Chapter 55: Saunders Musculoskeletal review - AHN p. 1095
A nurse in the emergency room is caring for a client with a fractured arm. The nurse understands that which of the following is not necessary before reduction of the fracture in the casting room?
Anesthesia consent
A patient, age 24, has a compartment syndrome after a fracture of his radius and ulna. Nursing assessment will include careful observation for signs and symptoms of
Volkmann's contracture.
A client has just had an application of a leg cast and the nurse is giving the client instructions on cast care at home. Which statement by the client indicated the need for further teaching?
" I should use a hair dryer set to the hot setting to dry by cast if it gets wet"
A nurse is reviewing the list of discharge instructions for a client who underwent left total knee replacement (TKR) with insertion of a metal prosthesis. Which statement by the client indicates the need for further instructions?
"I don't need to be worried if the shape of my knee changes."
A client is being discharged after application of a plaster leg cast. The nurse determines that the client understands proper care of the cast if the client makes which statement?
"I need to avoid getting the cast wet"
A nurse has given a 77-year-old female client instructions on how to do active range-of-motion (ROM) exercises on her contracted right hand. The nurse determines that the client understands the rationale for this procedure when the client makes which of the following statements?
"I'm doing these exercises so I can be more independent and begin to fasten my buttons and dress myself again."
A patient, age 89, has had a right below-the-knee amputation. He is progressing well but continues to complain of pain in the toes on his right foot. The physician told him that he is suffering from "phantom pain" in his amputated extremity. He asks the nurse to explain phantom pain. The most appropriate response would be
"Phantom pain occurs because the nerve tracts that register pain in the amputated limb continue to send a message to the brain."
A patient has sustained a fractured femur in a car accident. The physician has stated concern about the possibility of a fat embolism. The patient's wife asks the nurse about the cause of a fat embolism. The nurse's most appropriate response would be
"The break in the bone forces molecules of fat into the bloodstream."
The patient has been diagnosed as having gouty arthritis. The patient asks the nurse to explain the cause of the inflammation of the great toe. What is the most appropriate nursing response?
"The inflammation is from small accumulations of uric acid crystals, which are called tophi."
A nurse is planning to reinforce instructions to the client about how to stand on crutches. In the written instructions, the nurse plans to tell the client to place the crutches:
8 inches to the front and side of the client's toes
A patient, age 24, is recovering from a fractured tibia. She has been wearing a leg cast for the past month to immobilize the fracture and promote proper alignment. She is being seen at the clinic for follow-up radiographic evaluation of the fracture. The physician tells her that he is hoping for good callus formation to have occurred. When she asks what callus formation is, the nurse tells her it is
A part of the bone healing process after a fracture when new bone is being formed over the fracture site
The movement of an extremity away from the midline of the body is called
Abduction
A client has had surgery to repair a fractured left hip. The nurse plans to use which important item when repositioning the client from side to side in the bed?
Abductor splint
A client has been taught to use a walker to aid in mobility following internal fixation of a hip fracture. The nurse determines that the client is using the walker incorrectly if the client:
Advances the walker with both legs at the same time
The main purpose of traction is to: Select all that apply
Align and stabilize a fracture Relieve muscle spasms Prevent deformities
The nurse is preparing a list of cast care instructions for a client who just had a plaster cast applied to his right forearm. Which instructions should the nurse include on the list? Select all that apply.
Allow the wet cast 24-48 hours to dry.The cast needs to be kept clean and dry.Keep the cast and extremity elevated
This is a chronic progressive rheumatic disorder that affects primarily the spine, resulting in the spine fusing and fixation of the joint:
Ankylosing spondylitis. AKS
Patients with Fibromyalgia syndrome can benefit pharmacologically from:
Antidepressants
A client in skeletal leg traction with an overbed frame is not allowed to turn from side to side. Which action by the nurse would be most useful in trying to provide good skin care to the client?
Asking the client pull up on a trapeze to lift the hips off the bed
A patient, age 44, has chronic osteomyelitis. He should be taught to:
Avoid trauma to the affected bone
There are two divisions of the skeleton and these are:
Axial and appendicular
While backpacking with a youth group, a 17-year-old falls and sustains an injury to the lower leg. A nurse who is accompanying the group suspects a fracture of the tibia. How should the nurse apply a splint to immobilize the suspected fracture?
Below the knee to above the hip
A 76-year-old female patient is being seen for osteoarthritis of the knee in the clinic. In discussing strengthening exercises, which exercises would you recommend?
Bicycling for short distances
A patient, age 64, has osteoarthritis of the left hip. He just had a left total hip replacement 2hrs ago. To prevent from developing complications, the nurse should
Encourage the use of incentive spirometer
A client has just had skeletal traction applied following insertion of pins. The nurse should place highest priority on doing which of the following while caring for the client?
Ensure that the weights on the traction setup are hanging free.
The patient, age 58, is diagnosed with osteoporosis after densitometry testing. She has been menopausal for 5 years and has been concerned about her risk for osteoporosis because her mother has osteoporosis. In teaching her about her osteoporosis, which information does the nurse include?
Even with a family history of osteoporosis, the calcium loss from bones can be slowed by increased calcium intake and exercise.
A client seeks treatment in the emergency room for a lower leg injury. There is visible deformity to the lower aspect of the leg, and the injured leg appears shorter than the other. The area is painful, swollen, and beginning to become ecchymotic. The nurse interprets that this client has experienced a:
Fracture
The office nurse has noted the presence of an increase in lumbar curvature in a 20-year-old female patient. This condition is known as
Lordosis
A client has just undergone spinal fusion after suffering a herniated lumbar disk. The nurse would avoid which of the following to maintain client safety after this procedure?
Overhead trapeze
A client who is scheduled for surgery to be placed in skeletal traction says to the nurse, "I'm not sure if I want to have this skeletal traction or if the skin traction would be best to stabilize my fracture." Based on the client's statement, the nurse should make which response to the client?
You have concerns about skeletal versus skin traction for your type of fracture?"
A patient, age 79, fell at home and suffered an intracapsular fracture of his left hip. The orthopedic surgeon inserted a prosthetic implant for a bipolar hip replacement. The physician has instructed the nurse to turn him every 2 hours. The nurse understands that the correct nursing intervention is to keep the legs
abducted so the prosthesis does not become dislocated.
A patient has undergone a bipolar hip repair (hemiarthroplasty). She should be instructed to
avoid crossing her legs.
A 28-year-old male patient has a fractured left humerus. He has a cast on his arm. The nurse observes pallor, coolness, and a decrease in capillary refill time to his left hand and fingers. These observations are likely to indicate
compartment syndrome.
The patient who undergoes total hip replacement may be prescribed prophylactic drugs such as heparin or warfarin (Coumadin). The rationale for this is that it:
decreases the risk of thrombus formation.
Freely movable joints are also called as:
diarthrosis
A patient fell 2 days ago; he has a compound fracture of his left tibia. The physician performed an open reduction with internal fixation (ORIF) to treat the fracture. An important nursing assessment for him would include:
elevated temperature and presence of erythema at incision site.
When caring for the patient who is in shock, the nurse's priority is to provide
oxygen to support respiratory function.
Prolonged bed rest puts the older adult at risk for
pathological fractures and renal calculi
A patient, age 72, has a left intertrochanteric fracture as a result of a fall. In planning ways to increase her safety, the nurse realizes it is most important to determine
preexisting health conditions.
When caring for a patient who is 34 years old and has rheumatoid arthritis, the nurse should remember that
rest and exercise are both important parts of therapy and mobility.
Tough cord of connective tissue that anchor muscles to the bones are called:
tendons
A nurse is assigned to care for a client with multiple trauma who is admitted to the hospital. The client has a leg fracture and a plaster cast has been applied. In positioning the casted leg, the nurse should:
Elevate the leg on pillows continuously for 24 to 48 hours
An x-ray of the injured teenager's leg reveals a comminuted fracture of the distal tibia. What nursing explanation can best help this client understand the injury that has occurred?
The bone is splintered into pieces
Certain foods may increase the pain associated with gout. Which foods have the highest concentration of purines?
Brain, liver, kidney
Calcium is a mineral found in many foods that can slow bone loss during the aging process. The following are high in calcium:
Broccoli, yogurt, cheese
The bones serves as storage for which two minerals?
Calcium and phosphorus
A client with a fractured femur is placed in skeletal traction. The nurse should do which of the following to monitor for nerve injury?
Check the neurovascular status of the affected extremity.
A nurse is caring for a client being treated for a fat embolus after multiple fractures. Which of the following data would the nurse determine as the most favorable indication of resolution of the fat embolus?
Clear chest x-ray
A nurse is caring for a client following the application of a plaster cast because of a fractured left radius. The nurse monitors the neurovascular status of the client's casted extremity because:
Compartment syndrome may lead to irreversible nerve and muscle tissue injury
A patient age 45, has worked as a basket weaver for the past 10 years. She is being seen at the clinic for symptoms of carpal tunnel syndrome. Collection of subjective data might include:
Complaints of burning pain or tingling in the hands
A female patient diagnosed with osteoarthritis has numerous questions for the nurse about the disorder. In answering her questions, what does the nurse relay regarding osteoarthritis?
Considered to be a consequence of aging (degenerative)
A client is complaining of skin irritation from the edges of a cast applied the previous day. The nurse should plan for which intervention?
Crutches and the left leg, then advance the right leg
The nurse is giving the client with a left leg cast crutch-walking instructions using the three-point gait. The client is allowed to touch down the affected leg. How should the nurse teach the client to use the crutches?
Crutches and the left leg, then advance the right leg
A nurse is caring for an older client who had a hip pinned after being fractured. In planning nursing care, which of the following would the nurse avoid to minimize the chance for further injury?
Delays in responding to call light
A nurse is caring for a client who was just admitted to the hospital with a diagnosis of a fractured right femur sustained from a fall 5 hours ago. The nurse develops a plan of care for the client and includes interventions related to monitoring for signs of fat embolism. The nurse includes in the plan to monitor for which of the following?
Dyspnea and chest pain
A 71-year-old patient is manifesting signs and symptoms of gout. When assessing him for signs and symptoms of gout, the nurse should pay particular attention to
Edema, inflammation, and discoloration of the great toe
A nurse is monitoring a confused older client admitted to the hospital with a hip fracture. Which of the following data obtained by the nurse would not place the client at increased risk for disturbed thought processes?
Hearing aid available and in working order
Osteoarthritis involves development of nodes to a unilateral side of the body specially the fingers. What is the term use when nodes develop at the distal part of the fingers?
Heberden's
A nursing instructor asks a nursing student about the risk factors associated with osteoporosis. The instructor tells the student that she needs to read and learn about this disorder if the student incorrectly states that which of the following is an associated risk factor?
High-calcium diet consumption
Diagnosing carpal tunnel syndrome (CTS) includes test like Tinel's and Phalen's maneuver. Phalen's is:
Holding the wrists against each other in forced palmar flexion for 1 minutes causes numbness and tingling
You are caring for a recently admitted patient who has suffered a pelvic fracture. Which of the following is the most serious physical assessment finding for the nurse to report?
Hypotension, tachycardia, and hematuria
A nurse witnesses a client sustain a fall and suspects that the client's leg may be fractured. Which action is the priority?
Immobilize the leg before moving the client
A client sustained a closed fracture and has just had a cast applied to the affected arm. The client is complaining of intense pain, it is cool to touch and cap refill is 6 seconds. The nurse has elevated the limb, applied an ice bag, and administered an analgesic, which was ineffective in relieving the pain. The nurse interprets that this pain may be caused by:
Impaired tissue perfusion
A client being measured for crutches asks the nurse why the crutches cannot rest up underneath the arm for extra support. The nurse's response is based on the understanding that this could result in:
Injury to the brachial plexus nerves
A client diagnosed with gout has been started on medication therapy with allopurinol (Zyloprim). The nurse teaches the client which of the following points about this medication?
It is important to drink 3 L of fluid per day
A client with right-sided weakness needs to learn how to use a cane. How should the nurse teach the client to position the cane?
Left hand, and 6 inches lateral (side) to the left foot
A nurse is discussing with clients primary prevention measures regarding osteoporosis. The nurse plans to tell the clients that which of the following is a primary prevention measure?
Maintaining body weight at or slightly above minimum recommended levels
According to the Arthritis Foundation, the symptom of RA include the following: (Select ll that apply)
Morning stiffness The same joints on both sides of the body are affected Characterized by remission and exacerbation
A nurse is evaluating the client's use of a cane for left-sided weakness. The nurse would intervene and correct the client if the nurse observed that the client:
Moves the cane when the right leg is moved
A nurse is caring for a client with a long bone fracture at risk for fat embolism. The nurse specifically monitors for the earliest signs of this complication by checking the:
Neurological and respiratory systems
A patient has been casted to stabilize a fracture of the right radius and ulna. The nurse assesses a capillary refill of 5 seconds and cold fingers of the right hand. Which initial intervention should the nurse deploy?
Notify the charge nurse of a probable compartment syndrome.
Which of the following interventions would be contraindicated in the post procedure care of the client following a bone biopsy of the left arm?
Place the left arm in a dependent position for 24 hours.
What should the nurse include in the plan of care for a patient following a myelogram?
Position in a semi-fowler's or flat depending on the dye that was used for 8-12 hours to reduce potential of headache.
A nurse is checking the casted extremity of a client. The nurse would check for which of the following signs and symptoms indicative of infection?
Presence of a "hot spot" on the cast
A nurse is caring for a client who had an above the knee amputation 2 days ago. The residual limb was wrapped with an elastic compression bandage and has fallen off. The nurse immediately:
Re-wraps the stump with an elastic compression bandage
What should the nurse instruct the patient before a magnetic resonance imaging (MRI) procedure?
Remove all metal, such as jewelry, glasses, and hair clips.
A nurse is providing post procedure instructions to a client returning hime after arthroscopy of the shoulder. The nurse would encourage the client to:
Report to the physician the development of fever or redness at the site
A patient with rheumatoid arthritis asks the nurse about her condition. On what knowledge does the nurse base patient teaching?
Rheumatoid arthritis is an autoimmune disorder
A client has been taught to use a walker to aid in mobility following internal fixation of a hip fracture. The nurse determines that the client is using the walker incorrectly if which action is noted?
The client advances the walker alternately for each with movement of the legs.
The nurse reinforces cast application instructions to a client who is going to have a plaster cast applied. The nurse determines that the client needs further teaching if the client makes which statement about the casting?
The client may bear weight on the cast in 30 minutes.
A client has a newly fractured fibula, which is planter called in the emergency department. Because the client will need to use crutches, the nurse plans to teach the client which crutch walking gait before discharge?
Three Point Gait
A nurse is teaching the client with a below-the-knee amputation (BKA) measures to protect the residual limb, or stump. The nurse would be sure to include which of the following points in discussions with the client?
Use a mirror to inspect all areas of the residual limb.
A nurse has reviewed activity restrictions with a client who is being discharged following insertion of a femoral head prosthesis. The nurse determines that the client understands the material presented if the client states to
Use a raised toilet seat.
The patient is a 20 year old who has suffered a compound fracture of the femur. The nurse would expect the physician to order ________ intramuscularly
tetanus toxoid
What should the home health nurse include in assessment in the plan of care for an 82-year-old female with severe kyphosis from ankylosis?
Respiratory effort Respiratory effort can be affected by the compression of the ribcage resulting in kyphosis with AKS and scoliosis.
Rheumatoid arthritis is distinguished from osteoarthritis in that:
Rheumatoid arthritis is an autoimmune, systemic disease; osteoarthritis is a degenerative disease of the joints.
A client has sustained multiple fractures in the left leg and is in skeletal traction. The nurse has obtained an overhead trapeze for the client's use to aid in bed mobility. The nurse would pay particular attention to monitoring for which of the following high-risk areas for pressure and breakdown?
Right heel
A client with type 1 diabetes mellitus has had a left above-the-knee amputation. The nurse carefully inspects the residual limb for which of the following complications due to the history of diabetes?
Separation of wound edges and infection
A client is fearful about having an arm cast removed. Which action by the nurse would be the most helpful?
Showing the client the cast cutter and explaining how it works
The immediate medical management of any fracture is:
Splint and elevate the involved part.
A patient, age 45, has had a left intramedullary rod placed into his left femur. He is presenting with signs and symptoms of postoperative shock. The recommended position for a person going into shock is
Supine
A nurse has given the client instructions regarding crutch safety. The nurse determines that the client needs reinforcement of the instructions if the client states:
That crutch tips will not slip, even when wet or the floor is wet
A client is being discharged to home following spinal fusion with insertion of rods. The nurse would suggest a consultation with the continuing care nurse regarding the need for follow-up modification of the home environment if the client states that:
The bedroom and bath are on the second floor of the home
The nurse is one of several people who witness a vehicle hit a pedestrian at a fairly low speed on a small street. The individual is dazed and tries to get up, and the leg appears fractured. The nurse should plan to perform which action?
Stay with the person, calm him down and encourage the person to remain still while asking other witnesses to call for help
