Quiz 13- Musculoskeletal 2

A client with a fractured hip is placed in traction until surgery can be performed. What should the nurse explain is the purpose of this traction? A. Relieve muscle spasm and pain B. Prevent contractures from developing C. Keep the client fro turning and moving in bed D. Maintain limb in position of external rotation

A. Relieve muscle spasm and pain

The nurse is supervising a new graduate RN caring for a patient with a fracture of the right ankle who is at risk for complications of immobility. For which action should the supervising nurse intervene? A. Encouraging the patient to go from a lying to a standing position B. Administering pain medication before the patient begins exercise C. Explaining to the patient and family the purpose of the exercise program D. Reminding the patient about the correct use of crutches

A. Encouraging the patient to go from a lying to a standing position

A client is in skin traction while awaiting surgery for repair of a fractures femur. The client reports leg discomfort and asks the nurse to release the traction. Which is the nurse's best initial response? A. I can't because the weights are needed to keep the bone aligned B. I will remove half of the weights and notify your health care provider C. I'll get your prescribed pain medication to help relieve discomfort D. I have to follow the health care provider's orders and releasing the weights is not ordered

A. I can't because the weights are needed to keep the bone aligned

A client has a total knee replacement and a continuous passive motion device is being used. The nurse concluded that the teaching has been effective when the client states, "The goal of therapy is to?" A. Improve joint flexion B. Maintain muscle tone C. Prevent tissue breakdown D. Avoid formation of a blood clot

A. Improve joint flexion

What instructions should the nurse provide when the client is allowed out of bed after an above the knee amputation? A. Keep hip in extension and alignment B. Keep hip raised with residual limb elevated C. Lift the shoulder and hip of the affected side when taking a step D. Use the ordered crutches until the residual limb is completely healed

A. Keep hip in extension and alignment

A patient with a long leg cast that was applied in the ED is being admitted to orthopedic unit. Which task is best for the nurse to delegate to the UAP? A. Obtain a fracture pan and use caution to prevent spillage on the cast B. Assist the patient to stand and bear weight when the cast is dry C. Check flexion/extension and color of the toes D. Turn the patient every 4-6 hours to allow the cast to dry

A. Obtain a fracture pan and use caution to prevent spillage on the cast

An older adult patient has a skin traction in place for a hip fracture. Which outcome statement reflects that the goal of therapy is successful? A. Patient reports a decrease in painful muscle spasms B. X-ray indicates that the fracture shows signs of healing C. Patient can perform activities of daily living with some assistance D. There are no signs and symptoms of compression syndrome

A. Patient reports a decrease in painful muscle spasms

A client experiences a traumatic amputation of a leg in a motor vehicle accident. Which nursing intervention initially should receive the lowest priority? A. Teaching residual limb care B. Monitoring hemoglobin levels C. Maintaining a compression dressing D. Using therapeutic interviewing techniques

A. Teaching residual limb care

A patient who has sustained a traumatic amputation of the left leg expresses grief and loss. What resources could the nurse recommend to help the patient adjust to his lost limb? SATA A. Chaplain B. Psychiatric social worker C. Physical therapist D. Orthopedic surgeon E. National Amputation Foundation F. Other spiritual leaders

B. Psychiatric social worker D. Orthopedic surgeon E. National Amputation Foundation

For what clinical findings of compromised circulation should the nurse assess in a client with a long leg cat? SATA A. Foul odor B. Swelling of the toes C. Drainage on the cast D. Increased temperature E. Prolonged capillary refill

B. Swelling of the toes E. Prolonged capillary refill

Nursing care of a client with a fractured hip should include the assessment of pedal pulses. The nurse should assess for which important characteristics of the pedal pulses? A. Contractility and rate B. Color of skin and rhythm C. Amplitude and symmetry D. Local temperature and visible pulsations

C. Amplitude and symmetry

A client is admitted with a fracture of the neck of the femur. In what position should the nurse maintain the client's affected extremity? A. Internal rotation with flexion of the knee and hip B. External rotation with flexion of the knee and hip C. Internal rotation with extension of the knee and hip D. External rotation with extension of the knee and hip

C. Internal rotation with extension of the knee and hip

A client has an amputation of a lower limb. What instructions should the nurse give the client to prevent hip flexion contracture? A. Turn from side to side every 1-2 hours B. Sit in a chair for 30 minutes 3 times daily C. Lie on the abdomen 30 minutes 4 times daily D. Perform quadricep setting exercises twice daily

C. Lie on the abdomen 30 minutes 4 times daily

What should the nurse do to control edema of residual limb 1 week after a client has an above the knee amputation? A. Administer the prescribed diuretic B. Restrict the client's oral fluid intakr C. Rewrap the elastic bandage as necessary D. Keep residual limb elevated on pillow

C. Rewrap the elastic bandage as necessary

Which clinical indicator should the nurse expect to identify when assessing a client with a fracture of the neck of the femur? A. Adduction with internal rotation B. Abduction with external rotation C. Shortening of the affected extremity with external rotation D. Lengthening of the affected extremity with internal rotation

C. Shortening of the affected extremity with external rotation

The nurse is providing teaching for a patient with a forearm cast. What information does the nurse give to the patient? A. Forearm should be anatomically positioned when resting B. Use an ice pack for the first 6-8 hours and cover pack with a towel C. Sling should distribute weight over a large area of the shoulders and trunk D. Limit movement of the fingers or wrist joints to prevent pain

C. Sling should distribute weight over a large area of the shoulders and trunk

A patient in a cast reports painful "hot spot" underneath the cast, and the nurse notices an unpleasant odor. Which intervention is the nurse most likely to perform first? A. Offer the patient a PRN pain medication B. Help the patient with hygiene around the cast C. Take the patient's temperature and other VS D. Call the orthopedic tech to change the cast

C. Take the patient's temperature and other VS

A patient with a fractured fibula is receiving skeletal traction and has skeletal pins in place. What would the nurse instruct the UAP to report immediately? A. The patient wants to change position in bed B. There is a small amount of clear fluid at the pin sites C. The traction are resting on the floor D. The patient reports pain and muscle spasms

C. The traction are resting on the floor

A client has surgery to repair a fractured right hip. Where should the nurse stand when assisting the client to ambulate? A. Behind the client B. In front of the client C. On the client's left side D. On the client's right side

C. On the client's left side

A nurse is caring for a client with a fracture of the of the head of the femur. The health care provider places the client in a Buck extension. What explanation does the nurse give the client for why traction is being used? A. Reduces muscle spasms B. Prevents soft tissue edema C. Reduces the need for cast application D. Prevents damage to the surrounding nerves

A. Reduces muscle spasms

The nurse is supervising a nursing student who is caring for a patient with a cast to the lower leg who reports pain that is worsening despite medication, with decreased movement and skin sensation. The nurse would intervene if the student performed which action? A. Instructs the patient to moves toes B. Places an extra pillow underneath the cast C. Checks for dorsalis pedis pulse D. Checks agency protocol to see who may cut the cast

B. Places an extra pillow underneath the cast

Which position should a nurse avoid placing a client in who had surgery for a total hip replacement? A. Supine B. Lateral C. Orthopneic D. Semi-fowlerr

C. Orthopneic

An older patient is discharged to home following an orthopedic injury. Which mobilization device would be preferred if the patient is having trouble with balance? A. Crutches B. Cane C. Walker D. Wheelchair

C. Walker

The nurse is caring for patients on an orthopedic unit who are being treated with a variety of therapies, including immobilization with a bandage, a splint, a cast, specialized orthopedic shoe and traction. What is the priority nursing concern for all of these patients? A. Assessment and prevention of neurovascular dysfunction and compromise B. Assessment and management of pain and discomfort C. Assessment of abilities to do activities of daily living after discharge D. Assessment and interventions for concerns related to disability and immobility

A. Assessment and prevention of neurovascular dysfunction and compromise

When should the nurse begin the process of rehab when a client is scheduled for an amputation? A. Before the surgery B. During the convalescent phase C. On discharge from the hospital D. When it is time for a prosthesis

A. Before surgery

A nurse is caring for a client in the evening after client has had a below-the-knee amputation. What action should be implemented by the nurse? A. Elevate the foot of the bed B. Assist the client out of bed to a chair C. Have the client crutch walk in the room D. Reapply the elastic bandage every two hours

A. Elevate the foot of the bed

The care plan for a client with a fractured hip includes nursing actions to prevent which type of contracture? A. Flexion of the hip B. Abduction of the hip C. Hyperextension of the hip D. Internal rotation of the hip

A. Flexion of the hip

After an open reduction and internal fixation of a fractured hip. What assessments of the client's affected leg should the nurse make? SATA A. Skin temperature B. Mobility of the hip C. Sensation of the toes D. Condition of the pins E. Presence of pedal pulse

A. Skin temperature C. Sensation of the toes E. Presence of pedal pulse

A nurse suspects the development of compartment syndrome for a client who has sustained blunt trauma to the forearm. For which early sign of compartment syndrome should the nurse assess? A. Warm skin at site of injury B. Escalating pain in the fingers C. Rapid capillary refill in the affected hand D. Bounding radial pulse in the injured arm

B. Escalating pain in the fingers

A client has a long leg cast. What instructions should the nurse give the client in preparation for crutch walking? A. Use the trapeze to strengthen biceps B. Keep the affected limb in extension and abduction C. Sit up straight in a chair to develop the back muscles D. Do exercises in bed to strengthen the upper extremities

D. Do exercises in bed to strengthen the upper extremities

What should be included in the nurse's instructions to help a client prepare for walking with crutches? A. Use of a trapeze to strengthen the biceps muscle B. Exercises with or without weights to strengthen the muscles of the upper extremities C. The importance of keeping the affected limb in extension and abduction to prevent contractures D. Isometric exercises of the hamstring muscles while sitting in a chair until circulatory status is stable

B. Exercises with or without weights to strengthen the muscles of the upper extremities

After an above the knee amputation of a leg, a client reports pain in the foot that is no longer there. What should the nurse include about phantom limb pain in a discussion with the client? A. Tactile illusions associated with severed blood vessels B. Nerve endings in limb are still intact and react to stimuli C. An unconscious phenomenon to aid with grieving overr the lost body part D. Hallucinations secondary to emotional symptoms associated with distress of amputation

B. Nerve endings in limb are still intact and react to stimuli

The nurse is caring for a patient with an above the knee amputation. To prevent hip flexion contractures how foes the nurse position the patient? A. Supine position with a residual limb elevated on pillow B. Prone position every 3-4 hours for 20-30 min periods C. Supine position with an abduction pillow placed between the legs D. Head of the bed elevated 30 degrees with bandage snug around the limb

B. Prone position every 3-4 hours for 20-30 min periods

A patient has a fractured femur. Which finding would the nurse instruct the UAP to report immediately? A. The patient reports pain B. The patient appears confused C. The patient's BP is 136/88 D. The patient voided using the bedpan

B. The patient appears confused

The nurse is caring for a patient with a plaster splint applied to the ankle. The patient received oral pain medication at 0900. At 1100, the patient reports that the pain is getting worse, not better. What is the nurse's priority action? A. Give the patient IV pain medication B. Reposition the extremity on a pillow and place an ice pack C. Assess the pulses and skin temperature distal to the splint D. Call the health care provider to report the increasing pain

C. Assess the pulses and skin temperature distal to the splint

What should the nurse do to assess the neurovascular status of an extremity casted from the ankle to the thigh? A. Palpate the femoral artery B. Assess for a positive Homan sign C. Compress and release the client's toenails D. Instruct the client to extend and flex the knee

C. Compress and release the client's toenails

A nurse is caring for a client who developed aseptic necrosis after a fracture of the head of the femur. The nurse understands that aseptic necrosis is associated with which factor? A. Infection at site of wound B. Weight-bearing before fracture is healed C. Immobilization after reduction of the fracture D. Loss of blood supply to head of femur

D. Loss of blood supply to head of femur

A patient with a lower extremity injury is being treated with external fixation. Which nursing assessment is of particular concern in the care of a patient with this type of system? A. Maintaining a 30 degree flexed position of the knee B. Measuring the weights used for countertraction C. Observing the patient's ability to adjust to the clickers D. Observing the point of entry of the pins and wires

D. Observing the point of entry of the pins and wires

The nurse applies bandages to a patient's residual limb to help shape and shrink the limb prosthesis. What is the proper technique for the nurse to use? A. Reapply the bandages every 8 hours of more often if they become loose B. Uses a proximal to distal direction when wrapping C. Use soft, flexible bandage material and pad the area with gauze D. Use a figure-eight wrapping method to prevent restriction of blood flow

D. Use a figure-eight wrapping method to prevent restriction of blood flow

A patient injured a lower extremity and has been placed in running traction. what instruction should the nurse give to the UAP? A. support the weight when turning the patient every two hours B. ask the patient to turn and move himself so that he is in control of painful stimuli C. defer hygienic care and moving the patient until traction is removed. D. do not move the patient of the bed because the counter traction can be altered.

D. do not move the patient of the bed because the counter traction can be altered.

What should the nurse do to promote early and efficient ambulation after a client has a midthigh amputation? A. Keep the head of bed elevated B. Place the residual limb on pillow C. Turn the client to prone position routinely D. Encourage client to lie on unaffected side

C. Turn the client to prone position routinely

A patient is informed by the health care provider that a fiberglass cast must be applied to the lower extremity. What does the nurse teach the patient about the procedure before the cast is applied? A. The stockinette should be changed once a week B. The cast material will dry and become rigid in a few minutes C. The cast will increase your risk for skin breakdown D. The fiberglass is not waterproof, so avoid getting it wet

B. The cast material will dry and become rigid in a few minutes

A nurse is caring for a client who has had an open reduction internal fixation of a fractured hip. Which nursing assessment of the affected leg is most important after this surgery? A. Femoral pulse B. Toes for mobility C. Condition of the pin D. Range of motion of the knee

B. Toes for mobility

A client has a total hip replacement. Which clinical indications of pulmonary embolism indicate that the plan to prevent post-operative thrombus formation has been ineffective? SATA A. Flushing of the face B. Unilateral chest pain C. Elevation of temperature D. Sudden onset SOB E. Pain rating increase from 2 to 8 in the hip

B. Unilateral chest pain D. Sudden onset SOB

A client with a fractured hip is helped from the bed to a chair after surgery. The nurse instructs the client to bear most of the weight on the unaffected leg before sitting in a chair. What should the nurse explain is the benefit of bearing most of the weight? A. Can increase circulation in the lower extremities B. Will help maintain C. Is the quickest method of getting the client to and from the bed D. Reduces the amount of help necessary to lift the client from the bed to the chair

B. Will help maintain

After the nurse receives change-of-shift report, which patient should be assessed first? A. A 42-year old patient with carpal tunnel syndrome who reports pain B. A 64 year old patient with osetoporosis awaiting discharge C. A 28 year old patient with fracture who reports that the cast tight D. A 56 year old patient with a left leg amputation who reports phantom pain

C. A 28 year old patient with fracture who reports that the cast tight

To reduce a hip fracture, the client is placed in traction before surgery for an open reduction and internal fixation. Because the client keeps slipping down in bed, increased countertraction is ordered. How does the nurse increase the countertraction? A. Elevate the head of the bed B. Add more weight to the traction C. Use a slight trendelenburg D. Tie a chest restraint around the client`

C. Use a slight trendelenburg

Which nursing action is contraindicated when caring for a client with a newly applied long leg cast? A. Elevating cast on pillow B. Drying cast using fan C. Leaving cast open to air D. Handling cast with fingertips

D. Handling cast with fingertips

A nurse is caring for a client with a below-the-knee amputation. What should the nurse encourage the client to do to prepare the residual limb for a prosthesis? A. Abduct the residual limb when ambulating B. Dangle the residual limb off the bed frequently C. Soak the residual limb in warm water twice a day D. Press the end of the residual limb against a pillow periodically

D. Press the end of the residual limb against a pillow periodically

A nurse is caring for a client who had an open reduction and internal fixation of a femoral neck fracture. The client has an order for ambulation with slight weight-bearing in the affected extremity. During the physical assessment the nurse identifies that the client has kyphosis and strong upper arm strength. What assistive device does the nurse expect the provider to order? A. Crutches B. Quad cane C. Straight cane D. Standard walker

D. Standard walker