Med Surg: Patients With Musculoskeletal Trauma

Which term refers to the shaft of the long bone? Epiphysis Lordosis Scoliosis Diaphysis

Diaphysis The diaphysis is primarily cortical bone. An epiphysis is an end of a long bone. Lordosis refers to an increase in lumbar curvature of spine. Scoliosis refers to lateral curving of the spine.

A client undergoes a total hip replacement. Which statement made by the client indicates to the nurse that the client requires further teaching? "I'll need to keep several pillows between my legs at night." "I need to remember not to cross my legs. It's such a habit." "The occupational therapist is showing me how to use a sock puller to help me get dressed." "I don't know if I'll be able to get off that low toilet seat at home by myself."

"I don't know if I'll be able to get off that low toilet seat at home by myself." The client requires additional teaching if he is concerned about using a low toilet seat. To prevent hip dislocation after a total hip replacement, the client must avoid bending the hips beyond 90 degrees. The nurse should instruct the client to use assistive devices, such as a raised toilet seat, to prevent severe hip flexion. Using an abduction pillow or placing several pillows between the legs reduces the risk of hip dislocation by preventing adduction and internal rotation of the legs. Teaching the client to avoid crossing the legs also reduces the risk of hip dislocation. A sock puller helps a client get dressed without flexing the hips beyond 90 degrees.

The older client asks the nurse how best to maintain strong bones. What is the nurse's best response? "Weight-bearing exercises can strengthen bones." "Range of motion exercises build bone mass." "Cardio-training is the best way to build bones." "Weight-resistance exercises can strengthen bones."

"Weight-bearing exercises can strengthen bones." Weight-bearing exercises maintain bone mass. Weight-resistance exercises maintain and strengthen muscles. Cardio-training is important for heart health and weight maintenance/reduction. Range of motion exercises are essential for joint mobility.

A client is to undergo surgery to repair a ruptured Achilles tendon and application of a brace. The client demonstrates understanding of activity limitations when stating that a brace must be worn for which length of time? 2 to 4 weeks 6 to 8 weeks 10 to 12 weeks 14 to 16 weeks

6 - 8 weeks

Which is one of the most common causes of death in clients diagnosed with fat emboli syndrome? Myocardial infarction Stroke Acute respiratory distress syndrome Pulmonary embolism

Acute respiratory distress syndrome Acute pulmonary edema and acute respiratory distress syndrome are the most common causes of death.

An older adult client slipped on an area rug at home and fractured the left hip. The client is unable to have surgery immediately and is having severe pain. What interventions should the nurse provide for the patient to minimize energy loss in response to pain? -Administer prescribed analgesics around-the-clock. -Avoid administering too much medication becausethe client is older. -Administer prescribed pain medication only when the client requests it. -Give pain medication to the client after providing care.

Administer prescribed analgesics around-the-clock. Pain associated with hip fracture is severe and must be carefully managed with around-the-clock dosing of pain medication to minimize energy loss in response to pain. The client may not request the medication even if they are in pain, and it should be offered at the prescribed time. Give pain medication prior to providing any type of care involved in moving the client.

Traumatic injuries suffered in a workplace accident have required a 30-year-old man to have a below-the-knee (BKA) amputation. At what point following surgery should the nurse begin range-of-motion (ROM) exercises with this patient? -Once the patient has been fitted with a prosthesis -As soon as possible following surgery -After it has been determined that there are no postsurgical complications -Four to six weeks after surgery

As soon as possible following surgery Postoperative ROM exercises are started early after BKA because contracture deformities develop rapidly. It would be inappropriate to wait until the patient has a prosthesis or is free of any complications.

What refers to the separation of joint surfaces?

Dislocation

What is 'tennis elbow' also known as?

Epicondylitis

A professional tennis player comes to the orthopedic clinic and informs the nurse that he is having pain that radiates down the forearm and is unable to grasp the racket firmly. What does the nurse suspect is occurring with the client? Carpal tunnel syndrome Ganglion cyst Epicondylitis Shoulder dislocation

Epicondylitis Epicondylitis (tennis elbow) is a painful inflammation of the elbow that is caused by injury following excessive pronation and supination of the forearm, such as that which occurs when playing tennis, pitching a ball, or rowing. Client reports pain radiating down the dorsal surface of the forearm and a weak grasp. Carpal tunnel syndrome is compression of the median nerve and affects the hand with burning. Pain is more prominent in the early morning or at night. The pain of a ganglion cyst is more localized in the area of the cyst. The symptoms the client describes do not correlate with a diagnosis of shoulder rotation.

Which of the following surgical procedures may need to be done when removing a cast or bandage does not restore circulation to the extremity? Fasciotomy Open reduction with internal fixation (ORIF) Bone graft Hemiarthroplasty

Fasciotomy If pressure is not relieved by removing the bandage or cast and circulation is not restored, a fasciotomy may be necessary to relive the pressure within the muscle compartment. Hemiarthroplasty is the replacement of the femoral head with a prosthesis. An ORIF is done to reduce a fracture. A bone graft wound not be used to restore circulation.

What is the Triad of Clinical Manifestations of FES?

Hypoxemia, neurologic compromise, and a petechial rash

A nurse suspects that a client with a recent fracture has compartment syndrome. Assessment findings may include: -Body-wide decrease in bone mass. -A growth in and around the bone tissue. -Inability to perform active movement and pain with passive movement. -Inability to perform passive movement and pain with active movement.

Inability to perform active movement and pain with passive movement. With compartment syndrome, the client can't perform active movement, and pain occurs with passive movement. A body-wide decrease in bone mass is seen in osteoporosis. A growth in and around the bone tissue may indicate a bone tumor.

The nurse is caring for a patient who sustained an open fracture of the right femur in an automobile accident. What does the nurse understand is the most serious complication of an open fracture? -Infection -Muscle atrophy caused by loss of supporting bone structure -Necrosis of adjacent soft tissue caused by blood loss -Nerve damage

Infection In an open fracture, there is a risk for osteomyelitis, tetanus, and gas gangrene. The objectives of management are to prevent infection of the wound, soft tissue, and bone and to promote healing of bone and soft tissue

The nurse at the pediatrician's office is assessing a 17-year-old soccer player who presented to the clinic stating that he sustained an injury that resulted in the knee being struck medially while his foot was firmly planted on the ground. The nurse knows that the patient likely has experienced what? Lateral collateral ligament injury Medial collateral ligament injury Anterior cruciate ligament injury Posterior cruciate ligament injury

Lateral collateral ligament injury

Which factor inhibits fracture healing? Vitamin D Exercise Local malignancy Maximum bone fragment contact

Local malignancy Factors that inhibit fracture healing include local malignancy, bone loss, and extensive local trauma. Factors that enhance fracture healing include proper nutrition, vitamin D, exercise, and maximum bone fragment contact.

Which nursing intervention is appropriate for minimizing muscle spasms in the client with a hip fracture? -Apply a soft compression dressing. -Assist the client with use of a trapeze. -Maintain the internal fixator. -Maintain Buck's traction.

Maintain Buck's traction. Buck's traction decreases pain, muscle spasm, and external rotation by immobilizing the hip fracture.

What are the typical first clinical manifestations of FES?

Pulmonary symptoms and include hypoxia and tachypnea.

A _____ is caused by a wrenching or twisting motion.

Sprain

_______ refers to a muscle pull or tear.

Strain

What refers to partial separation or dislocation of joint surfaces?

Subluxation

What is a Hemiarthroplasty?

The replacement of the femoral head with a prosthesis.

A 77-year-old man is recovering in the hospital after a recent femoral fracture and has rung his call light. The nurse has entered the room to find the patient in distress, clutching his chest while struggling to say, "I can't breathe." The nurse should take prompt action based on the knowledge that this patient may be experiencing what complication of lower extremity fractures? Thromboembolism Unstable angina Acute respiratory distress syndrome (ARDS) Ischemic stroke

Thromboembolism Venous thromboemboli, including deep vein thrombosis (DVT) and pulmonary emboli (PE), are associated with reduced skeletal muscle contractions and bed rest. Patients with fractures of the lower extremities and pelvis are at high risk for venous thromboemboli. The most frequent signs are sudden onset shortness of breath, restlessness, increased respiratory rate, tachycardia, chest pain, and low-grade temperature. Angina, ARDS and stroke are not common complications of skeletal fractures.

Up to how long after the injury may a Fat Embolism occur?

Up to 10 days after

Which may occur if a client experiences compartment syndrome in an upper extremity? Whiplash injury Volkmann's contracture Callus Subluxation

Volkmann's contracture If compartment syndrome occurs in an upper extremity, it may lead to Volkmann's contracture, a clawlike deformity of the hand resulting from obstructed arterial blood flow to the forearm and hand. A whiplash injury is a cervical spine sprain. Callus refers to the healing mass that occurs with true bone formation after a fracture. Subluxation refers to a partial dislocation.