prepuU ch.37 musculosk

A client with a recent left above-the-knee amputation states, "I can feel pain in my left toes." Which is the best response by the nurse? "Pain medication usually does not help this type of pain." "Describe the pain and rate it on the pain scale." "Your left toes have been amputated." "The pain is really from the nerves in the upper leg."

"Describe the pain and rate it on the pain scale."

A client asks the nurse why his residual limb cannot be elevated on a pillow. What is the best response by the nurse? "Elevating the extremity may increase your chances of compartment syndrome." "Elevating the leg might lead to a flexion contracture." "I am sorry. We ran out of pillows. I can elevate it on a few blankets." "You need to turn yourself side to side. If your leg is on a pillow, you would not be able to do that."

"Elevating the leg might lead to a flexion contracture."

The nurse is caring for a patient after arthroscopic surgery for a rotator cuff tear. The nurse informs the patient that full activity can usually resume after what period of time? 8 weeks 3 to 4 months 3 to 4 weeks 6 to 12 months

6 to 12 months

Which would be an inappropriate initial pain relief measure for the client with a cast? Application of cold packs Elevation of the involved part Application of a new cast Administration of analgesics

Application of a new cast

When providing discharge teaching to a client with a fractured toe, the nurse should include which instruction? Perform ankle dorsiflexion three times per day. Apply ice to the fracture site. Apply heat to the fracture site. Use crutches for 1 week.

Apply ice to the fracture site.

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? Dislocation of the fingers Nodules on the knuckles of the third and fourth finger Extension of the fingers of the right hand Claw-like deformity of the right hand without ability to extend fingers

Claw-like deformity of the right hand without ability to extend fingers

An x-ray demonstrates a fracture in which a bone has splintered into several pieces. Which type of fracture is this? Depressed Impacted Compound Comminuted

Comminuted

An x-ray demonstrates a fracture in which a bone has splintered into several pieces. Which type of fracture is this? Impacted Depressed Comminuted Compound

Comminuted

A client sustains a fractured right humerus in an automobile accident. The arm is edematous, the client states not being able to move or feel the fingers, and the nurse does not feel a pulse. What condition should the nurse be concerned about that requires emergency measures? Compartment syndrome Muscle spasms Dislocation Subluxation

Compartment syndrome

In a client with a dislocation, the nurse should initially perform neurovascular assessments a minimum of every 15 minutes until stable. Which complication does the assessments help the nurse to monitor in the client? Fat embolism syndrome Disseminated intravascular coagulation Carpal tunnel syndrome Compartment syndrome

Compartment syndrome

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? Apply a fiberglass cast. Initiate physical therapy. Remove the cast. Cut a cast window.

Cut a cast window.

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? Removal of the cast Insertion of an external fixator Cutting of a bivalve cast Cutting a cast window

Cutting a cast window

A client is reporting pain following orthopedic surgery. Which intervention will help relieve pain? Breathe deeply and cough every 2 hours until ambulation is possible. Elevate the affected extremity and use cold applications. Apply antiembolism stockings as indicated. Do ROM exercises as indicated.

Elevate the affected extremity and use cold applications.

Which nursing intervention is appropriate for a client with a closed-reduction extremity fracture? Administer prescribed enema to prevent constipation Promote intake of omega-3 fatty acids Encourage participation in ADLs Use frequent dependent positioning to prevent edema

Encourage participation in ADLs

A patient in pelvic traction needs circulatory status assessed. How should the nurse assess for a positive Homans' sign? 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. Have the patient squeeze the nurse's hands with his or her hands to evaluate any difference in strength.

Have the patient extend each leg and dorsiflex each foot to determine if pain or tenderness is present in the lower leg.

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 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

Maintaining traction continuously to ensure its effectiveness

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

Obtaining a culture

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

Open reduction

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

Pain

A nurse is caring for a client who underwent a total hip replacement. What should the nurse and other caregivers do to prevent dislocation of the new prosthesis? Keep the affected leg in a position of adduction. Use measures other than turning to prevent pressure ulcers. Prevent internal rotation of the affected leg. Keep the hip flexed by placing pillows under the client's knee.

Prevent internal rotation of the affected leg.

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. Apply the traction straps snugly. Teach the client how to prevent problems caused by immobility.

Teach the client how to prevent problems caused by immobility.

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 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 leg strength is enforced by the wearing of the cast.

The skin may be covered with a yellowish crust that will shed in a few days.

Which of the following are associated with compartment syndrome? Select all that apply. Crushing injuries Casts Trauma from accidents Surgery Tight bandages

Trauma from accidents Surgery Casts Tight bandages Crushing injuries

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

Weights hanging and touching the floor

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

osteomyelitis

A client has a history of dislocations of the same joint. The nurse understands that this is most likely due to an insufficient deposit of collagen during the healing process, leading to: loss of function. allergic reaction. reduced tensile strength. lack of mobility.

reduced tensile strength.

A client undergoes a total hip replacement. Which statement made by the client indicates to the nurse that the client requires further teaching? "I don't know if I'll be able to get off that low toilet seat at home by myself." "The occupational therapist is showing me how to use a sock puller to help me get dressed." "I need to remember not to cross my legs. It's such a habit." "I'll need to keep several pillows between my legs at night."

"I don't know if I'll be able to get off that low toilet seat at home by myself."

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

"Metal pins will go through my skin to the bone."

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

Assessing the extremity for neurovascular integrity

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

Avascular necrosis

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

Compartment syndrome.

A client is admitted to the emergency room after being hit by a car while riding a bicycle. The client sustained a fracture of the left femur, and the bone is protruding through the skin. What type of fracture does the nurse recognize requires emergency intervention? Greenstick Oblique Spiral Compound

Compound

The nurse in an orthopedic clinic is caring for a new client. What sign or symptom would lead a nurse to suspect that a client has a rotator cuff tear? Difficulty lying on affected side Pain worse in the morning Minimal pain with movement Ability to stretch arm over the head

Difficulty lying on affected side

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

Difficulty lying on affected side

After a car accident, a client is admitted to an acute care facility with multiple traumatic injuries, including a fractured pelvis. For 24 to 48 hours after the accident, the nurse must monitor the client closely for which potential complication of a fractured pelvis? Fat embolism Compartment syndrome Volkmann's ischemic contracture Infection

Fat embolism

Which factor inhibits fracture healing? Local malignancy Exercise Maximum bone fragment contact Vitamin D

Local malignancy

A fracture is considered pathologic when it involves damage to the skin or mucous membranes. results in a fragment of bone being pulled away by a ligament or tendon and its attachment. occurs through an area of diseased bone. presents as one side of the bone being broken and the other side being bent.

occurs through an area of diseased bone.

A client is seen in the emergency department for an injury acquired from falling off of a bicycle and fracturing the arm. The client also has a long laceration that has been sutured in the same area. The client asks the nurse why a splint is applied and not a cast. What is the best explanation by the nurse? "You will be able to wear the splint longer than you would a cast." "The splint is less expensive than the cast." "We will need to monitor the status of the laceration to be sure it does not get infected." "The arm does not require the same immobilization that a leg fracture would."

"We will need to monitor the status of the laceration to be sure it does not get infected."

A 14-year-old client is treated in the emergency room for an acute knee sprain sustained during a soccer game. The nurse reviews discharge instructions with the client's parent. The nurse instructs the parent that the acute inflammatory stage will last how long? 4 to 5 days 24 to 48 hours At least 7 days 3 to 4 days

24 to 48 hours

An older adult client slipped on an area rug at home and fractured the left hip. The client is unable to have surgery immediately and is having severe pain. What interventions should the nurse provide for the patient to minimize energy loss in response to pain? Administer prescribed pain medication only when the client requests it. Give pain medication to the client after providing care. Administer prescribed analgesics around-the-clock. Avoid administering too much medication because the client is older.

Administer prescribed analgesics around-the-clock.

A patient sustains a fracture of the arm. When does the nurse anticipate pendulum exercise should begin? In 2 to 3 weeks, when callus ossification prevents easy movements of bony fragments In 2 to 3 months, after normal activities are resumed As soon as tolerated, after a reasonable period of immobilization In about 4 to 5 weeks, after new bone is well established

As soon as tolerated, after a reasonable period of immobilization

A client with an arm cast reports pain. What nursing interventions should the nurse provide in order to reduce the incidence of complications? Select all that apply. Administer a prescribed analgesic to promote comfort and allay anxiety. Assess for a pressure sore Cut the cast with a cast saw Assess the fingers for color and temperature. Determine the exact site of the pain.

Assess the fingers for color and temperature. Assess for a pressure sore Determine the exact site of the pain.

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

Better molding to the client

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? Contracture of the hip Dislocation of the hip Re-fracture of the hip Avascular necrosis of the hip

Dislocation of the hip

Which of the following disorders results in widespread hemorrhage andmicrothrombosis with ischemia? Avascular necrosis (AVN) Disseminated intravascular coagulation (DIC) Complex regional pain syndrome (CRPS) Fat embolism syndrome (FES)

Disseminated intravascular coagulation (DIC)

The nurse caring for a client, who has been treated for a hip fracture, instructs the client not to cross their legs and to have someone assist with tying their shoes. Which additional instruction should the nurse provide to client? Do not flex the hip more than 30 degrees. Do not flex the hip more than 120 degrees. Do not flex the hip more than 90 degrees. Do not flex the hip more than 60 degrees.

Do not flex the hip more than 90 degrees.

The nurse teaching the client with a cast about home care includes which instruction? Keep the cast below heart level Dry a wet fiberglass cast thoroughly to avoid skin problems Fix a broken cast by applying tape Cover the cast with plastic or rubber

Dry a wet fiberglass cast thoroughly to avoid skin problems

A client has delayed bone healing in a fractured right humerus. What should the nurse prepare the client for that promotes bone growth? Administration of antibiotics Joint fusion Electrical stimulation Administration of low-dose heparin

Electrical stimulation

A nurse is caring for a client who has had an amputation. What interventions can the nurse provide to foster a positive self-image? (Select all that apply.) Encouraging the client to have family and friends view the residual limb to decrease self-consciousness Introducing the client to local amputee support groups Encouraging the client to care for the residual limb Allowing the client to express grief Encouraging family and friends to refrain from visiting temporarily because this may increase the client's embarrassment

Encouraging the client to care for the residual limb Allowing the client to express grief Introducing the client to local amputee support groups

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 Deep vein thrombosis (DVT) Infection Permanent paresthesias

Foot drop

A female client has had a total hip replacement. Which of the following would the nurse do to minimize the client's risk for subluxation? Ensure the client sits with the knees higher than the hip. Maintain the client in a high-Fowler's position. Have the client sit on an elevated chair. Keep the client's legs together.

Have the client sit on an elevated chair.

While riding a bicycle on a narrow road, the patient was hit from behind and thrown into a ditch, sustaining a pelvic fracture. What complications does the nurse know to monitor for that are common to pelvic fractures? Paresthesia and ischemia Hemorrhage and shock Thrombophlebitis and infection Paralytic ileus and a lacerated urethra

Hemorrhage and shock

The nurse is monitoring a patient who sustained an open fracture of the left hip. What type of shock should the nurse be aware can occur with this type of injury? Hypovolemic Neurogenic Septicemic Cardiogenic

Hypovolemic

The client returns to the nursing unit following an open reduction with internal fixation of the right hip. Nursing assessment findings include temperature 100.8 degrees Fahrenheit, heart rate 112 beats per minute, respiratory rate 28 breaths per minute, and blood pressure 86/58. There is no urine in the Foley catheter collection bag. The nurse interprets these findings as indicating which complication? Urinary retention Osteomyelitis Hypovolemic shock Atelectasis

Hypovolemic shock

Radiographic evaluation of a client's fracture reveals that a bone fragment has been driven into another bone fragment. The nurse identifies this as which type of fracture? Compression Comminuted Greenstick Impacted

Impacted

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? Compression Closed Stress Incomplete

Incomplete

A client experienced an open fracture to the left femur during a horse-riding accident. For which complication is this client at highest risk? Infection Complex regional pain syndrome Malunion Depression

Infection

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

Instruct the client to avoid internal rotation of the leg.

A bone graft may be used for which of the following reasons? Select all that apply. Joint stabilization Reduction of a fracture Improvement of motion Stimulation of bone healing Defect filling

Joint stabilization Defect filling Stimulation of bone healing

The nurse is caring for a client with a spica cast. What is the nurse's priority intervention? Promote elimination with a regular bedpan. Keep the cast clean and dry. Position the client on the affected side. Keep the legs in abduction.

Keep the cast clean and dry.

A client undergoes open reduction with internal fixation to treat an intertrochanteric fracture of the right hip. The nurse should include which intervention in the postoperative care plan? Performing passive range-of-motion (ROM) exercises on the client's legs once each shift Maintaining the client in semi-Fowler's position Turning the client from side to side every 2 hours Keeping a pillow between the client's legs at all times

Keeping a pillow between the client's legs at all times

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

A client who was in a motor vehicle crash is diagnosed with a stable T7 spinal fracture with no neurologic deficits. Which nursing intervention should the nurse implement? Withhold opioid pain medication to prevent ileus. Maintain bed rest with the head of the bed at 20 degrees. Maintain NPO (nothing by mouth) status for surgical repair. Sit the client upright in a padded chair for meals.

Maintain bed rest with the head of the bed at 20 degrees.

A client has undergone an external fixation. Which actions would be the priority for this client? Maintaining pin care. Planning the client's diet. Monitoring the client's urine output. Monitoring the client's blood pressure.

Maintaining pin care.

The nurse is caring for a patient who had a total hip replacement. What lethal postoperative complication should the nurse closely monitor for? Atelectasis Urinary tract infection Pulmonary embolism Hypovolemia

Pulmonary embolism

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

Rotator cuff tears

A client arrives in the emergency department with a suspected bone fracture of the right arm. How does the nurse expect the client to describe the pain? Similar to "muscle cramps" A dull, deep, boring ache Sore and aching Sharp and piercing

Sharp and piercing

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? Short leg cast Hip spica cast Long leg cast Walking cast

Short leg cast

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

Skeletal traction is interrupted to turn and reposition the client.

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? Sprain Strain Subluxation Dislocation

Sprain

A client sustains an injury to the ligaments surrounding a joint. What will the nurse identify this injury as? Strain Contusion Fracture Sprain

Sprain

A client is diagnosed with a first-degree strain of the left ankle related to running 5 miles daily. How would the nurse differentiate the first-degree strain from other strains and sprains? The client has ecchymosis, edema, and has no function of the left foot and ankle. The client has some edema of the left ankle with muscle spasms but is able to walk without assistive devices. The client complains of pain when the joint is moved and has mild edema. The client is unable to bear weight on the left ankle and has a large ecchymotic area.

The client has some edema of the left ankle with muscle spasms but is able to walk without assistive devices.

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

The hip may be flexed to put on clothing such as pants, stockings, socks, or shoes.

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

The nurse suspects that a client with an arm cast has developed a pressure ulcer. Where should the nurse assess for the presence of the ulcer? Radial styloid Olecranon Lateral malleolus Ulna styloid

Ulna styloid

Which may occur if a client experiences compartment syndrome in an upper extremity? Whiplash injury Callus Volkmann's contracture Subluxation

Volkmann's contracture

A patient falls while skiing and sustains a supracondylar fracture. What does the nurse know is the most serious complication of a supracondylar fracture of the humerus? Volkmann's ischemic contracture Malunion Hemarthrosis Paresthesia

Volkmann's ischemic contracture

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? With the affected hip rotated externally With the leg on the affected side abducted With the leg on the affected side adducted With the affected hip flexed acutely

With the leg on the affected side abducted