Musculoskeletal modalities Prep U

A client is treated in the emergency department for acute muscle strain in the left leg caused by trying a new exercise. During discharge preparation, the nurse should provide which instruction? "Apply ice packs for the first 12 to 18 hours." "Apply heat packs for the first 24 to 48 hours." "Apply ice packs for the first 24 to 48 hours, then apply heat packs." "Apply heat packs for the first 24 hours, then apply ice packs for the next 48 hours."

"Apply ice packs for the first 24 to 48 hours, then apply heat packs." The nurse should instruct the client to apply ice packs to the injured area for the first 24 to 48 hours to reduce swelling and then apply heat to increase comfort, promote reabsorption of blood and fluid, and speed healing.

A client with a recent left above-the-knee amputation states, "I can feel pain in my left toes." Which is the best response by the nurse? "Your left toes have been amputated." "The pain is really from the nerves in the upper leg." "Pain medication usually does not help this type of pain." "Describe the pain and rate it on the pain scale."

"Describe the pain and rate it on the pain scale." The nurse should recognize phantom pain as real and complete a pain assessment as if the limb were attached. The client's pain should be address and treated appropriately. By telling the client that the toes have been amputated or the pain is really from the nerves in the upper leg, the nurse is negating the client's pain. Opioid pain medication can be effective with phantom pain.

A client undergoes a total hip replacement. Which statement made by the client indicates to the nurse that the client requires further teaching? "I'll need to keep several pillows between my legs at night." "I need to remember not to cross my legs. It's such a habit." "The occupational therapist is showing me how to use a sock puller to help me get dressed." "I don't know if I'll be able to get off that low toilet seat at home by myself."

"I don't know if I'll be able to get off that low toilet seat at home by myself." The client requires additional teaching if he is concerned about using a low toilet seat. To prevent hip dislocation after a total hip replacement, the client must avoid bending the hips beyond 90 degrees.

A client is to undergo surgery to repair a ruptured Achilles tendon and application of a brace. The client demonstrates understanding of activity limitations when stating that a brace must be worn for which length of time? 2 to 4 weeks 6 to 8 weeks 10 to 12 weeks 14 to 16 weeks

6 to 8 weeks

A client with a long arm cast continues to complain of unrelieved throbbing pain even after receiving opioid pain medication. Which is the priority action by the nurse? Assess for complications. Assess for previous opioid drug use. Reposition the client for comfort. Teach relaxation techniques.

Assess for complications.

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. Administer a prescribed analgesic to promote comfort and allay anxiety. Assess for a pressure sore Determine the exact site of the pain.

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

A client has a Fiberglass cast on the right arm. Which action should the nurse include in the care plan? Keeping the casted arm warm by covering it with a light blanket Avoiding handling the cast for 24 hours or until it is dry Evaluating pedal and posterior tibial pulses every 2 hours Assessing movement and sensation in the fingers of the right hand

Assessing movement and sensation in the fingers of the right hand

A nurse is caring for a client placed in traction to treat a fractured femur. Which nursing intervention has the highest priority? Assessing the extremity for neurovascular integrity Keeping the client from sliding to the foot of the bed Keeping the ropes over the center of the pulley Ensuring that the weights hang free at all times

Assessing the extremity for neurovascular integrity

A group of students is 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? Better molding to the client Quicker drying Longer lasting More breathable

Better molding to the client

A patient has stepped in a hole in the yard, causing an ankle injury. The ankle is edematous and painful to palpation. How long should the nurse inform the patient that the acute inflammatory stage will last? Less than 24 hours Between 24 and 48 hours About 72 hours At least 1 week

Between 24 and 48 hours

An x-ray demonstrates a fracture in which a bone has splintered into several pieces. Which type of fracture is this? Compound Depressed Impacted Comminuted

Comminuted

A client sustains a fractured right humerus in an automobile accident. The arm is edematous, the client states that he cannot feel or move his fingers, and the nurse does not feel a pulse. What condition should the nurse be concerned about that requires emergency measures? Compartment syndrome Dislocation Muscle spasms Subluxation

Compartment syndrome

Two days after application of a cast to treat a fractured femur, the client reports severe, deep, and constant pain in the leg. What will the nurse suspect? Compartment syndrome. Phlebitis. Infection. Chronic venous insufficiency.

Compartment syndrome.

A client who has extremity right wrist fracture complains of severe burning pain, frequent changes in the skin from hot and dry to cold, and feeling clammy skin that is shiny and growing more hair in the injured extremity. The nurse should anticipate providing care for what complication? Complex regional pain syndrome Avascular necrosis of bone Reaction to an internal fixation device Heterotrophic ossification

Complex regional pain syndrome

A client is admitted to the emergency room after being hit by a car while riding a bicycle. The client sustained a fracture of the left femur, and the bone is protruding through the skin. What type of fracture does the nurse recognize requires emergency intervention? Compound Greenstick Oblique Spiral

Compound

A client is admitted to the emergency room after being hit by a car while riding a bicycle. The client sustained a fracture of the left femur, and the bone is protruding through the skin. What type of fracture does the nurse recognize requires emergency intervention? Compound Greenstick Oblique Spiral

Compound A compound fracture is a fracture in which damage also involves the skin or mucous membranes with the risk of infection great. A greenstick fracture is where one side of the bone is broken and the other side is bent; it does not protrude through the skin. An oblique fracture occurs at an angle across the bone but does not protrude through the skin. A spiral fracture twists around the shaft of the bone but does not protrude through the skin.

A client has a cast applied to the leg for treatment of a tibia fracture and also has a wound on the leg that requires dressing changes due to drainage. For what should the nurse prepare the client? Cutting of a bivalve cast Cutting a cast window Removal of the cast Insertion of an external fixator

Cutting a cast window

After undergoing surgery the previous day for a total knee replacement, a client states, "I am not ready to ambulate yet." What should the nurse do? Tell the client that this noncompliance will be reported to the health care provider. Discuss the complications that the client may experience if there is lack of cooperation with the care plan. Do nothing because the client has the ultimate right to determine the degree of participation. Document the client's refusal to ambulate.

Discuss the complications that the client may experience if there is lack of cooperation with the care plan.

Colles fracture occurs in which area? Elbow Humeral shaft Clavicle Distal radius

Distal radius A Colles fracture is a fracture of the distal radius (wrist). It is usually the result of a fall on an open, dorsiflexed hand.

A nurse is inspecting the area of contusion and notes numerous areas of bruising. How would the nurse document this finding? Whiplash injury Callus Ecchymosis Palsy

Ecchymosis

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

Elevate the affected area.

A client is reporting pain following orthopedic surgery. Which intervention will help relieve pain? Elevate the affected extremity and use cold applications. Breathe deeply and cough every 2 hours until ambulation is possible. Do ROM exercises as indicated. Apply antiembolism stockings as indicated.

Elevate the affected extremity and use cold applications.

Which general nursing measure is used for a client with a fracture reduction? Encourage participation in ADLs Promote intake of omega-3 fatty acids Examine the abdomen for enlarged liver or spleen Assist with intake of immune-enhancing tube feeding formulas

Encourage participation in ADLs

A patient sustained an open fracture of the femur 24 hours ago. While assessing the patient, the nurse observes the patient is having difficulty breathing, and oxygen saturation decreases to 88% from a previous 99%. What does the nurse understand is likely occurring with this patient? Spontaneous pneumothorax Cardiac tamponade Pneumonia Fat emboli

Fat emboli After fracture of long bones or pelvic bones, or crush injuries, fat emboli frequently form. Fat embolism syndrome (FES) occurs when fat emboli cause morbid clinical manifestations. The classic triad of clinical manifestations of FES include hypoxemia, neurologic compromise, and a petechial rash (NAON, 2007), although not all signs and symptoms manifest at the same time (Tzioupis & Giannoudis, 2011). The typical first manifestations are pulmonary and include hypoxia and tachypnea.

After a car accident, a client is admitted to an acute care facility with multiple traumatic injuries, including a fractured pelvis. For 24 to 48 hours after the accident, the nurse must monitor the client closely for which potential complication of a fractured pelvis? Compartment syndrome Fat embolism Infection Volkmann's ischemic contracture

Fat embolism Fat embolism is a relatively rare but life-threatening complication of pelvis and long-bone fractures, arising 24 to 48 hours after the injury. It occurs when fat droplets released at the fracture site enter the circulation, become lodged in pulmonary capillaries, and break down into fatty acids. Because these acids are toxic to the lung parenchyma, capillary endothelium, and surfactant, the client may develop pulmonary hypertension. Signs and symptoms of fat embolism include an altered mental status, fever, tachypnea, tachycardia, hypoxemia, and petechiae.

The client with a fractured left humerus reports dyspnea and chest pain. Pulse oximetry is 88%. Temperature is 100.2 degrees Fahrenheit (38.5 degrees Centigrade); heart rate is 110 beats per minute; respiratory rate is 32 breaths per minute. The nurse suspects the client is experiencing: Complex regional pain syndrome Delayed union Compartment syndrome Fat embolism syndrome

Fat embolism syndrome

A patient in pelvic traction needs circulatory status assessed. How should the nurse assess for a positive Homans' sign? Have the patient extend both hands while the nurse compares the volume of both radial pulses. Have the patient extend each leg and dorsiflex each foot to determine if pain or tenderness is present in the lower leg. Have the patient plantar flex both feet while the nurse performs the blanch test on all of the patient's toes. Have the patient squeeze the nurse's hands with his or her hands to evaluate any difference in strength.

Have the patient extend each leg and dorsiflex each foot to determine if pain or tenderness is present in the lower leg.

While riding a bicycle on a narrow road, the patient was hit from behind and thrown into a ditch, sustaining a pelvic fracture. What complications does the nurse know to monitor for that are common to pelvic fractures? Paresthesia and ischemia Hemorrhage and shock Paralytic ileus and a lacerated urethra Thrombophlebitis and infection

Hemorrhage and shock

Which factor inhibits fracture healing? Increased vitamin D and calcium in the diet Age of 35 years History of diabetes Immobilization of the fracture

History of diabetes

The nurse is caring for a client with a spica cast. What is the nurse's priority intervention? Keep the cast clean and dry. Position the client on the affected side. Promote elimination with a regular bedpan. Keep the legs in abduction.

Keep the cast clean and dry.

A client undergoes open reduction with internal fixation to treat an intertrochanteric fracture of the right hip. The nurse should include which intervention in the postoperative care plan? Performing passive range-of-motion (ROM) exercises on the client's legs once each shift Keeping a pillow between the client's legs at all times Turning the client from side to side every 2 hours Maintaining the client in semi-Fowler's position

Keeping a pillow between the client's legs at all times After open reduction with internal fixation, the client must keep the affected leg abducted at all times; placing a pillow between the legs reminds the client not to cross the legs and to keep the leg abducted.

The nurse teaches the client which intervention to avoid hip dislocation after replacement surgery? Keep the knees together at all times Never cross the affected leg when seated Avoid placing a pillow between the legs when sleeping Bend forward only when seated in a chair

Never cross the affected leg when seated

The nurse assesses a client after total right hip arthroplasty and observes a shortening of the extremity. The client reports severe pain in the right side of the groin. What is the priority action of the nurse? Apply Buck's traction. Notify the health care provider. Externally rotate the extremity. Bend the knee and rotate the knee internally.

Notify the health care provider.

The nurse is caring for a client with an external fixator that requires pin care twice a day. The nurse observes that there is a new purulent drainage around one of the pins. What intervention should the nurse anticipate doing? Scrubbing the drainage from around the pin site Obtaining a culture Applying iodine-based solution Apply ointment to the pin site.

Obtaining a culture

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

Risk for ineffective therapeutic regimen management

Which of the following musculoskeletal injuries is manifested by acromioclavicular joint pain? Rotator cuff tears Epicondylitis Heterotopic ossification Acute compartment syndrome

Rotator cuff tears

A client is having a cast applied for a fractured leg that extends from below the knee to the base of the toes. The foot is flexed at a right angle in a neutral position. What type of cast is the client having applied? Short leg cast Long leg cast Walking cast Hip spica cast

Short leg cast

Which device is designed specifically to initially support and immobilize a body part in a desired position until swelling subsides? Brace Continuous passive motion (CPM) device Splint Trapeze

Splint

A client sustains an injury to the ligaments surrounding a joint. What will the nurse identify this injury as? Strain Contusion Sprain Fracture

Sprain

Which term refers to an injury to ligaments and other soft tissues surrounding a joint? Sprain Dislocation Subluxation Strain

Sprain

A client who has injured a hip in a fall cannot place weight on the leg and is in significant pain. After radiographs indicate intact yet malpositioned bones, what repair would the physician perform? joint manipulation and immobilization analgesia and immobilization heat and immobilization ice and immobilization

joint manipulation and immobilization

An older adult patient had a hip replacement. When should the patient begin with assisted ambulation with a walker? 24 hours 72 hours 1 week 2 to 3 weeks

24 hours

The client displays manifestations of compartment syndrome. What treatment will the nurse expect the client to be scheduled for? An open reduction A fasciotomy A total hip replacement A total knee replacement

A fasciotomy

Which cleansing solution is the most effective for use in completing pin site care? Betadine Chlorhexidine Hydrogen peroxide Alcohol

Chlorhexidine

A client comes to the emergency department complaining of localized pain and swelling of his lower leg. Ecchymotic areas are noted. History reveals that the client got hit in the leg with a baseball bat. Which of the following would the nurse suspect as most likely? Fracture Contusion Sprain Strain

Contusion

Which of the following is a term used to describe a soft tissue injury produced by a blunt force? Contusion Sprain Strain Hematoma

Contusion

The nurse is caring for a client who sustained rib fractures in an automobile accident. What symptoms does the nurse recognize as a complication of rib fractures and should immediately be reported to the physician? Blood pressure of 140/90 mm Hg Crackles in the lung bases Client complains of pain in the affected rib area when taking a deep breath Heart rate of 94 beats/minute

Crackles in the lung bases

Which is an inappropriate use of traction? Immobilize a fracture Decrease space between opposing structures Reduce deformity Minimize muscle spasms

Decrease space between opposing structures

Which of the following would lead a nurse to suspect that a client has a rotator cuff tear? Ability to stretch arm over the head Difficulty lying on affected side Pain worse in the morning Minimal pain with movement

Difficulty lying on affected side

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 complication? Dislocation of the hip Re-fracture of the hip Contracture of the hip Avascular necrosis of the hip

Dislocation of the hip

Which type of cast encloses the trunk and a lower extremity? Body cast Hip spica Long-leg Short-leg

Hip spica

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 Fahrenheit, 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 complication? Hypovolemic shock Osteomyelitis Urinary retention Atelectasis

Hypovolemic shock 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.

Radiographic evaluation of a client's fracture reveals that a bone fragment has been driven into another bone fragment. The nurse identifies this as which type of fracture? Comminuted Compression Impacted Greenstick

Impacted

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? Closed Incomplete Stress Compression

Incomplete

Which type of fracture involves a break through only part of the cross-section of the bone? Incomplete Comminuted Open Oblique

Incomplete

Which is a benefit of a continuous passive motion (CPM) device when applied after knee surgery? It provides active range of motion. It promotes healing by increasing circulation and movement of the knee joint. It promotes healing by immobilizing the knee joint. It prevents infection and controls edema and bleeding.

It promotes healing by increasing circulation and movement of the knee joint.

A client is brought to the emergency department after injuring the right arm in a bicycle accident. The orthopedic surgeon tells the nurse that the client has a greenstick fracture of the arm. What does this mean? The fracture line extends through the entire bone substance. The fracture results from an underlying bone disorder. Bone fragments are separated at the fracture line. One side of the bone is broken and the other side is bent.

One side of the bone is broken and the other side is bent.

A client's fracture was reduced by surgically exposing the bone and realigning it. What type of treatment does the nurse identity this as? Buck's traction Skeletal traction Internal fixation Open reduction

Open reduction

Which is a hallmark sign of compartment syndrome? Motor weakness Edema Pain Weeping skin surfaces

Pain

A client with metastatic bone cancer sustained a left hip fracture without injury. What type of fracture does the nurse understand occurs without trauma or fall? Impacted fracture Transverse fracture Compound fracture Pathologic fracture

Pathologic fracture

A nurse is caring for a client who underwent a total hip replacement. What should the nurse and other caregivers do to prevent dislocation of the new prosthesis? Keep the affected leg in a position of adduction. Use measures other than turning to prevent pressure ulcers. Prevent internal rotation of the affected leg. Keep the hip flexed by placing pillows under the client's knee.

Prevent internal rotation of the affected leg.

The emergency department nurse teaches clients with sports injuries to remember the acronym PRICE. This acronym stands for which combination of treatments? Protection, rest, ice, circulation, examination Pressure, rotation, immersion, compression, elevation Protection, rest, ice, compression, elevation Pressure, rotation, ice, compression, examination

Protection, rest, ice, compression, elevation

Which nursing intervention is essential in caring for a client with compartment syndrome? Keeping the affected extremity below the level of the heart Wrapping the affected extremity with a compression dressing to help decrease the swelling Removing all external sources of pressure, such as clothing and jewelry Starting an I.V. line in the affected extremity in anticipation of venogram studies

Removing all external sources of pressure, such as clothing and jewelry

An adult is swinging a small child by the arms, and the child screams and grabs his left arm. It is determined in the emergency department that the radial head is partially dislocated. What is this partially dislocated radial head documented as? Volkmann's contracture Subluxation Compartment syndrome Sprain

Subluxation

The nurse is preparing a client to have his cast cut off after having it for 6 weeks to treat a fractured tibia. What should the nurse inform the client prior to the cast being removed? The leg will look as it did prior to the cast being applied. The leg will look moist and will have small bumps that will go away in a few days. The skin may be covered with a yellowish crust that will shed in a few days. The leg strength is enforced by the wearing of the cast.

The skin may be covered with a yellowish crust that will shed in a few days.

A client has severe osteoarthritis in the left hip and is having surgery to replace both articular surfaces of the hip. What type of surgical procedure will the nurse prepare the client for? Arthrodesis Hemiarthroplasty Total arthroplasty Osteotomy

Total arthroplasty

Which may occur if a client experiences compartment syndrome in an upper extremity? Whiplash injury Volkmann's contracture Callus Subluxation

Volkmann's contracture If compartment syndrome occurs in an upper extremity, it may lead to Volkmann's contracture, a claw-like deformity of the hand resulting from obstructed arterial blood flow to the forearm and hand.

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

Weights hanging and touching the floor

A client sustains an injury to the left ankle when he fell down three steps. There was immediate swelling and pain from the injury, and the client was taken to the local emergency department. What initial test does the nurse anticipate the physician will order to rule out a fracture? Arthrography Arthroscopy X-ray Computerized tomography (CT scan)

X-ray

A client is brought to the emergency department after being struck with a baseball bat on the upper arm while diving for a pitched ball. Diagnostic tests reveal that the humerus is not broken but that the client has suffered another type of injury. What type of injury would the physician likely diagnose? contusion sprain strain subluxation

contusion A contusion is a soft tissue injury resulting from a blow or blunt trauma.

Which is not one of the general nursing measures employed when caring for the client with a fracture? cranial nerve assessment administering analgesics providing comfort measures assisting with ADLs

cranial nerve assessment

A client who has fallen and injured a hip cannot place weight on the leg and is in significant pain. After radiographs indicate intact but malpositioned bones, what would the physician diagnose? dislocation strain sprain fracture

dislocation

The type of fracture described as having one side of the bone broken and the other side bent would be: greenstick. oblique. spiral. transverse.

greenstick.

A client has been in a motor vehicle collision. Radiographs indicate a fractured humerus; the client is awaiting the casting of the upper extremity and admission to the orthopedic unit. What is the primary treatment for musculoskeletal trauma? immobilization surgical repair external rotation enhancing complications

immobilization

A fracture is considered pathologic when it results in a fragment of bone being pulled away by a ligament or tendon and its attachment. occurs through an area of diseased bone. involves damage to the skin or mucous membranes. presents as one side of the bone being broken and the other side being bent.

occurs through an area of diseased bone.

A client with a right leg fracture is returning to the orthopedist to have the cast removed. What would the physician prescribe as further treatment? physical therapy discontinue use of crutches cold compresses to leg for swelling No options are correct.

physical therapy

A client has had surgical repair of a hip injury after joint manipulation was unsuccessful. After surgery, the nurse implements measures to prevent complications. Which complications is the nurse seeking to prevent? Select all that apply. skin breakdown wound infection pneumonia diarrhea

skin breakdown wound infection pneumonia

A client has been diagnosed with a muscle strain. What does the physician mean with the term "strain"? stretched or pulled beyond its capacity injury resulting from a blow or blunt trauma injuries to ligaments surrounding a joint subluxation of a joint

stretched or pulled beyond its capacity