Lewis 62 Soft Tissue Injuries

When teaching a group of young adults, what general measures should a nurse teach to prevent injuries? Select all that apply. A. Avoid drunken driving. B. Use seat belts regularly. C. Use safety equipment at work. D. Use protective athletic equipment. E. Drive slower than the posted speed limit. F. While driving, talk on the phone only if the call is important.

A. B. C. D. Rationale A nurse plays a pivotal role in teaching patients to take appropriate measures to prevent injuries. Some of these measures include regularly using seat belts, avoiding drunken driving, using protective athletic equipment (helmets and knee, wrist, and elbow pads), and using safety equipment at work. Obeying the speed limit is sufficient; the nurse does not need to teach that people should always drive slower than the speed limit. The teaching should encourage people not to use the phone at all while driving; if an important call must be made, the driver should find a safe place to stop before making it.

The nurse teaches an older adult about ways to prevent musculoskeletal problems. Which instructions are appropriate for the nurse to include in the patient's education? Select all that apply. "Perform tai chi exercises." "Eliminate scatter rugs at home." "Discuss the use of medications for pain." "Do not perform weight-bearing exercises on a daily basis." "Do not get involved in activities such as model building and jigsaw puzzles."

A. B. C. Rationale Older adults may be advised to learn tai chi because it is a low impact exercise that provides gentle range of motion. Scatter rugs in the home should be eliminated to decrease the risk of falling. The use of medications for any pain should be discussed so that mobility does not become restricted due to disuse. Weight-bearing exercises are recommended to reduce musculoskeletal problems. Model building and jigsaw puzzle activities help in exercising finger joints and preventing stiffness.

The nurse is teaching a group of elderly patients about techniques for preventing musculoskeletal problems. The nurse prioritizes which teaching points for these patients? Select all that apply. A. Avoid excessive weight gain. B. Remove throw rugs in the home. C. Start non-weight-bearing exercises. D. Change positions and rise to standing slowly. E. Use steps instead of ramps when ambulating.

A. B. D. Rationale Throw rugs in the home can create an unsafe environment for ambulation, causing potential falls, so the patient should remove them. It is important to change positions slowly to prevent dizziness that could cause the patient to faint or fall. Excessive weight gain can contribute to osteoarthritis and bone injury. Weight-bearing exercise is encouraged to strengthen the bones, rather than non-weight bearing exercise. The use of ramps would be preferred over steps to prevent falls.

A patient experiences inflammation and pain in the muscles, tendons, and nerves of the neck and spine due to repetitive strain injury (RSI). What ergonomic instructions should the nurse provide to the patient? Select all that apply. A. "Take hourly stretch breaks while working at your desk." B. "Apply moist, warm, heat to the affected area regularly." C. "Perform strengthening and conditioning exercises regularly." D. "Keep your hips and knees flexed to 90 degrees with the feet flat while sitting." E. "Keep your wrist straight when typing and keep the top of the computer monitor level with your forehead."

A. D. E. Rationale Ergonomic considerations for patients include taking hourly stretch breaks, keeping the hips and knees flexed at 90 degrees, keeping the feet flat on the floor to reduce strain on the soft tissue, keeping the wrist straight when typing, and keeping the top of the computer monitor even with the forehead to reduce strain of muscles and ligaments. Strengthening and conditioning exercises may reduce sprain and strain risk. Warm, moist heat application is used to help patients with a sprain after 48 hours of injury.

The patient had frostbite on the distal areas of the toes on both feet. The patient is scheduled for amputation of the damaged tissue. Which assessment finding or diagnostic study is the most objective indicator for locating the level of the patient's injury? A. Arteriography showing blood vessels B. Peripheral pulse assessment bilaterally C. Patches of black, indurated, and cold tissue D. Bilateral pale and cool skin below the ankles

A. Rationale Arteriography is the most objective study to determine viable tissue for salvage based on perfusion, because actual blood flow through the tissues is observed in real time. It is considered the gold standard for evaluating arterial perfusion. Bilateral peripheral pulse assessment; areas of black, indurated, and cold tissue; and bilateral pale and cool skin all identify the lack of tissue perfusion, but not the specific area where tissue perfusion stops and amputation needs to occur.

Which primary manifestation is associated with bursitis? Swelling Painless joints Tingling sensation Altered neurovascular status

A. Rationale Bursitis is the inflammation in the closed sacs lined with synovial membrane that contain synovial fluid and are located between tendons and bones near the joints. The swelling is the primary manifestation of bursitis. Bursitis is characterized by painful joints and a warm sensation, but not a tingling sensation. The manifestation of altered neurovascular status may appear later in acute soft tissue injury.

A nurse applies an elastic bandage to a patient's knee and provides discharge instructions after teaching the patient how to reapply the bandage. Which statement made by the patient indicates the need for further teaching? "I will leave it in place for prolonged periods." "I will wrap it starting from the distal end and finishing at the proximal position." "I will wrap it tightly but ensure that there is no numbness." "I will leave it in place for 30 minutes and then remove it for 15 minutes."

A. Rationale The elastic bandage should not be wrapped for prolonged periods, because it may irritate the area and cut off circulation. The bandage should not be wrapped too tightly, because it may interfere with the blood supply and cause numbness. The ideal way of wrapping the bandage is to start at the distal end and progress to the proximal area. The bandage should be wrapped for 30 minutes and removed for 15 minutes.

The nurse reviews a test result of a patient with bursitis and notes bursal wall thickening that interferes with normal joint function. Which treatment does the nurse anticipate will be prescribed to this patient? A. Surgical excision of bursae B. Aspiration of the bursal fluid C. Administering a corticosteroid through the intraarticular route D. Administering an oral nonsteroidal antiinflammatory drug (NSAID)

A. Rationale The thickening of bursal walls may interfere with normal joint function and may require surgical excision. Aspirating bursal fluid, administration of NSAIDs, and intraarticular injections of corticosteroids may not be beneficial in this situation.

What measures should a nurse take to prevent muscle spasms in cases of musculoskeletal injuries? Select all that apply. A. Massage the muscle spasms. B. Align the affected extremity appropriately. C. Use thermotherapy on the affected extremity. D. Provide isometric muscle strengthening exercises. E. Place the affected extremity in a comfortable position.

B. C. E. Rationale Muscle spasms are caused by involuntary muscle contraction after fracture, strain, or nerve injury. These may displace a nondisplaced fracture or prevent it from healing spontaneously. Therefore it is important to take measures to prevent muscle spasms. The affected extremity should be aligned appropriately. Thermotherapy may reduce muscle spasm. The extremity should be placed in a comfortable position. Massaging a muscle spasm may stimulate muscle tissue contraction, further increasing pain and spasm. Therefore it is not advisable to massage spasms. An isometric muscle-strengthening exercise regimen will not prevent muscle spasms in this injured patient.

A patient admitted with Parkinson's disease fell down the stairs in the hospital. The patient is conscious and states there is severe pain in the calf muscles. What should be the immediate course of action for the nurse? Select all that apply. A. Apply hot compresses. B. Elevate the affected limb. C. Apply ice to the painful area. D. Restrain the patient to the bed. E. Encourage the patient to mobilize the limb.

B. C. Rationale If an injury occurs, the immediate care focuses on applying ice compresses to the injured area to reduce pain, muscle spasms, inflammation, and edema. The affected limb should be elevated to mobilize excess fluid from the area and prevent further edema. The nurse should instruct the patient to limit movements of the affected limb. After the acute phase (usually 24 to 48 hours) moist heat may be applied to the affected area to reduce swelling and provide comfort. Restraining the patient to the bed is not related to the management of this injury.

How is cryotherapy beneficial in the treatment of a soft tissue injury? A. It increases lean muscles. B. It reduces muscle spasms. C. It induces a vasodilating effect. D. It increases muscle strength and endurance.

B. Rationale Cryotherapy is most useful when applied immediately after an injury. It induces various physiologic changes in the soft tissue of the involved part. Cryotherapy reduces muscle spasms and induces vasoconstriction in the tissue. Increasing lean muscle mass or muscle strength and endurance is not associated with cryotherapy.

The nurse cares for a patient who experiences a severe hip injury. What condition places the patient at risk for avascular necrosis? A. . Open joint injury B. Intraarticular injury C. Inadequate blood supply to the bone D. Damaged adjacent neurovascular tissue

C. Rationale A posterior hip dislocation due to severe injury may result in avascular necrosis if the joints remain unreduced for a long time. The dislocated parts may block the blood supply to the bone, resulting in bone death and necrosis. The open joint injuries are susceptible to infection but are not associated with avascular necrosis. Intraarticular injuries are another complication of dislocation and may not be related to avascular necrosis. The adjacent neurovascular tissue will be manifested by altered neurovascular status.

Which condition does the nurse anticipate if a patient experiences a severe injury to the ligament around the humerus bone? A. Strain B. Sprain C. Dislocation D. Subluxation

C. Rationale Severe injury of the ligamentous structures surrounding the humerus is a dislocation. A strain is an excessive stretching of the muscle, its fascial sheath, or a tendon. A sprain generally represents an injury to the ligamentous structures surrounding a joint. Subluxation is a partial displacement of the joint surface.

A patient is found to have a partially dislocated shoulder. How should the nurse document this finding? A. Rupture B. Fracture C. Subluxation D. Misalignment

C. Rationale Subluxation, also known as dislocation, may be assessed by means of palpation of the space between the head of the bone and the cavity where it is normally located. Subluxation results in partial loss of function and intense pain. A subluxation is not a fracture—there is no break in bone integrity—but a subluxation is treated similarly to a fracture. With subluxation, there is no rupture in the integrity of the bone. Subluxation may be described as a misalignment, but this is not an accurate term.

Which intervention will reduce the risk of infection in a patient who has sustained an open fracture of the femur? Applying an ice pack Administer analgesics Administering tetanus prophylaxis Immobilizing the affected extremity

C. Rationale Tetanus prophylaxis is administered when the patient has an open wound and an increased risk of infection. Application of ice may help relieve pain. Analgesics may help to relieve pain. Immobilizing the extremity helps in providing comfort.

Which type of adult is at an increased risk for carpel tunnel syndrome (CTS)? Male with asthma Male with glaucoma Female with asthma Female with diabetes mellitus

D. Patients with diabetes mellitus have greater incidence of CTS. Women have smaller carpel tunnels compared to men and are more prone to develop CTS. Men and women with asthma as well as men with glaucoma are at a lesser risk for CTS.

A patient sustains a severe hip injury with dislocation in the posterior direction. Joint aspiration reveals hemarthrosis. What condition does the nurse suspect? A. Bursitis B. Arthrofibrosis C. Avascular necrosis D. Intraarticular fracture

D. RATIONALE Severe injury may result from posterior hip dislocation due to damage to the ligament structure around the joint. The presence of hemarthrosis indicates an intraarticular fracture and bleeding into the joint space. Bursitis is the inflammation of closed sac bursae. Arthrofibrosis is the "freezing" of the shoulder after prolonged immobilization after surgery. Avascular necrosis is associated with inadequate blood supply, resulting in bone cell death.

What is the best intervention for a patient with an anterior cruciate ligament (ACL) injury who evidences tight and painful effusion? A. Applying ice B. Elevating the knee C. Administering aspirin D. Preparing for aspiration

D. RATIONALE The anterior cruciate ligament injury may involve a tear from the bone attachments that form the knee. The patient may report a tight and painful effusion, and a joint aspiration may be needed. Application of ice interferes with transmission of pain impulses and may not help in joint effusion. Elevation of the knee relieves edema. Nonsteroidal antiinflammatory drugs (NSAIDs) such as aspirin may relieve the pain at the injury site, but may not relieve effusion.

A patient reports a clicking, popping, and locking sensation with knee instability and tests positive when performing McMurray's test. Which condition can occur in the patient, if this is left untreated? A. Bursitis B. Pathologic fracture C. Avascular necrosis D. Quadriceps atrophy

D. Rationale A clicking, popping, and locking sensation with knee instability along with a positive McMurray's test indicate a meniscus injury. If untreated for a prolonged period, the meniscus injury may result in quadriceps atrophy due to disuse of the muscle. Bursitis is inflammation of the bursae and is not due to a meniscus injury. Avascular necrosis results from a lack of blood flow to the bones and does not occur due to untreated meniscus injury. A pathologic fracture is not associated with the prolonged lack of treatment of meniscus injury.

A patient experiences a ligament injury to the ankle joint. Which instruction by the nurse would be most helpful to relieve edema? A. Apply ice to the affected area. B. Elevate the injured part above the heart level. C. Immobilize the injured part for a prolonged period. D. Wrap an elastic bandage from distal to proximal end.

D. Rationale An elastic bandage should be wrapped around the injured part to relieve edema and encourage venous return. The ice application may also help in reducing edema but may not be as beneficial as the bandage. The injured part should also be elevated above the heart level to help mobilize the excess fluid from the affected area. Immobilization of the injured part for prolonged periods increases the risk of venous stasis.

What is impingement syndrome? A. The tear within the muscle or tendons and ligament structures around the shoulder B. The entrapment of soft tissue structures under the coracoacromial arch of the shoulder C. The traumatic tearing of a ligament by deceleration forces, combined with pivoting of the knee D. The injury to fibrocartilage of the knee characterized by popping, clicking, and tearing sensations

D. Rationale Impingement syndrome is the entrapment of soft tissue structures under the coracoacromial arch of shoulder. The tear within the muscle or tendons or ligament structures around the shoulder is a rotator cuff tear. Anterior cruciate ligament injury is the traumatic tearing of the ligament caused by deceleration forces combined with pivoting of the knee. A meniscus injury is an injury to the fibrocartilage of knee characterized by popping, clicking, and tearing sensation.

The nurse reviews the plan of care for the initial management of a patient with an injured ankle ligament. Which item listed on the care plan requires attention? A. Apply ice to the ankle. B. Limit movement of the ankle. C. Keep the affected ankle elevated. D. Apply warm, moist heat to the ankle.

D. Rationale The application of warm compresses should be applied after the acute phase of injury as the risk of internal bleeding subsides. Ice should be applied to the ankle to reduce inflammation and pain. The ankle should be elevated to prevent swelling and encourage fluid drainage. The movement of the ankle should be restricted to relive pain and provide rest.

The nurse reviews the results of a magnetic resonance image (MRI) study that was performed on a patient with a severe shoulder injury. Which MRI finding has the potential risk of dislocation? A. Tearing of the ligaments around the shoulder joint B Mild tears within the muscles around the shoulder joint C. Severe tearing within the muscles around the shoulder joint D. Deformation injury to the humerus around the shoulder joint

D. Rationale The patient with a dislocation may have deformation injury to the humerus around the shoulder joint. Tearing of ligaments in the shoulder may not indicate a dislocation. Mild tears in the shoulder muscles may not indicate dislocation. Severe tearing in the shoulder muscles may not indicate dislocation.

When teaching a group of athletes about reducing the risk of sprains and strains before vigorous exercise, what instructions should the nurse include? Rest after exercise. Rest before exercise. Avoid vigorous exercise. Warm up before exercise.

D. Rationale Warming up muscles before exercising and vigorous activity, followed by stretching, may significantly reduce the risk of sprains and strains. Resting before vigorous exercise may cause sprains and strains. In this group of athletes, vigorous exercise can be done, but it should be done after appropriate warming up. Resting after the exercise does not affect the risk of strains and sprains.

A patient experiences a traumatic tear of ligament caused by an excessive deceleration force combined with rotation of the limb. What diagnosis does the nurse suspect? Ligament injury Meniscus injury Rotator cuff tear Anterior cruciate ligament tear

Rationale An anterior cruciate ligament tear is the traumatic tearing of the ligament by excessive deceleration forces together with pivoting or rotating positions of the knee. Ligament injury can be described as traumatic tearing and stretching of a ligament as a result of excessive torque applied to the joint. Meniscus injury to the fibrocartilage of the knee is characterized by popping, clicking, tearing sensation, effusion, and swelling. A rotator cuff tear is a tear within muscle or tendinoligamentous structures around the shoulder.

Which patient condition may result in bursitis? A. Fracture B. Meniscus injury C. Rheumatoid arthritis D. Carpal tunnel syndrome

Rationale Bursitis is the inflammation of the closed sacs lined by the synovial membrane that contain synovial fluid. This inflammation may result from rheumatoid arthritis, which is a chronic disease causing inflammation in the joints. A fracture is a disruption in bone continuity and is unlikely to cause bursitis. Meniscus injuries are associated with ligament sprains and may not lead to bursitis. Carpal tunnel syndrome is median nerve compression and is not associated with bursitis.

While examining a patient with an injury to the distal humerus, the nurse suspects that the patient has compartment syndrome. What findings in the patient could have raised this suspicion? Select all that apply. A. Pyrexia B. Paralysis of the arm C. Redness and warmth D. Pain unrelieved by opioids E. Absence of the peripheral pulse

Rationale Compartment syndrome may occur initially from the body's physiologic response to the injury, or it may be delayed for several days after the injury. The usual signs include weakness and paralysis of the arm, absence of peripheral pulses, and pain that is not relieved by opioids. These signs are due to decreased compartment size resulting from an injury. The resultant pressure may compromise the function of blood vessels, nerves, or tendons that run through that compartment. Pyrexia indicates infection, but it is not a sign that suggests compartment syndrome. Redness and warmth may not be present; instead, the skin may be pale and cold to the touch.

What is the most useful initial nursing action for a patient who sustains a joint sprain? A. Applying ice compresses to the injured area B. Administering an over-the-counter analgesic C. Seeking a prescription for a prophylactic antibiotic D. Providing the patient with instructions about weight bearing

Rationale Ice application is the most useful intervention after a sprain. Cold compression produces hypothermia of the affected area, facilitating vasoconstriction and reducing the perception and transmission of nerve pain impulses. Antibiotic prophylaxis is administered for an open fracture or external extremity injury. Analgesics such as aspirin can be administered after the cold compress. Patient instructions should be provided after the extent of the injury is determined and initial interventions performed.

A patient experiences a tearing of a ligament as a result of shearing stresses applied to a joint. What diagnosis does the nurse anticipate? Ligament injury Rotator cuff tear Overuse syndrome Impingement syndrome

Rationale Ligament injury is the tearing or stretching of a ligament as a result of inversion, eversion, shearing, or torque applied to a joint. Overuse syndrome results from prolonged force or repetitive movements and awkward postures. A tear within the muscle or tendinoligamentous structures around the shoulder is a rotator cuff tear. Impingement syndrome is the entrapment of soft tissue structures under the coracoacromial arch of the shoulder.

The nurse assists in performing annual well visits for four patients. Which patient is least likely to develop overuse syndrome? A dancer A musician A football player A grocery store cashier

Rationale Repetitive strain injury (RSI) may result from prolonged force or repetitive movements and awkward postures. The repeated movements strain the tendons, ligaments, and muscles, causing tiny tears. It may result in inflammation, swelling, and pain in the muscles and nerves of the neck, shoulder, forearm, and hand. Persons at risk for RSI include dancers, musicians, grocery clerks, and workers who use power tools that cause vibration. The football player is least likely to develop this condition.

What is a key benefit associated with strengthening exercises? Reduction of pain Prevention of falls Elimination of infection Building of bone density

Rationale Strengthening exercises that involve working against resistance help to build bone density. Balancing exercises may help in prevention of falls. Pain reduction is not associated with these exercises. Strength exercises do not cure or treat infections.

A patient reports pain and inflammation of the knee. The nurse flexes the knee by 15 to 30 degrees and also pulls the tibia forward while keeping the femur stable. The nurse feels a soft forward motion of the tibia with an indistinct endpoint. What diagnosis does the nurse anticipate? Bursitis Rotator cuff injury Carpal tunnel syndrome Anterior cruciate ligament injury

Rationale The knee with an anterior cruciate ligament tear may produce a positive Lachman's test. This test involves flexing the knee by 15 to 30 degrees and pulling the tibia forward, keeping the femur stable. It is considered positive with forward motion of the tibia with a soft feeling and indistinct endpoint. This test is not performed to assess bursitis. A rotator cuff injury may be examined by a drop arm test. Carpel tunnel syndrome may be examined by positive results for Tinel's sign and Phalen's sign.

A patient with a history of a cervical injury frequently works at a desk and uses a computer. The patient reports a recurrence of pain and stiffness in the neck. Which action may be the cause of the symptoms? The patient takes hourly stretch breaks. The patient elevates the wrist when typing. The patient keeps the top of the computer monitor even with the forehead. The patient keeps the hips and knees flexed to 90 degrees with feet flat while sitting.

Rationale The patient with a cervical injury who frequently works at a desk and uses the computer may suffer from a repetitive strain injury from repetitive movements and awkward positions of the wrist. Taking hourly stretch breaks helps in promoting circulation. The computer monitor's top should be kept even with the forehead to keep the neck muscles from straining. The hips and knees should be kept flexed at 90 degrees with the feet flat.