Chapter 37- Management of patients with musculoskeletal trauma

Which principle applies to the client in traction? Weights are removed routinely. Knots in the ropes should touch the pulley. Weights should rest on the bed. Skeletal traction is never interrupted.

Skeletal traction is never interrupted

A client in the emergency department is being treated for a wrist fracture. The client asks why a splint is being applied instead of a cast. What is the best response by the nurse? "Not all fractures require a cast." "A splint is applied when more swelling is expected at the site of injury." "You would have to stay here much longer because it takes a cast longer to dry." "It is best if an orthopedic doctor applies the cast."

"A splint is applied when more swelling is expected at the site of injury."

Following a total knee replacement, the surgeon orders a continuous passive motion (CPM) device. The client asks about the purpose of this treatment. What is the best response by the nurse? "CPM prevents injury by limiting flexion of the knee." "CPM delivers analgesic agents directly into the joint." "CPM strengthens the muscles of the leg." "CPM increases range of motion of the joint."

"CPM increases range of motion of the joint."

Which statement by a staff nurse on the orthopedic floor indicates the need for further staff education? "The client is receiving physical therapy twice per day, so the client doesn't need a continuous passive motion device." "Monitoring skin integrity is important while the continuous passive motion device is in place." "Bleeding is a complication associated with the continuous passive motion device." "The continuous passive motion device can decrease the development of adhesions."

"The client is receiving physical therapy twice per day, so the client doesn't need a continuous passive motion device."

A client diagnosed with a right ulnar fracture asks why the cast needs to go all the way up the arm. What is the best response by the nurse? "The method allows for the fastest healing time and the greatest mobility." "This allows for the strength in the arm to remain consistent." "The joint above the fracture and below the fracture must be immobilized." "When a spica cast is ordered, the arm must be immobilized."

"The joint above the fracture and below the fracture must be immobilized."

The nurse is assigned to care for a client who has had a total knee arthroplasty yesterday. What type of pharmacologic therapy does the nurse anticipate administering to this client to prevent complications related to the surgery? Antidysrhythmic therapy Anticoagulation therapy Antineoplastic therapy Antianginal therapy

Anticoagulation therapy

A client with a fractured femur is placed in skeletal traction. Which intervention will increase client independence when moving in bed? Apply a trapeze to the bed frame. Instruct to use the elbows to reposition. Remove the weights prior to repositioning. Remind to use the heel of the unaffected foot to reposition.

Apply a trapeze to the bed frame

A group of students is reviewing information about cast composition in preparation for a discussion on the advantages and disadvantages of each. The students demonstrate understanding of the topic when they cite which of the following as an advantage of a plaster cast? Quicker drying More breathable Better molding to the client Longer lasting

Better molding to the client

The nurse is assigned to care for a client who has had an open reduction and internal fixation of a fractured right femur 2 days ago. The nurse is listening to the client's lungs and, when moving the gown, observes petechial hemorrhages on the skin of the chest. What is the first action by the nurse? Administer pain medication. Increase the intravenous fluids for hemorrhage. Request an antihistamine for the allergic reaction. Call the physician to inform them of the findings.

Call the physician to inform them of the findings

A client who is undergoing skeletal traction reports pressure on bony areas. Which action would be most appropriate to provide comfort for the client? Assisting with range-of-motion and isometric exercises. Changing the client's position within prescribed limits. Administering prescribed analgesics. Applying warm compresses.

Changing the client's position within prescribed limits

A client who is undergoing skeletal traction reports pressure on bony areas. Which action would be most appropriate to provide comfort for the client? Changing the client's position within prescribed limits. Applying warm compresses. Administering prescribed analgesics. Assisting with range-of-motion and isometric exercises.

Changing the client's position within prescribed limits

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

Comminuted

A client sustains a fractured right humerus in an automobile accident. The arm is edematous, the client states not being able to move or feel the fingers, and the nurse does not feel a pulse. What condition should the nurse be concerned about that requires emergency measures? Compartment syndrome Muscle spasms Subluxation Dislocation

Compartment syndrome

In a client with a dislocation, the nurse should initially perform neurovascular assessments a minimum of every 15 minutes until stable. Which complication does the assessments help the nurse to monitor? Ganglion cysts Carpal tunnel syndrome Compartment syndrome Gastrointestinal bleeding

Compartment syndrome

A client comes to the emergency department and reports localized pain and swelling in the lower leg. Ecchymotic areas are noted. History reveals that the client got hit in the leg with a baseball bat. What will the nurse most likely suspect? Strain Sprain Fracture Contusion

Contusion

Which of the following is a term used to describe a soft tissue injury produced by a blunt force? Sprain Strain Contusion Hematoma

Contusion

The nurse in an orthopedic clinic is caring for a new client. What sign or symptom would lead a nurse to suspect that a client has a rotator cuff tear? Ability to stretch arm over the head Pain worse in the morning Difficulty lying on affected side Minimal pain with movement

Difficulty lying on affected side

The nurse in an orthopedic clinic is caring for a new client. What sign or symptom would lead a nurse to suspect that a client has a rotator cuff tear? Minimal pain with movement Difficulty lying on affected side Pain worse in the morning Ability to stretch arm over the head

Difficulty lying on affected side

The nurse caring for a client, who has been treated for a hip fracture, 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 120 degrees. Do not flex the hip more than 90 degrees. Do not flex the hip more than 30 degrees. Do not flex the hip more than 60 degrees.

Do not flex the hip more than 90 degrees

A client is reporting pain following orthopedic surgery. Which intervention will help relieve pain? Breathe deeply and cough every 2 hours until ambulation is possible. Do ROM exercises as indicated. Elevate the affected extremity and use cold applications. Apply antiembolism stockings as indicated.

Elevate the affected extremity and use cold applications

A teenage client is brought to the clinic by a parent and reports pain in the arm. The client is a member of a high school crew team and practices for 2 ½ hours every day after school. Which of the following would the nurse suspect? Carpal tunnel syndrome Epicondylitis Tendonitis Ganglion

Epicondylitis

A client with a fracture develops compartment syndrome that requires surgical intervention. What treatment will the nurse would most likely prepare the client for? Bone graft Joint replacement Amputation Fasciotomy

Fasciotomy

A nurse is caring for a client with a cast on the left arm after sustaining a fracture. Which assessment finding is most significant for this client? Presence of a normal popliteal pulse Fingers on the left hand are swollen and cool Cast edges are rough, with skin irritation present Minimal pain in the left arm

Fingers on the left hand are swollen and cool

Which term refers to a break in the continuity of a bone? Malunion Dislocation Subluxation Fracture

Fracture

A nurse is caring for a client who has suffered a hip fracture and who will require an extended hospital stay. The nurse should ensure that the client does what action to prevent common complications associated with a hip fracture? Increase fluid intake and perform prescribed foot exercises. Remain on bed rest for 14 days or until instructed by the orthopedic surgeon. Avoid requesting analgesia unless pain becomes unbearable. Use supplementary oxygen when transferring or mobilizing.

Increase fluid intake and perform prescribed foot exercises

A client undergoes open reduction with internal fixation to treat an intertrochanteric fracture of the right hip. The nurse should include which intervention in the postoperative care plan? Maintaining the client in semi-Fowler's position Performing passive range-of-motion (ROM) exercises on the client's legs once each shift Turning the client from side to side every 2 hours Keeping a pillow between the client's legs at all times

Keeping a pillow between the client's legs at all times

Which factor inhibits fracture healing? Vitamin D Maximum bone fragment contact Exercise Local malignancy

Local malignancy

The nurse is caring for a client with an external fixator that requires pin care twice a day. The nurse observes that there is a new purulent drainage around one of the pins. What intervention should the nurse anticipate doing? Applying iodine-based solution Scrubbing the drainage from around the pin site Apply ointment to the pin site. Obtaining a culture

Obtaining a culture

A client's fracture was reduced by surgically exposing the bone and realigning it. What type of treatment does the nurse identity this as? Buck's traction Internal fixation Open reduction Skeletal traction

Open reduction

Which orthopedic surgery is done to correct and align a fracture after surgical dissection and exposure of the fracture? Open reduction Arthrodesis Total joint arthroplasty Joint arthroplasty

Open reduction

Elderly clients who fall are most at risk for which injuries? Cervical spine fractures Wrist fractures Pelvic fractures Humerus fractures

Pelvic fractures

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? Keep the affected leg in a position of adduction. Keep the hip flexed by placing pillows under the client's knee. Use measures other than turning to prevent pressure ulcers. Prevent internal rotation of the affected leg.

Prevent internal rotation of the affected leg

A client with a traumatic amputation of the right lower leg is refusing to look at the leg. Which action by the nurse is most appropriate? Encourage the client to perform range-of-motion (ROM) exercises to the right leg. Provide feedback on the client's strengths and available resources. Provide wound care without discussing the amputation. Request a referral to occupational therapy.

Provide feedback on the client's strengths and available resources

A client with a traumatic amputation of the right lower leg is refusing to look at the leg. Which action by the nurse is most appropriate? Provide feedback on the client's strengths and available resources. Provide wound care without discussing the amputation. Encourage the client to perform range-of-motion (ROM) exercises to the right leg. Request a referral to occupational therapy.

Provide feedback on the client's strengths and available resources

Which nursing intervention is essential in caring for a client with compartment syndrome? Removing all external sources of pressure, such as clothing and jewelry Wrapping the affected extremity with a compression dressing to help decrease the swelling Starting an I.V. line in the affected extremity in anticipation of venogram studies Keeping the affected extremity below the level of the heart

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

A nurse is providing discharge education to a client who is going home with a cast on his leg. What topic should the nurse emphasize in the teaching session? Exercising joints above and below the cast, as prescribed Reporting signs of impaired circulation Removing the cast correctly at the end of the treatment period Using crutches efficiently

Reporting signs of impaired circulation

A nurse is planning the care of a client who will require a prolonged course of skeletal traction. When planning this client's care, the nurse should prioritize interventions related to what risk nursing diagnosis? Risk for Imbalanced Fluid Volume Risk for Aspiration Risk for Impaired Skin Integrity Risk for Falls

Risk for Impaired Skin Integrity

While assessing a client who has had knee replacement surgery, the nurse notes that the client has developed a hematoma at the surgical site. The affected leg has a decreased pedal pulse. What would be the priority nursing diagnosis for this client? Unilateral Neglect Related to Hematoma Disturbed Kinesthetic Sensory Perception Risk for Infection Risk for Ineffective Peripheral Tissue Perfusion

Risk for Ineffective Peripheral Tissue Perfusion

Which device is designed specifically to initially support and immobilize a body part in a desired position until swelling subsides? Brace Trapeze Splint Continuous passive motion (CPM) device

Splint

A client sustains an injury to the ligaments surrounding a joint. What will the nurse identify this injury as? Contusion Strain Sprain Fracture

Sprain

Which term refers to an injury to ligaments and other soft tissues surrounding a joint? Sprain Strain Dislocation Subluxation

Sprain

Which term refers to an injury to ligaments and other soft tissues surrounding a joint? Sprain Strain Subluxation Dislocation

Sprain

A client has been diagnosed with a muscle strain. What does the physician mean by the term "strain"? injury resulting from a blow or blunt trauma stretched or pulled beyond its capacity injuries to ligaments surrounding a joint subluxation of a joint

Stretched or pulled beyond its capacity

The nurse is preparing a client to have his cast cut off after having it for 6 weeks to treat a fractured tibia. What should the nurse inform the client prior to the cast being removed? The leg will look as it did prior to the cast being applied. The leg strength is enforced by the wearing of the cast. The skin may be covered with a yellowish crust that will shed in a few days. The leg will look moist and will have small bumps that will go away in a few days.

The skin may be covered with a yellowish crust that will shed in a few days

Which may occur if a client experiences compartment syndrome in an upper extremity? Subluxation Callus Volkmann's contracture Whiplash injury

Volkmann's contracture

The nurse is checking the traction apparatus for a client in skin traction. Which finding would require the nurse to intervene? Pulleys without evidence of the obstruction Weights hanging and touching the floor Body aligned opposite to line of traction pull Ropes freely moving over pulleys

Weights hanging and touching the floor

The nurse is helping to set up Buck's traction on an orthopedic client. How often should the nurse assess circulation to the affected leg? Within 30 minutes, then every 4 hours Within 30 minutes, then every shift Within 30 minutes, then every 8 hours Within 30 minutes, then every 1 to 2 hours

Within 30 minutes, then every 1 to 2 hours

There are a variety of problems that can become complications after a fracture. Which 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? fat embolism avascular necrosis shock pulmonary embolism

avascular necrosis

A client undergoes an open reduction of a femur fracture, and returns to the orthopedic unit with a cast in place. What is the rationale for frequently assessing the client's pedal pulses? ensuring adequate circulation to the casted limb ensuring surgery was successful ensuring there wasn't nerve damage during surgery providing typical postoperative nursing management

ensuring adequate circulation to the casted limb

A client has had surgical repair of a hip injury after joint manipulation was unsuccessful. After surgery, the nurse implements measures to prevent complications. Which complications is the nurse seeking to prevent? Select all that apply. pneumonia skin breakdown diarrhea wound infection

skin breakdown wound infection pneumonia

A client with a right leg fracture is returning to the orthopedist to have the cast removed. During cast removal, it is important for the nurse to assure: the client that he or she won't be cut. that the leg will be as good as new. that the cast cutter blade is new. that pedal pulses are present.

the client that he or she won't be cut

A client is experiencing pain, joint instability, and difficulty walking due to an injury to the knee ligaments. The injury was judged not to require surgery. Which intervention would not be included in this client's care? joint immobilization limited weight bearing ice and NSAIDs traction

traction