Chapter 37: Management of Patients with Musculoskeletal Trauma

A client has delayed bone healing in a fractured right humerus. What should the nurse prepare the client for that promotes bone growth?

Electrical stimulation

A client is transported to the emergency department for a femur fracture following a motor vehicle crash. What action by the nurse is the highest priority?

assess vital signs and level of consciousness

Which would be consistent as a component of self-care activities for the client with a cast?

cushioning rough edges of the cast with tape

Which type of fracture involves a break through only part of the cross-section of the bone?

incomplete

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

osteomyelitis

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 a cast window

A nurse is caring for a client who has suffered a hip fracture and who will require an extended hospital stay. The nurse should ensure that the client does what action to prevent common complications associated with a hip fracture?

Increase fluid intake and perform prescribed foot exercises.

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?

Subluxation

The nurse is preparing a client to have his cast cut off after having it for 6 weeks to treat a fractured tibia. What should the nurse inform the client prior to the cast being removed?

The skin may be covered with a yellowish crust that will shed in a few days.

A client is being discharged home with a long arm cast. What education should the nurse include to prevent disuse syndrome in the arm?

Use of isometric exercises

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?

total athroplasty

A nurse is preparing to discharge a client from the emergency department after receiving treatment for an ankle sprain. While providing discharge education, the nurse should encourage what action?

Keep an elastic compression bandage on the ankle.

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

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?

Hypovolemic

A client is reporting pain following orthopedic surgery. Which intervention will help relieve pain?

Elevate the affected extremity and use cold applications.

When is it advisable for the nurse to apply heat to a sprain or a contusion?

After 2 days

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

Which cleansing solution is the most effective for use in completing pin site care?

Chlorhexidine

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?

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

A client asks the nurse why his residual limb cannot be elevated on a pillow. What is the best response by the nurse?

"Elevating the leg might lead to a flexion contracture."

A client has a Fiberglass cast on the right arm. Which action should the nurse include in the care plan?

Assessing movement and sensation in the fingers of the right hand

Which factor may contribute to compartment syndrome?

Hemorrhage

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?

Apply lotions and take warm baths or soaks.

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

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 feedback on the client's strengths and available resources.

The nurse is assigned to care for a client who has had a total knee arthroplasty yesterday. What type of pharmacologic therapy does the nurse anticipate administering to this client to prevent complications related to the surgery?

Anticoagulation therapy

A client has returned to the postsurgical unit from the PACU after an above-the-knee amputation of the right leg. Results of the nurse's initial postsurgical assessment were unremarkable but the client has called out. The nurse enters the room and observes copious quantities of blood at the surgical site. What should be the nurse's initial action?

Apply a tourniquet.

Which action would be most important postoperatively for a client who has had a knee or hip replacement?

Assisting in early ambulation.

An emergency department client is diagnosed with a hip dislocation. The client's family is relieved that the client has not suffered a hip fracture, but the nurse explains that this is still considered to be a medical emergency. What is the rationale for the nurse's statement?

Avascular necrosis may develop at the site if it is not promptly resolved.

An important nursing assessment, post fracture, is to evaluate neurovascular status. Therefore, the nurse should check for:

Capillary refill.

A client was playing softball and dislocated four fingers when diving for a ball. The physician manipulated the fingers into alignment and applied a splint to maintain alignment. What type of procedure does the nurse document this as?

Closed reduction

Which of the following type of fracture is associated with osteoporosis?

Compression

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

The nurse in an orthopedic clinic is caring for a new client. What sign or symptom would lead a nurse to suspect that a client has a rotator cuff tear?

Difficulty lying on affected side

A client with a fractured femur is admitted to the nursing unit. Which assessment finding requires follow up by the nurse? Select all that apply.

Dorsoplantar weak and unequal bilaterally "I have a pins-and-needles sensation in my toes." "I cannot seem to catch my breath." T 101.2 degrees F; HR 110; RR 28; pulse oximetry 90%

The nurse teaching the client with a cast about home care includes which instruction?

Dry a wet fiberglass cast thoroughly to avoid skin problems

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.

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:

Femoral neck.

Which term refers to a fracture in which one side of a bone is broken and the other side is bent?

Greenstick

To reduce the incidence of complications in a client in traction, which intervention should be included in the care plan?

Increase fiber intake.

An older adult client experienced a fall and required treatment for a fractured hip on the orthopedic unit. Which of the following are contributory factors to the incidence of falls and fractured hips among the older adult population? Select all that apply.

Loss of visual acuity Muscle weakness Adverse medication effects Slowed reflexes

A client who was in a motor vehicle crash is diagnosed with a stable T7 spinal fracture with no neurologic deficits. Which nursing intervention should the nurse implement?

Maintain bed rest with the head of the bed at 20 degrees.

After a traumatic back injury, a client requires skeletal traction. Which intervention takes priority?

Maintaining traction continuously to ensure its effectiveness

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?

Prevent internal rotation of the affected leg.

A client has had a brace prescribed to facilitate recovery from a knee injury. What are the potential therapeutic benefits of a brace? Select all that apply.

Preventing additional injury Providing support Controlling movement

The clinic nurse is caring for a client with an injured body part that does not require rigid immobilization. What method of immobilization would the nurse expect the health care provider to use on a short-term basis?

Splint

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?

Teach the client how to prevent problems caused by immobility.

A client is diagnosed with a first-degree strain of the left ankle related to running 5 miles daily. How would the nurse differentiate the first-degree strain from other strains and sprains?

The client has some edema of the left ankle with muscle spasms but is able to walk without assistive devices.

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

A nurse is caring for a client in skin traction. In order to prevent bony fragments from moving against one another, the nurse should caution the client against performing what action?

Turning from side to side

A patient had a total hip replacement. What recommended leg position should the nurse ensure is maintained to prevent prosthesis dislocation?

abduction

There are a variety of problems that can become complications after a fracture. Which is described as a condition that occurs from interruption of the blood supply to the fracture fragments after which the bone tissue dies, most commonly in the femoral head?

avascular necrosis

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?

fat embolism

The type of fracture described as having one side of the bone broken and the other side bent would be:

greenstick

Which factor inhibits fracture healing?

history of diabetes

Which term refers to the failure of fragments of a fractured bone to heal together?

nonunion

Which is a hallmark sign of compartment syndrome?

pain

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

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."

A client is being prepared for a total hip arthroplasty, and the nurse is providing relevant education. The client is concerned about being on bed rest for several days after the surgery. The nurse should explain what expectation for activity following hip replacement?

"The physical therapist will likely help you get up using a walker the day after your surgery."

A client with an arm cast reports pain. What nursing interventions should the nurse provide in order to reduce the incidence of complications? Select all that apply.

*Determine the exact site of the pain. *Assess the fingers for color and temperature. *Assess for a pressure sore

A client is brought in by ambulance to the emergency department after being involved in a motorcycle accident. The client has an open fracture on his tibia. The wound is highly contaminated and there is extensive soft- tissue damage. How would this client's fracture likely be graded?

Grade III

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."

An older adult client slipped on an area rug at home and fractured the left hip. The client is unable to have surgery immediately and is having severe pain. What interventions should the nurse provide for the patient to minimize energy loss in response to pain?

Administer prescribed analgesics around-the-clock.

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?

Hemorrhage and shock

The nurse assesses a client after 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?

Notify the health care provider.

A client has sustained a long bone fracture and the nurse is preparing the client's care plan. Which of the following should the nurse include in the care plan?

Monitor temperature and pulses of the affected extremity.

A client who plays tennis is experiencing elbow discomfort. Following assessment, the client receives a diagnosis of tendinitis, epicondylitis, or tennis elbow. What symptoms and signs did the client have? Select all that apply.

*pain radiating down the dorsal surface of the forearm *weak grasp

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?

Protect the affected leg from internal rotation.

A patient in pelvic traction needs circulatory status assessed. How should the nurse assess for a positive Homans' sign?

Have the patient extend each leg and dorsiflex each foot to determine if pain or tenderness is present in the lower leg.