Musculoskeletal

A client in the emergency department is being treated for a wrist fracture. The client asks why a splint is being applied instead of a cast. What is the best response by the nurse? a. "You would have to stay here much longer because it takes a cast longer to dry." b. "A splint is applied when more swelling is expected at the site of injury." c. "It is best if an orthopedic doctor applies the cast." d. "Not all fractures require a cast."

"A splint is applied when more swelling is expected at the site of injury." Splints are non-circumferential and will not compromise circulation when swelling is expected. A splint is applied to support and immobilize the injured joint. A fracture will swell as part of the inflammation process. The client would not have to stay longer if a fiberglass cast is applied. Fiberglass cast dry in approximately 30 minutes. An orthopedic doctor is not needed to apply the cast. Many nurses and technicians are trained in proper application of a cast. Some fractures may not be treated with a cast but it would not be appropriate to answer with this response because it does not reflect the actual reason for a splint being applied.

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. a. "I cannot seem to catch my breath." b. "I have a pins-and-needles sensation in my toes." c. Dorsiplantar weak and unequal bilaterally d. T 101.2 degrees F; HR 110; RR 28; pulse oximetry 90% e. Both feet warm with capillary refill < 3 seconds

"I cannot seem to catch my breath." Dorsiplantar weak and unequal bilaterally "I have a pins-and-needles sensation in my toes." T 101.2 degrees F; HR 110; RR 28; pulse oximetry 90% Fat embolism syndrome and compartment syndrome are complications of a fracture, especially of the long bones. Dyspnea, tachycardia, tachynea, fever, and low pulse oximetry would be indicators of fat embolism syndrome. Paresthesia (pins-and-needles sensation), limited motion, and motor weakness would be indicators of compartment syndrome. Capillary refill less than 3 seconds is a normal finding.

A client with a right below-the-knee amputation is being transferred from the postanesthesia care unit to a medical-surgical unit. What is the highest priority nursing intervention by the receiving nurse? a. Ensure that a large tourniquet is in the room. b. Document the receiving report from the transferring nurse. c. Delegate the gathering of enough pillows for proper positioning and comfort. d. Review the physician's orders for type and frequency of pain medication.

Ensure that a large tourniquet is in the room. The client with an amputation is at risk for hemorrhage. A tourniquet should be placed in plain sight for use if the client hemorrhages. Documenting the receiving report is important but is not the highest priority. The nurse may delegate to unlicensed assistive personnel (UAP) the job of gathering more pillows for positioning, but this is not the highest priority. The nurse will need to review the physician's orders for pain medication, but again, this is not the highest priority, because any hemorrhaging by the client needs to be addressed first.

The client with a newly applied cast reports severe unrelenting pain. What is the nurse's best response? a. Make the client NPO and notify the health care provider. b. Loosen the edges of the cast and elevate the leg. c. Reposition the extremity for comfort and apply ice. d. Administer a dose of morphine sulfate.

Make the client NPO and notify the health care provider. The client is exhibiting symptoms of compartment syndrome. The health care provider needs to be contacted as treatment options include bivalving of the cast or a possible fasciotomy, a surgical procedure.

An unresponsive client had a plaster cast applied to the right lower leg 8 hours ago. When moving the client, the nurse notices an indentation on the posterior lower portion of the cast. What is the best action by the nurse? a. Document the findings. b. Notify the physician. c. Remove the cast immediately. d. Assess for pedal pulse and mobility of toes.

Notify the physician. Indentations in the cast can cause skin irritation and breakdown. The physician needs to be notified to assess the need for a new cast or manipulation of the current cast to prevent the skin breakdown. The nurse will need to document the findings and actions taken to resolve the issue but cannot document actions without completing an action, such as notifying the physician. The cast does not need to be removed immediately. Pedal pulse will indicate whether a circulatory issue is present, but with the client being unresponsive, mobility of the toes cannot be assessed.

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

Risk for infection related to effects of trauma A compound fracture involves an opening in the skin at the fracture site. Because the skin is the body's first line of defense against infection, any skin opening places the client at risk for infection. Imbalanced nutrition: Less than body requirements is rarely associated with fractures. Although Impaired physical mobility and Activity intolerance may be associated with any fracture, these nursing diagnoses don't take precedence because they aren't as life-threatening as infection.

While reading a client's chart, the nurse notices that the client is documented to have paresthesia. The nurse plans care for a client with a. absence of muscle movement suggesting nerve damage. b. involuntary twitch of muscle fibers. c. abnormal sensations. d. absence of muscle tone.

abnormal sensations. Abnormal sensations, such as burning, tingling, and numbness, are referred to as paresthesias. The absence of muscle tone suggesting nerve damage is referred to as paralysis. A fasciculation is the involuntary twitch of muscle fibers. A muscle that holds no tone is referred to as flaccid.

A client is hospitalized for open reduction of a fractured femur. During the postoperative assessment, the nurse notes that the client is restless and observes petechiae on the client's chest. Which nursing action is indicated first? a. Elevate the affected extremity. b. Contact the nursing supervisor. c. Administer oxygen. d. Contact the health care provider.

Administer oxygen. The client is demonstrating clinical manifestations consistent with a fatty embolus. Administering oxygen is the top priority. Elevating the extremity won't alter the client's condition. Notifying the nursing supervisor may be indicated by facility policy after other immediate actions have been taken. The nurse should contact the health care provider after administering oxygen.

Which instruction should the nurse include when teaching the client following hip replacement surgery? (Select all that apply.) a. "You may cross your legs at the ankles only." b. "Place pillows between your legs when you lay on your side." c. "Avoid bending forward when sitting in a chair." d. "Use a raised toilet seat and high-seated chair." e. "It is okay to briefly flex the hip to put on your clothes."

"Use a raised toilet seat and high-seated chair." "Place pillows between your legs when you lay on your side." "Avoid bending forward when sitting in a chair." The client following post hip replacement should not cross the legs, even at the ankle. He or she should avoid bending forward when sitting in a chair, avoid flexing the hip when dressing, and use a raised toilet seat. A pillow should be placed between the legs when side-lying.

A client comes back to the clinic with a continued complaint of back pain. What time frame does the nurse understand constitutes "chronic pain"? a. 4 weeks b. 3 months c. 6 months d. 1 year

3 months The typical client reports either acute back pain (lasting fewer than 3 months) or chronic back pain (3 months or longer without improvement) and fatigue.

A client with diabetes punctured his foot with a broken acorn in the yard. Within a week, the client developed osteomyelitis of the foot. The client was admitted for IV antibiotic therapy. How long does the nurse anticipate the client will receive IV antibiotics? a. 6 months b. 3 months c. 7 to 10 days d. 3 to 6 weeks

3 to 6 weeks Identification of the causative organism to initiate appropriate and ongoing antibiotic therapy for infection control. IV antibiotic therapy is administered for 3 to 6 weeks. Oral antibiotics then follow for as long as 3 months.

Which action would be most important postoperatively for a client who has had a knee or hip replacement? a. Providing crutches to the client. b. Assisting in early ambulation. c. Using a continuous passive motion (CPM) machine. d. Encouraging expressions of anxiety.

Assisting in early ambulation. An anticoagulant therapy and early ambulation are important for clients who undergo a knee or hip replacement. A CPM machine or crutches may be provided when prescribed. It is important to encourage clients to express their feelings of anxiety or depression. This is more crucial for clients who undergo an amputation rather than for clients who undergo a replacement surgery.

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

Avascular necrosis Avascular necrosis refers to the death of the bone from insufficient blood supply, typically manifested by complaints of increased pain and decreased function. Fever or redness, purulent drainage, and swelling of the site would suggest infection. Respiratory distress would suggest a pulmonary embolism. Changes in vital signs, level of consciousness, and signs and symptoms of fluid loss would suggest hypovolemic shock.

A client has had a cast placed for the treatment of a humeral fracture. The nurse's most recent assessment shows signs and symptoms of compartment syndrome. What is the nurse's most appropriate action? a. Arrange for a STAT assessment of the client's serum calcium levels. b. Perform active range of motion exercises. c. Assess the client's joint function symmetrically. d. Contact the primary provider immediately.

Contact the primary provider immediately. This major neurovascular problem is caused by pressure within a muscle compartment that increases to such an extent that microcirculation diminishes, leading to nerve and muscle anoxia and necrosis. Function can be permanently lost if the anoxic situation continues for longer than 6 hours. Therefore, immediate medical care is a priority over further nursing assessment. Assessment of calcium levels is unnecessary.

Which actions by the nurse demonstrate an understanding of caring for a client in traction? Select all that apply. a. Placing a trapeze on the bed b. Ensuring that the weights are hanging freely c. Assessing the client's alignment in the bed d. Removing skeletal traction to turn and reposition the client e. Frequently assessing pain level

Frequently assessing pain level Placing a trapeze on the bed Assessing the client's alignment in the bed Ensuring that the weights are hanging freely The weights must hang freely, with the client in good alignment in the center of the bed. The nurse should frequently monitor pain, as uncontrolled pain may be a sign of a complication. The client will be able to assist with alignment and bed mobility if a trapeze is placed on the bed. Skeletal traction should never be interrupted.

A female client is at risk for developing osteoporosis. Which action will reduce the client's risk? a. Living a sedentary lifestyle to reduce the incidence of injury b. Stopping estrogen therapy c. Taking a 300-mg calcium supplement to meet dietary guidelines d. Initiating weight-bearing exercise routines

Initiating weight-bearing exercise routines. Performing weight-bearing exercise increases bone health. A sedentary lifestyle increases the risk of developing osteoporosis. Estrogen is needed to promote calcium absorption. The recommended daily intake of calcium is 1,000 mg, not 300 mg.

A client has undergone an external fixation. Which actions would be the priority for this client? a. Maintaining pin care. b. Planning the client's diet. c. Monitoring the client's urine output. d. Monitoring the client's blood pressure.

Maintaining pin care. Pin care is a priority for a client with external fixation, because pin sites are entry points for infection. The nurse should also monitor redness, drainage, and tenderness at the site. Planning the client's diet and monitoring the client's urine output and blood pressure, although necessary, are not as important as maintaining pin care.

Which of the following is the first-line medication that would be used to treat and prevent osteoporosis? a. Bisphosphonates b. Calcitonin c. Selective estrogen receptor modulators e. Anabolic agents

Bisphosphonates Bisphosphonates, along with calcium and vitamin D supplements, are the first-line medications given to prevent/treat osteoporosis. The other medications are prescribed after these drugs are used.

The nurse suspects "compartment syndrome" for a casted extremity. What characteristic symptoms would the nurse assess that would confirm these suspicions? (Select all that apply.) a. Decreased sensory function b. Excruciating pain c. Loss of motion d. Capillary refill less than 3 seconds e. 2+ peripheral pulses in the affected distal pulse

Decreased sensory function Loss of motion Excruciating pain Clinical manifestations include dusky, pale appearance of the exposed extremity; cool skin temperature; delayed capillary refill; paresthesia; and unrelenting pain not relieved by position changes, ice, or analgesia. A hallmark sign is pain that occurs or intensifies with passive range of motion (Johnston-Walker & Hardcastle, 2011). The patient may complain that the cast, brace, or splint is too tight. The primary provider must be notified immediately.

The primary nursing intervention that will control swelling while treating a musculoskeletal injury is: a. Apply cold (moist or dry). b. Immobilize the injured area. c. Elevate the affected area. e. Apply an elastic compression bandage.

Elevate the affected area. Elevation is used to control swelling. It is facilitated by cold, immobilization, and compression. Refer to Box 42-1 in the text.

The nurse is conducting an admission history of a client admitted with a fracture. The nurse recognizes that which of the client's medications placed the client at risk for fractures? a. prednisone (Deltasone) b. furosemide (Lasix) c. digoxin (Lanoxin) d. metoprolol (Lopressor)

prednisone (Deltasone) Prednisone, a corticosteroid, causes increased bone resorption and decreased bone formation, resulting in increased risk for fractures.

A nurse is planning the care of an older adult client who will soon be discharged home after treatment for a fractured hip. In an effort to prevent future fractures, the nurse should encourage what actions? Select all that apply. a. Regular bone density testing b. A high-calcium diet c. Use of falls prevention precautions d. Use of corticosteroids as prescribed e. Weight-bearing exercise

Use of falls prevention precautions A high-calcium diet Regular bone density testing Weight-bearing exercise Health promotion measures after an older adult's hip fracture include weight-bearing exercise, promotion of a healthy diet, falls prevention, and bone density testing. Corticosteroids have the potential to reduce bone density and increase the risk for fractures.

A client had a total left hip arthroplasty. What clinical manifestation would indicate to the nurse that the prosthesis is dislocated? a. The left leg is internally rotated. b. The leg length is the same as the right leg. c. The client has discomfort when moving in the bed. d. There are diminished peripheral pulses on the affected extremity.

The left leg is internally rotated. The nurse must monitor the client for signs and symptoms of dislocation of the prosthesis, which include abnormal external or internal rotation of the affected extremity. The length of the leg with a dislocated prosthesis may be shorter. The client's discomfort will not indicate a dislocation. The diminished peripheral pulse of the affected extremity would be a indication of circulation issues.

A client with low back pain is being seen in the clinic. In planning care, which teaching point should the nurse include? a. Sleep on the stomach to alleviate pressure on the back. b. A soft mattress is most supportive by conforming to the body. c. Avoid twisting and flexion activities. d. Use the large muscles of the leg when lifting items.

Use the large muscles of the leg when lifting items. The large muscles of the leg should be used when lifting.

The nurse is providing care for a client who has had a below-the-knee amputation. The nurse enters the client's room and finds the client resting in bed with his residual limb supported on pillow. What is the nurse's most appropriate action? a. Inform the surgeon of this finding. b. Explain the risks of flexion contracture to the client. c. Transfer the client to a sitting position. d. Encourage the client to perform active ROM exercises with the residual limb.

Explain the risks of flexion contracture to the client. The residual limb should not be placed on a pillow, because a flexion contracture of the hip may result. There is no acute need to contact the client's surgeon. Encouraging exercise or transferring the client does not address the risk of flexion contracture.

A client was fitted with an arm cast after fracturing her humerus. Twelve hours after the application of the cast, the client tells the nurse that her arm hurts. Analgesics do not relieve the pain. What would be the most appropriate nursing action? a. Prepare the client for opening or bivalving of the cast. b. Obtain a prescription for a different analgesic. c. Encourage the client to wiggle and move the fingers. d. Petal the edges of the client's cast.

Prepare the client for opening or bivalving of the cast. Acute compartment syndrome involves a sudden and severe decrease in blood flow to the tissues distal to an area of injury that results in ischemic necrosis if prompt, decisive intervention does not occur. Removing or bivalving the cast is necessary to relieve pressure. Prescribing different analgesics does not address the underlying problem. Encouraging the client to move the fingers or perform range-of-motion exercises will not treat or prevent compartment syndrome. Petaling the edges of a cast with tape prevents abrasions and skin breakdown, not compartment syndrome.

A client reports phantom limb pain to the nurse two months after a leg amputation. Which intervention should the nurse implement when caring for the client? a. Reposition the residual limb, elevating it on two pillows. b. Assess the residual limb for signs and symptoms of infection. c. Reassure the client that phantom pain is common. d. Assess the residual limb for signs and symptoms of bleeding.

Reassure the client that phantom pain is common. The nurse acknowledges the client's reports of pain and provides support that phantom pain is common. Repositioning the residual limb is not helpful for the client. The nurse will assess the residual limb for infection and bleeding but will not acknowledge the client's reports of pain.

A nurse is assigned to support a patient while a cast is being applied to treat a greenstick fracture. The nurse documents that this fracture is classified as what type of fracture? a. Closed b. Incomplete c. Stress d. Compression

Incomplete A greenstick fracture involves a break through only part of the cross-section of the bone.

What is the best action by the nurse to achieve optimal outcomes when caring for a client with a musculoskeletal disorder who is using a cast? a. Educate the client on cast care and complications b. Prepare the client for cast application c. Assess for neurovascular compromise d. Provide effective pain control

Educate the client on cast care and complications Educating the client is essential to achieve optimal outcomes. Although the nurse should prepare the client for cast applications, assess for neurovascular compromise, and provide effective pain control, these interventions are centered on care provided by the nurse. The client is more likely to be in the home setting while a cast is in place, requiring the client to have the education to properly care for the cast and have knowledge of the complications so that early interventions can happen.

The nurse has identified the diagnosis of Risk for Impaired Tissue Perfusion Related to Deep Vein Thrombosis in the care of a client receiving skeletal traction. What nursing intervention best addresses this risk? a. Encourage independence with ADLs whenever possible. b. Monitor the client's nutritional status closely. c. Teach the client to perform ankle and foot exercises within the limitations of traction. d. Administer clopidogrel as prescribed.

Teach the client to perform ankle and foot exercises within the limitations of traction. The nurse educates the client how to perform ankle and foot exercises within the limits of the traction therapy every 1 to 2 hours when awake to prevent DVT. Nutrition is important, but does not directly prevent DVT. Similarly, independence with ADLs should be promoted, but this does not confer significant prevention of DVT, which often affects the lower limbs. Clopidogrel is not normally used for DVT prophylaxis.