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Chapter 66: Nursing Management: Musculo-skeletal ProblemsLewis: Medical-Surgical Nursing in Canada, 4th Canadian Edition
MULTIPLE CHOICE
1. The nurse is caring for a client who is hospitalized for initiation of regional antibiotic
irrigation for acute osteomyelitis of the right femur. Which of the following interventions
should be included in the plan of care?
a. Immobilization of the right leg
b. Frequent weight-bearing exercise
c. Avoiding administration of nonsteroidal anti-inflammatory drugs (NSAIDs)
d. Support of the right leg in a flexed position
ANS: A
Immobilization of the affected leg helps decrease pain and reduce the risk for pathological
fractures. Weight-bearing exercise increases the risk for pathological fractures. NSAIDs
are frequently prescribed to treat pain. Flexion of the affected limb is avoided to prevent
contractures.
DIF: Cognitive Level: Application TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity
2. The nurse is preparing a client for discharge after 2 weeks of IV antibiotic therapy for
acute osteomyelitis in the left leg. Which of the following information should be included
in the discharge teaching?
a. How to apply warm packs safely to the leg to reduce pain?
b. How to monitor and care for the long-term IV catheter site?
c. The need for daily aerobic exercise to help maintain muscle strength
d. The reason for taking oral antibiotics for 7–10 days after discharge
ANS: B
The client will be on IV antibiotics for several months, and the client will need to
recognize signs of infection at the IV site and how to care for the catheter during daily
activities such as bathing. IV antibiotics rather than oral antibiotics are used for acute
osteomyelitis. Clients are instructed to avoid exercise and heat application because these
will increase swelling and the risk for spreading infection.
DIF: Cognitive Level: Application TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity
3. The home care nurse is caring for a client who has chronic osteomyelitis of the left femur
who is being managed at home with administration of IV antibiotics. Which of the
following findings would indicate to the nurse that a nursing diagnosis of ineffective
health maintenance is appropriate for this client?
a. Takes and records the oral temperature twice a day
b. Is unable to plantar flex the foot on the affected side
c. Uses crutches to avoid weight bearing on the affected leg
d. Is irritable and frustrated with the length of treatment required
ANS: B
, Foot drop is an indication that the foot is not being supported in a neutral position by a
splint. Using crutches and monitoring the oral temperature are appropriate self-care
activities. Frustration with the length of treatment is not an indicator of ineffective health
maintenance of the osteomyelitis.
DIF: Cognitive Level: Application TOP: Nursing Process: Diagnosis
MSC: NCLEX: Physiological Integrity
4. Which of the following statements by a client who is scheduled for an above-the-knee
amputation for treatment of an osteosarcoma of the right tibia indicates that client teaching
is needed?
a. “I did not have this bone cancer until my leg broke a week ago.”
b. “I wish that I did not have to have chemotherapy after this surgery.”
c. “I know that I will need to participate in physical therapy after surgery.”
d. “I will use the patient-controlled analgesia (PCA) to control postoperative pain.”
ANS: A
Ewing’s sarcoma may be diagnosed following a fracture, but it is not caused by the injury.
The other client statements indicate that client teaching has been effective.
DIF: Cognitive Level: Application TOP: Nursing Process: Evaluation
MSC: NCLEX: Physiological Integrity
5. The nurse is caring for a client with pes planus. Which of the following actions should the
nurse expect to provide symptom relief for this client?
a. The administration of a corticosteroid
b. The use of longitudinal arch supports
c. Passive manual stretching of the PIP joint
d. Casting of the affected foot
ANS: B
Symptoms of pes planus are usually relieved by use of resilient longitudinal arch supports.
Casting of the affected foot, passive manual stretching of the PIP joint, and the
administration of a corticosteroid are not part of the treatment for pes planus.
DIF: Cognitive Level: Application TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity
6. The nurse is caring for a client who has muscle spasms and acute low back pain. Which of
the following actions is most appropriate to teach the client to promote comfort?
a. Avoid the use of cold because it will exacerbate the muscle spasms.
b. Keep both feet flat on the floor when prolonged standing is required.
c. Keep the hips and knees flexed when resting in bed.
d. Twist gently from side to side to maintain range of motion in the spine.
ANS: C
Resting with the hips and knees flexed will reduce the strain on the back and decrease
muscle spasms. Twisting from side to side will increase tension on the lumbar area. A
pillow placed under the upper back will cause strain on the lumbar spine. Alternate
application of cold and heat should be used to decrease pain.
DIF: Cognitive Level: Application TOP: Nursing Process: Planning
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