Unit 6: Musculoskeletal Trauma and Ortho Surgeries

A nurse is assessing a client who is 24 hours postoperative following an open reduction and internal fixation to repair a fracture of the femur. Which of the following assessment findings is an early manifestation of fat embolism syndrome (FES)? a. Dyspnea b. Red-brown petechiae c. Headache d. Agitation

a. Dyspnea

A nurse is assessing a client who has a fracture of the femur. The nurse obtains vital signs on admission and again in 2 hours. Which of the following changes in assessment should indicate to the nurse that the client could be developing a serious complication? a. Increased respiratory rate from 18 to 44/minute b. Increased oral temperature from 36.6 to 37 c. Increased blood pressure from 112/68 to 120/72 mmHg d. Increased heart rate from 68 to 72/minute

a. Increased respiratory rate from 18 to 44/minute

A nurse is caring for a client who is postoperative following a total hip arthroplasty. The nurse assists the client into a supine position. Which of the following actions is appropriate to prevent dislocation of the hip? a. Place a wedge pillow between the legs b. Elevate the head of the bed to a Fowler's position c. Position the legs in alignment with the spine d. Place a footboard on the bed

a. Place a wedge pillow between the legs

A nurse is teaching a client who has a pelvic fracture about manifestations of fat embolism syndrome. The nurse should include which of the following findings as an early manifestation? a. Tachypnea b. Hypertension c. Bradycardia d. Swollen calf

a. Tachypnea

A patient with a pelvic fracture should be monitored for a. changes in urine output b. petechiae on the abdomen c. a palpable lump in the buttock d. sudden increase in BP

a. changes in urine output

A patient with a humeral fracture is returning for a 4-week checkup. The nurse explains that initial evidence of healing on x-ray is indicated by a. formation of callus. b. complete bony union. c. hematoma at the fracture site. d. presence of granulation tissue.

a. formation of callus.

A nurse is caring for a client who has acute osteomyelitis. Which of the following interventions is the nurse's priority? a. Provide the client with antipyretic therapy b. Administer antibiotics to the client c. Increase the client's protein intake d. Teach relaxation of breathing to reduce the client's pain

b. Administer antibiotics to the client

A nurse is planning care for a newly admitted client who has skeletal traction for a fractured femur. Which of the following interventions should the nurse include in the plan? a. Instruct the client to flex and extend the ankle twice daily b. Monitor the client's pedal pulses every hour c. Remove the weights every four hours d. Evaluate pressure points daily

b. Monitor the client's pedal pulses every hour

A nurse is teaching a client who has a fractured femur about fat embolism syndrome. Which of the following findings should the nurse include as a manifestation of a fat embolism? a. Swollen calf b. Petechiae on the chest c. Paresthesia distal to the fracture d. Fever

b. Petechiae on the chest

A nurse is planning care for a client who is postoperative following a total hip arthroplasty. Which of the following interventions should the nurse include in the plan of care? a. Instruct the patient to avoid movement of the affected leg b. Prevent hip flexion of the affected extremity c. Position the lower extremities so that they are touching d. Ensure that the client's heels are touching the bed

b. Prevent hip flexion of the affected extremity

A nurse is caring for a client who sustained a femur fracture in an automobile accident and is placed into skeletal traction. The nurse may remove the weights from the traction device if which of the following occurs? a. The client complains of pain b. The client develops a life-threatening situation c. The client needs to have an x-ray of the femur performed d. The client has to be repositioned in the bed

b. The client develops a life-threatening situation

A patient with osteoarthritis is scheduled for a total hip arthroplasty. The nurse explains that the purpose of this procedure is to (select all that apply) a. fuse the joint b. replace the joint c. prevent further damage d. improve or maintain ROM e. decrease the amount of destruction in the joint

b. replace the joint d. improve or maintain ROM

A patient is diagnosed with a fat embolism after a MVA. Which bone fracture is most commonly associated with fat embolism? a. radial b. rib c. humeral d. femur

d. femur

A nurse is assessing a client who has a puncture wound on his foot. Which of the following findings is a manifestation of acute osteomyelitis? a. Numbness of toes on the affected foot b. Hypothermia c. Localized erythema d. Bradycardia

c. Localized erythema

A nurse is caring for a client who is postoperative following an open reduction and internal fixation of a fractured femur. Which of the following actions is the most important for the nurse to complete in the postoperative period? a. Medicate the client for pain b. Instruct the client on use of crutches c. Perform neurovascular checks of the extremities d. Direct the client to perform exercises of the ankle and toes

c. Perform neurovascular checks of the extremities

The nurse suspects a neurovascular problem based on assessment of a. exaggerated strength with movement b. increased redness and heat below the injury c. decreased sensation distal to the fracture site d. purulent drainage at the site of an open fracture

c. decreased sensation distal to the fracture site

A patient with a comminuted fracture of the tibia is to have an open reduction with internal fixation (ORIF) of the fracture. The nurse explains that ORIF is indicated when a. the patient is unable to tolerate prolonged immobilization b. the patient cannot tolerate the surgery for closed reduction c. other nonsurgical methods cannot achieve adequate alignment d. a temporary cast would be too unstable to provide normal mobility

c. other nonsurgical methods cannot achieve adequate alignment

A nurse is caring for a client following a right total hip arthroplasty. Postoperatively the nurse should maintain the right leg in which of the following positions? a. Adduction b. External rotation c. Internal rotation d. Abduction

d. Abduction

A nurse is assessing a client who is in skeletal traction. Which of the following findings should the nurse identify as an indication of infection at the pin site? a. Serosanguineous drainage b. Mild erythema c. Warmth d. Fever

d. Fever

Following a motor-vehicle accident, a patient arrives in the emergency department with massive right lower-leg swelling. Which action will the nurse take first? a. elevate the leg on pillows b. immobilize the leg c. apply a compression bandage d. check leg pulses and sensation

d. check leg pulses and sensation

A patient with a stable, closed humeral fracture has a temporary splint with bulky padding applied with an elastic bandage. The nurse notifies the provider of possible early compartment syndrome when the patient has a. increasing edema of the limb b. muscle spasms of the lower arm c. bounding pulse at the fracture site d. pain when passively extending the fingers

d. pain when passively extending the fingers

What is a late sign of compartment syndrome? a. pallor b. pain c. paresthesia d. pulselessness

d. pulselessness

In developing a care plan for a patient with an open reduction and internal fixation (ORIF) of an open, displaced fracture of the tibia, the priority nursing diagnosis is a. risk for constipation related to prolonged bed rest b. activity intolerance related to deconditioning c. risk for impaired skin integrity related to immobility d. risk for infection related to disruption of skin integrity

d. risk for infection related to disruption of skin integrity

The nurse suspects an ankle sprain when a patient at the urgent care center describes a. being hit by another soccer player during a game b. having ankle pain after sprinting around the track c. dropping a 10 lb weight on his lower leg at the health club d. twisting his ankle while running bases during a baseball game

d. twisting his ankle while running bases during a baseball game