Chapter 51: Care of Patients with Musculoskeletal Trauma

A nurse delegates care of a client in traction to an unlicensed assistive personnel (UAP). Which statement should the nurse include when delegating hygiene care for this client?

"Ensure that the weights remain freely hanging at all times."

A nurse is caring for a client who is recovering from an above-the-knee amputation. The client reports pain in the limb that was removed. How should the nurse respond?

"How would you describe the pain that you are feeling?"

After teaching a client who is recovering from a vertebroplasty, the nurse assesses the client's understanding. Which statement by the client indicates a need for additional teaching?

"I can drive myself home after the procedure."

A phone triage nurse speaks with a client who has an arm cast. The client states, "My arm feels really tight and puffy." How should the nurse respond?

"Please come to the clinic today to have your arm checked by the provider."

A nurse cares for a client placed in skeletal traction. The client asks, "What is the primary purpose of this type of traction?" How should the nurse respond?

"Skeletal traction will assist in realigning your fractured bone."

A nurse teaches a client about prosthesis care after amputation. Which statements should the nurse include in this client's teaching? (Select all that apply.)

"The device has been custom made specifically for you." "Make sure that you wear the correct liners with your prosthetic." "I have scheduled a follow-up appointment for you."

A nurse cares for an older adult client who is recovering from a leg amputation surgery. The client states, "I don't want to live with only one leg. I should have died during the surgery." How should the nurse respond?

"This is a big change for you. What support system do you have to help you cope?"

A nurse coordinates care for a client with a wet plaster cast. Which statement should the nurse include when delegating care for this client to an unlicensed assistive personnel (UAP)?

"Use a cloth-covered pillow to elevate the client's leg."

A nurse cares for a client who had a wrist cast applied 3 days ago. The client states, "The cast is loose enough to slide off." How should the nurse respond?

"You need a new cast now that the swelling is decreased."

A trauma nurse cares for several clients with fractures. Which client should the nurse identify as at highest risk for developing deep vein thrombosis?

A 74-year-old man who smokes and has a fractured pelvis

A nurse cares for a client with a fracture injury. Twenty minutes after an opioid pain medication is administered, the client reports pain in the site of the fracture. Which actions should the nurse take? (Select all that apply.)

Administer additional opioids as prescribed. Elevate the extremity on pillows. Apply ice to the fracture site.

A nurse cares for a client who had a long-leg cast applied last week. The client states, "I cannot seem to catch my breath and I feel a bit light-headed." Which action should the nurse take next?

Administer oxygen to keep saturations greater than 92%

A nurse assesses an older adult client who was admitted 2 days ago with a fractured hip. The nurse notes that the client is confused and restless. The client's vital signs are heart rate 98 beats/min, respiratory rate 32 breaths/min, blood pressure 132/78 mm Hg, and SpO2 88%. Which action should the nurse take first?

Administer oxygen via nasal cannula.

An emergency department nurse cares for a client who sustained a crush injury to the right lower leg. The client reports numbness and tingling in the affected leg. Which action should the nurse take first?

Assess the pedal pulses.

A nurse assesses a client with a cast for potential compartment syndrome. Which clinical manifestations are correctly paired with the physiologic changes of compartment syndrome? (Select all that apply.)

Edema - Increased capillary permeability Unequal pulses - Increased production of lactic acid Cyanosis - Anaerobic metabolism *Clinical manifestations of compartment syndrome are caused by several physiologic changes. Edema is caused by increased capillary permeability, release of histamine, decreased tissue perfusion, and vasodilation. Unequal pulses are caused by an increased production of lactic acid. Cyanosis is caused by anaerobic metabolism. Pallor is caused by decreased oxygen to tissues, and tingling is caused by increased tissue pressure.

A nurse plans care for a client who is recovering from open reduction and internal fixation (ORIF) surgery for a right hip fracture. Which interventions should the nurse include in this client's plan of care? (Select all that apply.)

Elevate heels off the bed with a pillow. Ambulate the client on the first postoperative day. Re-position the client every 2 hours.

A nurse plans care for a client who is recovering from a below-the-knee amputation of the left leg. Which intervention should the nurse include in this client's plan of care?

Encourage range-of-motion exercises.

A nurse teaches a client who is at risk for carpal tunnel syndrome. Which health promotion activities should the nurse include in this client's teaching? (Select all that apply.)

Frequently assess the ergonomics of the equipment being used. Take breaks to stretch fingers and wrists during working hours. Adjust chair height to allow for good posture.

A nurse assesses a client with a pelvic fracture. Which assessment finding should the nurse identify as a complication of this injury?

Hematuria

A nurse notes crepitation when performing range-of-motion exercises on a client with a fractured left humerus. Which action should the nurse take next?

Immobilize the left arm.

A nurse assesses a client with a rotator cuff injury. Which finding should the nurse expect to assess?

Inability to initiate or maintain abduction of the affected arm at the shoulder

A nurse cares for a client recovering from an above-the-knee amputation of the right leg. The client reports pain in the right foot. Which prescribed medication should the nurse administer first?

Intravenous calcitonin

A nurse teaches a client with a fractured tibia about external fixation. Which advantages of external fixation for the immobilization of fractures should the nurse share with the client? (Select all that apply.)

It leads to minimal blood loss. It allows for early ambulation. It promotes healing.

A nurse reviews prescriptions for an 82-year-old client with a fractured left hip. Which prescription should alert the nurse to contact the provider and express concerns for client safety?

Meperidine (Demerol) 50 mg IV every 4 hours *Meperidine (Demerol) should not be used for older adults because it has toxic metabolites that can cause seizures. The nurse should question this prescription. The other prescriptions are appropriate for this client's pain management.

A nurse cares for a client with a fractured fibula. Which assessment should alert the nurse to take immediate action?

Numbness in the extremity

A nurse cares for a client in skeletal traction. The nurse notes that the skin around the client's pin sites is swollen, red, and crusty with dried drainage. Which action should the nurse take next?

Obtain a prescription to culture the drainage.

A nurse obtains the health history of a client with a fractured femur. Which factor identified in the client's history should the nurse recognize as an aspect that may impede healing of the fracture?

Paget's disease

A nurse cares for an older adult client with multiple fractures. Which action should the nurse take to manage this client's pain?

Patient-controlled analgesia (PCA) pump with morphine *The older adult client should never be treated with meperidine because toxic metabolites can cause seizures. The client should be managed with a PCA pump to control pain best. Motrin most likely would not provide complete pain relief with multiple fractures. IV morphine PRN would not control pain as well as a pump that the client can control.

A home health nurse assesses a client with diabetes who has a new cast on the arm. The nurse notes the client's fingers are pale, cool, and slightly swollen. Which action should the nurse take first?

Raise the arm above the level of the heart.

An emergency department nurse triages a client with diabetes mellitus who has fractured her arm. Which action should the nurse take first?

Remove the medical alert bracelet from the fractured arm.

After teaching a client with a fractured humerus, the nurse assesses the client's understanding. Which dietary choice demonstrates that the client correctly understands the nutrition needed to assist in healing the fracture?

Roast beef with low-fat milk and a vitamin C supplement

A nurse plans care for a client who is prescribed skeletal traction. Which intervention should the nurse include in this plan of care to decrease the client's risk for infection?

Schedule for pin care to be provided every shift. *To decrease the risk for infection in a client with skeletal traction of external fixation, the nurse should provide routine pin care and assess manifestations of infection at the pin sites every shift. The traction lines and sockets are external and do not come in contact with the client's skin; these do not need to be washed. Although traction weights should not be removed or released for any period of time without a prescription, or placed on the floor, this does not decrease the risk for infection.

A nurse assesses a client with a fracture who is being treated with skeletal traction. Which assessment should alert the nurse to urgently contact the health provider?

Traction weights are resting on the floor

An emergency nurse assesses a client who is admitted with a pelvic fracture. Which assessments should the nurse monitor to prevent a complication of this injury? (Select all that apply.)

Urinary Output Blood Pressure Skin Color