Chapter 40 Musculoskeletal Care Modalities prep-u

A patient had a total hip replacement. What recommended leg position should the nurse ensure is maintained to prevent prosthesis dislocation? Adduction Flexion Abduction Internal rotation

Abduction Explanation: The nurse educates the patient about protective positioning, which includes maintaining abduction and avoiding internal and external rotation, hyperextension, and acute flexion.

A client with a right leg fracture is returning to the orthopedist to have the cast removed. What would the physician prescribe as further treatment? cold compresses to leg for swelling No options are correct. physical therapy discontinue use of crutches

physical therapy Explanation: For some time, the limb will need support. An elastic bandage may be wrapped on a leg, the client may use a cane, and an arm may be kept in a sling until progressive active exercise and physical therapy help the client regain normal strength and motion.

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. Administering prescribed analgesics. Changing the client's position within prescribed limits. Applying warm compresses.

Changing the client's position within prescribed limits. Explanation: Changing the position of a client within prescribed limits helps relieve pressure on bony areas and promotes comfort. Analgesics help to relive pain but may not help relieve pressure on bony areas. Warm compresses aid blood circulation. The client should not exercise while on traction unless prescribed to regain strength in the affected limb.

The nurse is very concerned about the potential debilitating complication of peroneal nerve injury. What symptom does the nurse recognize as a result of that complication? Foot drop Infection Deep vein thrombosis (DVT) Permanent paresthesias

Foot drop Explanation: Injury to the peroneal nerve as a result of pressure is a cause of foot drop (the inability to maintain the foot in a normally flexed position). Consequently, the patient drags the foot when ambulating.

Which intervention should the nurse implement with the client who has undergone a hip replacement? Adduct the legs by placing a pillow between the legs. Instruct the client to avoid internal rotation of the leg. Place the client in high Fowler's position for meals. Have the client bend forward to rise from the chair.

Instruct the client to avoid internal rotation of the leg. Explanation: The client should avoid all activities that can result in dislocation of the hip. The affected leg should not cross midline or be turned inward. A pillow is used to keep the legs in abduction. The hip should not bend more than 90 degrees when seated. The head of bed should be kept at 60 degrees or less.

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

Weights hanging and touching the floor Explanation: When checking traction equipment, the weights should be freely hanging. Weights that touch the floor require the nurse to intervene. The body should be aligned in an opposite line to the pull of the traction. The ropes should be freely moving over unobstructed pulleys.

The client is scheduled for a meniscectomy of the right knee. The nurse would plan postoperative care based on what surgical procedure? Excision of damaged joint fibrocartilage Replacement of one of the articular surfaces of a joint Replacement of knee with artificial joint Incision and diversion of the muscle fascia

Excision of damaged joint fibrocartilage Explanation: The most common site for meniscectomy is the knee; the procedure refers to the excision of damaged joint fibrocartilage. Fasciotomy refers to the incision and diversion of the muscle fascia to relieve muscle constriction. Hemiarthroplasty refers to the replacement of one of the articular surfaces of a joint. Total joint arthroscopy is the replacement of a joint with synthetic material.

The nurse assesses a client after total right hip arthroplasty and observes a shortening of the extremity. The client reports severe pain in the right side of the groin. What is the priority action of the nurse? Externally rotate the extremity. Apply Buck's traction. Bend the knee and rotate the knee internally. Notify the health care provider.

Notify the health care provider. Explanation: If any clinical manifestations of dislocation of the prosthesis occur, including acute groin pain in the affected hip or shortening of the affected extremity, the nurse (or the client, if at home) must immediately notify the surgeon, because the hip must be reduced and stabilized promptly so that the leg does not sustain circulatory and nerve damage. After closed reduction, the hip may be stabilized with Buck's traction or a brace to prevent recurrent dislocation. As the muscles and joint capsule heal, the chance of dislocation diminishes. Stresses to the new hip joint should be avoided for the first 8 to 12 weeks, when the risk of dislocation is greatest.

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 delivers analgesic agents directly into the joint." "CPM prevents injury by limiting flexion of the knee." "CPM increases range of motion of the joint." "CPM strengthens the muscles of the leg."

"CPM increases range of motion of the joint." Explanation: CPM increases circulation and range of motion of the knee joint.

When discussing physical activities with the client who has just undergone a right total hip replacement, which instruction should the nurse provide? "Intermittently cross and uncross your legs several times each day." "Perform rotation exercises each day." "Limit hip flexion to 90 degrees." "Avoid weight bearing until the hip is completely healed."

"Limit hip flexion to 90 degrees." Explanation: The client should avoid all activities that can result in dislocation of the hip. The affected leg should not cross midline or be turned inward. The hip should not bend more than 90 degrees. Ambulation begins the day following surgery, and weight bearing ambulation may not be restricted, depending on the type of prosthesis.

The nurse is providing instructions to the client who is being prepared for skeletal traction. Which statement by the client indicates teaching was effective? "Metal pins will go through my skin to the bone." "The traction can be removed once a day so I can shower." "I will wear a boot with weights attached." "A belt will go around my pelvis and weights will be attached."

"Metal pins will go through my skin to the bone." Explanation: In skeletal traction, metal rods or pins are used to apply continuous traction directly to the bone. Weights are used to apply the traction. Casts, external fixators, or splints are used when the traction is discontinued.

A client has a plaster cast applied to the left leg. Which comment by the client following the procedure should the nurse address first? "My toes are pink." "My toes are stiff." "My cast is still wet." "My pain is a 3."

"My toes are stiff." Explanation: Compartment syndrome is characterized by neurovascular compromise. Stiffness of the toes may be a preliminary finding that the client is having trouble with motor function.

Which instruction should the nurse include when teaching the client following hip replacement surgery? (Select all that apply.) "It is okay to briefly flex the hip to put on your clothes." "Use a raised toilet seat and high-seated chair." "You may cross your legs at the ankles only." "Avoid bending forward when sitting in a chair." "Place pillows between your legs when you lay on your side."

"Place pillows between your legs when you lay on your side." "Avoid bending forward when sitting in a chair." "Use a raised toilet seat and high-seated chair." Explanation: The client following post hip replacement should not cross the legs, even at the ankle. He or she should avoid bending forward when sitting in a chair, avoid flexing the hip when dressing, and use a raised toilet seat. A pillow should be placed between the legs when side-lying.

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? "When a spica cast is ordered, the arm must be immobilized." "The joint above the fracture and below the fracture must be immobilized." "This allows for the strength in the arm to remain consistent." "The method allows for the fastest healing time and the greatest mobility."

"The joint above the fracture and below the fracture must be immobilized." Explanation: Generally, the joints proximal and distal to the fracture are immobilized to promote healing. The purpose is not for the strength to remain consistent; most clients will lose strength. A spica cast would not be ordered for an ulnar fracture. Although immobilizing the joints above and below fractures may shorten healing time, it does not allow for increased mobility.

An older adult patient had a hip replacement. When should the patient begin with assisted ambulation with a walker? 24 hours 72 hours 1 week 2 to 3 weeks

24 hours Explanation: Following hip arthroplasty (total hip replacement), patients begin ambulation with the assistance of a walker or crutches within a day after surgery.

A client with a long arm cast continues to complain of unrelieved throbbing pain even after receiving opioid pain medication. Which is the priority action by the nurse? Assess for previous opioid drug use. Assess for complications. Reposition the client for comfort. Teach relaxation techniques.

Assess for complications. Explanation: Unrelieved pain can be an indicator of a complication, such as compartment syndrome. Previous opioid drug use should not influence a complete and thorough assessment. Repositioning the client for comfort may be appropriate once all indications of a complication are ruled out. It is appropriate to teach relaxation techniques to help ease the pain, but assessing for a complication remains the highest priority.

Which action would be most important postoperatively for a client who has had a knee or hip replacement? Assisting in early ambulation. Providing crutches to the client. Using a continuous passive motion (CPM) machine. Encouraging expressions of anxiety.

Assisting in early ambulation. Explanation: An anticoagulant therapy and early ambulation are important for clients who undergo a knee or hip replacement. A CPM machine or crutches may be provided when prescribed. It is important to encourage clients to express their feelings of anxiety or depression. This is more crucial for clients who undergo an amputation rather than for clients who undergo a replacement surgery.

The client who had a total hip replacement was discharged home and developed acute groin pain in the affected leg, shortening of the leg, and limited movement of the fractured leg. The nurse interprets these findings as indicating which complication? Dislocation of the hip Re-fracture of the hip Avascular necrosis of the hip Contracture of the hip

Dislocation of the hip Explanation: Manifestations of a dislocated hip prosthesis are increased pain at the surgical site, acute groin pain in the affected leg, shortening of the leg, abnormal external or internal rotation, and limited movement of the fractured leg. The client may report a "popping" sensation in the hip.

A patient in pelvic traction needs circulatory status assessed. How should the nurse assess for a positive Homans' sign? Have the patient extend each leg and dorsiflex each foot to determine if pain or tenderness is present in the lower leg. Have the patient squeeze the nurse's hands with his or her hands to evaluate any difference in strength. Have the patient extend both hands while the nurse compares the volume of both radial pulses. Have the patient plantar flex both feet while the nurse performs the blanch test on all of the patient's toes.

Have the patient extend each leg and dorsiflex each foot to determine if pain or tenderness is present in the lower leg. Explanation: The nurse should assess for pain on passive flexion of each foot, which could indicate deep vein thrombosis.

Which type of cast encloses the trunk and a lower extremity? Short-leg Hip spica Body cast Long-leg

Hip spica Explanation: A hip spica cast encloses the trunk and a lower extremity. A body cast encloses the trunk. A long-leg cast extends from the junction of the upper and middle third of the thigh to the base of the toes. A short-leg cast extends from below the knee to the base of the toes.

To reduce the incidence of complications in a client in traction, which intervention should be included in the care plan? Increase calorie intake. Reduce fluid intake. Increase fiber intake. Remove the weights during linen changes.

Increase fiber intake. Explanation: Immobility increases the incidence of constipation. Increasing fiber intake will reduce GI complications. The weights in traction should never be removed. Inactivity results in fewer calories being burned. Increasing calories would be counterproductive. Reducing fluids will increase the likelihood of constipation.

Which is a benefit of a continuous passive motion (CPM) device when applied after knee surgery? It prevents infection and controls edema and bleeding. It promotes healing by increasing circulation and movement of the knee joint. It provides active range of motion. It promotes healing by immobilizing the knee joint.

It promotes healing by increasing circulation and movement of the knee joint. Explanation: A CPM device applied after knee surgery promotes healing by increasing circulation and movement of the knee joint.

A client is seen in the orthopedic clinic for complaints of severe pain in the left hip. After a series of diagnostic tests, the client is diagnosed with severe degenerative joint disease of the left hip and suggested to have the hip reconstructed. What procedure will the nurse schedule the client for? Left hip arthroplasty Left hip arthroscopy Open reduction and internal fixation of the left hip. Closed reduction of the left hip.

Left hip arthroplasty Explanation: Clients with arthritis, trauma, hip fracture, or a congenital deformity may have an arthroplasty, or reconstruction of the joint. This procedure uses an artificial joint that restores previously lost function and relieves pain. An arthroscopy is not used to reconstruct a diseased hip. A closed reduction is not an invasive surgical procedure and would not be used to reconstruct the hip. An open reduction and internal fixation is not the treatment for reconstruction of the hip related to a diseased hip.

A client is having traction applied to a fractured left lower extremity prior to surgery. What outcomes does the nurse expect from the application of the traction for the client? Select all that apply. Surgery will not be required. Immobilization of the left leg will be maintained. Muscle spasms will be relieved. Less pain medication will be required. The bones of the left leg will be aligned.

Muscle spasms will be relieved. The bones of the left leg will be aligned. Immobilization of the left leg will be maintained. Explanation: Traction is used to relieve muscle spasm, align bones, and maintain immobilization when used properly. It will not replace surgery to correct the fracture. The client will still require pain medication prior to surgical correction.

A client is brought to the emergency department by a softball team member who states the client and another player ran into each other, and the client is having severe pain in the right shoulder. What symptoms of a fractured clavicle does the nurse recognize? Right shoulder slopes downward and droops inward. Client complains of tingling and numbness in the right shoulder. Right shoulder is elevated above the left. Client complains of pain in the unaffected shoulder.

Right shoulder slopes downward and droops inward. Explanation: The client with a fractured clavicle has restricted motion, and the affected shoulder appears to slope downward and droop inward. The client will have pain, not typically tingling and numbness in the right shoulder. Pain is not felt in the unaffected shoulder.

Which is an inaccurate principle of traction? The weights are not removed unless intermittent treatment is prescribed. The weights must hang freely. The client must be in good alignment in the center of the bed. Skeletal traction is interrupted to turn and reposition the client.

Skeletal traction is interrupted to turn and reposition the client. Explanation: Skeletal traction is never interrupted. The weights are not removed unless intermittent treatment is prescribed. The weights must hang freely, with the client in good alignment in the center of the bed.

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

Skeletal traction is never interrupted. Explanation: Skeletal traction is applied directly to the bone and is never interrupted. To be effective, the weights must hang freely and not rest on the bed or floor. Knots in the rope or the footplate must not touch the pulley or the foot of the bed. Traction must be continuous to be effective in reducing and immobilizing fractures.

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

Splint Explanation: A splint may be applied to a fractured extremity initially until swelling subsides. A brace is an externally applied device to support a body part, control movement, and prevent injury. A CPM device is an instrument that moves a body part to promote healing and circulation. A trapeze is an overhead device to promote client mobility in bed.

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

Splint Explanation: A splint may be applied to a fractured extremity initially until swelling subsides. A brace is an externally applied device to support a body part, control movement, and prevent injury. A CPM device is an instrument that moves a body part to promote healing and circulation. A trapeze is an overhead device to promote client mobility in bed.

A client's left leg is in skeletal traction with a Thomas leg splint and Pearson attachment. Which intervention should the nurse include in this client's care plan? Remove the traction at least every 8 hours. Assess the client's level of consciousness. Teach the client how to prevent problems caused by immobility. Apply the traction straps snugly.

Teach the client how to prevent problems caused by immobility. Explanation: By teaching the client about prevention measures, the nurse can help prevent problems caused by immobility, such as hypostatic pneumonia, muscle contracture, and atrophy. The nurse applies traction straps for skin traction — not skeletal traction. For a client in skeletal traction, the nurse should assess the affected limb, rather than assess the level of consciousness. Removing skeletal traction is the physician's responsibility — not the nurse's.

Which is not a guideline for avoiding hip dislocation after replacement surgery. Put a pillow between the legs when sleeping. Keep the knees apart at all times. The hip may be flexed to put on clothing such as pants, stockings, socks, or shoes. Never cross the legs when seated.

The hip may be flexed to put on clothing such as pants, stockings, socks, or shoes. Explanation: Guidelines for avoiding hip dislocation after replacement surgery specify that the hip should not be flexed to put on clothing such as pants, stockings, socks, or shoes. Clients should keep the knees apart at all times, put a pillow between the legs when sleeping, and never cross the legs when seated.

A variety of complications can occur after a leg amputation. Which is not a possibility in the immediate postoperative period? infection hematoma osteomyelitis hemorrhage

osteomyelitis Explanation: Chronic osteomyelitis may occur after persistent infection in the late postoperative period. Hematoma, hemorrhage, and infection are potential complications in the immediate postoperative period.

To prepare a client who has a fractured femur for ambulation, the nurse teaches the client how to do quadriceps setting exercises. Which instruction is the most accurate? "Try to lift your legs up when I press against your feet." "Contract and relax your buttocks." "Press the back of your knee against the bed." "Flex and extend your toes."

"Press the back of your knee against the bed." Explanation: Quadriceps setting exercises help the immobilized client keep the quadriceps muscles strong and ready for resuming ambulation. Pressing the back of the knee against the bed promotes tightening of the quadriceps muscle.

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." "Bleeding is a complication associated with the continuous passive motion device." "Monitoring skin integrity is important while the continuous passive motion device is in place." "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." Explanation: Further staff education is needed when the nurse states that the continuous passive motion device isn't needed because the client receives physical therapy twice per day. The continuous passive motion device should be used in conjunction with physical therapy because the device helps prevent adhesions. Bleeding is a complication associated with the continuous passive motion device; skin integrity should be monitored while the device is in use.

A client with a fractured ankle is having a fiberglass cast applied. The client starts yelling, "My leg is burning, take it off." What action by the nurse is most appropriate? Administer antianxiety and pain medication. Explain that the sensation being felt is normal and will not burn the client. Call for assistance to hold the client in the required position until the cast has dried. Remove the cast immediately, notifying the physician.

Explain that the sensation being felt is normal and will not burn the client. Explanation: A fiberglass cast will give off heat when applied. The reaction is a normal, temporary sensation. Heat given off during the application phase of the cast does not burn the skin. By explaining these principles to the client, the nurse can alleviate any anxiety associated with the application of the cast. Because this is a known reaction to the application of the fiberglass cast, it is not necessary to remove the cast. Holding the client may cause more harm to the injury. Antianxiety medications are generally not needed when applying a cast.

The clinic nurse is caring for a client with an injured body part that does not require rigid immobilization. What method of immobilization would the nurse expect the health care provider to use on a short-term basis? Brace Cast Skin traction Splint

Splint Explanation: A splint immobilizes and supports an injured body part in a functional position and is used when the condition does not require rigid immobilization, causes a large degree of swelling, or requires special skin treatment. Casts and traction provide rigid immobilization. A brace provides support, controls movement, and prevents additional injury for more long-term use.

Which statement is accurate regarding care of a plaster cast? A dry plaster cast is dull and gray. The cast can be dented while it is damp. The cast will dry in about 12 hours. The cast must be covered with a blanket to keep it moist during the first 24 hours.

The cast can be dented while it is damp. Explanation: The cast can be dented while it is damp. A dry plaster case is white and shiny. The cast will dry in 24 to 72 hours. A freshly applied cast should be exposed to circulating air to dry and should not be covered with clothing or bed linens or placed on plastic-coated mats or bedding.

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? "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." "Not all fractures require a cast." "It is best if an orthopedic doctor applies the cast."

"A splint is applied when more swelling is expected at the site of injury." Explanation: Splints are noncircumferential and will not compromise circulation when swelling is expected. A splint is applied to support and immobilize the injured joint. A fracture will swell as part of the inflammation process. The client would not have to stay longer if a fiberglass cast is applied. Fiberglass cast dry in approximately 30 minutes. An orthopedic doctor is not needed to apply the cast. Many nurses and technicians are trained in proper application of a cast. Some fractures may not be treated with a cast but it would not be appropriate to answer with this response because it does not reflect the actual reason for a splint being applied.

The nurse is caring for a patient with a total hip replacement. How should the nurse allow the patient to turn? From the prone to the supine position only, and the patient must keep the affected hip extended and abducted To the operative side if the affected hip remains extended 45 degrees onto the unoperated side if the affected hip is kept abducted To any comfortable position as long as the affected leg is extended

45 degrees onto the unoperated side if the affected hip is kept abducted Explanation: When the nurse turns the patient in bed to the unaffected side, it is important to keep the operative hip in abduction (movement away from the center or median line of the body). The patient should not be turned to the operative side, which could cause dislocation, unless specified by the surgeon. The patient's hip is never flexed more than 90 degrees.

The client displays manifestations of compartment syndrome. What treatment will the nurse expect the client to be scheduled for? A fasciotomy An open reduction A total knee replacement A total hip replacement

A fasciotomy Explanation: A treatment option for compartment syndrome is fasciotomy.

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. Remind to use the heel of the unaffected foot to reposition. Remove the weights prior to repositioning.

Apply a trapeze to the bed frame. Explanation: To encourage movement, an assistive device called a trapeze can be suspended overhead within easy reach of the client. The trapeze helps the client move about in bed and move on and off the bedpan. The client's elbows frequently become sore, and nerve injury may occur if the client repositions by pushing on the elbows. Clients frequently push on the heel of the unaffected leg when they raise themselves. This digging of the heel into the mattress may injure the tissues. It is important to instruct clients not to use their heels or elbows to push themselves up in bed. The weights should not be removed to reposition the client or for any other reason.

Which device is designed specifically to support and immobilize a body part in a desired position? Brace Sling Traction Splint

Splint Explanation: A splint may be applied to a fractured extremity initially until swelling subsides. Splints are designed to provide stability for fractures that are unstable and to immobilize and support the body part in a functional position. A brace is an externally applied device to support a body part, control movement, and prevent injury; braces are used to enhance movement while preventing injury. A sling is a bandage used to support an arm temporarily while the client ambulates; it is not designed to immobilize the body part. Traction is the use of a pulling force on a body part and thus it is not designed to immobilize; the goal of traction is to achieve or maintain alignment, decrease muscle spasms and pain, or correct or prevent deformities.

Arthrodesis is: fusion of a joint (most often the wrist or knee) for stabilization and pain relief. total reconstruction or replacement of a joint (most often the knee or hip) with an artificial joint to restore function and relieve pain. replacement of one of the articular surfaces in a joint, such as the femoral head but not the acetabulum. cutting and removal of a wedge of bone (most often the tibia or femur) to change the bone's alignment, thereby improving function and relieving pain.

fusion of a joint (most often the wrist or knee) for stabilization and pain relief. Explanation: Arthrodesis is fusion of a joint (most often the wrist or knee) for stabilization and pain relief. Arthroplasty is total reconstruction or replacement of a joint (most often the knee or hip) with an artificial joint to restore function and relieve pain. Hemiarthroplasty is the replacement of one of the articular surfaces in a joint, such as the femoral head but not the acetabulum. Osteotomy is the cutting and removal of a wedge of bone (most often the tibia or femur) to change the bone's alignment, thereby improving function and relieving pain.

A nurse is caring for a client placed in traction to treat a fractured femur. Which nursing intervention has the highest priority? Ensuring that the weights hang free at all times Keeping the ropes over the center of the pulley Assessing the extremity for neurovascular integrity Keeping the client from sliding to the foot of the bed

Assessing the extremity for neurovascular integrity Explanation: Although all measures are correct, assessing neurovascular integrity takes priority because a decrease in neurovascular integrity could compromise the limb. The pull of the traction must be continuous to keep the client from sliding. Sufficient countertraction must be maintained at all times by keeping the ropes over the center of the pulley. The line of pull is maintained by allowing the weights to hang free.

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? Better molding to the client Longer lasting Quicker drying More breathable

Better molding to the client Explanation: Plaster casts require a longer time for drying but mold better to the client and are initially used until the swelling subsides. Fiberglass casts dry more quickly, are lighter in weight, longer lasting, and breathable.

A nurse is caring for a client in skeletal leg traction. Which nursing assessment findings indicate the client has met expected outcomes? Select all that apply. Capillary refill less than 3 seconds Repositions self with trapeze Elbows are free of skin breakdown Peripheral pulses +2 bilaterally Right calf warm and swollen

Capillary refill less than 3 seconds Repositions self with trapeze Peripheral pulses +2 bilaterally Elbows are free of skin breakdown Explanation: A capillary refill time of less than 3 seconds, the ability to reposition using a trapeze, peripheral pulses +2 bilaterally, and elbows free of skin breakdown are normal assessments for the nurse to find with a client in skeletal leg traction. An abnormal finding of a deep vein thrombosis include calf tenderness, warmth, redness, and swelling of the affected extremity.

Which nursing assessment finding would be indicative of compartment syndrome in the client with a cast applied to the left forearm 3 hours earlier? Capillary refill of left fingers greater than 3 seconds Radial pulses palpable and +2 bilaterally Fingers pink and warm and move freely Absence of numbness and tingling

Capillary refill of left fingers greater than 3 seconds Explanation: Compartment syndrome is characterized by neurovascular compromise. Capillary refill should be less than 3 seconds.

Which would be contraindicated as a component of self-care activities for the client with a cast? Elevate the casted extremity to heart level frequently Do not attempt to scratch the skin under a cast Cushioning rough edges of the cast with tape Cover the cast with plastic to insulate it

Cover the cast with plastic to insulate it Explanation: The cast should be kept dry, but do not cover it with plastic or rubber because this causes condensation, which dampens the cast and skin. The other activities are consistent with cast care.

The nurse is caring for a client who sustained rib fractures in an automobile accident. What symptoms does the nurse recognize as a complication of rib fractures and should immediately be reported to the physician? Crackles in the lung bases Blood pressure of 140/90 mm Hg Heart rate of 94 beats/minute Client complains of pain in the affected rib area when taking a deep breath

Crackles in the lung bases Explanation: Crackles in the lung bases can be an indicator that the client has developed pneumonia from shallow respirations. The blood pressure is high but may be due to pain. It is expected that the client will have pain in the rib area when taking deep breaths. A heart rate of 94 beats/minute is within normal range.

A client with a fractured distal left radius reports discomfort at the cast site, with pain specifically in the upper forearm. What would the nurse expect the physician to do? Cut a cast window. Initiate physical therapy. Remove the cast. Apply a fiberglass cast.

Cut a cast window. Explanation: After the cast dries, a cast window, or opening, may be cut. This usually is done when the client reports discomfort under the cast or has a wound that requires a dressing change. The window permits direct inspection of the skin, a means to check the pulse in a casted arm or leg, or a way to change a dressing.

A client has a cast applied to the leg for treatment of a tibia fracture and also has a wound on the leg that requires dressing changes due to drainage. For what should the nurse prepare the client? Insertion of an external fixator Cutting a cast window Removal of the cast Cutting of a bivalve cast

Cutting a cast window Explanation: After the cast dries, a cast window, or opening, may be cut. This usually is done when the client reports discomfort under the cast or has a wound that requires a dressing change. The window permits direct inspection of the skin, a means to check the pulse in a casted arm or leg, or a way to change a dressing. A bivalve cast is when the cast is cut in two if the leg swells or if the client is being weaned from a cast, when a sharp x-ray is needed, or as a splint for immobilizing painful joints when a client has arthritis. The cast should not be removed due to the instability of a fracture. The client's condition does not indicate an external fixator is required.

The nurse suspects "compartment syndrome" for a casted extremity. What characteristic symptoms would the nurse assess that would confirm these suspicions? (Select all that apply.) Excruciating pain 2+ peripheral pulses in the affected distal pulse Loss of motion Decreased sensory function Capillary refill less than 3 seconds

Decreased sensory function Excruciating pain Loss of motion Explanation: Clinical manifestations include dusky, pale appearance of the exposed extremity; cool skin temperature; delayed capillary refill; paresthesia; and unrelenting pain not relieved by position changes, ice, or analgesia. A hallmark sign is pain that occurs or intensifies with passive range of motion (Johnston-Walker & Hardcastle, 2011). The patient may complain that the cast, brace, or splint is too tight. The primary provider must be notified immediately.

After undergoing surgery the previous day for a total knee replacement, a client states, "I am not ready to ambulate yet." What should the nurse do? Discuss the complications that the client may experience if there is lack of cooperation with the care plan. Document the client's refusal to ambulate. Tell the client that this noncompliance will be reported to the health care provider. Do nothing because the client has the ultimate right to determine the degree of participation.

Discuss the complications that the client may experience if there is lack of cooperation with the care plan. Explanation: The nurse should discuss the care plan and its rationale with the client. Calling the health care provider to report the client's noncompliance won't alter the client's degree of participation and shouldn't be used to force the client to comply. Doing nothing isn't acceptable. Although the client does have the right to make choices, it's the nurse's responsibility to provide education to help the client make informed decisions. Although the nurse should ultimately document the client's refusal, the nurse should first discuss the care plan with the client.

What is the best action by the nurse to achieve optimal outcomes when caring for a client with a musculoskeletal disorder who is using a cast? Assess for neurovascular compromise Provide effective pain control Prepare the client for cast application Educate the client on cast care and complications

Educate the client on cast care and complications Explanation: Educating the client is essential to achieve optimal outcomes. Although the nurse should prepare the client for cast applications, assess for neurovascular compromise, and provide effective pain control, these interventions are centered on care provided by the nurse. The client is more likely to be in the home setting while a cast is in place, requiring the client to have the education to properly care for the cast and have knowledge of the complications so that early interventions can happen.

A client has just undergone a leg amputation. What will the nurse closely monitor the client for during the immediate postoperative period? Neuroma Unexplainable burning pain (causalgia) Chronic osteomyelitis Hematoma

Hematoma Explanation: Hematoma, hemorrhage, and infection are potential complications in the immediate postoperative period. Sleeplessness, nausea, and vomiting may occur but are adverse reactions, not complications. Chronic osteomyelitis and causalgia are potential complications that are likely to arise in the late postoperative period. A neuroma occurs when the cut ends of the nerves become entangled in the healing scar. This would occur later in the postoperative course.

A client returns to the nursing unit following an open reduction with internal fixation of the right hip. Which nursing interventions would be appropriate for the prophylactic treatment of deep vein thrombosis? Select all that apply. Increasing fluid intake Administering enoxaparin Maintaining antiembolic stockings Encouraging coughing exercises Increasing fiber intake

Increasing fluid intake Maintaining antiembolic stockings Administering enoxaparin Explanation: Increasing fluid intake decreases stasis by lessening hemoconcentration. Antiembolic stockings and administering enoxaparin are standards of care associated with decreasing deep vein thrombosis. Encouraging coughing exercises helps to reduce respiratory complications. Increased fiber intake increases bulk in stool, but does not prevent deep vein thrombosis.

After a traumatic back injury, a client requires skeletal traction. Which intervention takes priority? Restricting the client's fluid and fiber intake to reduce the movement required for bedpan use Maintaining traction continuously to ensure its effectiveness Monitoring the client for skin breakdown Supporting the traction weights with a chair or table to prevent accidental slippage

Maintaining traction continuously to ensure its effectiveness Explanation: The nurse must maintain skeletal traction continuously to ensure its effectiveness. The nurse should assess skin for breakdown; however, maintaining skeletal traction takes priority. Traction weights must hang freely to be effective; they should never be supported. The nurse should increase, not restrict, the client's fluid and fiber intake (unless contraindicated by a concurrent illness) to prevent constipation associated with complete bed rest.

The nurse teaches the client which intervention to avoid hip dislocation after replacement surgery? Keep the knees together at all times Bend forward only when seated in a chair Never cross the affected leg when seated Avoid placing a pillow between the legs when sleeping

Never cross the affected leg when seated Explanation: Crossing the affected leg may result in dislocation of the hip joint after total hip replacement. The client should be taught to keep the knees apart at all times, to put a pillow between the legs when sleeping, and to avoid bending forward when seated in a chair.

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? Obtaining a culture Apply ointment to the pin site. Applying iodine-based solution Scrubbing the drainage from around the pin site

Obtaining a culture Explanation: A culture should be obtained if purulent drainage is present. Drainage should be gently removed, not scrubbed. Iodine-based products interfere with tissue healing and are not recommended for cleaning pin sites. Ointment should not be applied to the pin site unless specifically ordered.

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

Open reduction Explanation: An open reduction is the correction and alignment of the fracture after surgical dissection and exposure of the fracture. Arthrodesis is immobilizing fusion of a joint. A joint arthroplasty or replacement is the replacement of joint surfaces with metal or synthetic materials. A total joint arthroplasty is the replacement of both the articular surfaces within a joint with metal or synthetic materials.

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 Open reduction Skeletal traction Internal fixation

Open reduction Explanation: In an open reduction, the bone is surgically exposed and realigned. Buck's traction is a type of skin traction that provides pulling on the structures. Skeletal traction is applied directly to the bone using a wire, pin, or cranial tongs. Internal fixation involves the use of metal screws, plates, rods, nails or pins to stabilize a reduced fracture.

Which actions by the nurse demonstrate an understanding of caring for a client in traction? Select all that apply. Frequently assessing pain level Removing skeletal traction to turn and reposition the client Placing a trapeze on the bed Assessing the client's alignment in the bed Ensuring that the weights are hanging freely

Placing a trapeze on the bed Ensuring that the weights are hanging freely Assessing the client's alignment in the bed Frequently assessing pain level Explanation: The weights must hang freely, with the client in good alignment in the center of the bed. The nurse should frequently monitor pain, as uncontrolled pain may be a sign of a complication. The client will be able to assist with alignment and bed mobility if a trapeze is placed on the bed. Skeletal traction should never be interrupted.

A nurse is giving instructions to a client who's going home with a leg cast. Which teaching point is most critical? Avoiding walking on a leg cast without the health care provider's permission Using crutches properly Reporting signs of impaired circulation Exercising joints above and below the cast, as ordered

Reporting signs of impaired circulation Explanation: Although all of these points are important, reporting signs of impaired circulation is the most critical. Signs of impaired circulation must be reported to the health care provider immediately to prevent permanent damage. The other options reflect more long-term concerns. The client should learn to use crutches properly to avoid nerve damage. The client may exercise above and below the cast, as the health care provider orders. The client should be told not to walk on the cast without the health care provider's permission.

Which of the following is an inappropriate nursing diagnosis for the client following casting? Risk for deficient knowledge: procedure Risk for impaired skin integrity Risk for impaired tissue perfusion Risk for disuse syndrome

Risk for deficient knowledge: procedure Explanation: The client needs adequate information before experiencing the procedure. Information about its purpose, the actual steps of the procedure, and the client's role during and after the procedure is essential. Appropriate nursing diagnoses following the procedure would include risk for disuse syndrome, risk for impaired skin integrity, and risk for impaired tissue perfusion.

The nurse is caring for a client who lives alone and had a total knee replacement. An appropriate nursing diagnosis for the client is: Risk for ineffective therapeutic regimen management Situational low self-esteem Disturbed body image Risk for avascular necrosis of the joint

Risk for ineffective therapeutic regimen management Explanation: The client without adequate support and resources is at risk for ineffective therapeutic regimen management. A total knee replacement may be used to treat avascular necrosis. While an orthopedic client is at risk for disturbed body image and situational low self-esteem, there is no evidence that these exist for this client.

A client is being discharged home with a long arm cast. What education should the nurse include to prevent disuse syndrome in the arm? Repositioning the arm in the cast Abduction and adduction of the shoulder Proper use of a sling Use of isometric exercises

Use of isometric exercises Explanation: Isometric exercises allow for use of the muscle without moving the bone. Doing isometric exercises every hour while the client is awake will help prevent disuse syndrome. Proper use of a sling does not prevent disuse syndrome. The client should not attempt to reposition the arm in the cast. Abduction and adduction of the shoulder will help the shoulder joint but does not require the use of muscles in the lower arm.

A client is having a cast applied for a fractured leg that extends from below the knee to the base of the toes. The foot is flexed at a right angle in a neutral position. What type of cast is the client having applied? Hip spica cast Walking cast Short leg cast Long leg cast

Short leg cast Explanation: A short leg cast extends from below the knee to the base of the toes. The foot is flexed at a right angle in a neutral position. A long leg cast extends from the junction of the upper and middle third of the thigh to the base of the toes. The knee may be slightly flexed. A walking cast is a short or long leg cast reinforced for strength. A hip spica cast encloses the trunk and a lower extremity.

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 strength is enforced by the wearing of the cast. The leg will look as it did prior to the cast being applied. 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. Explanation: Once the cast is off, the skin appears mottled and may be covered with a yellowish crust composed of accumulated body oil and dead skin. The client usually sheds this residue in a few days. The leg will not look as it did prior to the cast but will regain the same shape and status as the other leg. There should be no bumps underneath the cast. The leg may be weak and stiff for some time after the cast is removed, not stronger.

External fixation: The surgeon inserts metal pins into the bone or bones from outside the skin surface and then attaches a compression device to the pins. The surgeon secures the bone with metal screws, plates, rods, nails, or pins. A cast or other mode of immobilization is applied. The bone is surgically exposed and realigned. The bone is restored to its normal position by external manipulation.

The surgeon inserts metal pins into the bone or bones from outside the skin surface and then attaches a compression device to the pins. Explanation: In external fixation, the surgeon inserts metal pins into the bone or bones from outside the skin surface and then attaches a compression device to the pins. In internal fixation, the surgeon secures the bone with metal screws, plates, rods, nails, or pins. A cast or other mode of immobilization is applied. In closed reduction, the bone is restored to its normal position by external manipulation. In open reduction, the bone is surgically exposed and realigned.

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 cast cutter blade is new. that pedal pulses are present. that the leg will be as good as new.

the client that he or she won't be cut. Explanation: Casts are removed with a mechanical cast cutter. Cast cutters are noisy and frightening but the blade does not penetrate deep enough to cut the client. The client needs reassurance that the machine will not cut into the skin. The other options are either irrelevant or not something the nurse knows for certain at this time.