Chapter 40: Musculoskeletal Care Modalities

To reduce the incidence of complications in a client in traction, which intervention should be included in the care plan? Remove the weights during linen changes. Increase calorie intake. Reduce fluid intake. Increase fiber intake.

Increase fiber intake.

Which is a benefit of a continuous passive motion (CPM) device when applied after knee surgery? It provides active range of motion. It promotes healing by increasing circulation and movement of the knee joint. It promotes healing by immobilizing the knee joint. It prevents infection and controls edema and bleeding.

It promotes healing by increasing circulation and movement of the knee joint.

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? Apply the traction straps snugly. Assess the client's level of consciousness. Remove the traction at least every 8 hours. Teach the client how to prevent problems caused by immobility.

Teach the client how to prevent problems caused by immobility.

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? "You would have to stay here much longer because it takes a cast longer to dry." "A splint is applied when more swelling is expected at the site of injury." "It is best if an orthopedic doctor applies the cast." "Not all fractures require a cast."

"A splint is applied when more swelling is expected at the site of injury."

A patient had a total hip replacement. What recommended leg position should the nurse ensure is maintained to prevent prosthesis dislocation? Abduction Adduction Flexion Internal rotation

Abduction

An older adult patient had a hip replacement. When should the patient begin with assisted ambulation with a walker? 24 hours 72 hours 1 week 2 to 3 weeks

24 hours

The client displays manifestations of compartment syndrome. What treatment will the nurse expect the client to be scheduled for? An open reduction A fasciotomy A total hip replacement A total knee replacement

A fasciotomy

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

Assessing the extremity for neurovascular integrity

Which type of cast encloses the trunk and a lower extremity? Body cast Hip spica Long-leg Short-leg

Hip spica

A client is in Buck's traction after fracturing his right hip. The nurse should include which action in the care plan? Removing the weights once every shift Maintaining the bed in the knee gatch position Keeping the client in semi-Fowler's position Maintaining correct body alignment

Maintaining correct body alignment

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. Loosen the edges of the cast and elevate the leg. Reposition the extremity for comfort and apply heat. Administer a dose of morphine sulfate.

Make the client NPO and notify the health care provider.

The nurse is caring for a client who has had a fracture reduction using a cast. What is most important for the nurse to assess? Cardiac status Renal function Sleep status Neurovascular status

Neurovascular status

The nurse is caring for a client who lives alone and had a total knee replacement. An appropriate nursing diagnosis for the client is: Risk for ineffective therapeutic regimen management Disturbed body image Situational low self-esteem Risk for avascular necrosis of the joint

Risk for ineffective therapeutic regimen management

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? A dull, deep, boring ache Sharp and piercing Similar to "muscle cramps" Sore and aching

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 Long leg cast Walking cast Hip spica cast

Short leg cast

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

Elevate the affected extremity and use cold applications.

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

Weights hanging and touching the floor

A client has a plaster cast applied to the left leg. Which comment by the client following the procedure should the nurse address first? "My toes are stiff." "My toes are pink." "My cast is still wet." "My pain is a 3."

"My toes are stiff."

Which statement by a staff nurse on the orthopedic floor indicates the need for further staff education? "The client is receiving physical therapy twice per day, so the client doesn't need a continuous passive motion device." "The continuous passive motion device can decrease the development of adhesions." "Bleeding is a complication associated with the continuous passive motion device." "Monitoring skin integrity is important while the continuous passive motion device is in place."

"The client is receiving physical therapy twice per day, so the client doesn't need a continuous passive motion device."

A client diagnosed with a right ulnar fracture asks why the cast needs to go all the way up the arm. What is the best response by the nurse? "This allows for the strength in the arm to remain consistent." "The joint above the fracture and below the fracture must be immobilized." "When a spica cast is ordered, the arm must be immobilized." "The method allows for the fastest healing time and the greatest mobility."

"The joint above the fracture and below the fracture must be immobilized."

A client's cast is removed. The client is worried because the skin appears mottled and is covered with a yellowish crust. What advice should the nurse give the client to address the skin problem? Consult a skin specialist. Scrub the area vigorously to remove the crust. Apply lotions and take warm baths or soaks. Avoid exposure to direct sunlight.

Apply lotions and take warm baths or soaks.

A client with a long arm cast continues to complain of unrelieved throbbing pain even after receiving opioid pain medication. Which is the priority action by the nurse? Assess for complications. Assess for previous opioid drug use. Reposition the client for comfort. Teach relaxation techniques.

Assess for complications.

Which cleansing solution is the most effective for use in completing pin site care? Betadine Chlorhexidine Hydrogen peroxide Alcohol

Chlorhexidine

A client with a tibia fracture was placed in an external fixator 24 hours ago. The nurse is completing pin care and notices redness at the pin site and a small amount of serous drainage. What action by the nurse is appropriate? Notify the physician. Document the findings. Prepare for surgical removal of the fixator. Assess the client's hemoglobin and hematocrit.

Document the findings.

A nurse would most likely expect the need for open reduction for a client with which of the following? Closed fracture Little bone separation Soft tissue free of bone ends Joint fracture

Joint fracture

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

Keep the cast clean and dry.

A client's fracture was reduced by surgically exposing the bone and realigning it. What type of treatment does the nurse identity this as? Buck's traction Skeletal traction Internal fixation Open reduction

Open reduction

A client is placed in traction for a femur facture. The nurse would document which expected outcomes of traction? Select all that apply. Realignment of the fracture Decreased pedal pulse Reduction of deformity Minimization of muscle spasms Increased ability to bear weight Full range of motion to extremity

Realignment of the fracture Reduction of deformity Minimization of muscle spasms

Which principle applies to the client in traction? Weights should rest on the bed. Skeletal traction is never interrupted. Knots in the ropes should touch the pulley. Weights are removed routinely.

Skeletal traction is never interrupted.

A client has severe osteoarthritis in the left hip and is having surgery to replace both articular surfaces of the hip. What type of surgical procedure will the nurse prepare the client for? Arthrodesis Hemiarthroplasty Total arthroplasty Osteotomy

Total arthroplasty

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

osteomyelitis

A client has a Fiberglass cast on the right arm. Which action should the nurse include in the care plan? Keeping the casted arm warm by covering it with a light blanket Avoiding handling the cast for 24 hours or until it is dry Evaluating pedal and posterior tibial pulses every 2 hours Assessing movement and sensation in the fingers of the right hand

Assessing movement and sensation in the fingers of the right hand

The nurse is assisting with the application of a cast. What will the nurse expect to be done first? Covering the skin with a stockinette. Applying strips of the cast material evenly. Arranging for an x-ray to check bone alignment. Cleaning the skin surface.

Cleaning the skin surface.

Which would be contraindicated as a component of self-care activities for the client with a cast? Cover the cast with plastic to insulate it Cushioning rough edges of the cast with tape Elevate the casted extremity to heart level frequently Do not attempt to scratch the skin under a cast

Cover the cast with plastic to insulate it

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? Permanent paresthesias Foot drop Deep vein thrombosis (DVT) Infection

Foot drop

A client has just undergone a leg amputation. What will the nurse closely monitor the client for during the immediate postoperative period? Neuroma Hematoma Chronic osteomyelitis Unexplainable burning pain (causalgia)

Hematoma

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. Have the client bend forward to rise from the chair. Adduct the legs by placing a pillow between the legs.

Instruct the client to avoid internal rotation of the leg.

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.

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

Open reduction

A nurse is giving instructions to a client who's going home with a leg cast. Which teaching point is most critical? Using crutches properly Exercising joints above and below the cast, as ordered Avoiding walking on a leg cast without the health care provider's permission Reporting signs of impaired circulation

Reporting signs of impaired circulation

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

Skeletal traction is interrupted to turn and reposition the client.

Which device is designed specifically to initially support and immobilize a body part in a desired position until swelling subsides? Brace Continuous passive motion (CPM) device Splint Trapeze

Splint

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 Capillary refill less than 3 seconds 2+ peripheral pulses in the affected distal pulse

Decreased sensory function Excruciating pain Loss of motion

After a traumatic back injury, a client requires skeletal traction. Which intervention takes priority? Monitoring the client for skin breakdown Maintaining traction continuously to ensure its effectiveness Supporting the traction weights with a chair or table to prevent accidental slippage Restricting the client's fluid and fiber intake to reduce the movement required for bedpan use

Maintaining traction continuously to ensure its effectiveness

A client is being discharged home with a long arm cast. What education should the nurse include to prevent disuse syndrome in the arm? Use of isometric exercises Proper use of a sling Repositioning the arm in the cast Abduction and adduction of the shoulder

Use of isometric exercises

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

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

Which action would be most important postoperatively for a client who has had a knee or hip replacement? Providing crutches to the client. Assisting in early ambulation. Using a continuous passive motion (CPM) machine. Encouraging expressions of anxiety.

Assisting in early ambulation.

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

Better molding to the client

Which would be consistent as a component of self-care activities for the client with a cast? Cover the cast with plastic to insulate it Cushion rough edges of the cast with tape Frequently place the casted extremity in a dependent position Use a plastic hanger wrapped in gauze to scratch under the cast.

Cushion rough edges of the cast with tape

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

Dry a wet fiberglass cast thoroughly to avoid skin problems

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 Prepare the client for cast application Assess for neurovascular compromise Provide effective pain control

Educate the client on cast care and complications

The client with a fractured femur is upset and agitated that skeletal traction will be necessary for 6 to 8 weeks. The client states, "How can I stay like this for weeks? I can't even move!" Based on these statements, the nurse would identify which of the following as the most appropriate nursing diagnosis? Ineffective Coping related to prolonged immobility Impaired Physical Mobility related to traction Deficient Diversional Activity related to prolonged hospitalization Activity Intolerance related to impaired mobility

Ineffective Coping related to prolonged immobility

A client is having traction applied to a fractured left lower extremity prior to surgery. What outcomes does the nurse expect from the application of the traction for the client? Select all that apply. Surgery will not be required. Muscle spasms will be relieved. The bones of the left leg will be aligned. Immobilization of the left leg will be maintained. Less pain medication will be required.

Muscle spasms will be relieved. The bones of the left leg will be aligned. Immobilization of the left leg will be maintained.

A client presents at the emergency department with a compound fracture of the right femur. Skeletal traction is applied to align the bones. What type of traction would be used? Steinmann traction Buck's traction Russell traction Thomas splint

Steinmann traction

Which statement is accurate regarding care of a plaster cast? The cast must be covered with a blanket to keep it moist during the first 24 hours. The cast will dry in about 12 hours. The cast can be dented while it is damp. A dry plaster cast is dull and gray.

The cast can be dented while it is damp.

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 leg will look moist and will have small bumps that will go away in a few days. The skin may be covered with a yellowish crust that will shed 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.

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

Cut a cast window.

A client with a fractured ankle is having a fiberglass cast applied. The client starts yelling, "My leg is burning, take it off." What action by the nurse is most appropriate? Explain that the sensation being felt is normal and will not burn the client. Remove the cast immediately, notifying the physician. Administer antianxiety and pain medication. Call for assistance to hold the client in the required position until the cast has dried.

Explain that the sensation being felt is normal and will not burn the client.

When discussing physical activities with the client who has just undergone a right total hip replacement, which instruction should the nurse provide? "Limit hip flexion to 90 degrees." "Perform rotation exercises each day." "Intermittently cross and uncross your legs several times each day." "Avoid weight bearing until the hip is completely healed."

"Limit hip flexion to 90 degrees."

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? "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." "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."

A patient has a cast removed after bone healing takes place. What should the nurse instruct the patient to do after removal? (Select all that apply.) Apply an emollient lotion to soften the skin. Control swelling with elastic bandages, as directed. Gradually resume activities and exercise. Use friction to remove dead surface skin by rubbing the area with a towel. Use a razor to shave the dead skin off.

Apply an emollient lotion to soften the skin. Control swelling with elastic bandages, as directed. Gradually resume activities and exercise.

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

Cutting a cast window

Which evaluation finding requires follow up by the nurse caring for a client with a total knee replacement? Select all that apply. Client reports pain rating of 2. Pedal pulses strong and equal bilaterally 650 ml bloody drainage in drain wound Knee flexion at 30 degrees Client ambulates 10 feet by postoperative day 2

650 ml bloody drainage in drain wound Knee flexion at 30 degrees

A client with a right leg fracture is returning to the orthopedist to have the cast removed. During cast removal, it is important for the nurse to assure: the client that he or she won't be cut. that the cast cutter blade is new. that pedal pulses are present. that the leg will be as good as new.

the client that he or she won't be cut.

Which of the following is an inappropriate nursing diagnosis for the client following casting? Risk for deficient knowledge: procedure Risk for impaired tissue perfusion Risk for impaired skin integrity Risk for disuse syndrome

Risk for deficient knowledge: procedure

Arthrodesis is: fusion of a joint (most often the wrist or knee) for stabilization and pain relief. total reconstruction or replacement of a joint (most often the knee or hip) with an artificial joint to restore function and relieve pain. replacement of one of the articular surfaces in a joint, such as the femoral head but not the acetabulum. cutting and removal of a wedge of bone (most often the tibia or femur) to change the bone's alignment, thereby improving function and relieving pain.

fusion of a joint (most often the wrist or knee) for stabilization and pain relief.

Which of the following would the nurse expect a physician to use on a short-term basis for a client with an injured body part that does not require rigid immobilization? Cast Brace Splint Skin traction

Splint

The nurse is caring for a client who sustained rib fractures in an automobile accident. What symptoms does the nurse recognize as a complication of rib fractures and should immediately be reported to the physician? Blood pressure of 140/90 mm Hg Crackles in the lung bases Client complains of pain in the affected rib area when taking a deep breath Heart rate of 94 beats/minute

Crackles in the lung bases

Which intervention would the nurse implement with the client in skeletal traction? Select all that apply. Apply 8-pound weight to the rope. Ensure the pins or wires are covered with caps. Remove foam boot and inspect skin daily. Position trapeze within the client's reach. Instruct the client on isometric exercises for immobilized extremity.

Ensure the pins or wires are covered with caps. Position trapeze within the client's reach. Instruct the client on isometric exercises for immobilized extremity.

A continuous passive motion (CPM) machine is used to promote healing and flexibility in the knee and hip joint and increase circulation to the operative area. What is true about the use of CPM? Select all that apply. The physician orders the amount of extension and flexion produced by the machine. The physician orders the frequency of use of the machine. The amount of flexion for clients with hip replacements should never exceed 30 degrees in the CPM machine. The amount of flexion for clients with hip replacements should never exceed 60 degrees in the CPM machine.

The physician orders the amount of extension and flexion produced by the machine. The physician orders the frequency of use of the machine. The amount of flexion for clients with hip replacements should never exceed 30 degrees in the CPM machine.

Which statement describes external fixation? 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 secures the bone with metal screws, plates, rods, nails, or pins. A cast or other mode of immobilization is applied. The bone is restored to its normal position by external manipulation. The bone is surgically exposed and realigned.

The surgeon inserts metal pins into the bone or bones from outside the skin surface and then attaches a compression device to the pins.

A client was playing softball and dislocated four of his fingers when diving for a ball. The physician manipulated the fingers into alignment and applied a splint to maintain alignment. What type of procedure does the nurse document this as? Open reduction Closed reduction Open reduction with internal fixation External fixation

Closed reduction

The nurse is caring for a patient postoperatively following orthopedic surgery. The nurse assesses an oxygen saturation of 89%, confusion, and a rash on the upper torso. What does the nurse suspect is occurring with this patient? Polyethylene-induced infection Pneumonia Fat emboli syndrome Disseminated intravascular coagulation

Fat emboli syndrome

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

Application of a new cast

Which instruction should the nurse include when teaching the client following hip replacement surgery? (Select all that apply.) "You may cross your legs at the ankles only." "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." "It is okay to briefly flex the hip to put on your clothes."

"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."

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

Which device is designed specifically to support and immobilize a body part in a desired position? Brace Sling Splint Traction

Splint

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

Dislocation of the hip

The nurse is caring for a client who had a total knee replacement 3 days ago. Which nursing assessment finding requires immediate attention by the nurse? Drainage from wound suction device = 100 ml Previous shift urine output = 500 ml Crackles that clear with coughing Hypoactive bowel sounds

Drainage from wound suction device = 100 ml

The client is scheduled for a meniscectomy of the right knee. The nurse would plan postoperative care based on what surgical procedure? Replacement of one of the articular surfaces of a joint Incision and diversion of the muscle fascia Excision of damaged joint fibrocartilage Replacement of knee with artificial joint

Excision of damaged joint fibrocartilage

A nurse is caring for a client after stabilization of a radial fracture. Which actions by the nurse would be appropriate for the client following arm casting? Select all that apply. Elevate the arm on a plastic-covered pillow Protect the cast by covering with a sheet Handle the cast with the palms of hands Circulate room air with a portable fan Petal and smooth the edges of the cast

Handle the cast with the palms of hands Circulate room air with a portable fan Petal and smooth the edges of the cast

The nurse teaches the client which intervention to avoid hip dislocation after replacement surgery? Keep the knees together at all times Never cross the affected leg when seated Avoid placing a pillow between the legs when sleeping Bend forward only when seated in a chair

Never cross the affected leg when seated