Iggy Chapter 47 Care of Patient w/ Musculoskeletal Trauma

13. A client has undergone an elective below-the-knee amputation of the right leg as a result of severe peripheral vascular disease. In postoperative care teaching, the nurse would instruct the client to notify the primary health care provider immediately if which change occurs? A. Large amount of serosanguineous or bloody drainage B. Mild to moderate pain controlled with prescribed analgesics C. Absence of erythema and tenderness at the surgical site D. Ability to flex and extend the right knee

A

15. A client who had a right elective above-the-knee amputation reports severe pain in the right lower leg and foot. What is the nurse's best action at this time? A. Assess the level of the client's pain. B. Remind the client that the lower leg was removed. C. Change the subject and talk about the client's hobbies. D. Distract the client with stories about the nurse's family.

A

18. A client with an open fracture of the left femur is admitted to the emergency department after a motorcycle crash. Which action is essential for the nurse to take first? A. Check the dorsalis pedis pulses. B. Immobilize the left leg with a splint. C. Administer the prescribed analgesic. D. Place a dressing on the affected area.

A

A client has a new synthetic leg cast for a right fractured tibia. What health teaching will the nurse include before discharge to home? Select all that apply. A. "Elevate your right leg as often as possible to reduce swelling." B. "Report increased pain or burning sensation under your cast." C. "Use ice on the affected leg for the first 24-36 hours." D. "Do not bear weight on the affected leg until instructed to do so." E. "Do not cover the cast when you are in bed; keep it open to air to dry."

A,B,C,D

21. A rock climber has sustained an open fracture of the right tibia after a 20-foot (6 m) fall 2 days ago. The nurse plans to assess the client for which potential complications? (Select all that apply.) A. Acute compartment syndrome (ACS) B. Fat embolism syndrome (FES) C. Heart failure D. Urinary tract infection (UTI) E. Osteomyelitis

A,B,E

6. An older adult client has had an open reduction and internal fixation of a fractured right hip. Which intervention does the nurse implement for this client? A. Keep the client's heels off the bed at all times. B. Reposition the client every 3 to 4 hours. C. Administer pain medication before deep-breathing exercises. D. Avoid the use of antiembolism stockings.

A. Because the client is an older adult and is more at risk for skin breakdown because of impaired circulation and sensation, the client's heels must be kept off the bed at all times to avoid constant pressure on this sensitive area.Repositioning the older adult client must be done every 2 hours, not every 3 to 4 hours, to prevent skin breakdown and to inspect the skin for any signs of breakdown. Pain medication would not be administered for deep-breathing exercises because this client typically would not experience pain upon breathing. Antiembolic stockings or sequential compression devices are used for older adults to help prevent venous thromboembolism (VTE).

8. Which intervention would the nurse suggest to a client who has undergone a leg amputation to help cope with loss of the limb? A. Talking with an amputee close to the client's age who has a similar amputation B. Drawing a picture of how the client sees him- or herself C. Talking with a psychiatrist about the amputation D. Engaging in diversional activities to avoid focusing on the amputation

A. Meeting with someone of a comparable age who has gone through a similar experience will help the client cope better with his or her own situation.Drawing a picture is not therapeutic and may cause more harm than good. Unless the client is having serious maladjustment problems or has a coexisting psychological disorder, meeting with a psychiatrist would not be necessary. Diversional activities do not help the client deal with loss of the limb.

11. A client sustains a fracture of one arm and the primary health care provider applies a synthetic cast to the extremity. What will the nurse teach the client to do during the first 24 hours after discharge from the emergency department? A. Monitor neuromuscular status for decreased circulation and sensation in the extremity. B. Apply a heating pad for 15 to 20 minutes four times daily to help with pain. C. Check the fit of the cast by inserting a tongue blade between the cast and the skin. D. Keep the cast covered with a soft towel to help it to dry quickly.

A. The most important intervention the nurse teaches the client is to monitor the neurovascular status during the first 24 hours after ED discharge.The client should apply ice for discomfort, not heat. The client should not place anything between the cast and the skin. In assessing fit, one finger should easily fit between the cast and the skin. The cast dries quickly because it is made of synthetic materials.

3. A client in the emergency department receives moderate sedation while having a closed reduction of a fractured ankle. What is the nurse's priority assessment during this procedure? A. Monitor the client's respiratory rate. B. Monitor the client's pain level. C. Check the client's blood pressure frequently. D. Perform circulation checks before and after the procedure.

A. The drugs used for moderate sedation can suppress respiratory rate which requires constant monitoring during the procedure. The client should not feel any pain.

1. The nurse is assigned to care for a postoperative client who had an open reduction, internal fixation of the right tibia yesterday. The client reports increased right leg pain, numbness, and tingling. What would be the nurse's first action at this time? A. Elevate the surgical leg on a pillow. B. Perform a neurovascular assessment. C. Administer pain medication. D. Call the primary health care provider.

B

16. A client who uses a computer for hours each day asks the nurse how to help prevent carpal tunnel syndrome (CTS). Which statement by the client indicates a need for further teaching? A. "I need to make sure I have an ergonomically sound computer station." B. "I need to exercise repetitively to strengthen my wrists." C. "I may need to wear a wrist splint when my wrist gets inflamed." D. "I should stretch my fingers and wrists frequently during the day."

B

3. The nurse is caring for a client who was admitted to the emergency department (ED) with report of left knee pain and swelling after playing baseball with friends. Which nursing actions are appropriate when caring for the client? Select all that apply. A. Apply heat to the affected area. B. Assess the severity and quality of pain. C. Perform a neurovascular assessment. D. Elevate the affected extremity. E. Immobilize the injured knee joint.

B,C,D,E

20. A client is admitted to the emergency department following a left severe ankle sprain caused by playing football with friends. What nursing actions will the nurse implement at this time? (Select all that apply.) A. Apply heat to promote blood flow and healing. B. Elevate the left leg above the level of the heart. C. Apply an elastic wrap or ankle or compression brace. D. Administer morphine via IV push. E. Tell the client to keep his left leg still.

B,C,E

A client had an open reduction internal fixation (ORIF) of the right wrist. What health teaching is appropriate for the nurse to provide for this client before returning home? Select all that apply. A. "Keep your right arm below the level of your heart as often as possible." B. "Use an ice pack for the first 24 hours to decrease tissue swelling." C. "Report coolness or discoloration of your right hand to your doctor." D. "Don't place any device under the cast to scratch the skin if it itches." E. "Move the fingers of the right hand frequently to promote blood flow."

B,C,E

4. Buck's (skin) traction for a fractured hip is applied to a client while a urinary tract infection is treated before surgery. What instruction will the nurse give assistive personnel (AP) for providing client care related to the traction? A. "Remove traction weights when turning the client." B. "Do not allow the traction weights to rest on the ground." C. "Inspect the pins in the traction for signs of infection." D. "Remove the boot every shift to inspect the skin."

B. Although Buck's traction is not used commonly today because clients have surgical hip repairs to reduce pain, for some clients such as this client, it is used short term until surgery can be performed. The AP should allow the weights to hang freely and not remove them. There are no pins and the boot can be removed by the nurse for skin inspection.

10. The nurse is teaching a client about the use of crutches following a foot fracture. When adjusting the crutches to ensure a correct fit, what action will the nurse take? A. Ensure that each crutch fits firmly into the client's armpit. B. Be sure that the top of each crutch is well padded. C. Check to see how many steps the client can take with the crutches. D. Use the crutch on the affected side only.

B. The crutches are used a set and require that the nurse ensure that the client does not develop axillary nerve damage. The tops of the crutches should be well padded and should be at least 2 to 3 finger-breadths below the armpit.

12. A client is in skeletal traction for a complex femoral fracture. Which nursing intervention ensures proper care of this client? A. Ensure that weights are placed on the floor. B. Ensure that pins are not loose and tighten as needed. C. Inspect the skin at least every 8 hours. D. Remove the traction weights only for bathing.

C

17. A client has sustained a rotator cuff tear while playing baseball. The nurse anticipates that the client will receive which immediate conservative treatment? A. Surgical repair of the rotator cuff B. Prescribed exercises of the affected arm C. Activity limitations for the affected arm D. Patient-controlled analgesia with morphine

C

2. The nurse teaches assistive personnel (AP) how to position a client who had an above-the-knee amputation (AKA) last week. Which statement by the AP indicates understanding of the teaching? A. "We should keep the surgical leg elevated on two pillows at all times." B. "We should keep the client in a sitting position as long as possible." C. "We should keep the surgical leg as flat on the bed as possible." D. "We should keep the client in a prone position most of the day."

C

What is the nurse's priority when doing an admission for a client who returned directly from the operating suite after a carpal tunnel repair? A. Monitor vital signs, including pulse oximetry. B. Check the surgical dressing to ensure that it is intact. C. Assess neurovascular assessment in the affected arm. D. Monitor intake and output.

C

5. The nurse is instructing a local community group about ways to reduce the risk for musculoskeletal injury. What information will the nurse include in the teaching plan? A. "Avoid contact sports." B. "Avoid rigorous exercise." C. "Wear helmets when riding a motorcycle." D. "Avoid driving in inclement weather."

C.

9. The nurse is caring for a client who has an external fixator for an open fracture of the tibia and fibula. What is the nurse's priority for care related to the fixator? A. Make sure that the wound is managed using a moist wound healing method. B. Keep the leg covered to keep the extremity warm to promote circulation. C. Inspect the pins to monitor for infection and do not remove crusts. D. Keep the extremity elevated to three pillows while in bed or in a chair.

C. An external fixator is a series of pins attached to a metal frame to hold the bone ends in place while the wound can be managed. The nurse would frequently monitor the pin insertion sites for signs and symptoms of infection. Crusting that occurs at the sites should not be removed because it helps seal the open pin site areas to prevent infection. Leg elevation is important but the client would not necessarily need three pillows.

1. The nurse is caring for an older client who has a large bulky lower leg dressing with posterior splint to maintain alignment after closed reduction for an ankle fracture. Which client assessment finding would the nurse report to the primary health care provider or Rapid Response Team immediately? A. Reports pain level is 4 on a 0-10 pain intensity scale. B. Pedal pulse on affected foot is 1+ and regular. C. Reports tingling and numbness in affected foot. D. Affected foot slightly cooler than the other foot.

C. This client is at risk for neurovascular compromise or compartment syndrome from the external dressing. Pain and a slightly cooler foot is to be expected. However, the client should not have tingling and numbness suggesting that arterial blood flow is diminished.

14. The nurse is caring for a client immediately after a vertebroplasty. In what position would the nurse most likely place the client? A. Prone for the first 1 to 2 hours B. Side-lying for the first 2 hours C. High-Fowler for the first hour D. Flat supine for the first 1 to 2 hours

D

19. Which information about a client who was admitted with a pelvic fracture after being crushed by a tractor is most important for the nurse to assess to monitor for serious complications from this type of injury? A. Skin to evaluate lacerations and abrasions B. Lungs for bilateral normal breath sounds C. Pain score and level of alertness D. Urine specimen to assess for the red blood cells

D

A client who had an elective below-the-knee amputation (BKA) reports pain in the foot that was amputated last week. What is the nurse's most appropriate response to the client's pain? A. "The pain will go away after the swelling decreases." B. "That's phantom limb pain, and every amputee has that." C. "Your foot has been amputated, so it's in your head." D. "On a scale of 0 to 10, how would you rate your pain?"

D

7. A client is recovering from an above-the-knee amputation resulting from peripheral vascular disease. Which statement indicates that the client is coping well after the procedure? A. "My spouse will be the only person to change my dressing." B. "I can't believe that this has happened to me. I can't stand to look at it." C. "I do not want any visitors while I'm in the hospital." D. "It will take me some time to get used to this."

D. Acknowledging that it will take time to get used to the amputation indicates that the client is expressing acceptance and effective coping.Stating that the spouse will change the dressing indicates the client does not want to participate in self-care. Expressing disbelief and disgust over the amputation indicates the client is unwilling to address what has happened. The client who does not want to receive visitors is having difficulty coping with the change in body image.

2. A client had a fractured tibia repair several weeks ago and tells the nurse that she has persistent burning pain, ongoing edema, and muscle spasms in her affected leg. For which chronic complication is the client at risk? A. Chronic osteomyelitis B. Severe osteoporosis C. Compartment syndrome D. Complex regional pain syndrome

D. When pain is not managed appropriately or interventions are not implemented to prevent complex regional pain syndrome (CRPS), the client is at risk for developing CRPS, a chronic debilitating complication of traumatic injury.