Musculoskeletal Final Exam quiz

A client has undergone an external fixation. Which actions would be the priority for this client?

Maintaining pin care. Explanation: Pin care is a priority for a client with external fixation, because pin sites are entry points for infection. The nurse should also monitor redness, drainage, and tenderness at the site. Planning the client's diet and monitoring the client's urine output and blood pressure, although necessary, are not as important as maintaining pin care.

Which actions by the nurse demonstrate an understanding of caring for a client in traction? Select all that apply.

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.

The primary nursing intervention that will control swelling while treating a musculoskeletal injury is:

Elevate the affected area. Explanation: Elevation is used to control swelling. It is facilitated by cold, immobilization, and compression. Refer to Box 42-1 in the text.

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."

The typical client reports either acute back pain

lasting fewer than 3 months

A client with a fractured femur is admitted to the nursing unit. Which assessment finding requires follow up by the nurse? Select all that apply.

"I cannot seem to catch my breath." "I have a pins-and-needles sensation in my toes." Dorsiplantar weak and unequal bilaterally T 101.2 degrees F; HR 110; RR 28; pulse oximetry 90% Explanation: Fat embolism syndrome and compartment syndrome are complications of a fracture, especially of the long bones. Dyspnea, tachycardia, tachynea, fever, and low pulse oximetry would be indicators of fat embolism syndrome. Paresthesia (pins-and-needles sensation), limited motion, and motor weakness would be indicators of compartment syndrome. Capillary refill less than 3 seconds is a normal finding.

Which instruction should the nurse include when teaching the client following hip replacement surgery? (Select all that apply.)

"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 comes back to the clinic with a continued complaint of back pain. What time frame does the nurse understand constitutes "chronic pain"?

3 months

A client who has sustained a fracture reports an increase in pain and decreased function of the affected extremity. What will the nurse suspect?

Avascular necrosis

Which of the following is the first-line medication that would be used to treat and prevent osteoporosis?

Bisphosphonates Explanation: Bisphosphonates, along with calcium and vitamin D supplements, are the first-line medications given to prevent/treat osteoporosis. The other medications are prescribed after these drugs are used.

A client has had a cast placed for the treatment of a humeral fracture. The nurse's most recent assessment shows signs and symptoms of compartment syndrome. What is the nurse's most appropriate action?

Contact the primary provider immediately. Explanation: This major neurovascular problem is caused by pressure within a muscle compartment that increases to such an extent that microcirculation diminishes, leading to nerve and muscle anoxia and necrosis. Function can be permanently lost if the anoxic situation continues for longer than 6 hours. Therefore, immediate medical care is a priority over further nursing assessment. Assessment of calcium levels is unnecessary.

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.)

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.

A client with a right below-the-knee amputation is being transferred from the postanesthesia care unit to a medical-surgical unit. What is the highest priority nursing intervention by the receiving nurse?

Ensure that a large tourniquet is in the room. Explanation: The client with an amputation is at risk for hemorrhage. A tourniquet should be placed in plain sight for use if the client hemorrhages. Documenting the receiving report is important but is not the highest priority.

The nurse is providing care for a client who has had a below-the-knee amputation. The nurse enters the client's room and finds the client resting in bed with his residual limb supported on pillow. What is the nurse's most appropriate action?

Explain the risks of flexion contracture to the client.

A female client is at risk for developing osteoporosis. Which action will reduce the client's risk?

Initiating weight-bearing exercise routines Explanation: Performing weight-bearing exercise increases bone health. A sedentary lifestyle increases the risk of developing osteoporosis. Estrogen is needed to promote calcium absorption. The recommended daily intake of calcium is 1,000 mg, not 300 mg.

An unresponsive client had a plaster cast applied to the right lower leg 8 hours ago. When moving the client, the nurse notices an indentation on the posterior lower portion of the cast. What is the best action by the nurse?

Notify the physician. Explanation: Indentations in the cast can cause skin irritation and breakdown. The physician needs to be notified to assess the need for a new cast or manipulation of the current cast to prevent the skin breakdown. The nurse will need to document the findings and actions taken to resolve the issue but cannot document actions without completing an action, such as notifying the physician. The cast does not need to be removed immediately. Pedal pulse will indicate whether a circulatory issue is present, but with the client being unresponsive, mobility of the toes cannot be assessed.

which intervention should the nurse implement when caring for the client who complains of phantom limb pain two months after amputation?

Reassure the client that phantom pain is common.

A nurse is planning the care of an older adult client who will soon be discharged home after treatment for a fractured hip. In an effort to prevent future fractures, the nurse should encourage what actions? Select all that apply.

Regular bone density testing A high-calcium diet Use of falls prevention precautions Weight-bearing exercise

Which nursing diagnosis takes highest priority for a client with a compound fracture?

Risk for infection related to effects of trauma

The nurse has identified the diagnosis of Risk for Impaired Tissue Perfusion Related to Deep Vein Thrombosis in the care of a client receiving skeletal traction. What nursing intervention best addresses this risk?

Teach the client to perform ankle and foot exercises within the limitations of traction.

A patient had a total left hip arthroplasty. What clinical manifestation would indicate to the nurse that the prosthesis is dislocated?

The left leg is internally rotated.

A client with low back pain is being seen in the clinic. In planning care, which teaching point should the nurse include?

Use the large muscles of the leg when lifting items.

While reading a client's chart, the nurse notices that the client is documented to have paresthesia. The nurse plans care for a client with

abnormal sensations.

A client is hospitalized for open reduction of a fractured femur. During the postoperative assessment, the nurse notes that the client is restless and observes petechiae on the client's chest. Which nursing action is indicated first?

Administer oxygen. explanation: The client is demonstrating clinical manifestations consistent with a fatty embolus. Administering oxygen is the top priority. Elevating the extremity won't alter the client's condition. Notifying the nursing supervisor may be indicated by facility policy after other immediate actions have been taken. The nurse should contact the health care provider after administering oxygen.

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?

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 nurse is assigned to support a patient while a cast is being applied to treat a greenstick fracture. The nurse documents that this fracture is classified as what type of fracture?

Incomplete

The client with a newly applied cast reports severe unrelenting pain. What is the nurse's best response?

Make the client NPO and notify the health care provider. Explanation: The client is exhibiting symptoms of compartment syndrome. The health care provider needs to be contacted as treatment options include bivalving of the cast or a possible fasciotomy, a surgical procedure.

The nurse is conducting an admission history of a client admitted with a fracture. The nurse recognizes that which of the client's medications placed the client at risk for fractures?

prednisone (Deltasone) Explanation: Prednisone, a corticosteroid, causes increased bone resorption and decreased bone formation, resulting in increased risk for fractures.

A client was fitted with an arm cast after fracturing her humerus. Twelve hours after the application of the cast, the client tells the nurse that her arm hurts. Analgesics do not relieve the pain. What would be the most appropriate nursing action?

Prepare the client for opening or bivalving of the cast. Explanation: Acute compartment syndrome involves a sudden and severe decrease in blood flow to the tissues distal to an area of injury that results in ischemic necrosis if prompt, decisive intervention does not occur. Removing or bivalving the cast is necessary to relieve pressure. Prescribing different analgesics does not address the underlying problem. Encouraging the client to move the fingers or perform range-of-motion exercises will not treat or prevent compartment syndrome. Petaling the edges of a cast with tape prevents abrasions and skin breakdown, not compartment syndrome.

A client with diabetes punctured his foot with a broken acorn in the yard. Within a week, the client developed osteomyelitis of the foot. The client was admitted for IV antibiotic therapy. How long does the nurse anticipate the client will receive IV antibiotics?

3 to 6 weeks

Which action would be most important postoperatively for a client who has had a knee or hip replacement?

Assisting in early ambulation. Explanation: An anticoagulant therapy and early ambulation are important for clients who undergo a knee or hip replacement.