Med Surg: Chapter 42: Nursing Management: Patients With Musculoskeletal Trauma

Two days after application of a cast to treat a fractured femur, the client reports severe, deep, and constant pain in the leg. What willl the nurse suspect? A Chronic venous insufficiency. B Compartment syndrome. C Phlebitis. D Infection.

B Compartment syndrome refers to the compression of nerves, blood vessels, and muscle within a closed space. This leads to tissue death from lack of oxygenation

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

C

Which of the following musculoskeletal injuries is manifested by acromioclavicular joint pain? A Acute compartment syndrome B Heterotopic ossification C Rotator cuff tears D Epicondylitis

C

Which type of fracture involves a break through only part of the cross-section of the bone? A Comminuted B Open C Incomplete D Oblique

C

Which nursing diagnosis takes highest priority for a client with a compound fracture? A Imbalanced nutrition: Less than body requirements related to immobility B Risk for infection related to effects of trauma C Impaired physical mobility related to trauma D Activity intolerance related to weight-bearing limitations

B

A client presents to the emergency department with an open fracture. What is the first action the nurse should take? A Assist the physician with reduction of the fracture. B Assess the client's vital signs and determine allergies. C Perform a neurovascular assessment of the affected extremity. D Cover the exposed bone with sterile dressing.

D

Which term refers to the failure of fragments of a fractured bone to heal together? A Malunion B Dislocation C Subluxation D Nonunion

D

An adult is swinging a small child by the arms, and the child screams and grabs his left arm. It is determined in the emergency department that the radial head is partially dislocated. What is this partially dislocated radial head documented as? A Subluxation B Volkmann's contracture C Compartment syndrome D Sprain

A A partial dislocation is referred to as a subluxation. A Volkmann's contracture is a claw like deformity that results from compartment syndrome or obstructed arterial blood flow to the forearm and hand. Compartment syndrome is a condition in which a structure such as a tendon or nerve is constricted in a confined space and affects nerve innervation, leading to subsequent palsy. A sprain is injury to the ligaments surrounding the joint.

A patient is recovering in the hospital following a total hip replacement that was performed 2 days ago. In an effort to prevent the common complications associated with the surgical procedure, the nurse should implement which of the following interventions, as ordered? A Application of sequential compression devices B Intermittent urinary catheterization to prevent urinary retention C Provision of a low-fiber, high-calorie diet D Passive range-of-motion (ROM) exercises with the affected leg

A

The nurse is caring for a client who was involved in an automobile accident and sustained multiple trauma. The client has a Volkmann's contracture to the right hand. What objective data does the nurse document related to this finding? A Clawlike deformity of the right hand without ability to extend fingers B Nodules on the knuckles of the third and fourth finger C Extension of the fingers of the right hand D Dislocation of the fingers

A A Volkmann's contracture is a claw like deformity of the hand resulting from obstructed arterial blood flow to the forearm and hand. The client is unable to extend the fingers and complains of unrelenting pain, particularly if attempting to stretch the hand

A 77-year-old man is recovering in the hospital after a recent femoral fracture and has rung his call light. The nurse has entered the room to find the patient in distress, clutching his chest while struggling to say, "I can't breathe." The nurse should take prompt action based on the knowledge that this patient may be experiencing what complication of lower extremity fractures? A Thromboembolism B Acute respiratory distress syndrome (ARDS) C Ischemic stroke D Unstable angina

A Venous thromboemboli, including deep vein thrombosis (DVT) and pulmonary emboli (PE), are associated with reduced skeletal muscle contractions and bed rest. Patients with fractures of the lower extremities and pelvis are at high risk for venous thromboemboli. The most frequent signs are sudden onset shortness of breath, restlessness, increased respiratory rate, tachycardia, chest pain, and low-grade temperature. Angina, ARDS and stroke are not common complications of skeletal fractures.

The nurse is caring for a patient who sustained an open fracture of the right femur in an automobile accident. What does the nurse understand is the most serious complication of an open fracture? A Muscle atrophy caused by loss of supporting bone structure B Infection C Nerve damage D Necrosis of adjacent soft tissue caused by blood loss

B

A nurse suspects that a client with a recent fracture has compartment syndrome. Assessment findings may include: A body-wide decrease in bone mass. B inability to perform active movement and pain with passive movement. C inability to perform passive movement and pain with active movement. D a growth in and around the bone tissue.

B With compartment syndrome, the client can't perform active movement, and pain occurs with passive movement. A body-wide decrease in bone mass is seen in osteoporosis. A growth in and around the bone tissue may indicate a bone tumor.

A client reports pain in the right knee, stating, "My knee got twisted when I was going down the stairs." The client was diagnosed with an injury to the ligaments and tendons of the right knee. Which terminology, documented by the nurse, best reflects the injury? A Subluxation B Strain C Sprain D Dislocation

C

When is it advisable for the nurse to apply heat to a sprain or a contusion? A Only after a week B Do not apply at all C After 2 days D Immediately

C It is advisable to apply heat on a sprain or a contusion 2 days after a sprain or a contusion has occurred. This is because after 2 days swelling is not likely to increase and as a result heat application reduces pain and relieves local edema by improving circulation. Delaying the application of heat prolongs the pain and increased the risk of local edema

Which of the following would lead a nurse to suspect that a client has a rotator cuff tear? A Increased ability to stretch arm over the head B Pain worse in the morning C Minimal pain with movement D Difficulty lying on affected side

D

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

D A contusion is a soft tissue injury produced by blunt force, such as a blow, kick, or fall, that results in bleeding into soft tissues (ecchymosis, or bruising). A hematoma develops when the bleeding is sufficient to form an appreciable solid swelling. A strain, or a "pulled muscle," is an injury to a musculotendinous unit caused by overuse, overstretching, or excessive stress. A sprain is an injury to the ligaments and supporting muscle fibers that surround a joint often caused by a trauma, wrenching or twisting motion.

When the client who has experienced trauma to an extremity reports severe burning pain, vasomotor changes, and muscles spasms in the injured extremity, the nurse recognizes that the client is likely demonstrating signs of A heterotrophic ossification. B complex regional pain syndrome. C avascular necrosis of bone. D a reaction to an internal fixation device.

B

A client with metastatic bone cancer sustained a left hip fracture without injury. What type of fracture does the nurse understand occurs without trauma or fall? A Impacted fracture B Pathologic fracture C Compound fracture D Transverse fracture

B A pathologic fracture is a fracture that occurs through an area of diseased bone and can occur without trauma or a fall. An impacted fracture is a fracture in which a bone fragment is driven into another bone fragment. A transverse fracture is a fracture straight across the bone. A compound fracture is a fracture in which damage also involves the skin or mucous membranes.

A client who suffers an injury in a local high school hockey game presents with left shoulder pain. The client cannot move the left arm, and the left shoulder is lower than the right shoulder. The nurse recognizes the client most likely has a: A Cervical injury B Dislocated shoulder C Clavicle fracture D Dislocated elbow

B Clinical manifestations of a dislocated shoulder include pain, lack of motion, feeling of an empty shoulder socket, and uneven posture

After surgery to treat a hip fracture, a client returns from the postanesthesia care unit to the medical-surgical unit. Postoperatively, how should the nurse position the client? A With the leg on the affected side abducted B With the affected hip rotated externally C With the leg on the affected side adducted D With the affected hip flexed acutely

A The nurse must keep the leg on the affected side abducted at all times after hip surgery to prevent accidental dislodgment of the affected hip joint. Placing a pillow or an A-frame between the legs helps maintain abduction and reminds the client not to cross the legs. The nurse should avoid acutely flexing the client's affected hip (for example, by elevating the head of the bed excessively), adducting the leg on the affected side (such as by moving it toward the midline), or externally rotating the affected hip (such as by removing support along the outer side of the leg) because these positions may cause dislocation of the injured hip joint.

Which is a hallmark sign of compartment syndrome? A Weeping skin surfaces B Edema C Pain D Motor weakness

C

A client has been in a motor vehicle collision. Radiographs indicate a fractured humerus; the client is awaiting the casting of the upper extremity and admission to the orthopedic unit. What is the primary treatment for musculoskeletal trauma? A external rotation B immobilization C surgical repair D enhancing complications

B

A patient has sustained a long bone fracture. The nurse is preparing a care plan for this patient. Which nursing action should the nurse include in the care plan to enhance fracture healing? A Administer high doses of corticosteroids. B Avoid prolonged immobilization of the fracture fragments. C Monitor color, temperature, and pulses of the affected extremity. D Limit weight-bearing and exercising during the recovery.

C The nurse should include monitoring for sufficient blood supply by assessing the color, temperature, and pulses of the affected extremity as adequate blood supply enhances the healing of a fracture. Factors that inhibit fracture healing include inadequate or lack of immobilization of the fracture fragments and administration of corticosteroids. Weight-bearing exercises are encouraged for patients with long bone fracture

A client is treated in the emergency department for acute muscle strain in the left leg caused by trying a new exercise. During discharge preparation, the nurse should provide which instruction? A "Apply ice packs for the first 12 to 18 hours." B "Apply heat packs for the first 24 to 48 hours." C "Apply heat packs for the first 24 hours, then apply ice packs for the next 48 hours." D "Apply ice packs for the first 24 to 48 hours, then apply heat packs."

D The nurse should instruct the client to apply ice packs to the injured area for the first 24 to 48 hours to reduce swelling and then apply heat to increase comfort, promote reabsorption of blood and fluid, and speed healing. Applying ice for only 12 to 18 hours may not keep swelling from recurring. Applying heat for the first 24 to 48 hours would worsen, not ease, swelling. Applying ice 48 hours after the injury would be less effective because swelling already has occurred by that time.

The primary nursing intervention that will control swelling while treating a musculoskeletal injury is: A Immobilize the injured area. B Apply cold (moist or dry). C Apply an elastic compression bandage. D Elevate the affected area.

D The acronym RICE—Rest, Ice, Compression, Elevation—is helpful for remembering treatment interventions for musculoskeletal injuries. Rest prevents additional injury and promotes healing. Intermittent application of moist or dry cold packs for 20-30 minutes during the first 24-48 hours after injury produces vasoconstriction, which decreases bleeding, edema, and discomfort. Ensure care to avoid skin and tissue damage from excessive cold. An elastic compression bandage controls bleeding, reduces edema, and provides support for the injured tissues. Elevation controls the swelling.

A client who has sustained a fracture reports an increase in pain and decreased function of the affected extremity. What will the nurse suspect? A Infection B Avascular necrosis C Hypovolemic shock D Pulmonary embolism

B Avascular necrosis refers to the death of the bone from insufficient blood supply, typically manifested by complaints of increased pain and decreased function. Fever or redness, purulent drainage, and swelling of the site would suggest infection. Respiratory distress would suggest a pulmonary embolism. Changes in vital signs, level of consciousness, and signs and symptoms of fluid loss would suggest hypovolemic shock.

The nurse is assessing a patient's right knee, and the assessment reveals edema, tenderness, muscle spasms, and ecchymosis. The patient states that 2 days ago he ran a half marathon and now it is painful to stand up. Based upon these symptoms, the nurse should plan care based upon the fact that the patient has likely experienced what? A. 1st degree strain B. 1st degree sprain C. 2nd degree strain D. 2nd degree sprain

C A second-degree strain involves tearing of muscle fibers and is manifested by notable loss of load-bearing strength with accompanying edema, tenderness, muscle spasm, and ecchymosis. A first-degree strain reflects tearing of few muscle fibers and is accompanied by minor edema, tenderness, and mild muscle spasm, without noticeable loss of function

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

D A sprain is caused by a wrenching or twisting motion. Dislocation refers to the separation of joint surfaces. Subluxation refers to partial separation or dislocation of joint surfaces. Strain refers to a muscle pull or tear.

Radiographs were ordered for a 10-year-old boy who had his right upper arm injured. The radiographs show that the humerus appears to be fractured on one side and slightly bent on the other. What type of fracture is this an example of? A Compound B Impacted C Compression D Greenstick (incomplete)

D Greenstick fractures are a result of the bone being broken on one side, while the other side is bent.

A client is being discharged from the Emergency Department after being diagnosed with a sprained ankle. Which client statement indicates the client understands the discharge teaching? A "I'll get the prescription filled for the narcotic pain reliever." B "I need to stay off my ankle for at least the next 3 to 4 weeks." C "I'll start with ice for the first couple of hours and then apply heat." D "I'll make sure to keep my ankle elevated as much as possible."

D Treatment consists of applying ice or a chemical cold pack to the area to reduce swelling and relieve pain for the first 24 to 48 hours. Elevation of the part and compression with an elastic bandage also may be recommended. After 2 days, when swelling no longer is likely to increase, applying heat reduces pain and relieves local edema by improving circulation.

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? A. Encourage the client to perform range-of-motion (ROM) exercises to the right leg. B Provide wound care without discussing the amputation. C Request a referral to occupational therapy. D Provide feedback on the client's strengths and available resources.

D

A patient has stepped in a hole in the yard, causing an ankle injury. The ankle is edematous and painful to palpation. How long should the nurse inform the patient that the acute inflammatory stage will last? A About 72 hours B At least 1 week C Less than 24 hours D Between 24 and 48 hours

D After the acute inflammatory stage (e.g., 24 to 48 hours after injury), intermittent heat application (for 15 to 30 minutes, four times a day) relieves muscle spasm and promotes vasodilation, absorption, and repair.