Musculoskeletal

The nurse is providing instructions to the client following application of a fiberglass cast. Which statement by the client indicates further education is needed?

"Under no circumstances should I get my cast wet."

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.

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

A client who has fractured the radial head asks the nurse about factors that will promote bone healing. Which statement should the nurse include when responding to the client? Select all that apply.

- "Immobilization of the fracture will promote healing by maximizing contact of bone fragments." - "Fractured bones require a good blood supply and adequate nutrition for healing." - "Weight bearing stimulates healing of the long bones of the leg, if the fracture is stabilized."

Which intervention would the nurse implement with the client in skeletal traction? Select all that apply.

- Ensure the pins or wires are covered with caps. - Position trapeze within the client's reach. - Instruct the client on isometric exercises for immobilized extremity.

A nurse is caring for a client after stabilization of a radial fracture. Which actions by the nurse would be appropriate for the client following arm casting? Select all that apply.

- Handle the cast with the palms of hands - Circulate room air with a portable fan - Petal and smooth the edges of the cast

Which statements describe open reduction of a fracture? Select all that apply.

- It is performed in the operating room. - The bone is surgically exposed and realigned. - The client usually receives general or spinal anesthetic.

A client is having traction applied to a fractured left lower extremity prior to surgery. What outcomes does the nurse expect from the application of the traction for the client? Select all that apply.

- Muscle spasms will be relieved. - The bones of the left leg will be aligned. - Immobilization of the left leg will be maintained.

A provider asks the nurse to teach a client with low back pain how to sit in order to minimize pressure on the spine. Which teaching points would the nurse include? Select all that apply.

- Sit in a straight-backed chair with arm rests. - avoid hip extension - place feet flat on the floor - Sit with the buttocks "tucked under."

The nurse is caring for the client with chronic osteomyelitis of the jaw with a draining wound. Which client goal is a priority for the client? Select all that apply.

- The client will experience a tolerable level of pain. - The client will demonstrate wound care. - The client will maintain adequate nutritional intake.

A client has suffered a muscle strain and is reporting pain at 6 on a 10-point scale. The nurse should recommend what action?

Applying a cold pack to the injured site

A client is scheduled for a total hip replacement and the surgeon has explained the risks of blood loss associated with orthopedic surgery. The risk of blood loss is the indication for which of the following actions?

Autologous blood donation

A nurse is caring for a client who is being assessed following reports of severe and persistent low back pain. The client is scheduled for diagnostic testing in the morning. Which of the following are appropriate diagnostic tests for assessing low back pain? Select all that apply.

CT, MRI, xray, ultrasound

A nurse is caring for an older adult client who is preparing for discharge following recovery from a total hip replacement. What outcome must be met prior to discharge?

Client is able to perform transfers safely.

A client is admitted to the orthopedic unit with a fractured femur after a motorcycle accident. The client has been placed in traction until the femur can be rodded in surgery. For what early complication(s) should the nurse monitor this client? Select all that apply.

DVT, fat embolism, and compartment syndrome

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 the residual limb supported on a pillow. What is the nurse's most appropriate action?

Explain the risks of flexion contracture to the client.

A client has just begun been receiving skeletal traction and the nurse is aware that muscles in the client's affected limb are spastic. How does this change in muscle tone affect the client's traction prescription?

Extra weight is needed initially to keep the limb in proper alignment.

A client diagnosed with osteoporosis is being discharged home. Which priority education should the nurse should provide?

Remove all small rugs from the home

What assessment findings of the leg are consistent with a fracture of the femoral neck?

Shortened, adducted, and externally rotated

Which is one of the most common causes of death in clients diagnosed with fat emboli syndrome?

acute respiratory distress syndrome (ARDS)

A physician writes a prescription to discontinue skeletal traction on an orthopedic client. The nurse should anticipate what subsequent intervention?

application of a cast

A client comes to the clinic 2 days after sustaining a sprain to the left ankle. What intervention can the nurse encourage the client to perform that will help improve circulation?

applying heat

Emergency medical technicians transport a client to the emergency department and inform the nurse that the client fell from a two-story building. The comatose client has a large contusion on the left side of the chest, a hematoma in the left parietal area, and a compound fracture of the left femur. The client was intubated and is maintaining an arterial oxygen saturation of 92% by pulse oximeter with a manual-resuscitation bag. Which intervention by the nurse has the highest priority?

assessing the left leg - airway and breathing is maintained, circulation should be assessed from the hip fracture

An older adult client has fallen in the home and is brought to the emergency department by ambulance with a suspected fractured hip. X-rays confirm a fracture of the left femoral neck. When planning assessments during the client's presurgical care, the nurse should be aware of the client's heightened risk of what complication?

avascular necrosis (AVN)

A client has low back pain and the healthcare provider needs to rule out the presence of a tumor. Which diagnostic procedure would the nurse anticipate to be ordered for the client?

bone scan

The client is admitted to the hospital with a diagnosis of left femoral neck fracture. Which treatment modality would the nurse expect the health care provider to order?

buck's traction

A client with a tibia fracture was placed in an external fixator 24 hours ago. The nurse is completing pin care and notices redness at the pin site and a small amount of serous drainage. What action by the nurse is appropriate?

document the findings - Serous drainage and redness at the pin site is an expected finding for 48 to 72 hours after insertion. The nurse should document the findings and continue to monitor the site. The physician does not need to be notified unless other signs and symptoms are present.

The health care provider is preparing to bivalve the client's cast. Which supplies should the nurse assemble?

elastic compression bandages - after bivalving the cast is immobilized

What areas of the body may be examined when bone densitometry is done? Select all that apply.

hip, wrist, spine

Which of the following describes failure of the ends of a fractured bone to unite in normal alignment?

nonunion

A 75-year-old client had surgery for a left hip fracture yesterday. When completing the plan of care, the nurse should include assessment for which complications? Select all that apply.

pneumonia, skin breakdown, sepsis, delirium

A client with a short arm cast is suspected to have compartment syndrome. What actions should the nurse include in the plan of care? Select all that apply.

prepare to remove the cast and provide support to the injured extremity

With fractures of the femoral neck, the leg is

shortened, adducted, and externally rotated

The nurse assesses subtle personality changes, restlessness, irritability, and confusion in a client who has sustained a fracture. The nurse suspects which complication?

fat embolism syndrome (cerebral disturbances)

A client has a cast that extends from below the elbow to the palmar crease and is secured around the base of the thumb. The thumb is also casted. The nurse identifies this as which type of cast?

gauntlet cast

A client who was injured while playing basketball reports an extremely painful elbow, which is very edematous. What type of injury has the client experienced?

sprain

Which of the following are associated with compartment syndrome? Select all that apply.

trauma from accidents, surgery, casts, tight bandages, crushing injuries

A client has undergone a leg amputation. What teachings should the nurse offer such a client to prevent abduction deformity? Select all that apply.

- Advise the client to use a trochanter roll. - Advise the client to adduct the stump so it presses against the other leg when the client is lying on the stomach.

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.

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

A client arrives in the emergency room complaining of severe pain in her left hip after falling out of the bed. What indication upon assessment does the nurse recognize as a dislocated left hip? Select all that apply.

- The left leg is shorter than the right. - Limited range of motion of the left hip. - The skin of the lower left leg is pale.

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.

- prevent additional injury - providing support - controlling movement

Lifestyle risk factors for osteoporosis include

lack of exposure to sunshine - other examples are a diet low in calcium and vit D, smoking, consumption of alcohol/caffeine, lack of weight bearing exercises - an individual factor is an estrogen deficiency or menopause