Chapter 47: Concepts of Care for Patients with Musculoskeletal Trauma

A nurse teaches assistive personnel (AP) about providing hygiene for a client in traction. Which statement would the nurse include as part of the teaching about this client's care?

"Ensure that the weights remain freely hanging at all times."

A nurse is caring for a client who is recovering from an above-the-knee amputation and reports pain in the limb that was removed. How would the nurse respond?

"How would you describe the pain that you are feeling?"

After teaching a client who is recovering from a vertebroplasty, the nurse assesses the patient's understanding. Which statement by the client indicates a need for additional teaching?

"I can drive myself home after the procedure."

The nurse is teaching a client how to use a cane after a right surgical fractured fibula repair. What health teaching would the nurse include?

"Place the cane on your left side."

A nurse cares for a client placed in skeletal traction. The client asks, "What is the primary purpose of this type of traction?" How would the nurse respond?

"Skeletal traction will assist in realigning your fractured bone."

A nurse is caring for an older client who is recovering from a leg amputation surgery. The client states, "I don't want to live with only one leg. I should have died during the surgery." What is the nurse's best response?

"This is a big change for you. What support system do you have to help you cope?"

A nurse cares for a client who had a wrist cast applied 3 days ago. The client states, "The cast is loose enough to slide off." How would the nurse respond?

"You need a new cast now that the swelling is decreased."

A client who had a traumatic above-the-knee amputation states that he fears he will never have an intimate relationship again. What is the nurse's best response?

"You think you won't be able to have sex again?"

A nurse teaches a client who is at risk for carpal tunnel syndrome. Which health promotion activities would the nurse include in the health teaching? (Select all that apply.)

- "Frequently assesses the ergonomics of the equipment being used." - "Take breaks to stretch fingers and wrists during working hours." - "Adjust chair height to allow for good posture."

A nurse teaches a client about prosthesis care after amputation. Which statements would the nurse include in the health teaching? (Select all that apply.)

- "The device has been custom made specifically for you." - "Make sure that you wear the correct liners with your prosthetic." - "I have scheduled a follow-up appointment for you."

A client with chronic osteomyelitis is being discharged from the hospital. What information is important for the nurse to teach this client and family? (Select all that apply.)

- Adherence to the antibiotic regimen - Correct intramuscular injection technique - Proper use of the intravenous equipment

A nurse cares for a client with a fracture injury. Twenty minutes after an opioid pain medication is administered, the client reports pain in the site of the fracture. Which actions should the nurse take? (Select all that apply.)

- Administer additional opioids as prescribed. - Elevate the extremity on pillows. - Apply ice to the fracture site.

A nurse is assessing a community group for dietary factors that contribute to osteoporosis. In addition to inquiring about calcium, the nurse also assesses for which other dietary components? (Select all that apply.)

- Alcohol - Caffeine - Carbonated beverages - Vitamin D

The nurse is caring for a client who just had a kyphoplasty. What nursing care is needed for the client at this time? (Select all that apply.)

- Apply an ice pack to the surgical area to help relieve pain. - Assess the client's pain level to compare it with pain before the procedure. - Take vital signs, including oxygen saturation, frequently. - Monitor for complications such as bleeding or shortness of breath. - Perform frequent neurologic assessments and report major changes.

A client with Pagets disease is hospitalized for an unrelated issue. The client reports pain and it is not yet time for more medication. What comfort measures can the nurse delegate to the unlicensed assistive personnel (UAP)? (Select all that apply.)

- Applying a heating pad. - Providing a massage

A client is admitted with a bone tumor. The nurse finds the client weak and lethargic with decreased deep tendon reflexes. What actions by the nurse are best? (Select all that apply.)

- Assess the daily serum calcium level. - Consult the provider about a loop diuretic. - Instruct the client to call for help out of bed.

The nurse studying osteoporosis learns that which drugs can cause this disorder? (Select all that apply.)

- Barbiturates. - Corticosteroids. - Loop diuretics

The nurse is assessing a client for chronic osteomyelitis. Which features distinguish this from the acute form of the disease? (Select all that apply.)

- Draining sinus tracts. - Presence of foot ulcers

A nurse assesses a client with a cast for potential compartment syndrome. Which clinical manifestations are correctly paired with the physiologic changes of compartment syndrome? (Select all that apply.)

- Edema Increased capillary permeability. - Unequal pulses Increased production of lactic acid. - Cyanosis Anaerobic metabolism

A client is suspected to have muscular dystrophy. About what diagnostic testing does the nurse educate the client? (Select all that apply.)

- Electromyography - Muscle biopsy - Serum aldolase - Serum creatinine kinase

A nurse plans care for a client who is recovering from open reduction and internal fixation (ORIF) surgery for a right hip fracture. Which interventions would the nurse include in this client's plan of care? (Select all that apply.)

- Elevate heels off the bed with a pillow - Ambulate the client on the first postoperative day - Re-position the client every 2 hours

A nurse plans care for a client who is recovering from open reduction and internal fixation (ORIF) surgery for a right hip fracture. Which interventions should the nurse include in this clients plan of care? (Select all that apply.)

- Elevate heels off the bed with a pillow. - Ambulate the client on the first postoperative day. - Re-position the client every 2 hours.

A nurse teaches a client who is at risk for carpal tunnel syndrome. Which health promotion activities should the nurse include in this clients teaching? (Select all that apply.)

- Frequently assess the ergonomics of the equipment being used. - Take breaks to stretch fingers and wrists during working hours. - Adjust chair height to allow for good posture.

The nurse is caring for a client who recently sustained a sports injury to his right leg. What nursing interventions are appropriate for this client? (Select all that apply.)

- Immobilize the right leg - Use compression to support the leg - Obtain an x-ray to detect possible fracture - Elevate the right leg to decrease swelling.

A nurse teaches a client with a fractured tibia about external fixation. Which advantages of external fixation for the immobilization of fractures would the nurse share with the client? (Select all that apply.)

- It leads to minimal blood loss - It allows for early ambulation - It promotes healing

A nurse is providing education to a community women's group about lifestyle changes helpful in preventing osteoporosis. What topics does the nurse cover? (Select all that apply.)

- Strengthening exercises are important. - Take recommended calcium and vitamin D. - Walk 30 minutes at least 3 times a week.

A nurse teaches a client about prosthesis care after amputation. Which statements should the nurse include in this clients teaching? (Select all that apply.)

- The device has been custom made specifically for you. - Make sure that you wear the correct liners with your prosthetic. - I have scheduled a follow-up appointment for you.

2. The nurse assesses a client who is admitted with a pelvic fracture. Which assessments would the nurse monitor to prevent or detect a complication of this injury? (Select all that apply.)

- Urinary output - Blood pressure - Skin color

An emergency nurse assesses a client who is admitted with a pelvic fracture. Which assessments should the nurse monitor to prevent a complication of this injury? (Select all that apply.)

- Urinary output. - Blood pressure. - Skin color

The nurse is performing a neurovascular assessment for an older client who has an extremity fracture. How many seconds would the nurse expect for a capillary refill in it is within normal range?

5 seconds

A nurse is caring for several clients with fractures. Which client would the nurse identify as being at the highest risk for developing deep vein thrombosis?

A 74-year-old male who smokes and has a fractured pelvis

A nurse assesses an older adult who was admitted 2 days ago with a fractured hip. The nurse notes that the client is confused and restless with an oxygen saturation of 88%. Which action would the nurse take first?

Administer oxygen via nasal cannula.

A client with osteoporosis is going home, where the client lives alone. What action by the nurse is best?

Arrange a home safety evaluation

A client has been advised to perform weight-bearing exercises to help minimize osteoporosis. The client admits to not doing the prescribed exercises. What action by the nurse is best?

Ask the client about fear of falling

A client is admitted to the emergency department with a fractured femur resulting from a motor vehicle crash. What the nurse's priority action?

Assess airway, breathing, and circulation.

A client is in the internal medicine clinic reporting bone pain. The clients alkaline phosphatase level is 180 units/L. What action by the nurse is most appropriate?

Assess the client for leg bowing

A client with bone cancer is hospitalized for a limb salvage procedure. How can the nurse best address the clients psychosocial needs?

Assess the clients coping skills and support systems

The nurse is caring for a postoperative client who have a regional nerve blockade for a surgical tibial fracture repair this morning. What assessment finding would the nurse expect?

Client reports little to no pain.

A nurse sees clients in an osteoporosis clinic. Which client should the nurse see first?

Client taking raloxifene (Evista) who reports unilateral calf swelling

The nurse sees several clients with osteoporosis. For which client would bisphosphonates not be a good option?

Client with a spinal cord injury who cannot tolerate sitting up

A client who had a fractured ankle open reduction internal fixation (ORIF) 4 weeks ago reports burning pain and tingling in the affected foot. For which potential complication would the nurse anticipate?

Complex regional pain syndrome

A nurse is assessing an older client and discovers back pain with tenderness along T2 and T3. What action by the nurse is best?

Consult with the provider about an x-ray

A nurse plans care for a client who is recovering from a below-the-knee amputation of the left leg. Which intervention would the nurse include in this client's plan of care?

Encourage range-of-motion exercises.

A nurse delegates care of a client in traction to an unlicensed assistive personnel (UAP). Which statement should the nurse include when delegating hygiene care for this client?

Ensure that the weights remain freely hanging at all times

A client in a nursing home refuses to take medications. She is at high risk for osteomalacia. What action by the nurse is best?

Ensure the client gets 15 minutes of sun exposure daily.

A client is scheduled for a bone biopsy. What action by the nurse takes priority?

Ensuring that informed consent is on the chart

What information does the nurse teach a women's group about osteoporosis?

For 5 years after menopause you lose 2% of bone mass yearly

A client has a metastatic bone tumor. What action by the nurse takes priority?

Handle the affected extremity with caution

A hospitalized client is being treated for Ewings sarcoma. What action by the nurse is most important?

Handling and disposing of chemotherapeutic agents per policy

A nurse assesses a client with a pelvic fracture. Which assessment finding should the nurse identify as a complication of this injury?

Hematuria

A nurse assesses a client with a pelvic fracture. Which assessment finding would the nurse identify as a complication of this injury?

Hematuria

A nurse is caring for a client who is recovering from an above-the-knee amputation. The client reports pain in the limb that was removed. How should the nurse respond?

How would you describe the pain that you are feeling?

A nurse cares for a client recovering from an above-the-knee amputation of the right leg. The client reports pain in the right foot. Which prescribed medication should the nurse administer first?

Intravenous calcitonin

A nurse is caring for a client recovering from an above-the-knee amputation of the right leg. The client reports pain in the right foot. Which prescribed medication would the nurse most likely administer?

Intravenous calcitonin

A client has been prescribed denosumab (Prolia). What instruction about this drug is most appropriate?

Make appointments to come get your shot

A nurse reviews prescriptions for an 82-year-old client with a fractured left hip. Which prescription should alert the nurse to contact the provider and express concerns for client safety?

Meperidine (Demerol) 50 mg IV every 4 hours

The nurse is caring for a client who had a closed reduction of the left arm and notes a large wet area of drainage on the cast. What action is the most important?

Notify the primary health care provider.

A nurse cares for a client with a fractured fibula. Which assessment should alert the nurse to take immediate action?

Numbness in the extremity

A nurse cares for a client with a recently fractured tibia. Which assessment would alert the nurse to take immediate action?

Numbness in the extremity

An older client who fell at home is admitted to the emergency department and reports pain in her left groin and behind her left knee. What action would the nurse anticipate?

Obtain a left hip x-ray.

A nurse obtains the health history of a client with a fractured femur. Which factor identified in the clients history should the nurse recognize as an aspect that may impede healing of the fracture?

Pagets disease

A nurse cares for an older adult client with multiple fractures. Which action should the nurse take to manage this clients pain?

Patient-controlled analgesia (PCA) pump with morphine

A client who had a surgical fractured femur repair reports new-onset shortness of breath and increased respirations. What is the nurse's first action?

Place the client in a high-Fowler position.

An older client with diabetes is admitted with a heavily draining leg wound. The clients white blood cell count is 38,000/mm3 but the client is afebrile. What action does the nurse take first?

Place the client on contact isolation

A nurse is caring for four clients. After the hand-off report, which client does the nurse see first?

Post-microvascular bone transfer client whose distal leg is cool and pale

A nurse is caring for a client with diabetes mellitus who has fractured her arm. Which action would the nurse take first?

Remove the medical alert bracelet from the fractured arm.

An emergency department nurse triages a client with diabetes mellitus who has fractured her arm. Which action should the nurse take first?

Remove the medical alert bracelet from the fractured arm.

After teaching a client with a fractured humerus, the nurse assesses the client's understanding. Which dietary choice demonstrates that the client correctly understands the nutrition needed to assist in healing the fracture?

Roast beef with low-fat milk and a vitamin C supplement

A nurse plans care for a client who is prescribed skeletal traction. Which intervention should the nurse include in this plan of care to decrease the clients risk for infection?

Schedule for pin care to be provided every shift

A nurse plans care for a client who has an external fixator on the lower leg. Which intervention would the nurse include in the plan of care to decrease the client's risk for infection?

Scheduling for pin care to be provided every shift

A nurse cares for a client placed in skeletal traction. The client asks, What is the primary purpose of this type of traction? How should the nurse respond?

Skeletal traction will assist in realigning your fractured bone

A nurse assesses a client with a fracture who is being treated with skeletal traction. Which assessment should alert the nurse to urgently contact the health provider?

Traction weights are resting on the floor

A nurse coordinates care for a client with a wet plaster cast. Which statement should the nurse include when delegating care for this client to an unlicensed assistive personnel (UAP)?

Use a cloth-covered pillow to elevate the clients leg

A nurse cares for a client who had a wrist cast applied 3 days ago. The client states, The cast is loose enough to slide off. How should the nurse respond?

You need a new cast now that the swelling is decreased.