Musculoskeletal Disorder (Q)

MUSCULOSKELETAL DISORDER

SITUATION I

Following total hip replacement surgery , the patient is worried to take a few steps with a walker during his first day.

see answer

Question 1:

What is the importance of early ambulation that you will discuss with the patient to encourage him to walk? Identify two (2).

1. _____________________________________________________________________________________________________________________________.

2. _____________________________________________________________________________________________________________________________.

SITUATION II

A client is treated in a physician's office for a sprained ankle after a fall. The radiographic examination has ruled out a fracture. see answer

Question 1:

Before sending the client home, what will you teach him to avoid on applying and why?

1. _____________________________________________________________________________________________________________________________.

SITUATION III

Following a motor vehicle accident, a patient arrives in the emergency department with massive right lower-leg swelling. You immediately checked for any evidence of injuries such as fractures or dislocations. see answer

Question 1:

Before elevating the patient's leg, applying a compression bandage and placing an ice pack on the lower leg, what other initial assessment that you will do on the patient's leg?

1. _____________________________________________________________________________________________________________________________.

SITUATION IV

A patient hospitalized with multiple fractures has a long arm plaster cast applied for immobilization of a fractured left radius. see answer

Question 1:

How will you handle the cast until it has completely dried and why?

1. _____________________________________________________________________________________________________________________________.

Question 2:

The patient tells you, "I will apply an ice pack to the cast over the fracture site for the next 24 hours." What would be your response? Justify.

1. _____________________________________________________________________________________________________________________________.

SITUATION V

A patient who suffered a fracture is treated with a plaster cast. The next day, the patient complains of severe pain in the leg, which is unrelieved by ordered analgesics. The patient's toes are pink, but the patient complains of numbness and tingling.

see answer

Question 1:

What is your initial appropriate action and why?

1. _____________________________________________________________________________________________________________________________.

SITUATION VI

A total hip replacement (hip arthroplasty) is planned for a 70-year-old patient with osteoarthritis. The physician instruct the patient to stop taking enteric-coated aspirin (Ecotrin) 1 week before surgery. see answer

Question 1:

What is the best explanation or rationale in the physician’s instruction that you will tell to the patient?

1. _____________________________________________________________________________________________________________________________.

SITUATION VII

Mrs. X, a 65-year-old female patient is newly diagnosed with osteoporosis. Her doctor prescribed Fosamax 70 mg tab, and Calcium + Vit. D. see answer

Question 1:

What would be your advice that you could give to prevent the exacerbation of her osteoporosis? Provide two (2).

1. _____________________________________________________________________________________________________________________________.

2. _____________________________________________________________________________________________________________________________.

Question 2:

Apart from properly storing and not missing her dose, how should Mrs. A take her Fosamax properly? Give three (3).

1. _____________________________________________________________________________________________________________________________.

2. _____________________________________________________________________________________________________________________________.

3. _____________________________________________________________________________________________________________________________.

SITUATION VIII

After the physician orders a low-purine diet for the patient, the nurse assesses the patient’s dietary needs and knowledge of appropriate foods. The patient chooses a meal that includes: Lentils, beets, sardines, milk, and eggs. see answer

Question 1:

You would like to request a consultation with the dietician on which food the patient has chosen?

1._______________________________________2.___________________________________________

SITUATION IX

A 45 year-old male patient is for discharge after an L4-L5 right herniated disc. He was ordered to be on sick leave from work.

MEDICAL ORDERS:see answer

-Bed rest at home -Naprosyn (NSAID) 375 mg p.o. BID

-Ice or heat to localized area -Acetaminophen (Tylenol) 500 mg p.o. q 4 h PRN for pain

-High fiber diet -Physiotherapy as needed

Question 1:

Why a high fiber diet was ordered for him?

1. _____________________________________________________________________________________________________________________________.

Question 2:

The patient asks, "Why do I need two pain medications?" What is your response to his question?

1. _____________________________________________________________________________________________________________________________.

SITUATION X

You’re taking care of a child who has undergone surgery for cleft lip repair and is on restrain right now.

The child's parent states, “The restraints can be removed when we are holding our child.”see answer

Question 1:

What is your best response to the parents?

1. _____________________________________________________________________________________________________________________________.

SITUATION XI

You're a rehabilitation nurse who is providing home care instruction for a client being discharged after above-the-knee amputation of the right lower limb with a fitted prosthesis.see answer

Question 1:

The client tells you, "I will elevate the residual limb on a pillow". What would be your response?

1. _____________________________________________________________________________________________________________________________.

SITUATION XII

A patient who has severe peripheral arterial disease and ischemic foot ulcers is upset with the health care provider's recommendation to have an above-the-knee amputation. The patient tells you, "If they want to cut off my leg, they should just shoot me instead."see answer

Question 1:

What is your most appropriate response on the patient's statement?

1. _____________________________________________________________________________________________________________________________.

On the second postoperative day, the patient with a below-the-knee amputation complains of pain in the amputated limb.

MEDICAL ORDERS:

-Physiotherapy -Docusate 50 mg daily

-Gravol 50 mg PRN -Dilaudid 2 mg PRN

Question 2:

What is your appropriate action?

1. _____________________________________________________________________________________________________________________________.

SITUATION XIII

A 70-year-old male patient is in the emergency department with a suspected dislocation of the right hip. He complains of pain and stiffness at the affected hip.see answer

Question 1:

What other assessment findings of the right leg would you expect? Identify two (2)

1. _____________________________________________________________________________________________________________________________.

2. _____________________________________________________________________________________________________________________________.

Question 2:

Give two (2) immediate nursing interventions that you will do?

1. _____________________________________________________________________________________________________________________________.

2. _____________________________________________________________________________________________________________________________.

SITUATION XIV

Mrs. X is a 75-year-old new patient in a long-term care facility. She wanders around the unit and is confused and disoriented.see answer

Question 1:

Identify three (3) interventions that you will do to help Mrs. X?

1. _____________________________________________________________________________________________________________________________.

2. _____________________________________________________________________________________________________________________________.

3. _____________________________________________________________________________________________________________________________.

SITUATION XV

A 75-year-old client, hospitalized with a cerebral vascular accident (stroke), becomes disoriented at times and tries to get out of bed, but is unable to ambulate without help.see answer

Question 1:

What is your most appropriate intervention for the safety of the patient?

1. _____________________________________________________________________________________________________________________________.

SITUATION XVI

The nurse, at change-of-shift report, learns that one of the clients in his care has bilateral soft wrist restraints. The client is confused, is trying to get out of bed, and had pulled out the IV line, which was subsequently reinserted. see answer

Question 1:

What interventions are most appropriate when you will start your shift for this patient?

1. _____________________________________________________________________________________________________________________________.

2. _____________________________________________________________________________________________________________________________.

3. _____________________________________________________________________________________________________________________________.

Question 2:

What is the least you can do to prevent the patient from pulling his IV line, apart from applying restraint?

1. _____________________________________________________________________________________________________________________________.

SITUATION XVII

A new patient is being admitted to the hospital because of a seizure that occurred at his home. The patient has no previous history of seizures, he is lying on his bed now and you're about to start your shift. The patient is alert and oriented, and V/S are all stable.see answer

Question 1:

In planning the patient's nursing care, what nursing intervention is most essential for you to do now?

1. _____________________________________________________________________________________________________________________________.

SITUATION XVIII

A 79-year-old resident in a long-term care facility is known to "wander at night" and has fallen in the past. His room is clutter free and a bed alarm is applied.see answer

Question 1:

What other intervention is most appropriate to do for this patient, apart from placing the patient near the nurse station and putting a stop sign on his door?

1. _____________________________________________________________________________________________________________________________.

SITUATION XIX

The patient who is currently being restrained with mechanical wrist restraint is angry, loud and crying, has urinary incontinence, hands are cool to the touch, and has reddened area on the wrist. Previous V/S: BP: 130/90, P: 99, RR:20, SPo2 95% on R/A.see answer

Question 1:

Which of the following assessment is most critical for the patient?

1. _____________________________________________________________________________________________________________________________.

See answers