Dynamic Quiz: Musculoskeletal
Spiral fracture
A fracture in which the bone has been twisted apart
Compression fracture
A loading force to the long axis of a bone collapses the bone. This is common with vertebral fractures.
A nurse is caring for a client with a hip fracture who has Buck's extension traction in place. Which of the following pieces of information should the nurse give the client about this type of traction? (Select all that apply.) A. "You'll have considerably less pain with the traction in place." B. "You'll have the traction in place for a week or so." C. "The traction will help decrease muscle spasms." D. "The weights act as a pulling force to keep your leg and hip still." E. "We have to make sure the weights are just barely touching the floor."
A. Pain is usually more severe without the traction. C. Buck's extension traction uses weights to help decrease muscle spasms. D. Typically, 2.3 to 5.5 kg (5 to 10 lb) of force helps stabilize the hip and leg preoperatively. Incorrect Answers: B. Buck's extension traction is for short-term stabilization of a hip fracture prior to surgery (a week or so is too much). E. The weights must stay suspended at all times and should NOT touch the floor.
A nurse is preparing a client for a bone scan. Which of the following statements indicates that the client understands the pre-procedure teaching? (SATA) A. "I will have to drink a radioactive solution before the test begins." B. "A special camera will scan the bones in my entire body." C. "There will be better absorption of the radiation by healthy bone." D. "I'll have to drink a lot of water to help get the radiation out of my body." E. "I understand the radiation is harmless, and I don't have to worry about it."
B. A bone scan is a radionuclide procedure that allows viewing of the entire skeleton. It is less common than other diagnostic tests but is still useful for identifying hairline fractures and some malignancies. D. The client should drink plenty of fluids to promote urinary excretion of the radioactive material. E. Also, the nurse should reassure the client that the radioactive material is not dangerous because it deteriorates quickly in the body and exits via urine and stool. Incorrect Answers: A. For a bone scan, the client will receive the radioactive material via IV injection (not PO). C. Increased absorption of contrast material indicates bone disease and disorders.
Greenstick fracture
Bending and incomplete break of a bone; most often seen in children
compound fracture
Bone breaks through the skin
Impacted fracture
Broken bone ends are forced into each other
A nurse is preparing a client for magnetic resonance imaging (MRI) of the spine. Which of the following pieces of information should the nurse give the client prior to the procedure? A. "You can have a mild sedative before the procedure." B. "You'll have to lie still on your back for 15 to 20 min." C. "You can't have this test if you've had cataract surgery." D. "Your exposure to radiation will be minimal."
Correct Answer: A. Some clients need mild sedation, especially when using an older closed MRI machine. Clients can feel claustrophobic and anxious as they slowly pass through what seems like a tunnel. Incorrect Answers: B. The client will have to lie supine and still for 45 to 60 min (not 15-20). C. Cataract surgery is NOT a contraindication to receiving an MRI, but an MRI can be unsafe for clients who have pacemakers or stents. D. There is NO exposure to radiation during an MRI.
A nurse is caring for a client who is postoperative following a lumbar disk excision. Which of the following interventions should the nurse include in the client's plan of care? A. Keep the client's legs flat with the knees extended B. Encourage the client to sit up in a chair for as long as possible C. Logroll the client in bed for care procedures D. Expect urinary retention for the first postoperative day
Correct Answer: C. The client should receive instructions about logrolling preoperatively. You may need to engage other staff members in assisting with logrolling to maintain proper alignment of the client's spine at all times postoperatively. Incorrect Answers: A. The client's knees should be in a position of SLIGHT FLEXION to help relax the back muscles. B. Except while defecating, the client should AVOID SITTING in the immediate postop period. D. Urinary retention is an indication of neurological deterioration following a laminectomy. The nurse should report this finding to the surgeon immediately.
A nurse in the emergency department is preparing to discharge a client following a Grade II (moderate) ankle sprain. Which of the following instructions should the nurse plan to give to the client? A. Perform passive range-of-motion exercises of the ankle hourly B. Keep the affected extremity in a dependent position C. Wrap a loose dressing around the affected ankle D. Apply cold compresses to the extremity intermittently
D. Cold minimizes swelling and erythema to the affected area. Therefore, the nurse should instruct the client to apply cold compresses for no more than 20 minutes at a time. Incorrect Answers: B. The nurse should instruct the client to elevate the extremity to decrease swelling. C. The nurse should instruct the client to apply a compression dressing to decrease swelling of the affected area.
Avulsion fracture
Tendon or ligament pulls bone away at site of attachment.
Fat embolism syndrome
The nurse should identify the triad of neurological changes, petechial rash, and hypoxemia as findings of fat embolism syndrome. Risk factors include multiple fractures and a fracture of a long bone. Male clients are also at greater risk. The manifestations occur when fat globules occlude small blood vessels.
Depressed fracture
broken bone portion is pressed inward
A nurse is reviewing the medical record of a client who has a prescription for probenecid to treat gout. The nurse should identify that which of the following medications can interact with probenecid? A. Colchicine B. Naproxen C. Aspirin D. Prednisone
Correct Answer: C. Aspirin can decrease the effectiveness of probenecid. caution the client to avoid interaction between probenecid and salicylate medications. Asprin antagonizes the uric acid blocking effect of probenecid. Incorrect Answers: A. Colchicine is an anti-inflammatory gout medication used in conjunction with probenecid in acute gout attacks. B. Naproxen decreases inflammation for clients who have gout; it is not known to interact with probenecid. D. Prednisone is a glucocorticoid medication used to treat gout; it is not known to interact with probenecid.
A nurse is caring for a client who has osteoporosis and a new prescription for calcium supplements. Which of the following foods should the nurse recommend to promote calcium absorption? A. Fortified milk B. Ripe bananas C. Steamed broccoli D. Green leafy vegetables
Correct Answer: A. Fortified milk provides 2.45 mcg of vitamin D, which promotes calcium absorption from the GI tract. Adults up to age 70 need 600 international units of vitamin D per day and 800 international units thereafter. Therefore, fortified milk is a good source of vitamin D. Incorrect Answers: B. Bananas are a good source of potassium and can reduce bone loss. However, bananas do not promote calcium absorption. C. Broccoli is a good source of vitamin C, which is important for bone matrix formation. However, steamed broccoli does not promote calcium absorption. D. Green leafy vegetables are a good source of vitamin K. However, green leafy vegetables contain oxalic acid, which decreases calcium absorption.
A nurse is caring for a client who had a below-the-knee amputation for gangrene of the right foot. The client reports sensations of burning and crushing pain in the toes of the absent right foot. Which of the following statements should the nurse make? A. "This type of pain usually decreases over time as the limb becomes less sensitive." B. "Try to look at the surgical wound as a reminder the limb is gone." C. "Use a cold compress intermittently to decrease these pain sensations." D. "Grief over the lost limb can sometimes cause denial that the limb is really gone."
Correct Answer: A. recognize that the client is reporting phantom limb pain, a frequent complication following an amputation. instruct the client that the sensation should decrease over time. recognize the pain, provide treatment, and handle the limb gently to decrease the risk of triggering pain. Incorrect Answers: B. This statement by the nurse does not address the client's current concerns. C. instruct the client to use HEAT and massage, along with pharmacological interventions, to manage this type of pain. D. validate the client's report of pain and treat it accordingly. The client is not exhibiting denial; therefore, this statement by the nurse is not appropriate.
A nurse is preparing an in-service presentation about the basics of bone injuries. Which of the following types of fractures results when a client's bone breaks into multiple pieces? A. Avulsion B. Comminuted C. Compression D. Spiral
Correct Answer: B. A comminuted fracture is one in which the bone breaks into multiple pieces or fragments. Incorrect Answers: A. In an avulsion fracture, a tendon and its attachment have pulled away a fragment of bone. C. In a compression fracture, a loading force to the long axis of a bone collapses the bone. This is common with vertebral fractures. D. In a spiral fracture, the break twists around the bone's shaft.
A nurse is caring for a client who is 72 hr postoperative following an above-the-knee amputation. Which of the following actions should the nurse take? A. Elevate the residual limb on a soft pillow B. Assist the client into a prone position every 4 hr C. Re-apply a bandage to the residual limb every 12 hr D. Apply dressings to the site in a proximal-to-distal direction
Correct Answer: B. assist the client into a prone position for 20 to 30 minutes every 3 to 4 hours following an amputation to reduce the risk of FLEXION CONTRACTURES. Incorrect Answers: A. avoid elevation of the residual limb for 72 hours following an amputation because this position increases the client's risk of FLEXION CONTRACTURES. C. reapply a bandage to the residual limb every 4 to 6 hours (not 12 hours) to assist in preparation for a prosthetic limb. D. apply bandages to the residual limb in a distal-to-proximal direction to prevent restriction of blood flow.
A nurse is caring for a client who is 3 days postoperative following a below-the-knee amputation. Which of the following actions should the nurse take? A. Place the client on a soft mattress B. Rewrap the residual limb with a bandage 3 times per day C. Assist the client into a prone position for 20 min every 8 hr daily D. Turn the client every 4 hr while in bed
Correct Answer: B. rewrap the client's residual limb with a pressure bandage 3x/day. This keeps the bandage taught, which ensures the residual limb will shrink. Rewrapping the bandage also allows the nurse to check the skin for redness or skin breakdown. Incorrect Answers: A. place the client on a firm mattress to prevent contractures from developing following surgery. C. assist the client into a prone position for 20 to 30 minutes every 3 to 4 hours daily. This prevents hip contractures from developing following surgery. D. turn the client every 2 hours while in bed to prevent contractures and increase the range of motion of the client's extremities. The nurse should turn the client slowly to prevent muscle spasms.
A nurse is preparing a client who is scheduled to have an arthroscopy the following day. Which of the following statements indicates that the client understands the pre-procedure teaching? A. "I have to keep my leg straight throughout the whole procedure." B. "The doctor will be able to see if I have signs of rheumatoid arthritis." C. "I should expect to stay overnight until I can walk around." D. "I'll have a scar that will be about an inch long."
Correct Answer: B. " An arthroscopy helps with diagnosing musculoskeletal disorders such as RA, osteoarthritis, and internal joint injuries. Incorrect Answers: A. The client has to be able to flex the knee at least 40° so the surgeon can insert the arthroscope into the joint space. C. An arthroscopy typically requires ambulatory or same-day surgery. Activity restrictions are likely; however, the client is allowed to ambulate after anesthesia recovery, most likely with crutches. D. The client might have several incisions that are typically about 0.6 cm (0.24 in) long.
A nurse is providing preoperative teaching for a client who is scheduled for total knee arthroplasty. Which of the following statements by the client indicates an understanding of the teaching? A. "I will wear a continuous movement machine on my knee for 24 hr a day." B. "I should avoid taking NSAID medications for pain after surgery." C. "I should wear elastic stockings on both of my legs." D. "I will begin exercising my legs the day after surgery."
Correct Answer: C. The purpose of elastic stockings is to prevent VTE, which is a common complication following orthopedic surgery. Therefore, identify this statement as an understanding of the teaching. Incorrect Answers: A. A continuous passive motion (CPM) machine is usually prescribed for a few hours at a time, several times a day. Not all clients are prescribed CPM therapy following total knee arthroplasty. B. The client's pain will be initially addressed with epidural or PCA and supplemented by other analgesic medications, including NSAIDs. D. Instruct the client to begin leg exercises while in bed during the IMMEDIATE postop period (not day after surgery), including heel pumps and quadriceps-setting exercises.
A nurse is assessing a client who has a fractured left femur and is in skeletal traction. Which of the following findings should the nurse report to the provider? A. Ecchymosis of the thigh B. Serous drainage at the pin site C. Chest petechiae D. Muscle spasms in the left leg
Correct Answer: C. identify chest petechiae as an indication of fat embolism syndrome. Clients who have fractures of the long bones such as the femur are at increased risk of fat emboli. Fat emboli typically occur 12 to 48 hours after the injury when fat droplets from the marrow enter into the systemic circulation and are deposited in the lungs. immediately notify HCP because the client could progress to acute respiratory failure. Incorrect Answers: A. Ecchymosis of the thigh is expected. B. Serous drainage is expected. monitor for PURULENT drainage that can indicate infection. D. Muscle spasms in the left leg are an expected finding.
A home health nurse is performing an assessment on a client who is 1 week postoperative following a total knee replacement. Which of the following statements by the client indicates an understanding of the teaching? A. "I will discontinue the blood thinner my doctor prescribed once I am at home." B. "I will keep a pillow under my knee when I am in bed." C. "I plan to use a walker to help me get around." D. "I will discontinue using the CPM machine when I get home."
Correct Answer: C. identify that the client will receive a Rx for a walker, cane, or crutches to promote ambulation following a total knee replacement. Incorrect Answers: A. A blood thinner such as warfarin is typically prescribed to a client following joint surgery to prevent the development of a DVT. The client should continue to take the medication until able to ambulate again and the provider decides it is no longer needed. B. A pillow should NOT be placed under the client's knee, as this can promote a CONTRACTURE of the knee joint, making full extension difficult. D. A CPM machine will be continued for a client who is going home following a total knee replacement. A CPM machine increases the ROM of the knee following surgery, and the client should continue to use the machine until PT has been discontinued by the provider.
A nurse is caring for a client who is scheduled to undergo surgery to repair an open hip fracture. In which of the following positions should the nurse plan to place the client postoperatively? A. With the leg on the affected side adducted B. With the hip externally rotated on the affected side C. With the leg on the affected side abducted D. With the hip flexed to 90° on the affected side
Correct Answer: C. plan to place the client with the leg abducted on the affected side postoperatively. Adduction or external rotation of the leg will cause the hip to dislocate. Incorrect Answers: A. Adduction of the client's leg will cause the hip to dislocate, requiring further surgery. B. External rotation of the client's leg will cause the hip to dislocate, requiring further surgery. D. Flexion of the client's hip at 90° or greater will cause the hip to dislocate, requiring further surgery.
A nurse is discussing the plan of care with a client who has osteomyelitis of an open wound on his heel. Which of the following information should nurse include? A. "You will need to apply a cold pack to the site 3 times a day." B. "Your provider might ask you to walk frequently to increase circulation to the area." C. "You will need to limit your consumption of high-protein foods." D. "Your provider might prescribe a central catheter line for long-term antibiotic therapy."
Correct Answer: D. Osteomyelitis is an acute or chronic bone infection. The client will require weeks to months of IV ABX therapy for treatment. Therefore, discuss the need for long-term IV access for ABX therapy. Incorrect Answers: A. Cold therapy is CONTRAindicated for a client who has an open wound. Cold causes decreased blood flow, which can further damage the impaired tissue. B. The client is at increased risk of a fracture of the weakened bone. Therefore, instruct the client to limit weight-bearing as prescribed by the provider. C. The client should consume a diet HIGH in protein to support wound healing.
A nurse is preparing an in-service presentation about the basics of bone injuries. Which of the following types of fractures is especially common in children? A. Impacted B. Depressed C. Compound D. Greenstick
Correct Answer: D. With a greenstick fracture, there is an incomplete break in the bone. One side of the bone usually splinters, while the other side is bent but intact. This type of fracture is common in children because their bones are more flexible than those of an adult. Incorrect Answers: A. In an impacted fracture, the force of the injury drives one fragment of bone into another fragment of bone. B. In a depressed fracture, the force of the injury drives the bone fragments inward. This is common with skull and facial fractures. C. In a compound fracture, the sharp edge of the bone breaks through the skin.
