309 Quiz 13 Musculo-skeletal

Which is a potentially fatal complication of acute compartment syndrome? a) Myoglobinuric renal failure b) Ischemic heart failure c) Acute liver failure d) Hypovolemic shock

a) Myoglobinuric renal failure

The nurse is assessing a patient for severe pain in the right wrist after falling off a step stool. How does the nurse assess this patient's motor function? a) Performing passive range of motion in the wrist. b) Asking the patient to move the fingers. c) Having the patient flex and extend the elbow. d) Instructing the patient to rotate the wrist.

b) Asking the patient to move the fingers.

What should the nurse do to assess the neurovascular status of an extremity casted from the ankle to the thigh? 1) Palpate the femoral artery. 2) Assess for a Homan sign. 3) Compress and release the client's toenails. 4) Instruct the client to flex and extend the knee.

3) Compress and release the client's toenails.

A nurse is teaching crutch walking to a client who had arthroscopic surgery of the knee. On which part of the body should the nurse instruct the client to place weight? 1) The upper arms 2) The axillary region 3) Palms of the hands 4) Both lower extremities

3) Palms of the hands

Which nursing action is contraindicated when caring for a client with a newly applied long leg cast? 1) Elevating the cast on a pillow 2) Drying the cast by using a fan 3) Leaving the cast exposed to air 4) Handling the cast with fingertips

4) Handling the cast with fingertips

A patient in traction reports severe pain from a muscle spasm. What is the nurse's priority action? a) Assess the patient's body alignment. b) Give the patient prn pain medication. c) Notify the heath care provider. d) Remove some of the weights.

a) Assess the patient's body alignment.

The nursing diagnosis for a patient with a fracture of the right ankle is Impaired Physical Mobility. As charge nurse, you observe a newly-graduated RN perform all of the interventions. For which action should you intervene? 1) Encouraging the patient to go from a lying to a standing position. 2) Administering pain medication before the patient begins exercises. 3) Explaining to the patient and family the purpose of the exercise program. 4) Reminding the patient about the correct use of crutches.

1) Encouraging the patient to go from a lying to a standing position.

During assessment of a patient with fractures of the medial ulna and radius, you find all of these data. Which assessment finding should you report to the health care provider immediately? 1) The patient reports pressure and pain. 2) The cast is in a place and is dry and intact. 3) The skin is pink and warm to the touch. 4) The patient can move all the fingers and the thumb.

1) The patient reports pressure and pain.

A nurse suspects the development of compartment syndrome for a client who has sustained blunt trauma to the forearm. For which early sign of compartment syndrome should the nurse assess the client? 1) Warm skin at the site of injury 2) Escalating pain in the fingers. 3) Rapid capillary refill in affected hand 4) Bounding radial pulse in the injured arm

2) Escalating pain in the fingers.

For what clinical findings of compromised circulation should the nurse assess in a client with a long leg cast? (Select all) 1) Foul odor 2) Swelling of the toes 3) Drainage on the cast 4) Increased temperature 5) Prolonged capillary refill

2) Swelling of the toes 5) Prolonged capillary refill

A patient has a fractured femur. Which finding would you instruct the UAP to report immediately? 1) The patient reports pain. 2) The patient appears confused. 3) The patient's blood pressure is 136/88 mm Hg. 4) The patient voided using the bed pan.

2) The patient appears confused.

A patient with a fractured fibula is receiving skeletal traction and has skeletal pins in place. What would you instruct the UAP to report immediately? 1) The patient wants to change position in bed. 2) There is a small amount of clear fluid at the pin sites. 3) The traction weights are resting on the floor. 4)The patient reports pain and muscle spasm.

3) The traction weights are resting on the floor.

A client is ready to walk with crutches after knee surgery. Which crutch walking technique will the nurse most likely have to reinforce after the client returns from physical therapy? 1) Two-point 2) Four-point 3) Three-point 4) Swing-through

3) Three-point

A client has a long leg cast. What instructions should the nurse give the client in preparation for crutch walking? 1) Use the trapeze to straighten the biceps 2) Keep the affected limb in extension and abduction 3) Sit up straight in a chair to develop the back muscles 4) Do exercises in bed to strengthen the the upper extremities

4) Do exercises in bed to strengthen the the upper extremities

The nurse is caring for a patient with an open fracture. Which intervention does the nurse preform to prevent infection of the fracture? a) Use clean or aseptic technique for dressing changes and wound irrigations. b) Use clean technique for dressing changes and wound irrigations. c) Place the patient in contact isolation and wear sterile gloves. d) Place the patient in reverse isolation and wear sterile gloves.

a) Use clean or aseptic technique for dressing changes and wound irrigations.

The nurse is educating a patient who will have external fixation for treatment of a compound tibial fracture. What information does the nurse include in the teaching session? a) the device allows for early ambulation b) There is some danger of blood loss, but no danger of infection c) The device is a substitute therapy for a cast d) The advantage of the device is rapid bone healing

a) the device allows for early ambulation

Which factors affect bone healing after a fracture has occurred? (Select all) a) Patient's age b) Patient's Occupation c) Type of bone injured d) How the fracture is managed e) Presence of infection at the fracture site

a) Patient's age c) Type of bone injured d) How the fracture is managed e) Presence of infection at the fracture site

An older adult sustained injury to the lower legs after being trapped underneath a fallen bookcase. Because the patient is at high risk for crush syndrome, which laboratory values will the nurse specifically monitor? a) Serum potassium level and myoglobin in urine b) White cell count and red cells in the urine c) Prothrombin level and serum lipase level d) Platelet count and serum calcium level

a) Serum potassium level and myoglobin in urine

The nurse is caring for a patient in Buck's (skin) traction. Which task is best to delegate to the UAP (with supervision)? a) Turning and repositioning b) Inspecting heels and sacral area c) Asking the patient about muscle spasms d) Adjusting the weights on the apparatus

a) Turning and repositioning

The nurse is caring for a patient with skeletal pins that have been placed for traction. What does the nurse expect to see in the first 48 hours? a) Clear fluid drainage weeping from the pin insertion site b) Some bloody drainage, but very minimal c) Swelling at the site with tenderness to gentle touch d)Dressings around the pin sites to be dry and intact

a) Clear fluid drainage weeping from the pin insertion site

A chronic complication of bone healing is called avascular necrosis. Which statements about this complication are true? (Select all) a) It involves disrupting the blood supply to the bone. b) It occurs when fat globules disrupt blood supply to the bone. c) It involves disrupting the nerve supply to the bone. d) It results in the death of bone tissue. e) It is most often a complication of hip fractures.

a) It involves disrupting the blood supply to the bone. d) It results in the death of bone tissue. e) It is most often a complication of hip fractures.

The nurse is caring for a patient with a external fixation of a bone fracture. What are the advantages of this type of treatment? (Select all) a) It is less painful than other treatments. b) It allows for earlier ambulation. c) It decreases the risk for infection. d) It maintains bone alignment. e) It stabilizes commuted fractures that require bone grafting.

a) It is less painful than other treatments. b) It allows for earlier ambulation. d) It maintains bone alignment. e) It stabilizes commuted fractures that require bone grafting.

The nurse is caring for several patients on an orthopedic trauma unit. Which conditions have a high risk for development of acute compartment syndrome? (select all) a) Lower legs caught between the bumpers of two cars b) Massive infiltration of IV fluid into forearm c) Bivalve cast on lower leg d) Multiple insect bites to lower legs e) Daily use of oral contraceptives f) Severe burns to upper extremities

a) Lower legs caught between the bumpers of two cars b) Massive infiltration of IV fluid into forearm d) Multiple insect bites to lower legs f) Severe burns to upper extremities

the nurse is caring for a patient who had a kyphoplasty. What does postoperative care for this patient include? (Select all) a) Monitor and record vital signs b) Perform frequent neurologic assessments. c) Apply a warm pack to the puncture site if needed to relieve pain. d) Assess the patient's pain level and compare it to the preoperative level. e) Give opioid analgesics as needed. f) Monitor for bleeding at the puncture site.

a) Monitor and record vital signs b) Perform frequent neurologic assessments. d) Assess the patient's pain level and compare it to the preoperative level. f) Monitor for bleeding at the puncture site.

A patient with a long leg cast that was applied in the ED is being admitted to the orthopedic unit. Which task is the best for the nurse to delegate to the UAP? a) Obtain a fracture pan and use caution to prevent spilage on the cast. b) Obtain several plastic-covered pillows for elevation of the leg. c) Check flexion/extension and color of the toes. d) Turn the patient every 4 to 6 hours to allow the cast to dry.

a) Obtain a fracture pan and use caution to prevent spilage on the cast.

An older patient's family is trying to find an appropriate cane for the patient to use because of chronic pain in the right ankle. The nurse instructs the family to purchase which type of cane? a) One with the top being parallel to the greater trochanter of the femur b) One that creates about 45 degrees of flexion of the elbow c) One that is based on the patient's weight to provide adequate support d) One that has padding on the handle grip to ensure safety

a) One with the top being parallel to the greater trochanter of the femur

A female patient with osteoporosis comes to the ED after falling suddenly while opening her car door. She said it felt as though her "leg gave away" and caused her to fall. What type of fracture does this patient likely have? a) Pathologic (spontaneous) b) Spiral c) Impacted d) Incomplete

a) Pathologic (spontaneous)

A patient comes to the ED with crush syndrome from a crush injury to his right upper extremity and right lower extremity when heavy equipment fell on him at a construction site. The patient has signs and symptoms of hypovolemia, hyperkalemia, and compartment syndrome. Management of care for this patient will focus on preventing which complications? (Select all) a) Sepsis b) Cardiac dysrithmias c) Respiratory failure d) Acute kidney failure e) Fluid overload

b) Cardiac dysrithmias d) Acute kidney failure

An older adult patient has a fractured humerus. The physicain is considering the use of electrical bone stimulation and asks the nurse to take a medical history on the patient. Which specific condition, which is a contraindication for this therapy, does the nurse ask the patient about? a) Seizures b) Cardiac pacemaker c) Stroke d) Peripheral nerve damage

b) Cardiac pacemaker

The nurse is helping to evaluate several patients to determine candidacy for the Ilizaroz external fixation device. Which patient is the best candidate? a) Older woman who lives alone with a fracture of nonunion b) Child with congenital bone deformity whose mother is a licensed practical nurse c) Teenager with an open fracture and bone loss of the left lower leg d) Middle aged man with a new comminuted fracture of the dominant forearm

b) Child with congenital bone deformity whose mother is a licensed practical nurse

A patient in a body cast reports nausea, vomiting, and epigastric pain. the nurse notifies the physician for orders. Which intervention is the most conservative, and therefore the first thing to try, to address this patient's symptoms? a) Insert a nasogastric tube and attach to low wall suction. b) Cut a window over the abdominal area of the cast. c) Obtain an order for an x-ray to diagnose a paralytic ileus. d) Administer prn antiemetic and prn pain medication.

b) Cut a window over the abdominal area of the cast.

A 30-year old patient who is hospitalized for repair of a fractured tibia and fibula sorts shortness of breath. Which complication related to the injury might the patient be experiencing? a) Hypovolemic shock b) Fat embolism c) Acute compartment syndrome d) Pneumonia

b) Fat embolism

The nurse is caring for several orthopedic patients who are in different types of traction. What should the nurse do in assessing the traction equipment? (Select all) a) Inspect all ropes, knots and pulleys once every 24 hours. b) Inspect ropes and knots for fraying or loosening every 8 to 12 hours. c) Check the amount of weight being used against the prescribed weight. d) Observe the traction equipment for proper functioning. e) Check if the ropes have been changed or cleaned within the past 48 hours.

b) Inspect ropes and knots for fraying or loosening every 8 to 12 hours. c) Check the amount of weight being used against the prescribed weight. d) Observe the traction equipment for proper functioning.

A patient comes to the ED after falling off his four-wheeler. His lower leg is obviously broken; it is bleeding and bone fragments are protruding from the skin. What type of fracture does this patient likely have? a) Impacted b) Open (compound) c) Comminuted (fragmented) d) Displaced

b) Open (compound)

The nurse is reviewing the orders for a patient who was admitted for 24-hour observation of a leg fracture. A cast is in place. Which order does the nurse question? a) Elevate the lower leg above the level of the heart. b) Perform neurovascular assessments ("circ checks") every 8 hours. c) Apply ice packs for 24 hours. d) Provide regular diet as tolerated.

b) Perform neurovascular assessments ("circ checks") every 8 hours.

What members of the health care team will be consulted to teach a patient about proper use of the cane? (Select all) a) Occupational therapist b) Physical therapist c) Registered nurse d) Unlicensed assistive personnel e) Medical social worker

b) Physical therapist c) Registered nurse

In the emergency care of a patient with a fracture, which action does the nurse implement first? a) Check the neurovascular status of the area distal to the extremity: temperature, color, sensation, movement, and capillary refill. Compare affected and unaffected limbs. b) Remove the patient's clothing (cut if necessary) to inspect the affected area while supporting the injured area above and below the injury. Do not remove shoes because this can cause increased trauma. c) Apply direct pressure on the area if there is bleeding and pressure over the proximal artery nearest the fracture. d) Immobilize the extremity by splinting: include joints above and below the fracture site. recheck circulation after splinting.

b) Remove the patient's clothing (cut if necessary) to inspect the affected area while supporting the injured area above and below the injury. Do not remove shoes because this can cause increased trauma.

A patient is informed by the physician that he must have a fiberglass cast applied to the lower extremity. What does the nurse teach the patient about the procedure before the cast is applied? a) The cast will be applied after a stockinette is fitted to your skin. b) The cast material will dry and become rigged in a few minutes. c) The cast will increase your risk for skin breakdown. d) The plaster is not a waterproof material.

b) The cast material will dry and become rigged in a few minutes.

A patient is receiving scheduled prn narcotics for severe pain related to a musculoskeletal injury. The nurse finds that the patient's abdomen is distended and bowel sounds are hypoactive. Because the nurse suspects that the patient is having a medication side effect, which question does the nurse ask the patient? a) Are you having nausea and vomiting? b) When was your last bowel movement? c) Does your abdomen hurt? d) Ar you having diarrhea or loose stool?

b) When was your last bowel movement?

A patient was put in traction at 0800 hours. Hourly neurovascular checks were ordered for the first 24 hours and then every 4 hours there-after. At what time can the nursing staff start performing the 4 hour checks? a) 2000 hours the same day b) 0000 hours the next day c) 0800 hours the next day d)1200 hours the next day

c) 0800 hours the next day

A patient with a leg cast denies pain; toes are pink; capillary refill is brisk and toes move freely; the leg is elevated with an ice pack. Six hours later, the patient reports worsening pain unrelieved by medication. The patient's toes are cool and capillary refill is sluggish. What does the nurse suspect is occurring with this patient? a) Crush syndrome b) Fat embolism syndrome c) Acute compartment syndrome d) Fascitis

c) Acute compartment syndrome

The nurse is caring for a patient with a plaster splint applied to the ankle. The patient received oral pain medication at 0900. At 1100, the patient reports that the pain is getting worse, not better. What is the nurse's priority action? a) Give the patient IV pain medication. b) Reposition the extremity on a pillow and place an ice pack. c) Assess the pulses and skin temperature distal to the splint. d) Call the physician to report the patient's increasing pain.

c) Assess the pulses and skin temperature distal to the splint.

An older adult has been admitted with a hip fracture. Approximately 20 hours post injury, the patient develops a symptom recognized as an early sign of fat embolism syndrome. Which symptom is the patient displaying? a) Severe respiratory distress b) Significantly increased pulse rate c) Change in mental status d) Petechiae rash over the neck

c) Change in mental status

The nurse must adjust a pair of crutches to properly fit a patient. Which description illustrates correct crutch adjustment? a) Axilla rests lightly on the top of the crutch when the crutch is moved forward. b) Patient can easily use the crutch without subjective complaints. c) Elbow is flexed no more than 30 degrees when the palm is on the handle. d) Adult patient is of average height and the crutches are medium-sized.

c) Elbow is flexed no more than 30 degrees when the palm is on the handle.

The nurse case manager is making a home visit to help an older patient with a hip fracture. During the home visit, the nurse reviews home environment safety. Which observation indicates a need for additional teaching? a) Patient's bed has been moved to the ground floor level. b) There are handle bars around the toilet and tub. c) Floors are clean and shiny and covered with throw rugs. d) Patient's walker is close to the patient's beside.

c) Floors are clean and shiny and covered with throw rugs.

The older patient has a fracture that has failed to heal. Which fracture complication best describes this situation? a) Malunion b) Avascular necrosis c) Nonunion d) Crush syndrome

c) Nonunion

The nurse is assessing a patient with an injury to the shoulder and upper arm after being thrown from a horse. What is the best position for this patient's pain assessment? a) Supine so that the extremity can be elevated b) Low Fowler's on an exam table for patient comfort c) Sitting to observe for shoulder droop d) Slow ambulation to observe for natural arm movement

c) Sitting to observe for shoulder droop

The patient has a musculoskeletal injury that resulted from excessive stretching of a muscle or tendon. Which type best describes this patient's injury? a) Dislocation b) Sprain c) Strain d) Subluxation

c) Strain

The nurse is providing teaching for a patient with a forearm cast. What information does the nurse give to the patient? a) The hand should be elevated above the shoulder when resting. b) Use an ice pack for the first 6 to 8 hours, and cover the ice pack with a towel to absorb condensation. c) The sling should distribute the weight over a large area of the shoulders and trunk. d) Limit movement of the fingers or wrist joints to prevent pain.

c) The sling should distribute the weight over a large area of the shoulders and trunk.

The nursing student is assisting with the care of a patient with musculoskeletal pain related to soft tissue injury and bone disruption. The student sees that the patient has a prn (as needed) order for pain medication. What does the student do first in order to decide when to give the pain medication? a) Ask the physician to clarify the order for specific parameters. b) Check with the primary nurse or the charge nurse for advice. c). Ask the patient about types of activities that increase the pain. d) Ask the instructor for help interpreting the order.

c). Ask the patient about types of activities that increase the pain.

A patient is prescribed low-intensity ultrasound treatments for a very slow healing fracture of the right lower leg.What instructions does the nurse give this patient related to the treatment? a) Test for pregnancy before the therapy and use birth control until treatment is complete. b) the treatment is experimental, but there are no known adverse effects. c) The device is implanted directly into the fracture site and there is no external apparatus. d) Expect to dedicate approximately 20 minutes a day for one treatment.

d) Expect to dedicate approximately 20 minutes a day for one treatment.

The nurse is instructing a teenage patient with a tibia-fibula fracture that was treated with internal fixation and a long leg cast. He is anxious to know when the cast will be removed so that he can resume football practice. Which statement by the patient indicates a need for additional teaching? a) There's a possibility that the cast could be removed in 4 weeks. b) The plates and screws reduce the length of time I'll be in the cast. c) The cast could remain in place as long as 6 weeks. d) I'll use crutches for 2 weeks and then the cast will be removed.

d) I'll use crutches for 2 weeks and then the cast will be removed.

A patient comes to the ED after slipping on some chalk in her classroom. She did not fall far and was able to walk with the assistance of one of her students. What type of fracture does this patient likely have? a) Closed, non displaced b) Oblique c) Impacted d) Incomplete

d) Incomplete

A patient who tripped and fell down several stairs reports having heard a popping sound and fears that she has broken her ankle. How does the nurse initially assess for fracture in this patient? a) Measuring the circumference of the distal leg b) Gently moving the ankle through the full range of motion c) Inspecting for crepitus and skin color d) Observing for deformity or misalignment

d) Observing for deformity or misalignment

A patient with a lower extremity injury is being treated by external fixation. What nursing assessment is of particular concern in the care of this patient with this type of system? a) Maintaining a 30-degree flexed position of the knee. b) Measuring the weights used for counter-traction. c) Observing the patients ability to adjust the clickers. d) Observing the points of entry of the pins and wires.

d) Observing the points of entry of the pins and wires

A patient has a fracture of the right wrist. What is an early sign that indicates this patient may be having a complication? a) Patient loses ability to wiggle fingers without pain. b) Fingers are cold and pale; capillary refill is sluggish. c) Pain is severe and seems out of proportion to injury. d) Patient reports a subjective numbness and tingling.

d) Patient reports a subjective numbness and tingling.

An older patient with a lower leg fracture is having difficulty performing the weight-bearing exercises. Based on the fracture pathophysiology and the patient's abilities, which condition could the patient develop? a) Osteomyelitis b) Internal derangement c)Neuroma d) Pulmonary embolism

d) Pulmonary embolism

the student nurse is assessing a patient with a probable fractured tibia-fibula. What assessment technique used by the student nurse causes the supervising nurse to intervene? a) Inspects the fracture site for swelling or deformity b) Instructs the patient to wiggle the toes c) Assesses the bilateral dorsals pedis pulse d) Pushes on the leg to elicit pain response

d) Pushes on the leg to elicit pain response

Which term related to the fracture healing process is the process of bone building and resorption? a) Callus b) Granulation c) Hematoma d) Remodeling

d) Remodeling

The unlicensed assistive personnel (UAP) is assisting the orthopedic physician to cut a window in a patient's cast. What does the nurse instruct the UAP to do? a) Check the pulse that is assessed after the window is cut b) Clean up and dispose of all casting debris c) Inform the patient that the procedure is painless d) Save the plaster piece that was cut so it can be taped in place

d) Save the plaster piece that was cut so it can be taped in place

What potential adverse effect prevents meperidine (Demerol) from being used in older adults? a)Hypertension b) Angina c) Kidney failure d) Seizures

d) Seizures