Chapter 39 Promoting Musculoskeletal Function

Chapter 39  Promoting Musculoskeletal Function

Complete Chapter Questions And Answers
 

Sample Questions

MULTIPLE CHOICE

1. The nurse directs the immobilized patient in frequent deep breathing exercises during the day in order to combat:
a.
low oxygen saturation.
b.
atelectasis.
c.
hypostatic pneumonia.
d.
respiratory alkalosis.

ANS: C
Hypostatic pneumonia is a result of decreased physical mobility and is the most common hospital acquired disorder in immobilized patients.

DIF: Cognitive Level: Comprehension REF: p. 790 OBJ: Theory #1
TOP: Hypostatic Pneumonia KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

2. The nurse explains that range of motion exercises are necessary so that movement improves venous circulation by:
a.
vasodilation.
b.
compression of muscles on venous walls.
c.
increased metabolism.
d.
maintaining strength in muscles.

ANS: B
The range of motion exercises mimic normal muscle movement, which compresses the venous walls as a support to venous circulation.

DIF: Cognitive Level: Comprehension REF: p. 790 OBJ: Theory #5
TOP: Psychosocial Effects of Immobilization
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity: Reduction of Risk

3. A nurse enters the room of a patient who is in Buck’s traction (skin traction). An error in the traction setup observed would be:
a.
feet resting against the foot of the bed.
b.
weights hanging free in the air.
c.
knee gatch raised.
d.
head of bed elevated 20 degrees.

ANS: A
Feet should not rest against the foot of the bed because this interrupts the counter traction.

DIF: Cognitive Level: Analysis REF: p. 793 OBJ: Clinical Practice #1
TOP: Traction KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

4. The daughter of an older woman with a diagnosis of a fractured tibia asks why her mother is in Buck’s traction. The nurse’s most informative response would be that Buck’s traction:
a.
helps the bone heal more quickly.
b.
allows for large traction weights to reduce the fracture.
c.
does not cause skin disruptions.
d.
reduces muscle spasm that accompanies fractures.

ANS: D
Skin traction such as Buck’s traction reduces muscle spasm that accompanies fractures.

DIF: Cognitive Level: Comprehension REF: p. 793 OBJ: Clinical Practice #1
TOP: Skin Traction KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

5. An anxious patient in skeletal traction is distressed by the clear fluid drainage that is oozing from the pin sites. The nurse’s best intervention would be to:
a.
notify the charge nurse of possible infection.
b.
wipe off drainage with a damp wash cloth.
c.
assure the patient that such drainage is expected.
d.
cover the pin with several gauze pads and tape securely.

ANS: C
Clear fluid drainage from pin sites is expected. The fluid can be removed with a sterile swab.

DIF: Cognitive Level: Application REF: p. 794 OBJ: Clinical Practice #1
TOP: Anxiety Relative to Skeletal Traction
KEY: Nursing Process Step: Assessment
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation