Musculoskeletal Problems

You are initiating a nursing care plan for a patient with osteoporosis. All of these nursing interventions apply to the nursing diagnosis Risk for Falls. Which intervention should you delegate to the UAP?

• Identifying environmental factors that increase risk for falls

• Monitoring gait, balance, and fatigue level with ambulation

• Collaborating with the physical therapist (PT) to provide the patient with a walker

• Assisting the patient with ambulation to the bathroom and in the halls

You are preparing to teach a patient with a new diagnosis of osteoporosis about strategies to prevent falls. Which teaching points will you be sure to include? (Select all that apply.)

• Wear a hip protector when ambulating

• Remove throw rugs and other obstacles at home

• Exercise to help build your strength

• Expect a few bumps and bruises when you go home

• Rest when you are tired

Your assessment reveals all of these data when you are admitting a patient with Paget disease. Which finding should you notify the physician about first?

• There is a bowing of both legs and the knees are asymmetrical

• The base of the skull is invaginated (platybasia).

• The patient is only 5 feet tall and weighs 120 lb.

• The skull is soft, thick, and larger than normal

The charge nurse observes an LPN/LVN providing all of these interventions for a patient with Paget disease. Which action requires that the charge nurse intervene?

• Administering 600 mg of ibuprofen (Advil) to the patient

• Encouraging the patient to perform PT-recommended exercises

• Applying ice and gentle massage to the patient’s lower extremities

• Reminding the patient to drink milk and eat cottage cheese

1. As charge nurse, you are making assignments for the day shift. Which patient would you assign to the nurse who was floated from the postanesthesia care unit (PACU) for the day?

• 35-year-old with osteomyelitis who needs teaching before hyperbaric oxygen therapy

• 62-year-old with osteomalacia who is being discharged to a long-term care facility

• 68-year-old with osteoporosis given a new orthotic device whose knowledge of its use must be assessed

• 72-year-old with Paget disease who has just returned from surgery for total knee replacement

You delegate the measurement of vital signs to an experienced UAP. Osteomyelitis has been diagnosed in a patient. Which vital sign value would you instruct the UAP to report immediately?

• Temperature of 101° F (38.3° C)

• Blood pressure of 136/80 mm Hg

• Heart rate of 96 beats/min

• Respiratory rate of 24 breaths/min

You are caring for a patient with carpal tunnel syndrome (CTS) who has been admitted for surgery. Which intervention should you delegate to the UAP?

• Initiating placement of a splint for immobilization during the day

• Assessing the patient’s wrist and hand for discoloration and brittle nails

• Assisting the patient with daily self-care measures such as bathing and eating

• Testing the patient for painful tingling in the four digits of the hand

You observe a UAP performing all of these interventions for a patient with CTS. Which action requires that you intervene immediately?

• Arranging the patient’s lunch tray and cutting his meat

• Providing warm water and assisting the patient with his bath

• Replacing the patient’s splint in hyperextension position

• Reminding the patient not to lift very heavy objects

A patient is scheduled for endoscopic carpal tunnel release surgery in the morning. What would you be sure to teach the patient?

• Pain and numbness will be experienced for several days to weeks

• Immediately after surgery, the patient will no longer need assistance

• After surgery, the dressing will be large and there will be lots of drainage

• The patient’s pain and paresthesia will no longer be present

As charge nurse, you assign the nursing care of a patient who has just returned from open carpal tunnel release surgery to an experienced LPN/LVN, who will perform under the supervision of an RN. Which instructions would you provide for the LPN/LVN?

(Select all that apply.)

• Check the patient’s vital signs every 15 minutes in the first hour.

• Check the dressing for drainage and tightness

• Elevate the patient’s hand above the heart

• The patient will no longer need pain medication

• Check the neurovascular status of the fingers every hour