Adult Health II Musculoskeletal Trauma Chapter 37 PREP U

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."

The nurse is caring for a patient with a total hip replacement. How should the nurse allow the patient to turn? 45 degrees onto the unoperated side if the affected hip is kept abducted From the prone to the supine position only, and the patient must keep the affected hip extended and abducted To any comfortable position as long as the affected leg is extended To the operative side if the affected hip remains extended

45 degrees onto the unoperated side if the affected hip is kept abducted Explanation: When the nurse turns the patient in bed to the unaffected side, it is important to keep the operative hip in abduction (movement away from the center or median line of the body). The patient should not be turned to the operative side, which could cause dislocation, unless specified by the surgeon. The patient's hip is never flexed more than 90 degrees.

When is it advisable for the nurse to apply heat to a sprain or a contusion? Do not apply at all Immediately After 2 days Only after a week

After 2 days Explanation: It is advisable to apply heat on a sprain or a contusion 2 days after a sprain or a contusion has occurred. This is because after 2 days swelling is not likely to increase and as a result heat application reduces pain and relieves local edema by improving circulation. Delaying the application of heat prolongs the pain and increased the risk of local edema.

A client had an above-the-knee amputation of the left leg related to complications from peripheral vascular disease. The nurse enters the client's room and observes the dressing and bed covers saturated with blood. What is the first action by the nurse? Notify the health care provider. Apply a tourniquet. Use skin clips to close the wound. Reinforce the dressing.

Apply a tourniquet Explanation: Following an amputation, immediate postoperative bleeding may develop slowly or may take the form of massive hemorrhage resulting from a loosened suture. A large tourniquet should be in plain sight at the client's bedside so that if severe bleeding occurs, it can be applied to the residual limb to control the hemorrhage. The nurse immediately notifies the surgeon in the event of excessive bleeding.

A young client is being treated for a femoral fracture suffered in a snowboarding accident. The nurse's most recent assessment reveals that the client is uncharacteristically confused. What diagnostic test should be performed on this client? Electrolyte assessment Electrocardiogram Arterial blood gases Abdominal ultrasound

Arterial Blood Gases Explanation: Subtle personality changes, restlessness, irritability, or confusion in a client who has sustained a fracture are indications for immediate arterial blood gas studies due to the possibility of fat embolism syndrome.

A nurse is caring for a client who has sustained ligament and a meniscal injury to the knee. Which action would be most appropriate to allow the client to progress without causing further injury? Administer nonsteroidal anti-inflammatory drugs (NSAIDs) regularly. Apply heat to the affected area every night. Apply a cold pack to the affected area every night. Assist with a gradual introduction of activity.

Assist with a gradual introduction of activity.

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.

A client who has sustained a fracture reports an increase in pain and decreased function of the affected extremity. What will the nurse suspect? Infection Pulmonary embolism Avascular necrosis Hypovolemic shock

Avascular necrosis Explanation: Avascular necrosis refers to the death of the bone from insufficient blood supply, typically manifested by complaints of increased pain and decreased function.

An x-ray demonstrates a fracture in which a bone has splintered into several pieces. Which type of fracture is this? Compound Depressed Impacted Comminuted

Comminuted

A client with a fractured distal left radius reports discomfort at the cast site, with pain specifically in the upper forearm. What would the nurse expect the physician to do? Cut a cast window. Remove the cast. Apply a fiberglass cast. Initiate physical therapy.

Cut a cast window. Explanation: 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.

The client who had a total hip replacement was discharged home and developed acute groin pain in the affected leg, shortening of the leg, and limited movement of the fractured leg. The nurse interprets these findings as indicating which complication? Dislocation of the hip Re-fracture of the hip Contracture of the hip Avascular necrosis of the hip

Dislocation of the hip Explanation: Manifestations of a dislocated hip prosthesis are increased pain at the surgical site, acute groin pain in the affected leg, shortening of the leg, abnormal external or internal rotation, and limited movement of the fractured leg. The client may report a "popping" sensation in the hip.

Colles fracture occurs in which area? Elbow Humeral shaft Clavicle Distal radius

Distal radius

A nurse is caring for a client who has had an amputation. What interventions can the nurse provide to foster a positive self-image? (Select all that apply.) Encouraging the client to care for the residual limb Allowing the client to express grief Encouraging the client to have family and friends view the residual limb to decrease self-consciousness Encouraging family and friends to refrain from visiting temporarily because this may increase the client's embarrassment Introducing the client to local amputee support groups

Encouraging the client to care for the residual limb Allowing the client to express grief Introducing the client to local amputee support group

The nurse is caring for a patient postoperatively following orthopedic surgery. The nurse assesses an oxygen saturation of 89%, confusion, and a rash on the upper torso. What does the nurse suspect is occurring with this patient? Polyethylene-induced infection Pneumonia Fat emboli syndrome Disseminated intravascular coagulation

Fat emboli syndrome Explanation: Fat embolism syndrome (FES) (see Chapter 43) may occur with orthopedic surgery. The nurse must be alert to any signs and symptoms that may suggest the development of FES. These may include respiratory distress; onset of delirium or any acute change in level of consciousness; and development of unusual skin rashes, especially a papular rash on the upper torso.

The femur fracture that commonly leads to avascular necrosis or nonunion because of an abundant supply of blood vessels in the area is a fracture of the: Condylar area. Femoral neck. Shaft of the femur. Trochanteric region.

Femoral neck. Explanation: A fracture of the neck of the femur may damage the vascular system and the bone will become ischemic. Therefore, a vascular necrosis is common.

While riding a bicycle on a narrow road, the patient was hit from behind and thrown into a ditch, sustaining a pelvic fracture. What complications does the nurse know to monitor for that are common to pelvic fractures? Paresthesia and ischemia Hemorrhage and shock Paralytic ileus and a lacerated urethra Thrombophlebitis and infection

Hemorrhage and shock Explanation: Hemorrhage and shock are two of the most serious consequences that may occur in a pelvic fracture.

An emergency department nurse is assessing a 17-year-old soccer player who presented with a knee injury. The client's description of the injury indicates that his knee was struck medially while his foot was on the ground. The nurse knows that the client likely has experienced what injury? Lateral collateral ligament injury Medial collateral ligament injury Anterior cruciate ligament injury Posterior cruciate ligament injury

Lateral collateral ligament injury Explanation: When the knee is struck medially, damage may occur to the lateral collateral ligament. If the knee is struck laterally, damage may occur to the medial collateral ligament. The ACL and PCL are not typically injured in this way.

A client is brought to the emergency department after injuring the right arm in a bicycle accident. The orthopedic surgeon tells the nurse that the client has a greenstick fracture of the arm. What does this mean? The fracture line extends through the entire bone substance. The fracture results from an underlying bone disorder. Bone fragments are separated at the fracture line. One side of the bone is broken and the other side is bent.

One side of the bone is broken and the other side is bent.

A nurse is caring for a client who underwent a total hip replacement. What should the nurse and other caregivers do to prevent dislocation of the new prosthesis? Keep the affected leg in a position of adduction. Use measures other than turning to prevent pressure ulcers. Prevent internal rotation of the affected leg. Keep the hip flexed by placing pillows under the client's knee.

Prevent internal rotation of the affected leg.

The nurse is caring for a client who underwent a total hip replacement yesterday. What should the nurse do to prevent dislocation of the new prosthesis? Keep the affected leg in a position of adduction. Have the client reposition himself independently. Protect the affected leg from internal rotation. Keep the hip flexed by placing pillows under the client's knee

Protect the affected leg from internal rotation. Explanation: Abduction of the hip helps to prevent dislocation of a new hip joint. Rotation and adduction should be avoided. While the hip may be flexed slightly, it shouldn't exceed 90 degrees and maintenance of flexion isn't necessary. The client may not be capable of safe independent repositioning at this early stage of recovery.

While assessing a client who has had knee replacement surgery, the nurse notes that the client has developed a hematoma at the surgical site. The affected leg has a decreased pedal pulse. What would be the priority nursing diagnosis for this client? Risk for Infection Risk for Ineffective Peripheral Tissue Perfusion Unilateral Neglect Related to Hematoma Disturbed Kinesthetic Sensory Perception

Risk for Ineffective Peripheral Tissue Perfusion

A client comes to the emergency department and it is found that the client's radial head is partially dislocated. What is this partially dislocated radial head documented as? Volkmann's contracture Subluxation Compartment syndrome Sprain

Subluxation A partial dislocation is referred to as a subluxation

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 Explanation: 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.

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

Volkmann's contracture

Which is not one of the general nursing measures employed when caring for the client with a fracture? cranial nerve assessment administering analgesics providing comfort measures assisting with ADLs

cranial nerve assessment

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. Explanation: 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

A patient has suffered a femoral shaft fracture in an industrial accident. What is an immediate nursing concern for this patient? Hypovolemic shock Infection Knee and hip dislocation Pain resulting from muscle spasm

Hypovolemic shock Explanation: Frequently, the patient develops shock, because the loss of 1,000 mL of blood into the tissues is common with fractures of the femoral shaft

A client sustains a fractured right humerus in an automobile accident. The arm is edematous, the client states not being able to move or feel the fingers, and the nurse does not feel a pulse. What condition should the nurse be concerned about that requires emergency measures? Compartment syndrome Dislocation Muscle spasms Subluxation

Compartment syndrome

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."

Which nursing diagnosis takes highest priority for a client with a compound fracture? Imbalanced nutrition: Less than body requirements related to immobility Impaired physical mobility related to trauma Infection related to effects of trauma Activity intolerance related to weight-bearing limitations

Infection related to effects of trauma

A client with a traumatic amputation of the right lower leg is refusing to look at the leg. Which action by the nurse is most appropriate? Provide wound care without discussing the amputation. Request a referral to occupational therapy. Encourage the client to perform range-of-motion (ROM) exercises to the right leg. Provide feedback on the client's strengths and available resources.

Provide feedback on the client's strengths and available resources. Explanation: Providing feedback on the client's strengths and resources may allow the client to start to adapt to the body image and lifestyle change

A nurse is giving instructions to a client who's going home with a leg cast. Which teaching point is most critical? Using crutches properly Exercising joints above and below the cast, as ordered Avoiding walking on a leg cast without the health care provider's permission Reporting signs of impaired circulation

Reporting signs of impaired circulation

The nurse is monitoring a patient who sustained a fracture of the left hip. The nurse should be aware that which kind of shock can be a complication of this type of injury? Cardiogenic Hypovolemic Neurogenic Septic

Hypovolemic Explanation: n a client with a pelvic fracture, the nurse should be aware of the potential for hypovolemic shock resulting from hemorrhage. Cardiogenic shock, in which the heart cannot pump enough blood to meet the body's needs, often arises from severe myocardial infarction. Neurogenic shock is often a consequence of spinal cord injury and resulting loss of sympathetic nervous system function. Septic shock results from body-wide infection.

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

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."

A client with a recent left above-the-knee amputation states, "I can feel pain in my left toes." Which is the best response by the nurse? "Your left toes have been amputated." "The pain is really from the nerves in the upper leg." "Pain medication usually does not help this type of pain." "Describe the pain and rate it on the pain scale."

"Describe the pain and rate it on the pain scale."

A client has sustained a right tibial fracture and has just had a cast applied. Which instruction should the nurse provide in client cast care? "Cover the cast with a blanket until the cast dries." "Keep your right leg elevated above heart level." "Use a knitting needle to scratch itches inside the cast." "A foul smell from the cast is normal."

"Keep your right leg elevated above heart level." Explanation: The nurse should instruct the client to elevate the leg to promote venous return and prevent edema.

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. Explanation: The nurse should assess for pain on passive flexion of each foot, which could indicate deep vein thrombosis.

Which nursing intervention is essential in caring for a client with compartment syndrome? Keeping the affected extremity below the level of the heart Wrapping the affected extremity with a compression dressing to help decrease the swelling Removing all external sources of pressure, such as clothing and jewelry Starting an I.V. line in the affected extremity in anticipation of venogram studies

Removing all external sources of pressure, such as clothing and jewelry Explanation: Nursing measures should include removing all clothing, jewelry, and external forms of pressure (such as dressings or casts) to prevent constriction and additional tissue compromise. The extremity should be maintained at heart level (further elevation may increase circulatory compromise, whereas a dependent position may increase edema). A compression wrap, which increases tissue pressure, could further damage the affected extremity. There is no indication that diagnostic studies would require I.V. access in the affected extremity.

An elite high school football player has been diagnosed with a shoulder dislocation. The client has been treated and is eager to resume his role on his team, stating that he is not experiencing pain. What should the nurse emphasize during health education? The need to take analgesia regardless of the short-term absence of pain The importance of adhering to the prescribed treatment and rehabilitation regimen The fact that he has a permanently increased risk of future shoulder dislocations The importance of monitoring for intracapsular bleeding once he resumes playing

The importance of adhering to the prescribed treatment and rehabilitation regimen

To reduce the incidence of complications in a client in traction, which intervention should be included in the care plan? Remove the weights during linen changes. Increase calorie intake. Reduce fluid intake. Increase fiber intake.

increase calorie intake

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

A nurse is developing a teaching plan for a client who must undergo an above-the-knee amputation of the left leg. After a leg amputation, exercise of the remaining limb: isn't necessary. should begin immediately postoperatively. should begin the day after surgery. begins at a rehabilitation center.

should begin the day after surgery.

A client is experiencing pain, joint instability, and difficulty walking due to an injury to the knee ligaments. The injury was judged not to require surgery. Which intervention would not be included in this client's care? traction joint immobilization limited weight bearing ice and NSAIDs

traction Explanation: Joint immobilization, limited weight bearing, ice, and NSAIDs would be included in the initial treatment. Traction is not required because there is no break, and surgery is not required.

A classic indicator of edema and alveolar hemorrhage associated with Fat Embolism Syndrome is: Tachycardia. Hyperventilation. Crackles and wheezes. Tachypnea.

Hyperventilation. Explanation: Occlusion of the small vessels in the alveoli leads to a PaO2 of less than 80 mm Hg with an early respiratory alkalosis. The patient experiences hyperventilation in an attempt to get oxygen into the lungs

A client was climbing a ladder, slipped on a rung, and fell on the right side of the chest. X-ray studies reveal three rib fractures, and the client reports pain with inspiration. What is the anticipated treatment for this client? Chest strapping Mechanical ventilation Coughing and deep breathing with pillow splinting Thoracentesis

Coughing and deep breathing with pillow splinting Explanation: Because these fractures cause pain with respiratory effort, the client tends to decrease respiratory excursions and refrains from coughing. As a result, tracheobronchial secretions are not mobilized, aeration of the lung is diminished, and a predisposition to atelectasis and pneumonia results. To help the client cough and take deep breaths and use an incentive spirometer, the nurse may splint the chest with his or her hands, or may educate the client on using a pillow to temporarily splint the affected site.

After a car accident, a client is admitted to an acute care facility with multiple traumatic injuries, including a fractured pelvis. For 24 to 48 hours after the accident, the nurse must monitor the client closely for which potential complication of a fractured pelvis? Compartment syndrome Fat embolism Infection Volkmann's ischemic contracture

Fat Embolism Explanation: Fat embolism is a relatively rare but life-threatening complication of pelvis and long-bone fractures, arising 24 to 48 hours after the injury. It occurs when fat droplets released at the fracture site enter the circulation, become lodged in pulmonary capillaries, and break down into fatty acids. Because these acids are toxic to the lung parenchyma, capillary endothelium, and surfactant, the client may develop pulmonary hypertension. Signs and symptoms of fat embolism include an altered mental status, fever, tachypnea, tachycardia, hypoxemia, and petechiae.

A nurse is performing a shift assessment on an elderly client who is recovering after surgery for a hip fracture. The client reports chest pain, has an increased heart rate, and increased respiratory rate. The nurse further notes that the client is febrile and hypoxic, coughing, and producing large amounts of thick, white sputum. The nurse recognizes that this is a medical emergency and calls for assistance, recognizing that this client is likely demonstrating symptoms of what complication? Avascular necrosis of bone Compartment syndrome Fat embolism syndrome Complex regional pain syndrome

Fat Embolism Syndrome Explanation: Fat embolism syndrome occurs most frequently in young adults and elderly clients who experience fractures of the proximal femur (i.e., hip fracture). Presenting features of fat embolism syndrome include hypoxia, tachypnea, tachycardia, and pyrexia. The respiratory distress response includes tachypnea, dyspnea, wheezes, precordial chest pain, cough, large amounts of thick, white sputum, and tachycardia. Avascular necrosis (AVN) occurs when the bone loses its blood supply and dies. This does not cause coughing. Complex regional pain syndrome does not have cardiopulmonary involvement.