NCLEX Musculoskeletal/Cast/Fracture

The nurse has given the client instructions about crutch safety. Which statements indicate that the client understands the instructions? Select all that apply. 1. "I should not use someone else's crutches." 2. "I need to remove any scattered rugs at home." 3. "I can use crutch tips even when they are wet." 4. "I need to have spare crutches and tips available." 5. "When I'm using crutches, my arms need to be completely straight."

1, 2, 4

A client being measured for crutches asks the nurse why the crutches cannot rest up underneath the arm for extra support. The nurse responds knowing that which would MOST LIKELY result from this improper crutch measurement. 1. A fall and further injury. 2. Injury to the brachial plexus nerves. 3. Skin breakdown in the area of the axilla. 4. Impaired range of motion while the client ambulates.

2

The nurse has conducted teaching with a client in an arm cast about the signs and symptoms of compartment syndrome. The nurse determines that the client understands the information if the client states that he or she should report which EARLY symptom of compartment syndrome? 1. Cold, bluish-colored fingers. 2. Numbness and tingling in the fingers. 3. Pain that increases when the arm is dependent. 4. Pain that is out of proportion to the severity of the fracture.

2

A client has sustained a closed fracture and has just had a cast applied to the affected arm. The client is complaining of intense pain. The nurse elevates the limb, applies an ice bag, and administers an analgesic, with little relief. Which problem may be causing this pain? 1. Infection under the cast. 2. The anxiety of the client. 3. Impaired tissue perfusion. 4. The recent occurrence of the fracture.

3

The nurse is assessing the casted extremity of a client. Which sign is indicative of infection? 1. Dependent edema. 2. Diminished distal pulse. 3. Presence of a "hot spot" on cast. 4. Coolness and pallor of the extremity.

3

The nurse is caring for a client who had an above knee amputation 2 days ago. The residual limb was wrapped with an elastic compression bandage, which has come off. Which IMMEDIATE action should the nurse take? 1. Apply ice to the site. 2. Call the primary health care provider. 3. Rewrap the residual limb with elastic an compression bandage. 4. Apply a dry, sterile dressing and elevate the residual limb on 1 pillow.

3

The nurse is evaluating a client in skeletal traction. When evaluating the pin sites, the nurse would be MOST concerned with which findings? 1. Redness around the pin sites. 2. Pain on palpation at the pin sites. 3. Thick, yellow drainage from pin sites. 4. Clear, watery drainage from pin sites.

3

A client with diabetes mellitus has had a right below knee amputation. Given the client's history of diabetes mellitus, which complication is the client MOST at risk for after surgery? 1. Hemorrhage. 2. Edema of the residual limb. 3. Slight redness of the incision. 4. Separation of the wound edges.

4

The nurse is admitting a client with multiple trauma injuries to the nursing unit. The client has a leg fracture and had a plaster cast applied. Which position would be BEST for the casted leg? 1. Elevated for 3 hours, then flat for 1 hour. 2. Flat for 3 hours, then elevated for 1 hour. 3. Flat for 12 hours, then elevated for 12 hours. 4. Elevated on pillows continuously for 24 to 48 hours.

4

The nurse witnessed a vehicle hit a pedestrian. The victim is dazed and tries to get up. A leg appears fractured. Which intervention should the nurse take? 1. Try to reduce the fracture manually. 2. Assis the victim to get up and walk to the sidewalk. 3. Leave the victim for a few moments to call an ambulance. 4. Stay with victim and encourage him or her to remain still.

4

A client is being discharged to home after application of a plaster leg cast. Which statement indicates that the client understands proper care of the cast? 1. "I need to avoid getting the cast wet." 2. "I need to cover the casted leg with warm blankets." 3. "I need to use my fingertips to lift and move my leg." 4. "I need to use something like a padded coat hanger end to scratch under the cast if it itches."

1

The nurse is caring for a client being treated for fat embolus after multiple fractures. Which data would the nurse evaluate as the MOST favorable indication of resolution of the fat embolus? 1. Clear mentation. 2. Minimal dyspnea. 3. Oxygen saturation of 85%. 4. Arterial oxygen level 78mm Hg.

1

Which cast care instructions should the nurse provide to a client who just had a plaster cast applied to the right forearm? Select all that apply. 1. Keep the cast clean and dry. 2. Allow the cast 24 to 72 hours to dry. 3. Keep the cast and extremity elevated. 4. Expect tingling and numbness in the extremity. 5. Use a hair dryer set on a warm to hot setting to dry the cast. 6. Use a soft, padded object that will fit under the cast to scratch the skin under the cast.

1, 2, 3