or wrapping joints may
actually predispose a person to injury by weakening the joint, unless a previous injury is being treated.
, 3. The patient asks, "What does the doctor mean when he says that I have an avulsion fracture in my
leg? I thought I had a sprain!" What is the best response by the nurse?
a. "It is a fracture with more than two fragments."
b. "It means that a ligament pulled a bone fragment loose."
c. "The line of the fracture is twisted along the shaft of the bone."
d. "The line of the fracture is at right angles to the longitudinal axis of the bone."
3. b. An avulsion fracture occurs when a ligament pulls a bone fragment loose, with pain similar to a
sprain. A fracture with two or more fragments is a comminuted fracture. It is a spiral fracture when it is
twisted around a bone shaft. It is a transverse fracture when the line of fracture is at right angles to the
longitudinal axis.
4. The patient with osteoporosis had a spontaneous hip fracture. How should the nurse document this
before the x-ray results return?
a. Open fracture
b. Oblique fracture
c. Pathologic fracture
d. Greenstick fracture
4. c. A pathologic fracture is a spontaneous fracture at the site of bone disease, such as osteoporosis. An
open fracture is when there is communication with the external environment. The oblique fracture has a
slanted fracture line. A greenstick fracture is splintered on one side and the other side is bent.
The patient works on a computer 8 hours each day. What kind of repetitive strain injury would be
expected in this patient?
a. Meniscus injury
b. Rotator cuff injury
c. Radial-ulnar fracture
d. Carpal tunnel syndrome
5. d. Carpal tunnel syndrome would be expected related to the continuous wrist movements. Injuries of
the menisci, which are fibrocartilage in the knee, are common with athletes. Radial-ulnar fractures are
seen with great force such as a car accident or a fall. Rotator cuff injuries occur with sudden adduction
forces applied to the cuff while the arm is held in abduction. They are commonly seen with repetitive
overhead motions.
6. The athlete comes to the clinic with bursitis. What does the nurse know happens to the tissue to
cause pain when bursitis occurs?
a. Tearing of a ligament
b. Stretching of muscle and fascia sheath
c. Inflammation of synovial membrane sac at friction sites
d. Incomplete separation of articular surfaces of joint caused by ligament injury
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