Ch. 43: Management of Patients With Musculoskeletal Trauma

A client undergoes a total hip replacement. Which statement made by the client indicates to the nurse that the client requires further teaching?

"I don't know if I'll be able to get off that low toilet seat at home by myself."

A client is being discharged from the Emergency Department after being diagnosed with a sprained ankle. Which client statement indicates the client understands the discharge teaching?

"I'll make sure to keep my ankle elevated as much as possible."

A client has sustained a right tibial fracture and has just had a cast applied. Which instruction should the nurse provide in his cast care?

"Keep your right leg elevated above heart level."

Sarah Butler, age 26 years, has been participating in a tennis tournament. She is being seen in the clinic for elbow discomfort. The physician has given her a diagnosis of tendinitis, epicondylitis, or tennis elbow. What symptoms and signs did she have? Choose all that are correct.

-Pain radiating down the dorsal surface of the forearm -Weak grasp

A client is to undergo surgery to repair a ruptured Achilles tendon and application of a brace. The client demonstrates understanding of his activity limitations when he states that he will need to wear the brace for which length of time?

6 to 8 weeks

When is it advisable for the nurse to apply heat to a sprain or a contusion?

After 2 days

A client who has sustained a fracture reports an increase in pain and decreased function of the affected extremity. The nurse would suspect which of the following?

Avascular necrosis

There are a variety of problems that can become complications after a fracture. Which of the following is described as a condition that occurs from interruption of the blood supply to the fracture fragments after which the bone tissue dies, most commonly in the femoral head?

Avascular necrosis

An important nursing assessment, post fracture, is to evaluate neurovascular status. Therefore, the nurse should check for:

Capillary refill.

The nurse is caring for a client who was involved in an automobile accident and sustained multiple trauma. The client has a Volkmann's contracture to the right hand. What objective data does the nurse document related to this finding?

Clawlike deformity of the right hand without ability to extend fingers

Which assessment findings would the nurse expect to find in the postoperative client experiencing fat embolism syndrome?

Column B

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

Comminuted

Which type of fracture produces several bone fragments?

Comminuted

Two days after application of a cast to treat a fractured femur, the patient tells the orthopedic heath care provider that he is experiencing severe, deep, and constant pain in his leg. The nurse suspects a diagnosis of:

Compartment syndrome.

Which assessment findings would cause the nurse to suspect compartment syndrome after casting of the leg?

Complaints of numbness and tingling in toes of affected leg

A patient 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 shiny skin that is growing more hair in the injured extremity. The nurse should anticipate providing care for what complication?

Complex regional pain syndrome (CRPS)

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

A 13-year-old client is brought to the emergency department. The client's mother reports that the client was struck with a baseball bat on his upper arm while diving for a pitched ball. After diagnostic tests are completed, the physician reassures the mother that her son's humerus is not broken but he has suffered another type of injury. What type of injury would you expect the physician to diagnose?

Contusion

A client presents to the emergency department with an open fracture. What is the first action the nurse should take?

Cover the exposed bone with sterile dressing

The patient presents to the emergency room with an open fracture of the femur. Which action would the nurse implement to prevent the most serious complication of an open fracture?

Cover the wound with a sterile dressing to prevent infection.

General nursing measures employed when caring for the client with fracture include all of the following, except?

Cranial nerve assessment

Which of the following would lead a nurse to suspect that a client has a rotator cuff tear?

Difficulty lying on affected side

The nurse recognizes that proper positioning of an amputated lower extremity for the prevention of contractures is:

Extension

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?

Fat emboli

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:

Fat embolism syndrome

Which of the following terms refers to a break in the continuity of a bone?

Fracture

Which of the following terms refers to a fracture in which one side of a bone is broken and the other side is bent?

Greenstick

Which of the following is a factor that inhibits fracture healing?

History of diabetes

When evaluating for hypovolemic shock, the nurse should be aware of which of the following clinical manifestations?

Hypotension

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?

Impacted

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

Incomplete

A patient suffered an open fracture to the left femur during a horse-riding accident. For which of the following complications is this patient at highest risk?

Infection

The nurse is caring for a patient who sustained an open fracture of the right femur in an automobile accident. What does the nurse understand is the most serious complication of an open fracture?

Infection

Which of the following is an inaccurate clinical manifestation of a fracture?

Lengthening

Which of the following is a factor that inhibits fracture healing?

Local malignancy

Which nursing intervention is appropriate for minimizing muscle spasms in the client with a hip fracture?

Maintain Buck's traction.

Which of the following terms refers to failure of fragments of a fractured bone to heal together?

Nonunion

A client is brought to the emergency department after injuring his 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?

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

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?

Prevent internal rotation of the affected leg.

A patient with a traumatic amputation of the right lower leg is refusing to look at the leg. Which of the following actions by the nurse is most appropriate?

Provide feedback on the patient's strengths and available resources.

A client sustains an injury to the ligaments surrounding a joint. The nurse identifies this as which of the following?

Sprain

Which of the following terms refers to an injury to ligaments and other soft tissues of a joint?

Sprain

A 45-year-old softball player arrives at the emergency department following his injury while sliding into a base during a game. After his examination and radiographs, the physician diagnoses muscle strain and prescribes appropriate treatment. What does the physician mean with the term "strain"?

Stretched or pulled beyond its capacity

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?

Subluxation

Which of the following may occur if a client experiences compartment syndrome in an upper extremity?

Volkmann's contracture

After surgery to treat a hip fracture, a client returns from the postanesthesia care unit to the medical-surgical unit. Postoperatively, how should the nurse position the client?

With the leg on the affected side abducted

A nurse suspects that a client with a recent fracture has compartment syndrome. Assessment findings may include:

inability to perform active movement and pain with passive movement.

A fracture is termed pathologic when the fracture:

occurs through an area of diseased bone

With fractures of the femoral neck, the leg is:

shortened, adducted, and externally rotated

When joint manipulation is unsuccessful for a client, he is taken to surgery for surgical repair of his hip injury. He is brought to the ICU where you practice nursing for postoperative recovery. After surgery, the nurse implements measures to prevent complications. Select all of the following which are complications that the nurse seeks to prevent.

-Skin breakdown -Wound infection -Pneumonia

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?

Contusion

Which of the following disorders results in widespread hemorrhage and microthrombosis with ischemia?

Disseminated intravascular coagulation (DIC)

The nurses instructs the client not to cross their legs and to have someone assist with tying their shoes. Which additional instruction should the nurse provide to client?

Do not flex the hip more than 90 degrees.

Which intervention should the nurse implement, when caring for the client who complains of phantom limb pain two months after amputation?

Reassure the client that phantom pain is common

Which nursing intervention is essential in caring for a client with compartment syndrome?

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

Which of the following musculoskeletal injuries is manifested by acromioclavicular joint pain?

Rotator cuff tears

A 19-year-old patient presents to the emergency room with an injury to her left ankle that occurred during a high school basketball game. She complains of limited motion and pain on walking, which increased over the last 2 hours. The nurse knows that her diagnosis is most likely which of the following?

Second-degree sprain

Ms. Bixley has been gardening all season and has come to the clinic with a complaint of shoulder pain. The physician assesses the shoulder and decided that she probably has a rotator cuff tear. What are the possible treatment options for treating this condition? Select all that apply.

-NSAIDs -Modify activities and rest the joint -Arthroscopic surgery

A client presents to the emergency department gently holding the left arm, which is slightly swollen and painful to the touch. Based on these findings, the nurse:

Elevates the arm and applies an ice pack

A client with arterial insufficiency undergoes below-knee amputation of the right leg. Which action should the nurse include in the postoperative care plan?

Elevating the stump for the first 24 hours