Module 11- Concepts of Care for Patients with Musculoskeletal Trauma

Which assessment findings on a client being prepared for a vertebroplasty for a compression fracture of the lumbar vertebrae will the nurse report immediately to the orthopedic surgeon? Select all that apply a. Platelet count is 40,000/mm3 b. WBC is 9,000/mm3 c. Client reports taking the prescribed dose of an antihypertensive this morning d. Client reports taking the prescribed dose of rivaroxaban this morning e. Pain rating is an 8 on a 0 to 10 scale f. Sensation to pinprick stimulation is reduced on the right leg

a, and d

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. Elevate the left leg above the level of the heart. b. Tell the client to keep his left leg still. c. Apply an elastic wrap or ankle or compression brace. d. Administer morphine via IV push. e. Apply heat to promote blood flow and healing.

a, b, and c

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 dry."

a, b, c, and d

Which points and actions will the nurse include when teaching a client and family after a below-the-knee amputation about care of the residual limb? Select all that apply. a. Demonstrating how to apply a figure-eight elastic wrap b. Reviewing the signs and symptoms of wound infection c. Reminding the client and family to rewrap the limb several times each day d. Obtaining a return demonstration of the elastic wrap application e. Reviewing positioning and exercises for prevention of flexion contractures f. Informing the client that after the incision is healed, it can be cleaned during bathing or showering with soap and water

a, b, c, d, e, and f

Which actions are appropriate for the nurse to perform when caring for a client who is placed in Buck's traction after a hip fracture? Select all that apply a. Ensuring that the weights never rest on the floor b. Removing the boot or belt every 8 hours to assess skin integrity c. Comparing the amount of weights applied with the amount prescribed d. Removing the weights every 8 hours for 30 minutes to prevent muscle spasms e. Assessing circulation distal to the traction device every hour for the first 24 hours f. Instructing all personnel and visitors to not touch or change the position of the weights

a, b, c, e, and f

Clients with which problems or factors will the nurse assess most frequently for development of acute apartment syndrome? Select all that apply a. Lower legs caught between the bumpers of two cars b. Massive infiltration of IV fluid into the forearm c. Bivalve cast on the lower logs d. Multiple insect bites to lower legs e. Daily use of oral corticosteroids f. Severe burns to the upper extremities

a, b, d, and f

Which assessments are a priority for the nurse to perform to prevent harm on a client who was hit by a motorcycle and has a suspected pelvic fracture? Select all that apply a. Checking vital signs b. Asking about opioid use c. Examining urine for presence of blood d. Asking the client to rate his or her pain e. Determining the level of consciousness f. Performing neurovascular checks on the lower limbs

a, c, and e

What is the nurse's best response when a client who had a long-leg plaster cast applied an hour ago reports that the cast feels "hot"? a. "Plaster gives off heat as it dries, and the heat does not mean anything is wrong." b. "It is likely that you have an infection and will need to be started on antibiotics immediately." c. "This means you are having an allergic reaction and this cast will have to be removed immediately." d. "Don't worry. This heat is normal and I will apply a cooling blanket over it for your comfort."

a. "Plaster gives off heat as it dries, and the heat does not mean anything is wrong."

Which client will the nurse assess most frequently for indications of VTE? a. 25 year old weightlifter with a fracture of the right femur b. 45 year old with metastatic cancer and a spinal compression fracture c. 55 year old car crash victim with multiple facial features d. 65 year old with a broken elbow and hypertension

a. 25 year old weightlifter with a fracture of the right femur

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. Change the subject and talk about the client's hobbies. c. Distract the client with stories about the nurse's family. d. Remind the client that the lower leg was removed.

a. Assess the level of the client's pain.

A client who has a plaster splint applied to the ankle at 7 am and received pain medication at 9 am now at 11 am reports that the pain is getting worse, not better. What is the nurse's best first action to prevent harm? a. Assessing the pulses and skin temperature distal to splint b. Loosening the splint and erasing the client's pain in 15 minutes c. Requesting a prescription to administer pain medication IV d. Repositioning the extremity on a pillow and placing an ice pack

a. Assessing the pulses and skin temperature distal to splint

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. Administer the prescribed analgesic. c. Place a dressing on the affected area. d. Immobilize the left leg with a splint.

a. Check the dorsalis pedis pulses.

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. Inspect the pins to monitor for infection and do not remove crusts. b. Make sure that the wound is managed using a moist wound healing method. c. Keep the leg covered to keep the extremity warm to promote circulation. d. Keep the extremity elevated to three pillows while in bed or in a chair.

a. Inspect the pins to monitor for infection and do not remove crusts.

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. Avoid the use of antiembolism stockings. d. Administer pain medication before deep-breathing exercises.

a. Keep the client's heels off the bed at all times.

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. Check the fit of the cast by inserting a tongue blade between the cast and the skin. c. Apply a heating pad for 15 to 20 minutes four times daily to help with pain. d. Keep the cast covered with a soft towel to help it to dry quickly.

a. Monitor neuromuscular status for decreased circulation and sensation in the extremity.

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. Urinary tract infection (UTI) b. Acute compartment syndrome (ACS) c. Fat embolism syndrome (FES) d. Osteomyelitis e. Heart failure

b, c, and d

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, and e

A client expresses concern over the presence of external pins and external devices used to manage her fracture and says she wishes it all could have been placed internally so it wouldn't be visible. What advantages will the nurse tell the client that external fixation has over internal fixation of fractures? Select all that apply a. The risk for infection is reduced b. You lost less blood than you would have with an internal fixation c. This device allows you to move and walk earlier than an internal device d. You will need surgery to remove these devices after healing is complete e. Most people have les pain with the external device than with interval devices f. This device replaces the need for the use of any other device, such as a cast or a boot, later

b, c, d, and e

The nurse is caring for a client who was admitted to the ED with report of left knee pain and swelling after playing baseball with friends. Which nursing actions are appropriate when caring for this 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, and e

Which client assessment findings or factors indicate to the nurse the possible presence of carpel tunnel syndrome (CTS)? Select all that apply a. Client has been taking calcium and vitamin D supplements for osteopenia b. Numbness and pain are reported on performance of the Phalen maneuver c. Muscle pad below the thumb is flat and atrophied d. Client's favoriet hobby is knitting and crocheting e. Wrist and hand pain awaken the client at night f. Lifestyle is very sedentary

b, c, d, and e

Which assessment findings in a client with a complete and displaced fracture of the femur indicates to the nurse possible fat embolism syndrome (FES)? Select all that apply a. Increased swelling over the fracture site b. Petechiae on the neck and chest c. Decreased platelet count d. Dry mucous membrane e. Sudden onset confusion f. PaO2= 72 mmHg

b, c, e, and f

Which clients with fractures will the nurse recognize as being at increased risk for delayed or slow bone healing? Select all that apply a. 28 year old male with multiple long bone fractures b. 35 year old female with diet induced osteopenia c. 45 year old female semiprofessional tennis player d. 58 year old female taking corticosteroids daily for autoimmune disorder e. 65 year old male with arteriosclerosis f. 75 year old male with COPD

b, d, e, and f

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 should stretch my fingers and wrists frequently during the day." d. "I may need to wear a wrist splint when my wrist gets inflamed."

b. "I need to exercise repetitively to strengthen my wrists."

What is the nurse's best response to a young adult client who says, "How will I ever walk on that?" on seeing his pale and thin leg after removal of a long leg cast that has been in place for 7 weeks? a. "Fractures can heal but the bones are never as strong as they were before the break." b. "The leg will be weak at first, but will regain muscle strength and size as you exercise." c. "The bone will thicken as healing continues and make this leg as large as your other one." d. "The color changes because the plaster in the cast rubbed off on it and will improve when you are able to shower."

b. "The leg will be weak at first, but will regain muscle strength and size as you exercise."

What is the nurse's best response to a client with a lower limb amputation who says, "I think I am going crazy. I know my foot is gone but I still feel my big toe burning and itching."? a. "Are you sure you were awake? Sometimes people dream this pain as part of hoping that the missing body part will grow back." b. "You are not crazy; many people continue to feel pain and other sensations in a limb that was amputated. How severe is this pain?" c. "This complication is usually seen in a person who has not accepted the fact that the limb is gone. A psychologist can help you cope with this." d. "This problem is very common and although nothing can be done about it, we can give you pain medication for the pain you feel at the surgical site."

b. "You are not crazy; many people continue to feel pain and other sensations in a limb that was amputated. How severe is this pain?"

Which client will the nurse determine requires the most assistance with performing ADLs? a. 28 year old with bilateral BKA b. 40 year old with amputation of the dominant hand c. 50 year old with the AKA of the dominant leg d. 70 year old with amputations of all the toes on the left foot

b. 40 year old with amputation of the dominant hand

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. Use the crutch on the affected side only. d. Check to see how many steps the client can take with the crutches.

b. Be sure that the top of each crutch is well padded.

Which assessment finding in a client who has a fracture of the right wrist alerts the nurse to a possible early indication of a complication? a. Wiggling fingers causes pain b. Client reports numbness and tingling c. Fingers are cold and pale; pulses are impalpable d. Pain is severe and seems out of proportion to injury

b. Client reports numbness and tingling

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. Complex regional pain syndrome c. Severe osteoporosis d. Compartment syndrome

b. Complex regional pain syndrome

Which assessment finding on a client who has a closed fracture of the lower femur with extensive swelling and bruising best indicates to the nurse that perfusion in the affected limb is adequate? a. Pulse oximetry on the right forefinger is 98% b. Pedal pulse of the affected limb is easily palpated and strong c. Femoral pulse of the affected limb is easily palpated and strong d. Capillary refill on great tow of the affected limb is about 4 seconds

b. Pedal pulse of the affected limb is easily palpated and strong

The nurse is assigned to care for a postoperative client who has 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? a. Elevate the surgical leg on a pillow b. Perform a neurovascular assessment c. Administer pain medication d. Call the primary HCP

b. Perform a neurovascular assessment

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. Lungs for bilateral normal breath sounds b. Urine specimen to assess for the red blood cells c. Pain score and level of alertness d. Skin to evaluate lacerations and abrasions

b. Urine specimen to assess for the red blood cells

Which actions will the nurse take to prevent a flexion contracture in a client who is post operative from an above the knee amputation low on the femur? Select all that apply a. Applying the elastic wraps on the stump distal to proximal in a figure eight pattern b. Using aseptic technique when irrigating the wound or changing the dressing c. Instructing the client to perform gluteal muscle contraction exercises hourly while awake d. Assisting the client to a prone position for 20 to 30 minutes every 3 to 4 hours e. Keep the remaining part of the extremity positioned above the level of the heart f. Encouraging the client to spend as much time as possible in a chair while awake

c, and d

Which precautions or care information are appropriate for the nurse to include when teaching a client going home with a synthetic forearm cast? a. "Be sure to change the stockinette at least once a week." b. "Limit movement of the fingers and wrist joints to prevent pain." c. "Keep your hand and arm elevated above the level of your heart to reduce swelling." d. "Use an ice pack on the cast for the first 6-8 hours, and cover the pack with a towel." e. "When upright, wear the sling so that it distributes over your shoulder and not just your neck." f. "Call your primary HCP immediately if numbness and tingling occur in your hand or fingers."

c, d, e, and f

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. "Inspect the pins in the traction for signs of infection." b. "Remove the boot every shift to inspect the skin." c. "Do not allow the traction weights to rest on the ground." d. "Remove traction weights when turning the client."

c. "Do not allow the traction weights to rest on the ground."

The nurse teaches assistive personnel (AP) how to position a client who has 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. "We should keep the surgical leg as flat on the bed as possible."

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 rigorous exercise." b. "Avoid contact sports." c. "Wear helmets when riding a motorcycle." d. "Avoid driving in inclement weather."

c. "Wear helmets when riding a motorcycle."

Which instructions for handling the amputated digit will the nurse provide to a caller to the ED who reports that a friend just sustained an amputation of a finger while cleaning his lawn mower? a. "Place the finger in a. glass of milk and keep it cold while transporting it." b. "Seal the finger in a plastic bag and pack with the cut side up in a cup of ice." c. "Wrap the finger in a clean cloth, seal it in a plastic bag, and place the bag in ice water." d. "Place the finger back on your friend's hand and wrap it tightly with an elastic bandage."

c. "Wrap the finger in a clean cloth, seal it in a plastic bag, and place the bag in ice water."

Which client with a non healing fracture of the humerus will the nurse recognize as having a contraindication for use of electrical bone stimulation? a. 30 year old with a seizure disorder b. 40 year old smoker with hypertension c. 50 year old with an implanted cardiac pacemaker d. 60 year old with reduced immunity from corticosteroid use

c. 50 year old with an implanted cardiac pacemaker

A client has sustained a rotator cuff tear while playing baseball. The nurse anticipates that the client will receive which immediateconservative treatment? a. Surgical repair of the rotator cuff b. Patient-controlled analgesia with morphine c. Activity limitations for the affected arm d. Prescribed exercises of the affected arm

c. Activity limitations for the affected arm

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

c. Assess neuromuscular assessment in the affected arm

Which action will the nurse perform first when a client in a body cast reports a painful "hot spot" underneath the cast and an unpleasant odor? a. Requesting a cast change b. Offering the client a PRN pain medication c. Assessing the client's temperature and other vital signs d. Elevating the extremity and applying an ice pack over the spot

c. Assessing the client's temperature and other vital signs

What is the most appropriate action for the nurse to take when assessment on a client with external fixation reveals crusts have formed around the pin sites? a. Assessing the client's temperature b. Notifying the surgeon immediately c. Documenting the findings as the only action d. Removing the crusts and culturing the drainage

c. Documenting the findings as the only action

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. Absence of erythema and tenderness at the surgical site b. Ability to flex and extend the right knee c. Large amount of serosanguineous or bloody drainage d. Mild to moderate pain controlled with prescribed analgesics

c. Large amount of serosanguineous or bloody drainage

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. Check the client's blood pressure frequently. b. Monitor the client's pain level c. Monitor the client's respiratory rate. d. Perform circulation checks before and after the procedure.

c. Monitor the client's respiratory rate.

Which assessment finding on an older client who fell while getting out of bed indicates to the nurse a possible fracture? a. The client is extremely confused and trying to get up b. The client cries out when the nurse attempts to examine him c. One leg is shorter than the other and has a protruding bump on the side d. The skin of both legs is cooler and darker than that of the upper extremities

c. One leg is shorter than the other and has a protruding bump on the side

Which assessment is the priority for the nurse to perform on a client admitted to the ED with multiple rib fractures? a. Pulses in all four extremities b. Pulse rate and rhythm c. Oxygen saturation d. Pain intensity

c. Oxygen saturation

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 a psychiatrist about the amputation b. Engaging in diversional activities to avoid focusing on the amputation c. Talking with an amputee close to the client's age who has a similar amputation d. Drawing a picture of how the client sees him- or herself

c. Talking with an amputee close to the client's age who has a similar amputation

Which suggestion will the nurse make to help a client who has complex regional pain syndrome (CRPS) in the right arm weeks after an open reduction was required to repair a broken elbow and fractured radius to reduce discomfort? a. Take pain medications around the clock even when the pain is not present b. When the sensations occur, immobilize and ice the limb until they pass c. Use a dry wash cloth and rub the skin on the arm several times daily d. Wrap the arm in warm, wet compresses as soon as the pain starts

c. Use a dry wash cloth and rub the skin on the arm several times daily

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. "I can't believe that this has happened to me. I can't stand to look at it." b. "I do not want any visitors while I'm in the hospital." c. "My spouse will be the only person to change my dressing." d. "It will take me some time to get used to this."

d. "It will take me some time to get used to this."

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. "On a scale of 0 to 10, how would you rate your pain."

Which question is most appropriate for the nurse to ask a client who has been receiving scheduled and PRN opioids for severe pain with multiple fractures who now has a distended abdomen and hypoactive bowel sounds? a. "Did your use opioids or other recreational drugs before your injury?" b. "What specific foods have you eaten in the past 2 days?" c. "How would you rate your pain on a 0 to 10 scale?" d. "When was your last bowel movement?"

d. "When was your last bowel movement?"

Which client will the nurse consider to be at highest risk for nonunion after a fracture? a. 40 year old who is 20 lb overweight and has a Colles fracture of the wrist b. 50 year old female with comminuted fracture of the humerus c. 60 year old male with multiple rib fractures d. 70 year old with a "tip-fib" fracture

d. 70 year old with a "tip-fib" fracture

Which precaution or care information will the nurse teach a client prescribed low-intensity pulsed ultrasound treatments for a very slow healing fracture of the lower leg specific for this treatment? a. Use a reliable form of birth control until treatment is complete b. The treatment cannot be used if you have any type of diabetes c. This device should not be used in the same room with a microwave oven d. Expect to dedicate approximately 20 minutes each day for treatment

d. Expect to dedicate approximately 20 minutes each day for treatment

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. High-Fowler for the first hour c. Side-lying for the first 2 hours d. Flat supine for the first 1 to 2 hours

d. Flat supine for the first 1 to 2 hours

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. Remove the traction weights only for bathing. c. Ensure that pins are not loose and tighten as needed. d. Inspect the skin at least every 8 hours.

d. Inspect the skin at least every 8 hours.

After ensuring airway, breathing, and circulation along with a head to toe assessment, which action will the nurse take next in the emergency care of a client with an extremity fracture? a. Checking the neurovascular status of the area distal to the injury: temperature, color, sensation, movement, and distal pulses by comparing the affected and unaffected limbs b. Elevating the affected are on pillows, applying an ice pack that is wrapped to protect the skin, and obtaining a prescription for pain medication c. Immobilizing the extremity by splinting; include joints above and below the fracture site, followed by rechecking circulation d. Removing or cutting the client's clothing to inspect the affected area while supporting the injured area above and below injury

d. Removing or cutting the client's clothing to inspect the affected area while supporting the injured area above and below injury

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. Affected foot slightly cooler than the other foot. b. Reports pain level is 4 on a 0-10 pain intensity scale. c. Pedal pulse on affected foot is 1+ and regular. d. Reports tingling and numbness in affected foot.

d. Reports tingling and numbness in affected foot.