NURS 3 - Mod 17 Musculoskeletal (Med Surg) EAQ's
The patient had tibia and fibula fractures and an open reduction, and now has a cast. The patient wants to know when they will be able to resume jazzercise classes. To answer this question, the nurse must first understand that the following stages of union occur in what order? 1. Ossification 2. Granulation 3. Remodeling 4. Consolidation 5. Callus formation 6. Fracture hematoma
1.Fracture hematoma 2.Granulation 3.Callus formation 4.Ossification 5.Consolidation 6.Remodeling A fracture hematoma occurs in the first 72 hours after the fracture injury. Granulation produces the basis for new bone substance 3 to 14 days after injury. Callus formation, composed of cartilage, osteoblasts, calcium, and phosphorus, appears by the end of the second week after injury. Ossification of the callus will prevent movement at the fracture when the bones are gently stressed; this occurs from three weeks to six months after the fracture, and continues until the fracture is healed. Consolidation is when the distance between bone fragments diminishes and there is radiologic union. Remodeling is the reabsorption of excess bone tissue in the final stage of bone healing and it occurs in response to gradually increased stress on the bone or weight bearing.
The registered nurse teaches a student nurse about care of a patient with a fracture of the humerus, compartment syndrome, and a plaster cast in place. The student nurse provides discharge education to the patient. Which statement made by the student nurse needs correction? 1 "Elevate the extremity above the heart level." 2 "Use a hair dryer on a low setting to dry the cast thoroughly." 3 "Avoid covering the cast with plastic for extended periods of time." 4 "Control the itching sensation by using a hair dryer on a cool setting at the site of itching."
1 - "Elevate the extremity above the heart level." Elevation of the extremity above the heart level is contraindicated for patients with compartment syndrome, which is a painful condition that occurs when the pressure within the muscle increases to dangerous levels. If the cast gets wet by mistake, it should be dried thoroughly using a hair dryer on the low setting. Itching is a common sensation experienced by patients and can be controlled by using a hair dryer on the cool setting instead of using hard objects to scratch the area. The patient should not cover the cast with plastic for prolonged periods.
A nurse is examining a patient who is in a body jacket brace. The patient states that the brace is applied too tightly. What findings in the patient may indicate that the brace is too tightly applied? Select all that apply. 1 Abdominal pain 2 Burning sensation 3 Guarding and rigidity 4 Nausea and vomiting 5 Increased abdominal pressure
1 - Abdominal pain 4 - Nausea and vomiting 5 - Increased abdominal pressure After application of the body jacket brace, it is important to assess the patient for the development of superior mesenteric artery syndrome (cast syndrome). This condition occurs if the brace is applied too tightly, compressing the superior mesenteric artery against the duodenum. The patient generally complains of abdominal pain, abdominal pressure, nausea, and vomiting. Burning sensations, guarding, and rigidity may not be found in cast syndrome; these symptoms are more prominent if an intraabdominal disorder is present.
What is the most useful initial nursing action for a patient who sustains a joint sprain? 1 Applying ice compresses to the injured area 2 Administering an over-the-counter analgesic 3 Seeking a prescription for a prophylactic antibiotic 4 Providing the patient with instructions about weight bearing
1 - Applying ice compresses to the injured area Ice application is the most useful intervention after a sprain. Cold compression produces hypothermia of the affected area, facilitating vasoconstriction and reducing the perception and transmission of nerve pain impulses. Antibiotic prophylaxis is administered for an open fracture or external extremity injury. Analgesics such as aspirin can be administered after the cold compress. Patient instructions should be provided after the extent of the injury is determined and initial interventions performed.
A coal miner with a history of rheumatoid arthritis reports pain, swelling, and a limited range of motion in the knee joints. What diagnosis does the nurse suspect? 1 Bursitis 2 Shin splints 3 Rotator cuff tear 4 Impingement syndrome
1 - Bursitis Bursitis is the inflammation of the bursae located near the joints. Rheumatoid arthritis causes inflammation in the joints, resulting in friction between joint surfaces. The repetitive kneeling involved in occupations such as coal mining may result in bursitis. A shin splint is inflammation along the anterior aspect of the calf due to periostitis. A rotator cuff tear is a muscle tear around the shoulder joint. Impingement syndrome is also a shoulder injury.
A nurse is taking care of a patient with a cast on the right leg maintained in external traction. However, during the routine examination, the nurse finds that the patient has compartment syndrome. What measures should a nurse take in the management of this patient? Select all that apply. 1 Cut the cast in half. 2 Reduce external traction weight. 3 Remove or loosen any bandage. 4 Apply cold compresses to the leg. 5 Elevate the affected limb above heart level.
1 - Cut the cast in half. 2 - Reduce external traction weight. 3 - Remove or loosen any bandage. If the patient has compartment syndrome, the cast should be split in half. If there are any bandages, they should be removed or loosened to remove the pressure. A reduction in traction weight may also decrease external circumferential pressures. Elevation of the extremity may lower venous pressure and slow arterial perfusion. Therefore the extremity should not be elevated above heart level. The application of cold compresses may result in vasoconstriction and exacerbate compartment syndrome.
What instructions should be given to a patient with a cast to prevent edema and skin breakdown? Select all that apply. 1 Exercise joints above and below the cast. 2 Cover the cast with plastic for prolonged periods. 3 Remove the padding of the cast after going home. 4 Apply ice on the fracture site during the first 24 hours. 5 Elevate the affected limb above heart level during the first 48 hours.
1 - Exercise joints above and below the cast. 4 - Apply ice on the fracture site during the first 24 hours. 5 - Elevate the affected limb above heart level during the first 48 hours. Regardless of the type of cast material, a cast can interfere with circulation and nerve function if edema occurs after the application of the cast. Therefore it is important to teach the patient and caregivers about measures to prevent edema. Elevating the limb above heart level and applying ice in the initial phase (24 to 48 hours) help in preventing edema. The patient should also be encouraged to exercise the joints above and below the cast. Pulling out the cast padding, inserting foreign objects into the cast to scratch an itch, and covering the cast with plastic may predispose patients to skin breakdown and infections. Therefore they should be advised to abstain from doing such things.
The nurse plans care for a patient who has a fractured femur. During the 48 to 72 hours after the fracture the nurse should monitor the patient for the development of what? 1 Fat emboli 2 Renal calculi 3 Muscle atrophy 4 Bone demineralization
1 - Fat emboli Pressure on the bone marrow or an increase in catecholamines (related to stress) can mobilize fatty acids and the development of fat globules in the bloodstream. These fat globules travel to the lung and become lodged, causing the pulmonary symptoms. Renal calculi, muscle atrophy, and bone demineralization are potential complications of immobility; however, they would develop much later than 72 hours after the fracture.
A nurse is caring for a patient with a fractured femur. The health care provider finds that the patient has fat embolism syndrome. What treatment (or treatments) of fat embolism syndrome should the nurse anticipate for this patient? Select all that apply. 1 Fluid resuscitation 2 Correction of acidosis 3 Avoidance of coughing 4 Fracture immobilization 5 Frequent change in positions
1 - Fluid resuscitation 2 - Correction of acidosis 4 - Fracture immobilization The treatment of fat embolism syndrome is directed toward the management of symptoms. This includes fluid resuscitation to prevent hypovolemic shock, correction of acidosis, and fracture immobilization. The patient should be encouraged to cough and perform deep breathing. The patient should be repositioned as little as possible to prevent dislodgment of fat droplets into the general circulation.
A patient arrives in the emergency department after sustaining a fall. The initial assessment reveals that the left leg is shorter than the right and externally rotated. What condition should the nurse suspect? 1 Fractured hip 2 Fractured pelvis 3 Fractured tibia/fibula 4 Nondisplaced fractured femur
1 - Fractured hip Older adults, especially women, are at high risk for fracture. One classic sign of a fractured hip is a leg that is shorter than the opposite one and abnormally rotated (internally or externally). A fractured hip is accompanied by pain and possibly neurovascular changes. A leg that is shorter than the other one and externally rotated is not a sign of a fractured pelvic, femur, or tibia/fibula.
A nurse is attending a patient who has sustained a fracture of the femur. What interventions should the nurse perform to ensure a healthy diet for optimal healing of the injured tissues? Select all that apply. 1 Include 1g/kg of protein daily. 2 Include foods rich in vitamins C and D. 3 Increase calcium-rich foods in the diet. 4 Decrease the intake of foods rich in B vitamins. 5 Decrease magnesium- and phosphorus-rich foods.
1 - Include 1g/kg of protein daily. 2 - Include foods rich in vitamins C and D. 3 - Increase calcium-rich foods in the diet. Proper nutrition is an essential component of the healing process in injured tissue. An adequate energy source is needed to promote muscle strength and tone, build endurance, and provide energy for ambulation and maintaining a proper gait. The patient's dietary requirements must include adequate protein, usually 1 g/kg of body weight. The calcium intake should be increased, because immobility and bone healing increase calcium needs. Intake of vitamins C and D should be increased, because these are necessary for optimal soft tissue and bone healing. Magnesium and phosphorus are also necessary for the healing process, and their intake should be increased. B vitamins also aid in the healing of soft tissues and bones.
A patient with a fracture of the femur is to be placed in Buck's traction. How should the nurse explain the functions of Buck's traction to the patient? Select all that apply. 1 It immobilizes the fracture. 2 It reduces muscle spasms. 3 It reduces injury-related edema. 4 It prevents hip flexion contractures. 5 It helps in union of the fractured bone.
1 - It immobilizes the fracture. 2 - It reduces muscle spasms. 4 - It prevents hip flexion contractures. Traction is the application of a pulling force to an injured or diseased part of the body, often an extremity. A Buck's traction boot is a type of skin traction used to immobilize the fracture, prevent hip flexion contractures, and reduce muscle spasms. The traction does not reduce edema or directly help in union of the fractured bone. However, it indirectly helps the process of union of the fractured bone by keeping the limb aligned and reducing spasms and contractures.
The nurse is caring for the patient with skeletal traction for an extremity fracture. What action(s) by the nurse are most appropriate? Select all that apply. 1 Keep the weights off of the floor. 2 Elevate the end of the bed as needed. 3 Ensure that the weights are secured to the pulleys. 4 Confirm that the forces are pulling in the same direction. 5 Make sure that the traction ranges from 5 to 45 pounds (2.3 to 20.4 kg). 6 Apply the traction intermittently as prescribed by the health care provider (HCP).
1 - Keep the weights off of the floor. 2 - Elevate the end of the bed as needed. 5 - Make sure that the traction ranges from 5 to 45 pounds (2.3 to 20.4 kg). The weights must be kept off of the floor. The end of the bed may need to be elevated so that the weights are off the floor for traction to be applied. Traction weight ranges from 5 to 45 pounds (2.3 to 20.4 kg). Weight forces have to be in the opposite direction (counter traction). Traction must be applied continuously to be effective and the weights have to move freely through the pulleys.
A bandage has been applied on the ankle of a patient for a sprain. The patient states the ankle is swollen, numb, and painful. What is the priority action by the nurse? 1 Loosen the bandage. 2 Check for Homan's sign. 3 Have the patient ambulate. 4 Administer an antibiotic for cellulitis.
1 - Loosen the bandage. The patient's signs and symptoms indicate that the bandage is too tight. In such cases, the bandage can be left in place for 30 minutes and then removed for 15 minutes. However, some elastic wraps are left on during training, athletic, and occupational activities. Although assessing for thrombophlebitis, deep vein thrombosis, and cellulitis can all cause pain and swelling, the differential diagnosis in this instance points to bandage tightness as the likeliest cause. Ambulation will increase the pain and swelling until the bandage is loosened.
The nurse is caring for a patient with a fracture who has a Buck's traction boot in place. Which complication is prevented by the use of the boot? 1 Muscle spasms 2 Posttraumatic arthritis 3 Intraarticular adhesions 4 Extraarticular adhesions
1 - Muscle spasms Traction devices apply a pulling force on a fractured extremity in order to realign the bone. A Buck's traction boot is a type of skin traction used to immobilize a fracture, prevent hip flexion contractures, and reduce muscle spasms. Continuous passive motions (CPM) decrease the incidence of posttraumatic arthritis. CPM is used for various joints, such as the knee and shoulder, to prevent intraarticular and extraarticular adhesions.
The nurse is caring for a patient with a fractured femur. Which nursing action(s) by the nurse is the priority? Select all that apply. 1 Resting the extremity. 2 Elevating the extremity. 3 Providing analgesia as necessary. 4 Compressing the involved extremity. 5 Applying ice compresses to the injured area. 6 Stopping the activity and limiting movement.
2 - Elevating the extremity. 3 - Providing analgesia as necessary. 4 - Compressing the involved extremity. 5 - Applying ice compresses to the injured area. 6 - Stopping the activity and limiting movement. There are five interventions performed for an acute injury. Stopping the activity and limiting movement, applying ice compresses to the injured area, compressing the involved extremity, elevating the extremity, and providing analgesia as necessary. Resting the extremity is not included in the immediate care.
A nurse has applied Buck's traction to a patient who has sustained a fractured femur. What are the main purposes of this type of traction? Select all that apply. 1 Reduce muscle spasms 2 Reduce the risk of a fat embolism 3 Repair the fracture without surgery 4 Immobilize and stabilize the fracture 5 Reduce the amount of analgesics required 6 Allow the nursing staff to care for the patient more easily
1 - Reduce muscle spasms 4 - Immobilize and stabilize the fracture Buck's traction, a type of skin traction, is used to stabilize and immobilize a fractured femur. This type of traction decreases the risk for further injury until surgery can be performed and can also ease painful muscle spasms. Secondarily, Buck's traction may reduce the risk of a fat embolism. Buck's traction may be used long-term until the patient is able to undergo surgery, but this is not the preferred treatment. Once muscle spasms have been relieved after the application of Buck's traction, the patient may require less pain medication. Buck's traction does not necessarily allow the nursing staff to care for the patient more easily.
A patient experiences a compound fracture. What assessment findings does the nurse expect? Select all that apply. 1 Soft tissue injury 2 The skin is intact 3 The absence of soft tissue injury 4 The bone is splintered and bent 5 The skin is broken, exposing the bone
1 - Soft tissue injury 5 - The skin is broken, exposing the bone In compound fractures, the soft tissue is injured, and the skin is broken, exposing the bone. In nondisplaced greenstick fractures, an incomplete fracture occurs, in which the bone is splintered on one side and bent on the other side. The skin is not broken and remains intact in simple fractures.
Which primary manifestation is associated with bursitis? 1 Swelling 2 Painless joints 3 Tingling sensation 4 Altered neurovascular status
1 - Swelling Bursitis is the inflammation in the closed sacs lined with synovial membrane that contain synovial fluid and are located between tendons and bones near the joints. The swelling is the primary manifestation of bursitis. Bursitis is characterized by painful joints and a warm sensation, but not a tingling sensation. The manifestation of altered neurovascular status may appear later in acute soft tissue injury.
A patient is admitted to the orthopedic surgical unit for a fracture of the left tibia. What instructions should a nurse give concerning the prevention of venous thromboembolism? Select all that apply. 1 Wear compression gradient stockings. 2 Exercise toes of the left lower limb against resistance. 3 Exercise toes of the right lower limb against resistance. 4 Perform range-of-motion exercises on the left lower limb. 5 Perform range-of-motion exercises on the right lower limb.
1 - Wear compression gradient stockings. 2 - Exercise toes of the left lower limb against resistance. 5 - Perform range-of-motion exercises on the right lower limb. There is a high risk of venous thromboembolism in the orthopedic surgical patient. Therefore measures should be taken by the attending nurse to prevent it. These measures include instructing the patient to wear compression gradient stockings (antiembolism hose) and to use sequential compression devices. The patient should also be encouraged to move (dorsiflex and plantar flex) the fingers or toes of the affected extremity against resistance and perform range-of-motion exercises on the unaffected lower extremities.
The nurse teaches a student nurse about traction. Which statement made by the student nurse reflects effective learning? 1 "Traction prevents active and passive exercise." 2 "Traction provides immobilization to the joint or body part." 3 "Traction decreases the joint space before a major joint reconstruction." 4 "A Buck's traction boot is a type of skeletal traction."
2 - "Traction provides immobilization to the joint or body part." Traction is the application of a pulling force to an injured or diseased part of the body or an extremity. Traction is used to immobilize a joint or part of the body in order to promote joint stabilization and prevent soft tissue damage. Traction promotes active and passive exercise. It does not prevent it. This minimizes muscle spasms, which may further complicate the injury. Traction helps to increase, not decrease, space in the joint before major joint reconstruction. A Buck's traction boot is s type of skin traction that is used preoperatively in a patient with a hip fracture awaiting surgery. It helps to reduce muscle spasm.
A patient with a fracture of the right tibia has been advised to use a cane. What instructions should the nurse give to this patient? Select all that apply. 1 Advance the left leg first. 2 Advance the left leg last. 3 Advance the right leg last. 4 Advance the right leg first. 5 Hold the cane in the left hand. 6 Hold the cane in the right hand.
2 - Advance the left leg last. 4 - Advance the right leg first. 5 - Hold the cane in the left hand. The decision to use assistive devices is made by the health care provider depending on the needs and lifestyle of patient. Use of these devices varies. When a cane is used, the affected limb is advanced along with or after the cane, and the unaffected limb is advanced last. The cane is held in the hand opposite the affected limb. In this case, the right leg is affected, and therefore the cane should be held in the left hand, the right leg should be advanced first, and the left leg should be advanced last.
A patient is suspected of having fat embolism syndrome (FES) following a traumatic femur fracture. Which assessment data gathered by the nurse supports this suspicion? Select all that apply. 1 Increased hematocrit 2 Chest pain 3 Mental status changes 4 Petechiae on the anterior chest wall 5 Increased partial pressure of arterial oxygen
2 - Chest pain 3 - Mental status changes 4 - Petechiae on the anterior chest wall FES is characterized by a classic triad of symptoms, including respiratory changes such as chest pain, dyspnea and cyanosis; mental status changes including restlessness, confusion, and memory loss; and skin changes including petechiae of the neck, anterior chest wall, buccal mucosa, and conjunctiva. In FES, the partial pressure of arterial oxygen (PaO 2) and hematocrit would be decreased, not increased.
A patient is brought to the emergency department after an accident with injury to the right leg. A radiograph of the right femur shows a fracture. What should the nurse note during the peripheral vascular assessment? Select all that apply. 1 Pain 2 Color 3 Edema 4 Motor function 5 Capillary refill
2 - Color 3 - Edema 5 - Capillary refill In cases related to fractures, peripheral vascular assessment should be done. This consists of assessment of color, temperature, capillary refill, peripheral pulses, and edema. Assessment of motor function and pain is included in the peripheral neurologic assessment.
While examining a patient with an injury to the distal humerus, the nurse suspects that the patient has compartment syndrome. What findings in the patient could have raised this suspicion? Select all that apply. 1 Pyrexia 2 Paralysis of the arm 3 Redness and warmth 4 Pain unrelieved by opioids 5 Absence of the peripheral pulse
2 - Paralysis of the arm 4 - Pain unrelieved by opioids 5 - Absence of the peripheral pulse Compartment syndrome may occur initially from the body's physiologic response to the injury, or it may be delayed for several days after the injury. The usual signs include weakness and paralysis of the arm, absence of peripheral pulses, and pain that is not relieved by opioids. These signs are due to decreased compartment size resulting from an injury. The resultant pressure may compromise the function of blood vessels, nerves, or tendons that run through that compartment. Pyrexia indicates infection, but it is not a sign that suggests compartment syndrome. Redness and warmth may not be present; instead, the skin may be pale and cold to the touch.
The nurse is providing postoperative care to a patient who underwent surgical repair of a fractured hip two days ago. Which assessment finding indicates the need for immediate nursing action and intervention? 1 Pain at the surgical site 2 Sudden shortness of breath 3 Serosanguineous wound drainage 4 Limited range of motion of the affected leg
2 - Sudden shortness of breath The sudden onset of shortness of breath could be an indication of fat embolism syndrome, a potentially fatal complication of long bone fractures. Pain at the surgical site, serosanguineous wound drainage, and limited range of motion of the affected leg are all expected findings in a patient who has just undergone repair of a fractured hip.
What action should a nurse implement to prevent foot drop in a patient who has a full-leg cast? 1 Encourage bed rest 2 Support the foot with 90 degrees of flexion 3 Maintain the foot in a boot with 45 degrees of flexion 4 Place an antiembolic garment on the affected leg and foot.
2 - Support the foot with 90 degrees of flexion As a means of preventing foot drop in a leg with a cast, the foot should be supported with 90 degrees of flexion. Encouraging bed rest for his patient is not required. Supporting the foot with 45 degrees of flexion will not prevent foot drop. Antiembolic garments will protect against thromboembolic events but not foot drop.
A soccer player has injured the anterior crucial ligament (ACL) and is having reconstructive surgery. The nurse knows that the patient will need more teaching when the patient makes which statement? 1 "I probably won't be able to play soccer for six to eight months." 2 "They will have me do range of motion with my knee soon after surgery." 3 "I can't wait to get this done now so I can play soccer for the next tournament." 4 "I will need to wear an immobilizer and progressively bear weight on my knee."
3 - "I can't wait to get this done now so I can play soccer for the next tournament." When the athlete has ACL reconstructive surgery, the patient does not understand the severity when the patient mentions planning to be back to playing soccer soon. The patient likely will not be able to play soccer for six to eight months. The patient will be able to do range of motion soon after surgery. Immobilization and progressive weight bearing with physical therapy will occur during rehabilitation.
A nurse is caring for a patient with reported fracture of the tibia. A plaster cast has been applied to the patient. What interventions are important for the care of the cast during the drying period and immediately thereafter? Select all that apply. 1 Avoid petaling the cast. 2 Cover the cast with a cloth. 3 Avoid direct pressure on the cast. 4 Handle the cast gently with an open palm. 5 Place several strips of tape over the rough edges.
3 - Avoid direct pressure on the cast. 4 - Handle the cast gently with an open palm. 5 - Place several strips of tape over the rough edges. Avoid direct pressure on the cast during the drying period. Handle the cast gently with an open palm to avoid denting the cast. The health care provider should place several strips (petals) of tape over the rough areas to ensure a smooth cast edge. A fresh plaster cast should never be covered, because covering it prevents air from circulating; this lack of air circulation allows heat to build up in the cast (which may cause a burn) and may also result in a delay in drying. After drying, the edges may need to be petaled to avoid skin irritation from rough edges and to prevent plaster of Paris debris from falling into the cast and causing irritation or pressure necrosis.
A patient with a leg fracture is scheduled for a fasciotomy. What complication is identified to have caused the need for this type of surgery? 1 Infection 2 Fat embolism syndrome 3 Compartment syndrome 4 Venous thromboembolism
3 - Compartment syndrome Compartment syndrome is characterized by swelling and increased pressure within a limited space, which presses and compromises the function of the blood vessels, nerves, and/or tendons that run through that compartment. Surgical decompression of soft tissue is done through fasciotomy. The occurrence of infection is greatly reduced with antibiotics in conjunction with aggressive surgical management. Fat embolism syndrome treatment includes fluid resuscitation to prevent hypovolemic shock, correction of acidosis, and replacement of blood loss. Venous thromboembolism can be managed with drug management therapy such as anticoagulants.
The nurse is teaching a patient about carpal tunnel syndrome. The nurse emphasizes that carpal tunnel syndrome is caused by which injury? 1 Subluxation of the ulna bone 2 Dislocation of the radial bone 3 Compression of the median nerve 4 Compartment syndrome of the triceps muscle
3 - Compression of the median nerve Carpal tunnel syndrome (CTS) is caused by compression of the median nerve, which enters the hand at the wrist through the narrow carpal tunnel. The carpal tunnel is formed by ligaments and bones. CTS is the most common compression neuropathy in the upper extremity. Subluxation and dislocation are bone, not soft tissue, injuries. Compartment syndrome of the triceps muscle is not associated with carpal tunnel syndrome.
A nurse is caring for a patient who has just sustained a hip fracture. Which nursing action should be performed first? 1 Administering pain medication 2 Preparing for immediate surgery 3 Immobilizing the affected extremity 4 Placing the injured extremity in traction
3 - Immobilizing the affected extremity The priority of emergency management for a fractured hip is immobilizing the affected extremity, because movement could cause further damage and more extensive internal bleeding and worsen the patient's pain. Administering pain medication, preparing the patient for immediate surgery, and placing the injured extremity in traction are secondary nursing interventions that require further direction from the primary health care provider.
A patient with an inflammation along the anterior aspect of the calf due to periostitis continues to report pain to the nurse. What is an appropriate action to be included on the patient's plan of treatment, which is specific to continued pain? 1 Apply a protective brace. 2 Consider reconstructive surgery. 3 Perform an x-ray to rule out a stress fracture of the tibia. 4 Perform a magnetic resonance imaging (MRI) to determine the need for arthroscopic surgery.
3 - Perform an x-ray to rule out a stress fracture of the tibia. Shin splints may cause inflammation along the anterior aspect of calf due to periostitis. In case of persistence of pain, an x-ray test is carried out to diagnose stress fracture of the tibia. Protective braces are used if there is a recurrence of symptoms in patients with tendonitis. Reconstructive surgery is usually recommended for patients with severe acute cruciate ligament injury. In case of a meniscus injury, an MRI will confirm the diagnosis
A patient with a cast for a fractured radius reports, "My fingers feel numb." Which action is the highest priority for the nurse? 1 Elevating the arm on two pillows 2 Notifying the primary health care provider 3 Performing a thorough neurovascular assessment 4 Reassuring the patient that this is a normal response
3 - Performing a thorough neurovascular assessment Numbness distal to a casted extremity is an indication of decreased circulation, nerve compression, and possibly compartment syndrome. The nurse should perform a full neurovascular assessment to determine the extent of the problem. After the nurse has performed the assessment, the arm may be elevated on two pillows while the primary health care provider is notified. Numbness in the fingers of the casted arm is not a normal response.
A patient is found to have a partially dislocated shoulder. How should the nurse document this finding? 1 Rupture 2 Fracture 3 Subluxation 4 Misalignment
3 - Subluxation Subluxation, also known as dislocation, may be assessed by means of palpation of the space between the head of the bone and the cavity where it is normally located. Subluxation results in partial loss of function and intense pain. A subluxation is not a fracture—there is no break in bone integrity—but a subluxation is treated similarly to a fracture. With subluxation, there is no rupture in the integrity of the bone. Subluxation may be described as a misalignment, but this is not an accurate term.
The nurse suspects that a patient is experiencing a fat embolism after sustaining a femur fracture. What clinical manifestations does the nurse expect? 1 Tachypnea, tachycardia, shortness of breath, and paresthesia 2 Paresthesia, bradycardia, bradypnea, petechial rash on the chest and neck 3 Tachypnea, tachycardia, shortness of breath, petechial rash on the chest and neck 4 Bradypnea, bradycardia, shortness of breath, petechial rash on the chest and neck
3 - Tachypnea, tachycardia, shortness of breath, petechial rash on the chest and neck A fat embolism may occur in a patient who has had a fracture of a large bone such as a femur or hip. The classic symptoms of a fat embolism include tachypnea, tachycardia, shortness of breath, and petechial rash on the chest and neck. Tachypnea, tachycardia, shortness of breath, and paresthesias; paresthesias, bradycardia, bradypnea, and petechial rash; and bradypnea, bradycardia, shortness of breath, and petechial rash are not directly characteristic of a pulmonary embolism.
When treating a patient with compartment syndrome, what measures should the nurse consider to be contraindicated? Select all that apply. 1 Bandage removal. 2 Bivalving of the bandage. 3 Reduction in traction weight. 4 Application of cold compresses. 5 Elevation of the limb above heart level.
4 - Application of cold compresses. 5 - Elevation of the limb above heart level. Elevation of the extremity may lower venous pressure and slow arterial perfusion. Therefore the extremity should not be elevated above heart level in case of compartment syndrome. Similarly, the application of cold compresses may result in vasoconstriction and exacerbate compartment syndrome. It may also be necessary to remove or loosen the bandage and split the cast in half (bivalving). A reduction in traction weight may also decrease external circumferential pressures.
A patient with a long leg cast reports pain in the toes. The nurse discovers that the toes are pale and cool to the touch with intact pulses and minimal neuropathy. The findings indicate that the patient may be experiencing what? 1 Osteomyelitis 2 A fat embolism 3 A pressure ulcer 4 Compartment syndrome
4 - Compartment syndrome Compartment syndrome is the progressive compromise of neurovascular function of tissue in a confined space such as a cast. It may also result from circumferential inflammation around an extremity. The earliest sign is paresthesias, followed by pain, pressure resulting from edema, pallor, paralysis, and absence of pulse. (Absence of the peripheral pulse is a late and ominous sign.) A pressure ulcer is caused by decreased circulation due to pressure, tissue hypoxia, and destruction. Osteomyelitis is an infectious process within the bone. A fat embolism is an acute event in which fat globules released into circulation obstruct pulmonary circulation. It is seen with fractures of long bones such as the femur.
The nurse is completing a neurovascular assessment on the patient with a tibial fracture and a cast. The feet are pulseless, pale, and cool. The patient says they are numb. What should the nurse suspect is occurring? 1 Paresthesia 2 Pitting edema 3 Poor venous return 4 Compartment syndrome
4 - Compartment syndrome The nurse should suspect compartment syndrome with one or more of the following six Ps: paresthesia, pallor, pulselessness, pain distal to the injury and unrelieved with opioids, pressure increases in the compartment, and paralysis. Although paresthesia and poor venous return are evident, these are just some of the manifestations of compartment syndrome. Pitting edema is not evident.
The nurse is assessing a patient who has a traumatic leg injury. What intervention is the most important in the initial assessment? 1 Assess the patient's pain level 2 Realign the extremity in the appropriate position 3 Check for full or partial loss of feeling and sensation 4 Determine the extremity's color and temperature in the area of the injury
4 - Determine the extremity's color and temperature in the area of the injury Baseline assessments are very important. It is most important to assess the extremity's color and temperature in the area of the injury to determine any venous or arterial insufficiency. If arterial or venous blood flow in the area is blocked, the area could become ischemic and die. Assessment of temperature is crucial to determine circulation and perfusion to the extremity and any change in temperature in the extremity should be reported promptly to the health care provider. Assessing the patient's pain is important but not as crucial as determining any arterial insufficiency. Realigning the injured extremity can lead to further damage or cause vascular insufficiency. Loss of sensation may be a late sign of neurovascular damage.
The nurse is caring for a patient with a spinal bone fracture and osteoporosis. The patient asks the nurse for information on osteoporosis. What is the most appropriate response by the nurse? 1 Tendons and ligaments become more flexible. 2 Almost 50% of a person's muscle mass is decreased by age 70. 3 An increase in motor neurons can lead to more problems with skeletal muscle movement. 4 For many people, diseases such as osteoarthritis and osteoporosis are not a normal part of growing older.
4 - For many people, diseases such as osteoarthritis and osteoporosis are not a normal part of growing older. These two bone diseases are not a normal part of aging for many people. In the aging adult, tendons and ligaments become less flexible, leading to more rigid movement. By age 70, a person's muscle mass is reduced by almost 30 percent. The number of motor neurons decrease, which leads to more physical problems.
The patient is brought to the emergency department after a car accident and has a femur fracture. What nursing intervention should the nurse implement to prevent a fat embolus in this patient? 1 Administer enoxaparin 2 Provide range of motion exercises 3 Apply sequential compression boots 4 Immobilize the fracture preoperatively
4 - Immobilize the fracture preoperatively To prevent fat emboli, the nurse immobilizes the long bone to reduce movement of the fractured bone ends and decrease the risk of a fat embolus from the bone before surgical reduction. Enoxaparin is used to prevent blood clots, not fat emboli. Range of motion and compression boots will not prevent a fat embolus in this patient.
A nurse evaluates a patient who reports twisting an ankle while walking down steps. Besides edema, which symptoms would most likely be observed if a nondisplaced simple fracture were present? 1 Numbness, coolness, and loss of pulse 2 Loss of sensation, redness, and warmth 3 Coolness, redness, and inability to bear weight 4 Redness, warmth, and inability to use the affected part
4 - Redness, warmth, and inability to use the affected part Common signs of a fracture include edema, redness, warmth, inability to bear weight or use the affected joint, and pain at the site of injury. Coolness, tingling, numbness, and loss of pulses are signs of a vascular problem or may reflect a complication of a more complex fracture.
The nurse is providing discharge education to a patient with a fiberglass cast. What should the nurse be sure to include with the education? 1 It must not get wet. 2 The fiberglass is heavier than a plaster cast. 3 It has to be replaced every one to two weeks. 4 Skin irritation is more common than with a plaster cast.
4 - Skin irritation is more common than with a plaster cast. Although there are many advantages of fiberglass casts, such as its capacity to withstand wetness and its lightness compared to plaster, the one major disadvantage is that the particles of fiberglass may be irritating to the skin. A fiberglass cast is water-repellent and does not require replacement if it becomes wet. A fiberglass cast may remain on the patient for the duration of the treatment and does not require replacement every one to two weeks. A fiberglass cast is lighter than plaster.
A patient with a fracture of the femur has the extremity in skeletal traction and is encouraged to use an overhead trapeze apparatus. The nurse explains that the primary purpose of the overhead trapeze is what? 1 To assist with leg exercises 2 To enhance breathing and lung expansion 3 To promote circulation throughout the body 4 To facilitate independent movement while the patient is in bed
4 - To facilitate independent movement while the patient is in bed An overhead trapeze will facilitate independent movement in bed. It also maintains range of motion of the upper extremities and strengthens the biceps. Assisting with stump exercises, enhancing breathing and lung expansion, and promoting circulation throughout the body are secondary benefits to using an overhead trapeze but are not the primary purpose.
