chpt. 68 Musculoskeletal System

Which cast care instruction should the nurse provide to a client who just had a plaster cast applied to the right forearm? 1. Keep the cast clean and dry 2. Allow the cast 24-72 hours to dry 3. Keep the cast and extremity elevated 4. Expect tingling and numbness in the extremity 5. Use a hair dryer set on a warm to hot setting to dry the cast 6. Use a soft padded object that will fit under the cast to scratch the skin under the cast

1. keep the cast clean and dry 2. allow the cast 24-72 hours to dry 3. keep the cast and extremity elevated

The nurse has given a client instructions about crutch safety. Which client statement indicates that the client understands the instructions? select all that apply 1. "I should not use someone else's crutches." 2. " I need to remove any scatter rugs at home." 3. "I can use crutch tips even when they are wet." 4. "I need to have spare crutches and tips available." 5. "when I'm using the crutches my arms need to be completely straight."

1. 2. 4. Rationale: The client should use only crutches measured for the client. When assessing for home safety, make sure the client knows to remove any scatter rugs and does not walk on highly waxed floors. The tips should be inspected for wear, and spare crutches and tips should be available if needed. Crutch tips should remain dry. If crutch tips get wet, the client should dry them with a cloth or paper towel. When walking with crutches, both elbows need to be flexed not more than 30 degrees when the palms are on the handle

The nurse is caring for a client who has had spinal fusion, with insertion of hardware. The nurse would be most concerned with which assessment finding? 1. Temp 101.6 F orally 2. Complaints of discomfort during repositioning 3. old bloody drainage outlines on the surgical dressing 4. Discomfort during coughing and deep-breathing exercises

1. Temperature of 101.6 orally

The nurse is caring for a client being treated for fat embolus after multiple fractures. which data would the nurse evaluate as the most favorable indication of resolution of the fat embolus? 1. clear mentation 2. minimal dyspnea 3. oxygen saturation of 85% 4. Arterial oxygen level of 78mm Hg

1. clear mentation

A client is complaining of low back pain that radiates down the left posterior thigh. The nurse should ask the client if the pain is worsened or aggravated by which factor? 1. Bed rest 2. Bending or lifting 3. Application of heat 4. Abuprofen (Motrin IB)

2. Bending or lifting

A client being measured for crutches ask the nurse why the crutches cannot rest up underneath the arm for extra support. The nurse responds knowing that which would most likely result from this improper crutch measurement? 1. A fall and further injury 2. Injury to the brachial plexus nerves 3. Skin breakdown in the area of the axilla 4. Impaired range of motion while the client ambulates

2. Injury to the brachial plexus nerves Rationale: Crutches are measured so that the tops are two to three fingerwidths from the axillae. This ensures that the client's axillae are not resting on the crutch or bearing the weight of the crutch, which could result in injury to the nerves of the brachial plexus. Although the conditions in options 1,3, and 4 can occur, they are not the most likely result from resting the axilla directly on the crutches

The nurse has conducted teaching with a client in an arm cast about the signs and symptoms of compartment syndrome. The nurse determines that the client understands the information if the client states that he or she should report which early symptom of compartment syndrome? 1. cold, bluish-colored fingers 2. Numbness and tingling in the fingers 3. Pain that increases when the arm is dependent 4. Pain that is out of proportion to the severity of the fracture

2. Numbness and tingling in the fingers Rationale: The earliest symptom of compartment syndrome is parasthesia. Other symptoms include pain unrelieved by opioids, pain that increases with limb elevation, and pallor and coolness to the distal limb. Cyanosis is a late sing. Pain that is out of proportion to the severity of the fracture is not an early manifestation

The nurse is evaluating the pin sites of a client in skeletal traction. The nurse would be least concerned with which finding? 1. Inflammation 2. Serous drainage 3. Pain at a pin site 4. Purulent drainage

2. Serous drainage

The nurse is caring for a client with a diagnosis of gout. Which laboratory value would the nurse expect to note in the client? 1. calcium level of 9.0 mg/dL 2. Uric acid level of 8.6mg/dL 3. Potassium level of 4.1 mg/dL 4. Phosphorus level of 3.1 mg/dL

2. Uric acid level of 8.6 mg/dL -normal is 2.5-8

The nurse is assessing the casted extremity of a client. Which sign is indicative of infection? 1. Dependent edema 2. Diminished distal pulse 3. Presence of a "hot spot" on the cast 4. coolness and pallor of the extremity

3. Presence of a "hot spot"

The nurse has given instructions to a client returning home after knee arthroscopy. Which statement by the client indicates that the instructions are understood? 1. "I can resume regular exercise tomorrow." 2. "I can't eat food for the remainder of the day." 3. "I need to stay off the leg entirely for the rest of the day." 4. "I need to report a fever or site inflammation to my health care provider."

4. "I need to report a fever or site inflammation to my health care provider

The nurse is conducting health screening for osteoporosis. Which client is at greatest risk of developing this disorder? 1. A 25-year-old woman who jogs 2. A 36-year-old man who has asthma 3. A 70-year-old man who consumes excess alcohol 4. A sedentary 65-year-old woman who smokes cigarettes

4. A sedentary 65-year-old woman who smokes cigarettes Rationale: Risk factors for osteopororsis include female gender, being postmenopausal, advanced age, a low-calcium diet, excessive alcohol intake, being sedentary, and smoking cigarettes. Long-term use of corticosteroids, anticonvulsants, and/or furosemide (Lasix) also increases the risk

The nurse is admitting a client with multiple trauma to the nursing unit. The client has a leg fracture and had a plaster cast applied. which position would be best for the casted leg? 1. flat for 12 hours, then elevated for 12 hours 2. Elevated for 3 hours and then flat for 1 hour 3. flat for 3 hours and then elevated for 1 hour 4. Elevated on pillows continuously for 24-48 hours

4. Elevated on pillows continuously for 24-48 hours Rationale: A casted extremity is elevated continuously for the first 24-28 hours to minimize swelling and promote venous drainage.

A client with a hip fracture asks the nurse why Buck's (extension) traction is being applied before surgery. The nurse provides a response based on which purpose of Buck's (extension) traction? 1. Allows bony healing to begin before surgery 2. Provides rigid immobilization of the fracture site 3. Lengthens the fractured leg to prevent severing of blood vessels 4. Provides comfort by reducing muscle spasms and provides fracture immobilization

4. Provides comfort by reducing muscle spasms and provides fracture immobilization

The nurse is caring for a client who had an above-knee amputation 2 days ago. The residual limb was wrapped with an elastic compression bandage, which has come off. Which immediate action should the nurse take? 1. Apply ice to the site. 2. Call the HCP 3. Apply a dry sterile dressing and elevate it on one pillow 4. Rewrap the residual limb with an elastic compression bandage.

4. Rewrap the residual limb with an elastic compression bandage Rationale: IF the client with an amputation has a cast or elastic compression bandage that slips off, the nurse must wrap the residual limb immediately with another elastic compression bandage. Otherwise, excessive edema will form rapidly, which could cause a significant delay in rehabilitation. IF the client had a cast that slipped off, the nurse would have to call the HCP so that a new one could be applied. Elevation on one pillow is not going to impede the development of edema greatly once compression is released. Ice would be of limited value in controlling edema from this cause. If the HCP were called, the prescription likely would be to reapply the compression dressing anyway

The nurse is one of several persons who witnessed a vehicle hit a pedestrian at a fairly low speed on a small street. The victim is dazed and tries to get up. The leg appears fractured. What intervention should the nurse take? 1. Try to reduce the fracture manually 2. Assist the victim to get up and walk to the sidewalk 3. Leave the victim for a few moments to call an ambulance 4. stay with the victim and encourage the person to remain still

4. Stay with the victim and encourage the person to remain still

A client with diabetes mellitus has had a right bleow-knee amuputation. Given the client's history of diabetes mellitus, which should the nurse specifically observe in the postoperative period? 1. Hemorrhage 2. Edema of the residual limb 3. slight redness of the incision 4. separation of the wound edges

4. separation of the wound edges

A client is being discharged to home after application of a plaster leg cast. Which statement indicates that the client understands proper care of the cast? 1. "I need to avoid getting the cast wet." 2. "I need to cover the casted leg with warm blankets." 3. "I need to use my fingertips to lift and move my leg." 4. "I need to use something like a padded coat hanger end to scratch under the cast if it itches."

1. "I need to avoid getting the cast wet"

A client has sustained a closed fracture and has just had a cast applied to the affected arm. The client is complaining of intense pain. The nurse elevates the limb, applies an ice bag, and administers an analgesic, with little relief. Which problem may be causing this pain? 1. Infection under the cast 2. The anxiety of the client 3. Impaired tissue perfusion 4. The recent occurrence of the fracture

3. Impaired tissue perfusion