Chp 41 Musculoskeletal Care Modalities P 1103

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

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

A client is being discharged after a total knee replacement. The nurse is reviewing the client's discharge instructions. Which client statement indicates that the client has understood the instructions? a) "I can gradually increase my activity as I feel able to do so." b) "I need to limit the amount of fluids I drink for the first week." c) "I need to avoid any exercise for the first few weeks." d) "I need to call my physician if I experience sudden pain or swelling."

"I need to call my physician if I experience sudden pain or swelling." Explanation: The client demonstrates knowledge when he states that he should notify the physician with any sudden onset of pain or swelling. This may signal a complication that needs to be addressed. The client should follow the directions for activity and exercise, not resuming any activity that has been restricted until told to do so. Additionally, the client needs to perform exercises exactly as prescribed by the physician and physical therapist. The client also should eat a nutritious diet and drink plenty of fluids to promote healing and maintain renal and gastrointestinal function.

A client has fractured his right arm playing football. What is an advantage of using a plaster of Paris cast for this client? a) Accommodates edema b) Dries faster c) Is lighter d) Is breathable

Accommodates edema Explanation: Plaster casts require a longer time for drying, but mold better to the client, and are initially used until the swelling subsides.

Which of the following would be an inconsistent initial pain relief measure for the patient with a cast? a) Elevation of the involved part b) Application of a new cast c) Administration of analgesics d) Application of cold packs

Application of a new cast Explanation: 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 group of students are 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? a) More breathable b) Better molding to the client c) Longer-lasting d) Quicker drying

Better molding to the client Explanation: 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, longer-lasting, and breathable.

A client's fracture was reduced by surgically exposing the bone and realigning it. The nurse identifies this as which of the following? a) Open reduction b) Buck's traction c) Internal fixation d) Skeletal traction

Open reduction Explanation: 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.

Which of the following is an inaccurate principle of traction? a) Skeletal traction is interrupted to turn and reposition the patient. b) The weights must hang freely. c) The weights are not removed unless intermittent treatment is prescribed. d) The patient must be in good alignment in the center of the bed.

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

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

Weights hanging and touching the floor Explanation: 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.

Choice Multiple question - Select all answer choices that apply. For which of the following immobility-related complications is the client in traction at risk? Select all that apply. a) Diarrhea b) Thromboemboli c) Cachexia d) Urinary stasis e) Lactose intolerance

• Thromboemboli • Urinary stasis Explanation: Immobility-related complications may include pressure ulcers, atelectasis, pneumonia, constipation, loss of appetite, urinary stasis, urinary tract infections, and venous thromboemboli formation.

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

"Limit hip flexion to 90 degrees." Explanation: 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? a) "A belt will go around my pelvis and weights will be attached." b) "The traction can be removed once a day so I can shower." c) "I will wear a boot with weights attached." d) "Metal pins will go through my skin to the bone."

"Metal pins will go through my skin to the bone." Explanation: 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.

The nurse is providing instructions to the client who is being prepared for skeletal traction. Which statement by the client indicates teaching was effective? a) "A belt will go around my pelvis and weights will be attached." b) "The traction can be removed once a day so I can shower." c) "I will wear a boot with weights attached." d) "Metal pins will go through my skin to the bone."

"Metal pins will go through my skin to the bone." Explanation: 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.

The client displays manifestations of compartment syndrome. The nurse expects the client to be scheduled for: a) An open reduction b) A fasciotomy c) A total hip replacement d) A total knee replacement

A fasciotomy Explanation: A treatment option for compartment is fasciotomy.

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? a) Apply lotions and take warm baths or soaks. b) Avoid exposure to direct sunlight. c) Scrub the area vigorously to remove the crust. d) Consult a skin specialist.

Apply lotions and take warm baths or soaks. Explanation: 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.

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? a) Crutchfield tongs b) Buck's c) Balanced suspension d) Thomas splint

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

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

Cover the cast with plastic to insulate it Explanation: 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.

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

Cover the cast with plastic to insulate it Explanation: 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.

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 of the following complications? a) Re-fracture of the hip b) Contracture of the hip c) Dislocation of the hip d) 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.

The physician is preparing to bivalve the client's cast. Which supplies should the nurse assemble? a) Elastic compression bandages b) Gauze bandages and tape c) Stockinette and cotton padding d) Sterile saline and basin

Elastic compression bandages Explanation: Bivalving of a cast involves splitting the cast longitutdinally and spreading the cast apart to relieve pressure. The fractured extremity is immobilized by securing the two parts of the cast together with an elastic compression bandage.

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? a) Exploring factors related to the client's home environment. b) Educating the client about the effects of menopause. c) Urging her to keep the affected limb in an elevated position. d) Advising the client to avoid red meat.

Exploring factors related to the client's home environment. Explanation: 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. Since the healing is almost complete, the client need not always keep the affected limb elevated unless prescribed to do so. Since 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.

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 of the following complications? a) Osteomyelitis b) Hypovolemic shock c) Atelectasis d) Urinary retention

Hypovolemic shock Explanation: 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 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? a) Deficient Diversional Activity related to prolonged hospitalization b) Activity Intolerance related to impaired mobility c) Impaired Physical Mobility related to traction d) Ineffective Coping related to prolonged immobility

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

A client's fracture was reduced by surgically exposing the bone and realigning it. The nurse identifies this as which of the following? a) Skeletal traction b) Internal fixation c) Open reduction d) Buck's traction

Open reduction Explanation: 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.

Which of the following orthopedic surgeries is done to correct and align a fracture after surgical dissection and exposure of the fracture? a) Total joint arthroplasty b) Arthrodesis c) Joint arthroplasty d) Open reduction

Open reduction Explanation: An open reduction is the correction and alignment of the fracture after surgical dissection and exposure of the fracture. Arthrodesis is immobilizing fusion of a joint. A joint arthroplasty or replacement is the replacement of joint surfaces with metal or synthetic materials. A total joint arthroplasty is the replacement of both the articular surfaces within a joint with metal or synthetic materials.

A client is about to have a cast applied to his left arm. The nurse would alert the client to which of the following as the cast is applied? a) Increased in pain in left arm b) Arm being moved to various positions c) Sensation of warmth or heat with application d) Sensation of weakness

Sensation of warmth or heat with application Explanation: When a cast is applied, the client needs to be aware that he 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.

Conservative treatment of a compressed nerve root is first line treatment. What conservative treatment is used to increase the distance between vertebrae and decrease severe muscle spasm? a) Skin traction b) Skeletal traction c) Sleeping on a hard mattress with a bed board d) Cool, moist compresses

Skin traction Explanation: Skin traction, which can be applied in the home, is used to decrease severe muscle spasm as well as increase the distance between adjacent vertebrae, keep the vertebrae correctly aligned, and, in many instances, relieve pain. Treatment relieves symptoms for an extended period.

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? a) Teach the client how to prevent problems caused by immobility. b) Apply the traction straps snugly. c) Remove the traction at least every 8 hours. d) Assess the client's level of consciousness.

Teach the client how to prevent problems caused by immobility. Explanation: 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.

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

The cast can be dented while it is damp. Explanation: 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.

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

"My toes are stiff." Explanation: 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.

A nurse is caring for a client with a cast on his left arm after sustaining a fracture. Which assessment finding is most significant for this client? a) Fingers on the left hand are swollen and cool b) Cast edges are rough, with skin irritation present c) Presence of a normal popliteal pulse d) Minimal pain in the left arm

Fingers on the left hand are swollen and cool Explanation: Swollen and cool fingers on the left hand are the most significant assessment findings. They represent altered circulation to the hand caused by the cast. A normal radial, not popliteal, pulse should be present in the left arm; the popliteal pulse is found on the leg. Skin irritation is an abnormal assessment finding but it isn't as significant as altered circulation. Minimal pain in the left arm is expected.

A nurse is caring for a client with a cast on his left arm after sustaining a fracture. Which assessment finding is most significant for this client? a) Fingers on the left hand are swollen and cool b) Cast edges are rough, with skin irritation present c) Presence of a normal popliteal pulse d) Minimal pain in the left arm

Fingers on the left hand are swollen and cool Correct Explanation: Swollen and cool fingers on the left hand are the most significant assessment findings. They represent altered circulation to the hand caused by the cast. A normal radial, not popliteal, pulse should be present in the left arm; the popliteal pulse is found on the leg. Skin irritation is an abnormal assessment finding but it isn't as significant as altered circulation. Minimal pain in the left arm is expected.

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

Instruct the client to avoid internal rotation of the leg. Explanation: 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 is in Buck's traction after fracturing his right hip. The nurse should include which action in the care plan? a) Removing the weights once every shift b) Maintaining correct body alignment c) Keeping the client in semi-Fowler's position d) Maintaining the bed in the knee-Gatch position

Maintaining correct body alignment Explanation: Buck's traction produces realignment by exerting a pulling force on the fractured hip. Therefore, the nurse must maintain correct body alignment. Traction should be continuous; if the weights must be removed, the nurse should apply manual traction until the weights are replaced. The nurse shouldn't use the knee-Gatch position because it disrupts the constant pulling force needed for alignment. Using the semi-Fowler's position would cause the client to slide in the direction of the traction, defeating the purpose of traction.

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

Risk for ineffective therapeutic regimen management Explanation: 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.

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

Risk for ineffective therapeutic regimen management Explanation: 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.

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

The cast can be dented while it is damp. Explanation: 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.