Adv. Concepts Chapter 37: Musculoskeletal Trauma

A client is treated in the emergency department for acute muscle strain in the left leg caused by trying a new exercise. During discharge preparation, the nurse should provide which instruction?

"Apply ice packs for the first 24 to 48 hours, then apply heat packs."

A client with a recent left above-the-knee amputation states, "I can feel pain in my left toes." Which is the best response by the nurse?

"Describe the pain and rate it on the pain scale."

The nurse is admitting a client who is to undergo an open reduction with internal fixation for a fractured femur. About which comment by the client should the nurse be most concerned?

"I was worried I would have an incision and scar."

A client is being discharged from the Emergency Department after being diagnosed with a sprained ankle. Which client statement indicates the client understands the discharge teaching?

"I'll make sure to keep my ankle elevated as much as possible."

The nurse is providing instructions to the client who is being prepared for skeletal traction. Which statement by the client indicates teaching was effective?

"Metal pins will go through my skin to the bone."

Which instruction should the nurse include when teaching the client following hip replacement surgery? (Select all that apply.)

"Place pillows between your legs when you lay on your side." "Avoid bending forward when sitting in a chair." "Use a raised toilet seat and high-seated chair."

A client is being prepared for a total hip arthroplasty, and the nurse is providing relevant education. The client is concerned about being on bed rest for several days after the surgery. The nurse should explain what expectation for activity following hip replacement?

"The physical therapist will likely help you get up using a walker the day after your surgery."

The client scheduled for a Syme amputation is concerned about the ability to eventually stand on the amputated extremity. How should the nurse best respond to the client's concern?

"You will eventually be able to withstand full weight-bearing after the amputation."

A 14-year-old client is treated in the emergency room for an acute knee sprain sustained during a soccer game. The nurse reviews discharge instructions with the client's parent. The nurse instructs the parent that the acute inflammatory stage will last how long?

24 to 48 hours

A patient had a total hip replacement. What recommended leg position should the nurse ensure is maintained to prevent prosthesis dislocation?

Abduction

A client has returned to the postsurgical unit from the PACU after an above-the-knee amputation of the right leg. Results of the nurse's initial postsurgical assessment were unremarkable but the client has called out. The nurse enters the room and observes copious quantities of blood at the surgical site. What should be the nurse's initial action?

Apply a tourniquet.

Which nursing action would help prevent deep vein thrombosis in a client who has had an orthopedic surgery?

Apply antiembolism stockings

When providing discharge teaching to a client with a fractured toe, the nurse should include which instruction?

Apply ice to the fracture site.

A patient sustains a fracture of the arm. When does the nurse anticipate pendulum exercise should begin?

As soon as tolerated, after a reasonable period of immobilization

A nurse is caring for a client who is in skeletal traction. To prevent the complication of skin breakdown in a client with skeletal traction, what action should be included in the plan of care?

Assess the pin insertion site every 8 hours.

A client is transported to the emergency department for a femur fracture following a motor vehicle crash. What action by the nurse is the highest priority?

Assess vital signs and level of consciousness.

An emergency department client is diagnosed with a hip dislocation. The client's family is relieved that the client has not suffered a hip fracture, but the nurse explains that this is still considered to be a medical emergency. What is the rationale for the nurse's statement?

Avascular necrosis may develop at the site if it is not promptly resolved.

The orthopedic surgeon has prescribed balanced skeletal traction for a client. What advantage is conferred by balanced traction?

Balanced traction allows for greater client movement and independence than other forms of traction.

The nurse is caring for a 24-year-old female client with a right tibial fracture treated with a cast 2 hours ago. The client now reports unrelenting pain, rated as 7/10, despite taking oxycodone, and decreased sensation in the right foot. A nursing assessment reveals the right foot is cooler and paler than the left foot, with delayed capillary refill and a weak pulse.

Based on the nursing assessment, the priority action the nurse should take is to -notify the orthopedic health care provider immediately and prepare the client for -bivalving of the cast.

The nurse is assisting with the application of a cast. What will the nurse expect to be done first?

Cleaning the skin surface.

A client who has undergone a lower limb amputation is preparing to be discharged home. What outcome is necessary prior to discharge?

Client can demonstrate safe use of assistive devices.

A client was playing softball and dislocated four fingers when diving for a ball. The physician manipulated the fingers into alignment and applied a splint to maintain alignment. What type of procedure does the nurse document this as?

Closed reduction

Which type of fracture produces several bone fragments?

Comminuted

A client sustains a fractured right humerus in an automobile accident. The arm is edematous, the client states not being able to move or feel the fingers, and the nurse does not feel a pulse. What condition should the nurse be concerned about that requires emergency measures?

Compartment syndrome

In a client with a dislocation, the nurse should initially perform neurovascular assessments a minimum of every 15 minutes until stable. Which complication does the assessments help the nurse to monitor in the client?

Compartment syndrome

Which type of fracture is one in which the skin or mucous membrane wound extends to the fractured bone?

Compound

Which term refers to a blunt force injury to soft tissue?

Contusion

The nurse is caring for a client who sustained rib fractures in an automobile accident. What symptoms does the nurse recognize as a complication of rib fractures and should immediately be reported to the physician?

Crackles in the lung bases

A nurse is planning the care of a client with osteomyelitis that resulted from a diabetic foot ulcer. The client requires a transmetatarsal amputation. When planning the client's postoperative care, which of the following nursing diagnoses should the nurse most likely include in the plan of care?

Disturbed Body Image

The nurse caring for a client, who has been treated for a hip fracture, instructs the client not to cross their legs and to have someone assist with tying their shoes. Which additional instruction should the nurse provide to client?

Do not flex the hip more than 90 degrees.

A client with a tibia fracture was placed in an external fixator 24 hours ago. The nurse is completing pin care and notices redness at the pin site and a small amount of serous drainage. What action by the nurse is appropriate?

Document the findings.

A client has delayed bone healing in a fractured right humerus. What should the nurse prepare the client for that promotes bone growth?

Electrical stimulation

Which nursing intervention is appropriate for a client with a closed-reduction extremity fracture?

Encourage participation in ADLs

A client with a fractured ulna has a plaster cast applied to the forearm. Which action(s) will the nurse take when caring for the client and cast? Select all that apply.

Ensure a free flow of air around the cast. Test cast dryness with the palm of the hand. Determine the cast is dry when it is white and shiny.

A client with a right below-the-knee amputation is being transferred from the postanesthesia care unit to a medical-surgical unit. What is the highest priority nursing intervention by the receiving nurse?

Ensure that a large tourniquet is in the room.

The client is scheduled for a meniscectomy of the right knee. The nurse would plan postoperative care based on what surgical procedure?

Excision of damaged joint fibrocartilage

A client with a fractured ankle is having a fiberglass cast applied. The client starts yelling, "My leg is burning, take it off." What action by the nurse is most appropriate?

Explain that the sensation being felt is normal and will not burn the client.

A client with a fracture develops compartment syndrome that requires surgical intervention. What treatment will the nurse would most likely prepare the client for?

Fasciotomy

The nurse is caring for a patient postoperatively following orthopedic surgery. The nurse assesses an oxygen saturation of 89%, confusion, and a rash on the upper torso. What does the nurse suspect is occurring with this patient?

Fat emboli syndrome

After a car accident, a client is admitted to an acute care facility with multiple traumatic injuries, including a fractured pelvis. For 24 to 48 hours after the accident, the nurse must monitor the client closely for which potential complication of a fractured pelvis?

Fat embolism

The femur fracture that commonly leads to avascular necrosis or nonunion because of an abundant supply of blood vessels in the area is a fracture of the:

Femoral neck.

The nurse is very concerned about the potential debilitating complication of peroneal nerve injury. What symptom does the nurse recognize as a result of that complication?

Foot drop

A patient in pelvic traction needs circulatory status assessed. How should the nurse assess for a positive Homans' sign?

Have the patient extend each leg and dorsiflex each foot to determine if pain or tenderness is present in the lower leg.

A client has just undergone a leg amputation. What will the nurse closely monitor the client for during the immediate postoperative period?

Hematoma

The nurse is monitoring a patient who sustained an open fracture of the left hip. What type of shock should the nurse be aware can occur with this type of injury?

Hypovolemic

A patient has suffered a femoral shaft fracture in an industrial accident. What is an immediate nursing concern for this patient?

Hypovolemic shock

The client returns to the nursing unit following an open reduction with internal fixation of the right hip. Nursing assessment findings include temperature 100.8 degrees Fahrenheit, heart rate 112 beats per minute, respiratory rate 28 breaths per minute, and blood pressure 86/58. There is no urine in the Foley catheter collection bag. The nurse interprets these findings as indicating which complication?

Hypovolemic shock

A patient sustains an open fracture with extensive soft tissue damage. The nurse determines that this fracture would be classified as what grade?

III

Radiographic evaluation of a client's fracture reveals that a bone fragment has been driven into another bone fragment. The nurse identifies this as which type of fracture?

Impacted

To reduce the incidence of complications in a client in traction, which intervention should be included in the care plan?

Increase fiber intake.

The nurse is caring for a client with a spica cast. What is the nurse's priority intervention?

Keep the cast clean and dry.

Pulselessness, a very late sign of compartment syndrome, may signify

Lack of distal tissue perfusion

A nurse is caring for a client who recently underwent a total hip replacement. What is the best action by the nurse for client care?

Limit hip flexion of the client's hip when the client sits up.

Which factor inhibits fracture healing?

Local malignancy

A client who was in a motor vehicle crash is diagnosed with a stable T7 spinal fracture with no neurologic deficits. Which nursing intervention should the nurse implement?

Maintain bed rest with the head of the bed at 20 degrees.

A client with a fractured femur is in balanced suspension traction. The client needs to be repositioned toward the head of the bed. During repositioning, what should the nurse do?

Maintain consistent traction tension while repositioning.

After a traumatic back injury, a client requires skeletal traction. Which intervention takes priority?

Maintaining traction continuously to ensure its effectiveness

A client is having traction applied to a fractured left lower extremity prior to surgery. What outcomes does the nurse expect from the application of the traction for the client? Select all that apply.

Muscle spasms will be relieved. The bones of the left leg will be aligned. Immobilization of the left leg will be maintained.

Which term refers to the failure of fragments of a fractured bone to heal together?

Nonunion

A nurse is admitting a client to the unit who presented with a lower extremity fracture. What signs and symptoms would suggest to the nurse that the client may have a peroneal nerve injury?

Numbness and burning of the foot

Which orthopedic surgery is done to correct and align a fracture after surgical dissection and exposure of the fracture?

Open reduction

A nurse is caring for a client who is recovering in the hospital following orthopedic surgery. The nurse is performing frequent assessments for signs and symptoms of infection in the knowledge that the client faces a high risk of what infectious complication?

Osteomyelitis

A nurse is planning the care of a client who will require a prolonged course of skeletal traction. When planning this client's care, the nurse should prioritize interventions related to what risk nursing diagnosis?

Risk for Impaired Skin Integrity

A client arrives in the emergency department with a suspected bone fracture of the right arm. How does the nurse expect the client to describe the pain?

Sharp and piercing

An elderly client's hip joint is immobilized prior to surgery to correct a femoral head fracture. What is the nurse's priority assessment?

Signs of neurovascular compromise

Which is an inaccurate principle of traction?

Skeletal traction is interrupted to turn and reposition the client.

Which principle applies to the client in traction?

Skeletal traction is never interrupted.

The clinic nurse is caring for a client with an injured body part that does not require rigid immobilization. What method of immobilization would the nurse expect the health care provider to use on a short-term basis?

Splint

Which device is designed specifically to support and immobilize a body part in a desired position?

Splint

A client reports pain in the right knee, stating, "My knee got twisted when I was going down the stairs." The client was diagnosed with an injury to the ligaments and tendons of the right knee. Which terminology, documented by the nurse, best reflects the injury?

Sprain

A client comes to the emergency department and it is found that the client's radial head is partially dislocated. What is this partially dislocated radial head documented as?

Subluxation

Which client(s) is most likely to have compartment syndrome after sustaining a fracture? Select all that apply.

The client with elevated pressure within the muscles The client with hemorrhage in the site of injury The client with a plaster cast applied immediately after injury

A client arrives in the emergency room complaining of severe pain in her left hip after falling out of the bed. What indication upon assessment does the nurse recognize as a dislocated left hip? Select all that apply.

The left leg is shorter than the right. Limited range of motion of the left hip. The skin of the lower left leg is pale.

Which statement describes external fixation?

The surgeon inserts metal pins into the bone or bones from outside the skin surface and then attaches a compression device to the pins.

A client has severe osteoarthritis in the left hip and is having surgery to replace both articular surfaces of the hip. What type of surgical procedure will the nurse prepare the client for?

Total arthroplasty

A nurse is preparing to discharge an emergency department client who has been fitted with a sling to support her arm after a clavicle fracture. What should the nurse instruct the client to do?

Use the arm for light activities within the range of motion.

A client sustains an open fracture of the left arm after an accident. What does emergency management of this fracture involve? Select all that apply.

covering the area with a sterile dressing if the fracture is open immobilizing the affected site splinting the injured limb

A client who has fallen and injured a hip cannot place weight on the leg and is in significant pain. After radiographs indicate intact but malpositioned bones, what would the physician diagnose?

dislocation

A variety of complications can occur after a leg amputation. Which is not a possibility in the immediate postoperative period?

osteomyelitis

Which is a hallmark sign of compartment syndrome?

pain