Chap 54: Musculoskeletal Trauma

While playing tennis a patient fell and fractured the right elbow. For which treatment should the nurse prepare this patient? 1) Cast 2) Splint 3) External fixator 4) Pressure dressing

ANS: 1 An elbow fracture is immobilized with a cast.

The nurse requests an occupational therapy consultation for a patient with bilateral carpal tunnel syndrome. What is the reason for this consultation? 1) Evaluate the work area 2) Instruct on hand exercises 3) Instruct on the use of splints 4) Review the action of NSAIDs

ANS: 1 An occupational therapist can evaluate the work area and make recommendations for modifications to eliminate causative factors.

A patient seeks medical treatment for a meniscus injury. What assessment finding would suggest a reason this injury occurred? 1) History of chronic joint disease 2) Participation in cycling or golf 3) Intake of sufficient water and protein 4) Use of nonsteroidal anti-inflammatory drugs (NSAIDs)

ANS: 1 Chronic joint diseases are risk factors for a meniscus injury.

A 70-year-old patient is diagnosed with a low energy fracture. What most likely caused this injury to occur? 1) A fall 2) Contact sport 3) Bicycle accident 4) Motor vehicle collision

ANS: 1 Fractures in people 65 or older are generally caused by low-energy trauma such as falls.

The nurse notes that a patient recovering from surgery to repair a torn meniscus has a blood pressure of 158/90 mm Hg. This finding would suggest that the nurse also assess the patient for which condition? 1) Pain 2) Edema 3) Infection 4) Hemorrhage

ANS: 1 Hypertension may indicate increased pain.

A patient recovering from surgery to repair a fractured femur is experiencing extreme pain and pulselessness. What should the nurse expect to be prescribed for this patient? 1) Fasciotomy 2) Limb CT scan 3) Intravenous fluids 4) Anticoagulant therapy

ANS: 1 Once compartment syndrome is suspected, the provider will often remove the cast or perform a fasciotomy to immediately relieve the compartment pressure.

A patient recovering from a traumatic amputation is experiencing phantom limb pain. What should the nurse expect to be included in the treatment plan for this patient? 1) Gabapentin 2) Rigid splint 3) Ice compresses 4) Elevate stump on a pillow

ANS: 1 The administration of antidepressant and anticonvulsant medications such as gabapentin has demonstrated effectiveness in treating phantom limb pain.

The nurse suspects that while playing basketball a patient sustained a meniscus tear. What information did the nurse use to make this decision? 1) Knee pops when bent 2) Weak peripheral pulses 3) Reduced muscle tone of the thigh 4) Calf cramping with the knees bent

ANS: 1 The diagnosis of meniscus injuries is based upon physical examination using either the McMurray's or Steinman's test in which the knee is supported and flexed while the lower leg is rotated internally and externally. A positive result is indicated when either test reveals an audible/palpable "click."

A patient is diagnosed with a third-degree sprain. What should the nurse expect to assess in this patient? Select all that apply. 1) Edema 2) Severe pain 3) Ecchymosis 4) Inability to ambulate 5) Altered ability to ambulate

ANS: 1, 2, 3, 4 Symptoms of a third-degree sprain include edema. Symptoms of a third-degree sprain include severe pain. Symptoms of a third-degree sprain include ecchymosis. Third-degree or severe sprains include the complete tearing of a ligament, which renders the patient unable to ambulate because of joint instability.

The nurse suspects that a patient with an injured ankle is experiencing neurovascular compromise. What did the nurse assess to come to this conclusion? Select all that apply. 1) Pain 2) Pressure 3) Paralysis 4) Peristalsis 5) Pulselessness

ANS: 1, 2, 3, 5 Symptoms of neurovascular compromise include pain. Symptoms of neurovascular compromise include pressure. Symptoms of neurovascular compromise include paralysis. Symptoms of neurovascular compromise include pulselessness.

The nurse is reviewing statistics about the frequency of anterior cruciate ligament (ACL) tears. What increases the risk of experiencing this type of injury? Select all that apply. 1) Knee torque 2) Less knee flexibility 3) Practicing ice skating 4) Performing gymnastics 5) Less muscular strength

ANS: 1, 2, 4, 5 A great degree of knee torque increases the risk of an ACL injury. Less knee flexibility increases the risk of an ACL injury. An ACL injury occurs most frequently in sports that involve twisting and jumping like gymnastics. Less muscular strength increases the risk for an ACL injury.

A patient is diagnosed with a small meniscus tear of the right knee. What should the nurse expect to be prescribed for this patient? Select all that apply. 1) Ice 2) Limited rest 3) Physical therapy for a month 4) Total immobility for several weeks 5) Use of nonsteroidal anti-inflammatory drugs (NSAIDs)

ANS: 1, 2, 5 Smaller tears often heal within a few months and are treated with ice. Smaller tears often heal within a few months and are treated with limited rest. Smaller tears often heal within a few months and are treated with NSAIDs.

During a home visit the nurse suspects that a patient recovering from an amputation is not complying with prescribed postoperative care. What observation caused the nurse to make this clinical determination? 1) Suture line pink and slightly edematous 2) Evidence of a developing hip contracture 3) Stump wrapped with a compression bandage 4) Taking opioid medication every 8 to 10 hours

ANS: 2 A developing hip contracture indicates that the patient is not complying with postoperative exercises and actions to prevent the development of a contracture.

A patient with peripheral vascular disease has a non-healing leg wound. Which observation indicates that the patient is at risk for an elective amputation? 1) Mutilation of soft tissue 2) Development of gangrene 3) Crushed lower extremity bone 4) Severed blood vessels and nerves

ANS: 2 Elective amputations are caused by disease that alters perfusion. Cell death causes necrotic tissue to form. The wound acts as a portal for an infection that can lead to gangrene.

A patient with Paget's disease is demonstrating manifestations of a fracture. What diagnostic test should be ordered to confirm if a fracture has occurred? 1) X-ray 2) Bone scan 3) Myelogram 4) Angiogram

ANS: 2 If a chronic illness is suspected as having a major role in the injury, a bone scan may be needed to confirm the diagnosis

A patient recovering from surgery to repair a fractured hip is placed on skin traction. Which finding indicates that the traction is being effective? 1) Strong peripheral pulses 2) Reduction in muscle spasms 3) Improved mobility of the foot 4) Reduction of lower extremity edema

ANS: 2 Skin traction is applied to relieve muscle spasms.

The nurse is reviewing postoperative instructions with a patient recovering from carpal tunnel syndrome (CTS) surgery. Which statement indicates that additional teaching would be required? 1) "I should take the pain medication as prescribed." 2) "I should expect my hand to feel numb for a few weeks." 3) "I should perform hand exercises as directed by the therapist." 4) "I should stop any activity that causes hand numbness or pain."

ANS: 2 The patient should report any worsening symptoms to the health-care provider.

A patient with bilateral carpal tunnel syndrome (CTS) does not want to have surgery. What is this patient at risk for developing? 1) Infection 2) Chronic pain 3) Further nerve injury 4) Hematoma formation

ANS: 2 Untreated CTS can lead to chronic pain.

A victim of a motor vehicle crash has a partially severed lowered extremity. What emergency care does this patient need? Select all that apply. 1) Administer antibiotics 2) Prepare for blood transfusions 3) Prepare for emergency surgery 4) Assess for active hemorrhaging 5) Monitor effectiveness of tourniquet

ANS: 2, 3, 4, 5 To prevent hemorrhagic shock after a traumatic amputation, the patient should be prepared for blood transfusions. The patient with a traumatic amputation should be prepared for emergency surgery. The patient with a traumatic amputation should be assessed for active hemorrhaging. The tourniquet or pressure bandage placed over the site of a traumatic amputation should be assessed for effectiveness.

A patient has an injury where one side of the bone is bent and the other is fractured. How should the nurse document this fracture? 1) Spiral 2) Oblique 3) Greenstick 4) Comminuted

ANS: 3 A greenstick fracture is an incomplete disruption where one side of the bone is bent and the other is fractured.

The nurse is preparing a teaching tool for a community health program. What should the nurse include as a risk factor for the development of carpal tunnel syndrome (CTS)? 1) Male gender 2) Age less than 20 3) Plays musical instruments 4) Works as a marketing manager

ANS: 3 Higher occurrences are noted in patients who have jobs requiring repetitive motions of the hands such as musicians.

A patient is treated for a second-degree sprain. Which patient statement indicates that teaching about care has been ineffective? 1) "I should apply ice." 2) "I should elevate my leg." 3) "I should expect the leg to feel numb." 4) "I should take pain medication as directed."

ANS: 3 Numbness could indicate neurovascular compromise and should be reported.

A patient sustained a meniscus injury several months ago and did not seek medical attention. What is this patient at risk of developing? 1) Tendonitis 2) Fractured patella 3) Dependent edema 4) Permanent joint damage

ANS: 4 If left untreated, meniscus tears can lead to permanent joint damage.

The nurse suspects that a patient is developing carpal tunnel syndrome (CTS). What finding caused the nurse to make this clinical determination? 1) Reduced radial pulses 2) Fingers cool to touch 3) Capillary refill > 3 seconds 4) Hand tingling during the night

ANS: 4 In CTS inflammation compresses the median nerve causing sharp pain, numbness, and tingling of the hand. Symptoms initially occur intermittently at night, then progress if not treated.

A patient is recovering from surgery to repair a third-degree strain. What needs to be emphasized to the patient about postoperative care? 1) Elevate the extremity 2) Rest the extremity for up to 72 hours 3) Apply ice to the area three to five times a day 4) Immobilize the extremity for four to six weeks

ANS: 4 Postoperative treatment for strains and sprains involves immobilization of the affected extremity for four to six weeks.