MSNCB Musculoskeletal Care 4 — Questions and Answers
Question 1: A patient 2 days post-total knee arthroplasty (TKA) has a temperature of 38.6°C, wound erythema, and purulent drainage. The priority nursing action is:
- Apply warm soaks to the wound
- Notify the surgeon and obtain wound cultures before starting antibiotics (Correct answer)
- Administer acetaminophen and reassess in 2 hours
- Increase the patient's fluid intake and monitor urine output
Correct answer: Notify the surgeon and obtain wound cultures before starting antibiotics
Signs of surgical site infection require wound cultures before antibiotics to identify the causative organism and guide treatment.
Question 2: Which assessment finding in a patient with gout indicates the need for immediate provider notification?
- Serum uric acid of 7.5 mg/dL
- Tophi formation on the ears
- Uric acid renal calculi with flank pain and hematuria (Correct answer)
- Acute joint pain and swelling in the great toe
Correct answer: Uric acid renal calculi with flank pain and hematuria
Uric acid kidney stones causing obstruction (flank pain, hematuria) are a serious complication of gout requiring urgent urologic evaluation.
Question 3: A patient with ankylosing spondylitis asks what activity best maintains spinal flexibility. The nurse's best response is:
- Bed rest during flares only
- Swimming and prone-lying extension exercises (Correct answer)
- High-impact aerobics
- Sitting in a recliner to maintain lumbar curve
Correct answer: Swimming and prone-lying extension exercises
Swimming and prone-lying extension exercises help maintain spinal flexibility and counteract the tendency toward kyphotic fusion in ankylosing spondylitis.
Question 4: A patient is receiving continuous passive motion (CPM) therapy after TKA. The patient requests to stop due to pain. The nurse should:
- Discontinue CPM permanently and notify the surgeon
- Stop CPM, administer prescribed analgesic, and restart after pain is controlled (Correct answer)
- Increase CPM speed to complete the session faster
- Ignore the request because CPM is essential for recovery
Correct answer: Stop CPM, administer prescribed analgesic, and restart after pain is controlled
Pain during CPM should be managed with analgesics before resuming; adequate pain control improves tolerance and outcomes.
Question 5: Which nursing intervention is most effective in preventing deep vein thrombosis (DVT) after hip replacement surgery?
- Applying ice packs to the operative leg for 20 minutes every hour
- Early ambulation and sequential compression devices with prescribed anticoagulation (Correct answer)
- Keeping the patient on strict bed rest for 48 hours postoperatively
- Massaging the calf muscles every 4 hours
Correct answer: Early ambulation and sequential compression devices with prescribed anticoagulation
Combined mechanical prophylaxis (SCDs, early ambulation) and pharmacologic anticoagulation is the most effective DVT prevention strategy post-arthroplasty.
Question 6: A patient with a below-knee amputation complains of pain that feels like it is coming from the missing foot. The nurse correctly identifies this as:
- Residual limb neuroma pain
- Phantom limb pain requiring psychiatric referral
- Phantom limb pain, a well-recognized neuropathic phenomenon (Correct answer)
- Psychosomatic pain due to adjustment disorder
Correct answer: Phantom limb pain, a well-recognized neuropathic phenomenon
Phantom limb pain is a real neuropathic phenomenon occurring in the majority of amputees and requires appropriate pain management.
Question 7: Which finding in a patient with a plaster cast on the forearm requires urgent intervention?
- Mild itching under the cast
- Warm, dry skin proximal to the cast
- Absent radial pulse and cool, pale fingers (Correct answer)
- Edema of the hand on the first postoperative day
Correct answer: Absent radial pulse and cool, pale fingers
Absent pulse with cool, pale skin distal to a cast signals acute arterial compromise and requires emergency cast removal.
MSNCB Musculoskeletal Care 4
A patient 2 days post-total knee arthroplasty (TKA) has a temperature of 38.6°C, wound erythema, and purulent drainage.
The priority nursing action is: