PrepU Chapter 40: Musculoskeletal Care

A client has a Fiberglass cast on the right arm. Which action should the nurse include in the care plan? -Keeping the casted arm warm by covering it with a light blanket -Avoiding handling the cast for 24 hours or until it is dry -Evaluating pedal and posterior tibial pulses every 2 hours -Assessing movement and sensation in the fingers of the right hand

-Assessing movement and sensation in the fingers of the right hand The nurse should assess a casted arm every 2 hours for finger movement and sensation to make sure the cast isn't restricting circulation. To reduce the risk of skin breakdown, the nurse should leave a casted arm uncovered, which allows air to circulate through the cast pores to the skin below. Unlike a plaster cast, a Fiberglass cast dries quickly and can be handled without damage soon after application. The nurse should assess the brachial and radial pulses distal to the cast — not the pedal and posterior tibial pulses, which are found in the legs.

A patient arrives in the emergency department with a suspected bone fracture of the right arm. How does the nurse expect the patient to describe the pain? -A dull, deep, boring ache -Sharp and piercing -Similar to "muscle cramps" -Sore and aching

-Sharp and piercing The nurse must carefully evaluate pain associated with the musculoskeletal condition, asking the patient to indicate the exact site and to describe the character and intensity of the pain using a pain rating scale. Most pain can be relieved by elevating the involved part, applying ice or cold packs, and administering analgesic agents as prescribed. Pain associated with the underlying condition (e.g., fracture, which is sharp and piercing) is frequently controlled by immobilization. Pain due to edema that is associated with trauma, surgery, or bleeding into the tissues can frequently be controlled by elevation and, if prescribed, intermittent application of ice or cold packs. Ice bags (one third to one half full) or cold application devices are placed on each side of the cast, if prescribed, making sure not to indent or wet the cast. Unrelieved or disproportionate pain may indicate complications. Pain associated with compartment syndrome is relentless and is not controlled by modalities such as elevation, application of ice or cold, and usual dosages of analgesic agents. Severe burning pain over bony prominences, especially the heels, anterior ankles, and elbows, warns of an impending pressure ulcer. This may also occur from too-tight elastic wraps used to hold splints in place.

The client displays manifestations of compartment syndrome. What treatment will the nurse expect the client to be scheduled for? -An open reduction -A fasciotomy -A total hip replacement -A total knee replacement

-A fasciotomy A treatment option for compartment snydrome is fasciotomy.

Which action by the nurse would be inappropriate for the client following casting? -Protect the cast by covering with a sheet. -Handle the cast with the palms of hands. -Circulate room air with a portable fan. -Petal and smooth the edges of the cast.

-Protect the cast by covering with a sheet. The nurse performs actions to facilitate drying of the cast. The cast should be exposed to air. Portable fans can be used to dry the cast. Pressure on the cast should be avoided.

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. -Remove the cast immediately, notifying the physician. -Administer antianxiety and pain medication. -Call for assistance to hold the client in the required position until the cast has dried.

-Explain that the sensation being felt is normal and will not burn the client. A fiberglass cast will give off heat when applied. The reaction is a normal, temporary sensation. Heat given off during the application phase of the cast does not burn the skin. By explaining these principles to the client, the nurse can alleviate any anxiety associated with the application of the cast. Because this is a known reaction to the application of the fiberglass cast, it is not necessary to remove the cast. Holding the client may cause more harm to the injury. Antianxiety medications are generally not needed when applying a cast.

Which type of cast encloses the trunk and a lower extremity? -Body cast -Hip spica -Long-leg -Short-leg

-Hip spica A hip spica cast encloses the trunk and a lower extremity. A body cast encloses the trunk. A long-leg cast extends from the junction of the upper and middle third of the thigh to the base of the toes. A short-leg cast extends from below the knee to the base of the toes.

Which would be an inappropriate initial pain relief measure for the client with a cast? -Application of cold packs -Application of a new cast -Administration of analgesics -Elevation of the involved part

-Application of a new cast Most pain can be relieved by elevating the casted part of the body, and by applying cold packs as prescribed and administering analgesics. Application of a new cast is usually not necessary.

A client with a right leg fracture is returning to the orthopedist to have the cast removed. What would the physician prescribe as further treatment? -physical therapy -discontinue use of crutches -cold compresses to leg for swelling -No options are correct.

-physical therapy For some time, the limb will need support. An elastic bandage may be wrapped on a leg, the client may use a cane, and an arm may be kept in a sling until progressive active exercise and physical therapy help the client regain normal strength and motion.

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." -"The surgeon is planning to use a metal plate and screws to fix my hip." -"A joint replacement or bone graft is not necessary." -"The surgeon can see the bones when putting them in correct position."

-"I was worried I would have an incision and scar." An open reduction involves a surgical dissection for the visualization of the bone ends and fragments. A metal plate and screws are used to correct and stabilize the fracture through internal fixation.

The nurse is caring for a client who lives alone and had a total knee replacement. An appropriate nursing diagnosis for the client is: -Risk for ineffective therapeutic regimen management -Disturbed body image -Situational low self-esteem -Risk for avascular necrosis of the joint

-Risk for ineffective therapeutic regimen management The client without adequate support and resources is at risk for ineffective therapeutic regimen management. A total knee replacement may be used to treat avascular necrosis. While an orthopedic client is at risk for disturbed body image and situational low self-esteem, there is no evidence that these exist for this client.

A client is having a cast applied for a fractured leg that extends from below the knee to the base of the toes. The foot is flexed at a right angle in a neutral position. What type of cast is the client having applied? -Short leg cast -Long leg cast -Walking cast -Hip spica cast

-Short leg cast A short leg cast extends from below the knee to the base of the toes. The foot is flexed at a right angle in a neutral position. A long leg cast extends from the junction of the upper and middle third of the thigh to the base of the toes. The knee may be slightly flexed. A walking cast is a short or long leg cast reinforced for strength. A hip spica cast encloses the trunk and a lower extremity.

Which device is designed specifically to support and immobilize a body part in a desired position? -Brace -Continuous passive motion (CPM) device -Splint -Trapeze

-Splint A splint may be applied to a fractured extremity initially until swelling subsides. A brace is an externally applied device to support a body part, control movement, and prevent injury. A CPM device is an instrument that moves a body part to promote healing and circulation. A trapeze is an overhead device to promote client mobility in bed.

Which device is designed specifically to support and immobilize a body part in a desired position? -Brace -Sling -Splint -Traction

-Splint A splint may be applied to a fractured extremity initially until swelling subsides. A brace is an externally applied device to support a body part, control movement, and prevent injury. A sling is used to support an arm, and traction is the use of a pulling force on a body part.

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? -Arthrodesis -Hemiarthroplasty -Total arthroplasty -Osteotomy

-Total arthroplasty A total arthroplasty is a replacement of both articular surfaces within one joint. An arthrodesis is a fusion of a joint for stabilization and pain relief and is usually done on a wrist or knee. A hemiarthroplastyis the replacement of one of the articular surfaces in a joint, such as the femoral head but not the acetabulum. An osteotomy is the cutting and removal of a wedge of bone to change the bone's alignment, thereby improving function and relieving pain.

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

-osteomyelitis Chronic osteomyelitis may occur after persistent infection in the late postoperative period. Hematoma, hemorrhage, and infection are potential complications in the immediate postoperative period.

Which intervention should the nurse implement with the client who has undergone a hip replacement? -Instruct the client to avoid internal rotation of the leg. -Place the client in high Fowler's position for meals. -Have the client bend forward to rise from the chair. -Adduct the legs by placing a pillow between the legs.

-Instruct the client to avoid internal rotation of the leg. The client should avoid all activities that can result in dislocation of the hip. The affected leg should not cross midline or be turned inward. A pillow is used to keep the legs in abduction. The hip should not bend more than 90 degrees when seated. The head of bed should be kept at 60 degrees or less.

A client with a long arm cast continues to complain of unrelieved throbbing pain even after receiving opioid pain medication. Which is the priority action by the nurse? -Assess for complications. -Assess for previous opioid drug use. -Reposition the client for comfort. -Teach relaxation techniques.

-Assess for complications. Unrelieved pain can be an indicator of a complication, such as compartment syndrome. Previous opioid drug use should not influence a complete and thorough assessment. Repositioning the client for comfort may be appropriate once all indications of a complication are ruled out. It is appropriate to teach relaxation techniques to help ease the pain, but assessing for a complication remains the highest priority.

A client has just undergone a leg amputation. What will the nurse closely monitor the client for during the immediate postoperative period? -Neuroma -Hematoma -Chronic osteomyelitis -Unexplainable burning pain (causalgia)

-Hematoma Hematoma, hemorrhage, and infection are potential complications in the immediate postoperative period. Sleeplessness, nausea, and vomiting may occur but are adverse reactions, not complications. Chronic osteomyelitis and causalgia are potential complications that are likely to arise in the late postoperative period. A neuroma occurs when the cut ends of the nerves become entangled in the healing scar. This would occur later in the postoperative course.

Which principle applies to the client in traction? -Weights should rest on the bed. -Skeletal traction is never interrupted. -Knots in the ropes should touch the pulley. -Weights are removed routinely.

-Skeletal traction is never interrupted. Skeletal traction is applied directly to the bone and is never interrupted. To be effective, the weights must hang freely and not rest on the bed or floor. Knots in the rope or the footplate must not touch the pulley or the foot of the bed. Traction must be continuous to be effective in reducing and immobilizing fractures.

A group of students is studying for a test on traction. The students demonstrate understanding of the types of traction when they identify which of the following as an example of skin traction? -Crutchfield tongs -Thomas splint -Buck's -Balanced suspension

-Buck's An example of skin traction is Buck's traction. Crutchfield tongs, a Thomas splint, or balanced suspension traction are types of skeletal traction.

Which is an inaccurate principle of traction? -The weights are not removed unless intermittent treatment is prescribed. -The weights must hang freely. -The client must be in good alignment in the center of the bed. -Skeletal traction is interrupted to turn and reposition the client.

-Skeletal traction is interrupted to turn and reposition the client. Skeletal traction is never interrupted. The weights are not removed unless intermittent treatment is prescribed. The weights must hang freely, with the client in good alignment in the center of the bed.

Following a total knee replacement, the surgeon orders a continuous passive motion (CPM) device. The client asks about the purpose of this treatment. What is the best response by the nurse? -"CPM increases range of motion of the joint." -"CPM strengthens the muscles of the leg." -"CPM delivers analgesic agents directly into the joint." -"CPM prevents injury by limiting flexion of the knee."

-"CPM increases range of motion of the joint." CPM increases circulation and range of motion of the knee joint.

Which action would be most important postoperatively for a client who has had a knee or hip replacement? -Providing crutches to the client. -Assisting in early ambulation. -Using a continuous passive motion (CPM) machine. -Encouraging expressions of anxiety.

-Assisting in early ambulation. An anticoagulant therapy and early ambulation are important for clients who undergo a knee or hip replacement. A CPM machine or crutches may be provided when prescribed. It is important to encourage clients to express their feelings of anxiety or depression. This is more crucial for clients who undergo an amputation rather than for clients who undergo a replacement surgery.

The nurse teaching the client with a cast about home care includes which instruction? -Cover the cast with plastic or rubber -Keep the cast below heart level -Fix a broken cast by applying tape -Dry a wet fiberglass cast thoroughly to avoid skin problems

-Dry a wet fiberglass cast thoroughly to avoid skin problems Instruct the client to keep the cast dry, to dry a wet fiberglass cast thoroughly to avoid skin problems, and not to cover it with plastic or rubber. A cast should be kept dry, but do not cover it with plastic or rubber because this causes condensation, which dampens the cast and skin. A casted extremity should be elevated frequently to heart level to prevent swelling. A broken cast should be reported to the physician and the client should not attempt to fix it.

The nurse is caring for a client with a spica cast. What is the nurse's priority intervention? -Keep the cast clean and dry. -Position the client on the affected side. -Promote elimination with a regular bedpan. -Keep the legs in abduction.

-Keep the cast clean and dry. Keeping the cast clean and dry around the perineal opening is a priority. A spica cast has a built-in abduction bar. The client should be positioned on the unaffected side every 2 hours and prone twice a day. A fracture bedpan is easier to use for the client with a spica cast.

After a traumatic back injury, a client requires skeletal traction. Which intervention takes priority? -Monitoring the client for skin breakdown -Maintaining traction continuously to ensure its effectiveness -Supporting the traction weights with a chair or table to prevent accidental slippage -Restricting the client's fluid and fiber intake to reduce the movement required for bedpan use

-Maintaining traction continuously to ensure its effectiveness The nurse must maintain skeletal traction continuously to ensure its effectiveness. The nurse should assess skin for breakdown; however, maintaining skeletal traction takes priority. Traction weights must hang freely to be effective; they should never be supported. The nurse should increase, not restrict, the client's fluid and fiber intake (unless contraindicated by a concurrent illness) to prevent constipation associated with complete bed rest.

The client is scheduled for a meniscectomy of the right knee. The nurse would plan postoperative care based on what surgical procedure? -Replacement of one of the articular surfaces of a joint -Incision and diversion of the muscle fascia -Excision of damaged joint fibrocartilage -Replacement of knee with artificial joint

-Excision of damaged joint fibrocartilage The most common site for meniscectomy is the knee; the procedure refers to the excision of damaged joint fibrocartilage. Fasciotomy refers to the incision and diversion of the muscle fascia to relieve muscle constriction. Hemiarthroplasty refers to the replacement of one of the articular surfaces of a joint. Total joint arthroscopy is the replacement of a joint with synthetic material.

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 Farenheit, 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 -Osteomyelitis -Urinary retention -Atelectasis

-Hypovolemic shock Indicators of hypovolemic shock include a heart rate greater than 100 beats per minute, a blood pressure less than 90/60 mm Hg, and urine output less than 30 ml per hour.

The nurse assesses a clientafter total right hip arthroplasty and observes a shortening of the extremity. The client reports severe pain in the right side of the groin. What is the priority action of the nurse? -Apply Buck's traction. -Notify the health care provider. -Externally rotate the extremity. -Bend the knee and rotate the knee internally.

-Notify the health care provider. If any clinical manifestations of dislocation of the prosthesis occur, including acute groin pain in the affected hip or shortening of the affected extremity, the nurse (or the client, if at home) must immediately notify the surgeon, because the hip must be reduced and stabilized promptly so that the leg does not sustain circulatory and nerve damage. After closed reduction, the hip may be stabilized with Buck's traction or a brace to prevent recurrent dislocation. As the muscles and joint capsule heal, the chance of dislocation diminishes. Stresses to the new hip joint should be avoided for the first 8 to 12 weeks, when the risk of dislocation is greatest.

Which instruction should the nurse include when teaching the client following hip replacement surgery? (Select all that apply.) -"You may cross your legs at the ankles only." -"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." -"It is okay to briefly flex the hip to put on your clothes."

-"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." The client following post hip replacement should not cross the legs, even at the ankle. He or she should avoid bending forward when sitting in a chair, avoid flexing the hip when dressing, and use a raised toilet seat. A pillow should be placed between the legs when side-lying.

A group of students is reviewing information about cast composition in preparation for a discussion on the advantages and disadvantages of each. The students demonstrate understanding of the topic when they cite which of the following as an advantage of a plaster cast? -Better molding to the client -Quicker drying -Longer lasting -More breathable

-Better molding to the client Plaster casts require a longer time for drying but mold better to the client and are initially used until the swelling subsides. Fiberglass casts dry more quickly, are lighter in weight, longerlasting, and breathable.

The nurse is checking the traction apparatus for a client in skin traction. Which finding would require the nurse to intervene? -Body aligned opposite to line of traction pull -Weights hanging and touching the floor -Pulleys without evidence of the obstruction -Ropes freely moving over pulleys

-Weights hanging and touching the floor When checking traction equipment, the weights should be freely hanging. Weights that touch the floor require the nurse to intervene. The body should be aligned in an opposite line to the pull of the traction. The ropes should be freely moving over unobstructed pulleys.

A hip spica cast: -encloses the trunk and a lower extremity. -encircles the trunk. -is a short or long leg cast reinforced for strength. -extends from the junction of the upper and middle third of the thigh to the base of the toes. The knee may be slightly flexed.

-encloses the trunk and a lower extremity. A hip spica cast encloses the trunk and a lower extremity. A double hip spica cast includes both legs. A body cast encircles the trunk. A walking cast is a short or long leg cast reinforced for strength. A long leg cast extends from the junction of the upper and middle third of the thigh to the base of the toes. The knee may be slightly flexed.

Which nursing action would help prevent deep vein thrombosis in a client who has had an orthopedic surgery? -Instruct about using client-controlled analgesia, if prescribed -Instruct about exercise, as prescribed -Apply antiembolism stockings -Apply cold packs

-Apply antiembolism stockings Applying antiembolism stockings helps prevent deep vein thrombosis (DVT) in a client who is immobilized due to orthopedic surgery. Regular administration of analgesics controls and prevents escalation of pain, while ROM exercises help maintain muscle strength and tone and prevent contractions. On the other hand, cold packs are applied to help reduce swelling; cold does not prevent deep vein thrombosis.

A patient in pelvic traction needs circulatory status assessed. How should the nurse assess for a positive Homans' sign? -Have the patient extend both hands while the nurse compares the volume of both radial pulses. -Have the patient extend each leg and dorsiflex each foot to determine if pain or tenderness is present in the lower leg. -Have the patient plantar flex both feet while the nurse performs the blanch test on all of the patient's toes. -Have the patient squeeze the nurse's hands with his or her hands to evaluate any difference in strength.

-Have the patient extend each leg and dorsiflex each foot to determine if pain or tenderness is present in the lower leg. The nurse should assess for pain on passive flexion of each foot, which could indicate deep vein thrombosis.

A client's cast is removed. The client is worried because the skin appears mottled and is covered with a yellowish crust. What advice should the nurse give the client to address the skin problem? -Consult a skin speciaqlist. -Scrub the area vigorously to remove the crust. -Apply lotions and take warm baths or soaks. -Avoid exposure to direct sunlight.

-Apply lotions and take warm baths or soaks. The client should be advised to apply lotions and take warm baths or soaks. This will help in softening the skin and removing debris. The client usually sheds this residue in a few days so the client need not consult a skin specialist. It is not advisable to scrub the area vigorously. The client need not avoid exposure to direct sunlight because the area is not photosensitive.

The nurse suspects that a client with an arm cast has developed a pressure ulcer. Where should the nurse assess for the presence of the ulcer? -Lateral malleolus -Olecranon -Radial styloid -Ulna styloid

-Ulna styloid Casts or inappropriately applied splints can put pressure on soft tissues, causing tissue anoxia and pressure ulcers. Lower extremity sites most susceptible are the heel, malleoli, dorsum of the foot, head of the fibula, and anterior surface of the patella. The main pressure sites on the upper extremity are located at the medial epicondyle of the humerus and the ulnar styloid.

A client is about to have a cast applied to the left arm. What will nurse alert the client to as the cast is applied? -Increased in pain in left arm -Sensation of warmth or heat with application -Arm being moved to various positions -Sensation of weakness

-Sensation of warmth or heat with application When a cast is applied, the client needs to be aware that he or she may feel a sensation of warmth or heat due to the material being mixed with water. The client should not feel an increase in pain during the application. The arm will be held in place to ensure proper alignment during the application. The client should not feel weakness in the extremity. This is more commonly experiences after a cast is removed.

The nurse suspects "compartment syndrome" for a casted extremity. What characteristic symptoms would the nurse assess that would confirm these suspicions? (Select all that apply.) -Decreased sensory function -Excruciating pain -Loss of motion -Capillary refill less than 3 seconds -2+ peripheral pulses in the affected distal pulse

-Decreased sensory function -Excruciating pain -Loss of motion Clinical manifestations include dusky, pale appearance of the exposed extremity; cool skin temperature; delayed capillary refill; paresthesia; and unrelenting pain not relieved by position changes, ice, or analgesia. A hallmark sign is pain that occurs or intensifies with passive range of motion (Johnston-Walker & Hardcastle, 2011). The patient may complain that the cast, brace, or splint is too tight. The primary provider must be notified immediately.

A client diagnosed with a right ulnar fracture asks why the cast needs to go all the way up the arm. What is the best response by the nurse? -"This allows for the strength in the arm to remain consistent." -"The joint above the fracture and below the fracture must be immobilized." -"When a spica cast is ordered, the arm must be immobilized." -"The method allows for the fastest healing time and the greatest mobility."

-"The joint above the fracture and below the fracture must be immobilized." Generally, the joints proximal and distal to the fracture are immobilized to promote healing. The purpose is not for the strength to remain consistent; most clients will lose strength. A spica cast would not be ordered for an ulnar fracture. Although immobilizing the joints above and below fractures may shorten healing time, it does not allow for increased mobility.

An older adult patient had a hip replacement. When should the patient begin with assisted ambulation with a walker? -24 hours -72 hours -1 week -2 to 3 weeks

-24 hours Following hip arthroplasty (total hip replacement), patients begin ambulation with the assistance of a walker or crutches within a day after surgery.

A patient had a total left hip arthroplasty. What clinical manifestation would indicate to the nurse that the prosthesis is dislocated? -The left leg is internally rotated. -The leg length is the same as the right leg. -The patient has discomfort when moving in the bed. -Diminished peripheral pulses on the affected extremity

-The left leg is internally rotated. The nurse must monitor for signs and symptoms of dislocation of the prosthesis, which include abnormal external or internal rotation of the affected extremity.

Which statement by a staff nurse on the orthopedic floor indicates the need for further staff education? -"The client is receiving physical therapy twice per day, so the client doesn't need a continuous passive motion device." -"The continuous passive motion device can decrease the development of adhesions." -"Bleeding is a complication associated with the continuous passive motion device." -"Monitoring skin integrity is important while the continuous passive motion device is in place."

-"The client is receiving physical therapy twice per day, so the client doesn't need a continuous passive motion device." Further staff education is needed when the nurse states that the continuous passive motion device isn't needed because the client receives physical therapy twice per day. The continuous passive motion device should be used in conjunction with physical therapy because the device helps prevent adhesions. Bleeding is a complication associated with the continuous passive motion device; skin integrity should be monitored while the device is in use.

A client who is undergoing skeletal traction reports pressure on bony areas. Which action would be most appropriate to provide comfort for the client? -Assisting with range-of-motion and isometric exercises. -Changing the client's position within prescribed limits. -Administering prescribed analgesics. -Applying warm compresses.

-Changing the client's position within prescribed limits. Changing the position of a client within prescribed limits helps relieve pressure on bony areas and promotes comfort. Analgesics help to relive pain but may not help relieve pressure on bony areas. Warm compresses aid blood circulation. The client should not exercise while on traction unless prescribed to regain strength in the affected limb.

The nurse is caring for a patient who had a total hip replacement. What lethal postoperative complication should the nurse closely monitor for? -Atelectasis -Hypovolemia -Pulmonary embolism -Urinary tract infection

-Pulmonary embolism Patients having orthopedic surgery are particularly at risk for venous thromboembolism, including deep vein thrombosis and pulmonary embolism.

Which is not a guideline for avoiding hip dislocation after replacement surgery. -The hip may be flexed to put on clothing such as pants, stockings, socks, or shoes. -Keep the knees apart at all times. -Put a pillow between the legs when sleeping. -Never cross the legs when seated.

-The hip may be flexed to put on clothing such as pants, stockings, socks, or shoes. Guidelines for avoiding hip dislocation after replacement surgery specify that the hip should not be flexed to put on clothing such as pants, stockings, socks, or shoes. Clients should keep the knees apart at all times, put a pillow between the legs when sleeping, and never cross the legs when seated.

A client has a plaster cast applied to the left leg. Which comment by the client following the procedure should the nurse address first? -"My toes are stiff." -"My toes are pink." -"My cast is still wet." -"My pain is a 3."

-"My toes are stiff." Compartment syndrome is characterized by neurovascular compromise. Stiffness of the toes may be a preliminary finding that the client is having trouble with motor function.

Which statement is accurate regarding care of a plaster cast? -The cast must be covered with a blanket to keep it moist during the first 24 hours. -The cast will dry in about 12 hours. -The cast can be dented while it is damp. -A dry plaster cast is dull and gray.

-The cast can be dented while it is damp. The cast can be dented while it is damp. A dry plaster case is white and shiny. The cast will dry in 24 to 72 hours. A freshly applied cast should be exposed to circulating air to dry and should not be covered with clothing or bed linens or placed on plastic-coated mats or bedding.

When discussing physical activities with the client who has just undergone a right total hip replacement, which instruction should the nurse provide? -"Limit hip flexion to 90 degrees." -"Perform rotation exercises each day." -"Intermittently cross and uncross your legs several times each day." -"Avoid weight bearing until the hip is completely healed."

-"Limit hip flexion to 90 degrees." The client should avoid all activities that can result in dislocation of the hip. The affected leg should not cross midline or be turned inward. The hip should not bend more than 90 degrees. Ambulation begins the day following surgery, and weight bearing ambulation may not be restricted, depending on the type of prosthesis.

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." -"I will wear a boot with weights attached." -"A belt will go around my pelvis and weights will be attached." -"The traction can be removed once a day so I can shower."

-"Metal pins will go through my skin to the bone." In skeletal traction, metal rods or pins are used to apply continuous traction directly to the bone. Weights are used to apply the traction. Casts, external fixators, or splints are used when the traction is discontinued.

A 68-year-old female client who had a total hip replacement is to be discharged because her healing is almost complete. Which of the following would be most important for this client? -Advising the client to avoid red meat -Urging her to keep the affected limb in an elevated position -Educating the client about the effects of menopause -Exploring factors related to the client's home environment

-Exploring factors related to the client's home environment Exploring factors related to the older adult client's home environment and determining a plan for continued rehabilitation before discharge is most important. The client should be encouraged to eat foods rich in protein, calcium, and vitamin D. Because the healing is almost complete, the client need not always keep the affected limb elevated unless prescribed to do so. Because the client is in her late 60s, she is most likely to have already undergone menopause. Therefore, educating her about the effects of menopause is not as important.

Which cleansing solution is the most effective for use in completing pin site care? -Betadine -Chlorhexidine -Hydrogen peroxide -Alcohol

-Chlorhexidine Chlorhexidine solution is recommended as the most effective cleansing solution; however, water and saline are alternate choices. Hydrogen peroxide and betadine solutions have been used, but they are believed to be cytotoxic to osteoblasts and may actually damage healthy tissue.

A client has undergone an external fixation. Which actions would be the priority for this client? -Maintaining pin care. -Planning the client's diet. -Monitoring the client's urine output. -Monitoring the client's blood pressure.

-Maintaining pin care. Pin care is a priority for a client with external fixation, because pin sites are entry points for infection. The nurse should also monitor redness, drainage, and tenderness at the site. Planning the client's diet and monitoring the client's urine output and blood pressure, although necessary, are not as important as maintaining pin care.

A client's fracture was reduced by surgically exposing the bone and realigning it. What type of treatment does the nurse identity this as? -Buck's traction -Skeletal traction -Internal fixation -Open reduction

-Open reduction In an open reduction, the bone is surgically exposed and realigned. Buck's traction is a type of skin traction that provides pulling on the structures. Skeletal traction is applied directly to the bone using a wire, pin, or cranial tongs. Internal fixation involves the use of metal screws, plates, rods, nails or pins to stabilize a reduced fracture.

The client with a fractured femur is upset and agitated that skeletal traction will be necessary for 6 to 8 weeks. The client states, "How can I stay like this for weeks? I can't even move!" Based on these statements, the nurse would identify which of the following as the most appropriate nursing diagnosis? -Ineffective Coping related to prolonged immobility -Impaired Physical Mobility related to traction -Deficient Diversional Activity related to prolonged hospitalization -Activity Intolerance related to impaired mobility

-Ineffective Coping related to prolonged immobility The client is displaying clinical manifestations of anxiety and ineffective coping.

Which is a benefit of a continuous passive motion (CPM) device when applied after knee surgery? -It provides active range of motion. -It promotes healing by increasing circulation and movement of the knee joint. -It promotes healing by immobilizing the knee joint. -It prevents infection and controls edema and bleeding.

-It promotes healing by increasing circulation and movement of the knee joint. A CPM device applied after knee surgery promotes healing by increasing circulation and movement of the knee joint.

A client is seen in the emergency department for an injury acquired from falling off of a bicycle and fracturing the arm. The client also has a long laceration that has been sutured in the same area. The client asks the nurse why a splint is applied and not a cast. What is the best explanation by the nurse? -"We will need to monitor the status of the laceration to be sure it does not get infected." -"The arm does not require the same immobilization that a leg fracture would." -"You will be able to wear the splint longer than you would a cast." -"The splint is less expensive than the cast."

-"We will need to monitor the status of the laceration to be sure it does not get infected." A splint would be used when there is special skin treatment or observation that is required. The arm fracture would require the same form of immobilization that a leg fracture does. The length of time the splint can be worn is equal to that of a cast to immobilize the fracture. The cost of the splint and cast would be similar.

Which would be contraindicated as a component of self-care activities for the client with a cast? -Cover the cast with plastic to insulate it -Cushioning rough edges of the cast with tape -Elevate the casted extremity to heart level frequently -Do not attempt to scratch the skin under a cast

-Cover the cast with plastic to insulate it The cast should be kept dry, but do not cover it with plastic or rubber because this causes condensation, which dampens the cast and skin. The other activities are consistent with cast care.

A client is reporting pain following orthopedic surgery. Which intervention will help relieve pain? -Elevate the affected extremity and use cold applications. -Breathe deeply and cough every 2 hours until ambulation is possible. -Do ROM exercises as indicated. -Apply antiembolism stockings as indicated.

-Elevate the affected extremity and use cold applications. Elevating the affected extremity and using cold applications reduce swelling. Deep breathing and coughing helps with maintenance of effective respiratory rate and depth. ROM exercises maintain full ROM of unaffected joints. Antiembolism stockings help prevent deep vein thrombosis (DVT).

Which intervention would the nurse implement with the client in skeletal traction? Select all that apply. -Apply 8-pound weight to the rope. -Ensure the pins or wires are covered with caps. -Remove foam boot and inspect skin daily. -Position trapeze within the client's reach. -Instruct the client on isometric exercises for immobilized extremity.

-Ensure the pins or wires are covered with caps. -Position trapeze within the client's reach. -Instruct the client on isometric exercises for immobilized extremity. Nursing care of the client in skeletal traction includes ensuring the trapeze is within the client's reach and the pins or wires are covered with caps. The nurse instructs the client on isometric exercises for the immobilized extremity. A foam boot is used with Buck's traction (skin traction) not skeletal traction. An 8-pound weight is used with Buck's traction, whereas a 15- to 25-pound weight is applied in skeletal traction.

A client is brought to the emergency department by a softball team member who states the client and another player ran into each other, and the client is having severe pain in the right shoulder. What symptoms of a fractured clavicle does the nurse recognize? -Client complains of tingling and numbness in the right shoulder. -Right shoulder is elevated above the left. -Client complains of pain in the unaffected shoulder. -Right shoulder slopes downward and droops inward.

-Right shoulder slopes downward and droops inward. The client with a fractured clavicle has restricted motion, and the affected shoulder appears to slope downward and droop inward. The client will have pain, not typically tingling and numbness in the right shoulder. Pain is not felt in the unaffected shoulder.

A client's left leg is in skeletal traction with a Thomas leg splint and Pearson attachment. Which intervention should the nurse include in this client's care plan? -Apply the traction straps snugly. -Assess the client's level of consciousness. -Remove the traction at least every 8 hours. -Teach the client how to prevent problems caused by immobility.

-Teach the client how to prevent problems caused by immobility. By teaching the client about prevention measures, the nurse can help prevent problems caused by immobility, such as hypostatic pneumonia, muscle contracture, and atrophy. The nurse applies traction straps for skin traction — not skeletal traction. For a client in skeletal traction, the nurse should assess the affected limb, rather than assess the level of consciousness. Removing skeletal traction is the physician's responsibility — not the nurse's.

The nurse is providing instructions to the client following application of a fiberglass cast. Which statement by the client indicates further education is needed? -"Under no circumstances should I get my cast wet." -"The cast should not come in contact with other plastics." -"I should avoid touching the cast while it is wet." -"The cast will be hot while it is drying."

-"Under no circumstances should I get my cast wet." Some fiberglass casts are waterproof, allowing the client to shower or swim. A wet fiberglass cast is susceptible to denting while it is wet. Fiberglass casting involves an exothermic reaction as the cast hardens. The cast should not come in contact with other plastics as the reaction occurs.

A nurse is caring for a client placed in traction to treat a fractured femur. Which nursing intervention has the highest priority? -Assessing the extremity for neurovascular integrity -Keeping the client from sliding to the foot of the bed -Keeping the ropes over the center of the pulley -Ensuring that the weights hang free at all times

-Assessing the extremity for neurovascular integrity Although all measures are correct, assessing neurovascular integrity takes priority because a decrease in neurovascular integrity could compromise the limb. The pull of the traction must be continuous to keep the client from sliding. Sufficient countertraction must be maintained at all times by keeping the ropes over the center of the pulley. The line of pull is maintained by allowing the weights to hang free.

A client has a cast applied to the leg for treatment of a tibia fracture and also has a wound on the leg that requires dressing changes due to drainage. For what should the nurse prepare the client? -Cutting of a bivalve cast -Cutting a cast window -Removal of the cast -Insertion of an external fixator

-Cutting a cast window After the cast dries, a cast window, or opening, may be cut. This usually is done when the client reports discomfort under the cast or has a wound that requires a dressing change. The window permits direct inspection of the skin, a means to check the pulse in a casted arm or leg, or a way to change a dressing. A bivalve cast is when the cast is cut in two if the leg swells or if the client is being weaned from a cast, when a sharp x-ray is needed, or as a splint for immobilizing painful joints when a client has arthritis. The cast should not be removed due to the instability of a fracture. The client's condition does not indicate an external fixator is required.

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. -The surgeon secures the bone with metal screws, plates, rods, nails, or pins. A cast or other mode of immobilization is applied. -The bone is restored to its normal position by external manipulation. -The bone is surgically exposed and realigned.

-The surgeon inserts metal pins into the bone or bones from outside the skin surface and then attaches a compression device to the pins. In 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. In internal fixation, the surgeon secures the bone with metal screws, plates, rods, nails, or pins. A cast or other mode of immobilization is applied. In closed reduction, the bone is restored to its normal position by external manipulation. In open reduction, the bone is surgically exposed and realigned.

A client in the emergency department is being treated for a wrist fracture. The client asks why a splint is being applied instead of a cast. What is the best response by the nurse? -"You would have to stay here much longer because it takes a cast longer to dry." -"A splint is applied when more swelling is expected at the site of injury." -"It is best if an orthopedic doctor applies the cast." -"Not all fractures require a cast."

-"A splint is applied when more swelling is expected at the site of injury." Splints are noncircumferential and will not compromise circulation when swelling is expected. A splint is applied to support and immobilize the injured joint. A fracture will swell as part of the inflammation process. The client would not have to stay longer if a fiberglass cast is applied. Fiberglass cast dry in approximately 30 minutes. An orthopedic doctor is not needed to apply the cast. Many nurses and technicians are trained in proper application of a cast. Some fractures may not be treated with a cast but it would not be appropriate to answer with this response because it does not reflect the actual reason for a splint being applied.

Which actions by the nurse demonstrate an understanding of caring for a client in traction? Select all that apply. -Placing a trapeze on the bed -Ensuring that the weights are hanging freely -Assessing the client's alignment in the bed -Removing skeletal traction to turn and reposition the client -Frequently assessing pain level

-Placing a trapeze on the bed -Ensuring that the weights are hanging freely -Assessing the client's alignment in the bed -Frequently assessing pain level The weights must hang freely, with the client in good alignment in the center of the bed. The nurse should frequently monitor pain, as uncontrolled pain may be a sign of a complication. The client will be able to assist with alignment and bed mobility if a trapeze is placed on the bed. Skeletal traction should never be interrupted.

A client is seen in the orthopedic clinic for complaints of severe pain in the left hip. After a series of diagnostic tests, the client is diagnosed with severe degenerative joint disease of the left hip and suggested to have the hip reconstructed. What procedure will the nurse schedule the client for? -Left hip arthroplasty -Left hip arthroscopy -Open reduction and internal fixation of the left hip. -Closed reduction of the left hip.

-Left hip arthroplasty Clients with arthritis, trauma, hip fracture, or a congenital deformity may have an arthroplasty, or reconstruction of the joint. This procedure uses an artificial joint that restores previously lost function and relieves pain. An arthroscopy is not used to reconstruct a diseased hip. A closed reduction is not an invasive surgical procedure and would not be used to reconstruct the hip. An open reduction and internal fixation is not the treatment for reconstruction of the hip related to a diseased hip.