UWorld Adult Health: Musculoskeletal

A client newly diagnosed with osteomalacia is reviewing home care instructions with the nurse. Which statements indicate the need for further instruction?

- I will avoid foods high in Ca+ and phosphorus - I will avoid going outside on sunny days - I will decrease activity to avoid bone injury

The new graduate nurse provides care for a client with a halo external fixation device. Which actions by the new nurse are appropriate?

- cleans around pins using sterile water - places small pillow under head while lying supine - use blow dryer on the cool setting

The nurse is caring for a client who has just returned from external fixation device placement for stabilization of a fractured femur. Which of the following interventions are appropriate to include in the client's plan of care?

1) Assess for increasing drainage from pin sites 2) Monitor pulses distal to external fixation device 3) Perform pin care with sterile cleaning solution 4) Promote early mobilization

The nurse reviews discharge teaching about residual limb care for a client who had a lower limb amputation. Which of the following instructions should the nurse include?

1) Assess limb for redness and irritation 2) Keep limb socks and elastic wraps clean and dry 3) Lie on your stomach 3 times daily for 30 mins 4) Wash residual limb daily with soap and water - Hip flexion contractures are a common complication during the recovery process. Nurses should teach clients to lie prone several times each day and to avoid sitting in a chair for ≥1 hour

The health care provider (HCP) suspects a fat embolism syndrome (FES) in a client who has had multiple long bone fractures. Which findings does the nurse expect to assess to support this diagnosis?

a triad of respiratory distress, mental status changes, and petechial skin rash. Fever and thrombocytopenia can also be present.

A client with a hip fracture is placed in Buck traction. Which activities are appropriate for the nurse to include in the client's plan of care?

Assess for skin breakdown Ensure adequate pain relief Keep limb in neutral position Preform frequent neurovascular checks on the limb in traction

What is buck traction?

Buck traction immobilizes hip and femur fractures. A boot or traction tape is applied to the affected extremity and a prescribed weight pulls the limb into traction. The client is typically placed in supine position with the foot of the bed raised to maintain counter-traction.

A nurse in the emergency department cares for 4 clients with orthopedic injuries. Which client should the nurse assess first?

Client with pain and obvious shoulder deformity reporting a pins and needles sensation - Joint dislocations may constitute an orthopedic emergency. Because articular tissues, blood vessels, and nerves are stretched and compressed, neurovascular compromise may occur. Prolonged disruption of the vasculature and nerves may cause permanent injury and even loss of the distal extremity.

What is compartment syndrome?

Compartment syndrome (CS) results from compression of vascular structures by either external compression (restrictive dressings/casts) or increased pressure within a compartment (bleeding, inflammation, and edema). After an injury or trauma (eg, surgery), the vessels surrounding the injury site are compressed by swelling muscle and connective tissues. Muscle is encapsulated by a fibrous layer of fascia (ie, a compartment), which does not yield to swelling. Eventually, compression of tissues within the compartment restricts blood flow to the extremity.

A registered nurse is precepting a new graduate nurse on the orthopedic unit. Which action by the graduate nurse requires the registered nurse to intervene?

Elevating a client's residual limb

Cane info

Hold the cane on the stronger side to provide maximum support and body alignment, keeping the elbow slightly flexed (20-30 degrees) (Option 1). Place the cane 6"-10" (15-25 cm) in front of and to the side of the foot to keep the body weight on both legs to provide balance (Option 3). For maximum stability, move the weaker leg forward to the level of the cane, so that body weight is divided between the cane and the stronger leg. If minimal support is needed, the cane and weaker leg are advanced forward at the same time. Move the stronger leg forward past the cane and the weaker leg, so the weight is divided between the cane and the weaker leg. Always keep at least 2 points of support on the floor at all times. Clients should hold the cane on the stronger side to provide maximum stability. Cane length should equal the distance from the greater trochanter to the floor.

The nurse is caring for a client with a fractured femur. Which nursing intervention is most effective in helping reduce the risk for fat emboli?

Minimizing movement of the fractured extremity

A graduate nurse (GN) is caring for a client who underwent a total knee replacement 1 day earlier. Which intervention by the GN would cause the supervising nurse to intervene?

Places a support pillow under the knee - Following a knee arthroplasty, the nurse should avoid placing a pillow behind the client's operative knee due to the risk of contracture.

A client who underwent open reduction and internal fixation of a right tibial fracture 10 hours ago reports worsening leg pain that is unrelieved by PRN morphine. The nurse assesses that the client's right foot is cooler than the left. What is the nurse's priority action?

Report these findings to HCP - A client with signs of compartment syndrome (eg, pain, pallor, pulselessness) after a fracture or orthopedic surgery should be evaluated by the health care provider (HCP) immediately. After notifying the HCP, the nurse should position the affected extremity at heart level and loosen any restrictive bandaging/casting material.

The health care provider suspects a rotator cuff injury in a client who is an avid tennis player. The nurse would most likely assess which of the following?

Shoulder pain with abduction

A client with a mandibular fracture who has the upper and lower teeth wired together begins to choke on excessive oral secretions. What is the nurse's immediate action?

Suction mouth and oropharynx - If choking occurs, the immediate intervention is to suction the mouth and oropharynx. If this is ineffective, cutting the wires may be necessary. What I put: elevate HOB Why it is the wrong answer? - Elevating the head of the bed is a preventive measure. Because the client is choking, the priority is suctioning secretions to clear the airway. The nurse should also turn the client to the side if the client has excessive oral secretions or begins to vomit to decrease the risk of aspiration.

What are the appropriate actions for a client who has been placed in Buck's traction?

The client should be supine or in semi-Fowler's position (maximum of 20-30 degrees). Elevating the head of the bed more than 30 degrees would promote sliding. Regularly assess the neurovascular status and skin integrity of the limb in traction. Loosen Velcro straps if the boot is too tight as they can impair neurovascular status and skin integrity; tighten the straps if the boot is too loose as this can decrease effectiveness of the traction. When a change is made in the application of the boot or traction pulley system, the nurse should reassess neurovascular status in 30 minutes. Provide a fracture pan, which is smaller than a bedpan, for elimination needs to minimize client movement and provide comfort. Weights should be free-hanging at all times and should never be placed onto the bed or touch the floor. A staff member should support the weight while the client is repositioned up in bed to prevent excessive pull on the extremity.

Above the knee amputation info/ positioning

To prevent hip flexion contractures in clients with above-the-knee amputation, the residual limb should not be elevated, especially after 24 hours. Instead, edema should be managed using a figure eight compression bandage. The bandage should be worn at all times until the residual limb is healed, and care should be taken not to wrap it too tightly. Hip flexion contractures can also be avoided by placing the client in prone position with hip in extension for 30 minutes 3 or 4 times a day.

A client with advanced osteoarthritis is admitted for right total knee arthroplasty. Which characteristic manifestations does the nurse expect to assess in this client?

1) Crepitus with joint movement 2) Morning stiffness lasting 10-15 mins 3) Pain exacerbated by weight bearing activities

The emergency department nurse assesses an elderly client who was just admitted with a fractured hip after a fall. Which assessment findings would the nurse most likely expect?

1) Ecchymosis over thigh and hip 2) Groin and hip pain with weight bearing 3) Muscle spasm over affected area 4) Shortening of affected extremity

The nurse teaches a client with osteopenia, who is lactose intolerant, how to increase dietary calcium and vitamin D intake. Which lunch food is the best choice?

Canned sardines - They include some fish (eg, sardines, salmon, trout), tofu, some green vegetables (eg, spinach, kale, broccoli), and almonds. - Good food sources of vitamin D include egg yolks and oily fish (eg, salmon, sardines, tuna).

A 25-year-old marathon runner is admitted for suspected rhabdomyolysis. The client has oliguria, dark amber urine, and muscle pain. The nurse should implement which prescription first?

NS bolus - Rhabdomyolysis is a medical emergency caused by muscle injury that releases myoglobin into the bloodstream. The nurse's priority when treating the client is to preserve kidney function by administering large volumes of IV fluid.

What is a Volkmann contracture?

Volkmann contracture (wrist contracture, inability to extend the fingers) occurs as a result of ischemia from compartment syndrome after a distal humerus fracture. It is a medical emergency that requires immediate intervention.

What is osteomalacia?

a rare condition of the adult bone associated with vitamin D deficiency, resulting in decalcification and softening of bone.

A client arrives at the clinic for a follow-up after an emergency department visit the night before. The client sustained an ulnar fracture, and a fiberglass cast was applied. Which of the following teachings related to cast care should the nurse reinforce?

- contact the clinic if any hot spots or foul odors occur - cover the cast with a plastic bag for bathing and avoid getting the cast wet - elevate the affected extremity above the level of the heart for the first 48 hours

A client in the postoperative period after an open reduction and internal fixation of a left wrist fracture reports constant, severe arm pain that is unrelieved by prescribed morphine administered 30 minutes ago. The client's nail beds appear dusky. What are the nurse's appropriate actions?

1) Assess temp and movement of fingers 2) Notify HCP - Compartment syndrome is caused by decreased blood flow to the tissue distal to the injury and can cause ischemic necrosis. - Pallor, pulselessness, and coolness are s/s.

Crutch information

Therefore, clients are taught to support body weight on the hands and arms, not the axillae, when ambulating to ensure that there is a 1-2 in (2.5-5 cm) space between the axilla and the axilla crutch pad.