Musculoskeletal Care

Edema

Applying Elastic Bandages Assess for _ in the limb or stump

Bear, Pain

Rest: The joint must be rested and should not __ weight until it can do so without __.

Infection

Skeletal traction In addition, you need to assess the pin sites for signs of __

4) The parent uses the abduction bar to help lift the child.

The nurse is assisting in the care of a 2-year-old in a spica cast whose parents are preparing to take him home. The nurse recognizes the need for further teaching if which of the following is observed? 1) The father picks the child up under the arms. 2) The parent helps the boy log roll to wash his back. 3) The mother holds the child in her lap while supporting the cast. 4) The parent uses the abduction bar to help lift the child.

Bone scans

These are ordered when there is suspected widespread disease of the bones, as in a metabolic condition or cancer.

2) Rest, ice, compression, elevation

A 13-year-old came to the urgent care clinic with a sprained ankle she got during soccer practice. The nurse is educating the patient and her parents about how to care for the ankle to promote healing. Which of the following are components of care for sprains? 1) Rest, ice, continuous motion, extension 2) Rest, ice, compression, elevation 3) Resistance, isometric exercise, continuous motion, extension 4) Resistance, isometric exercise, compression, elevation

1) Broken bones typically take 4 to 8 weeks to heal.

A 16-year-old presents to the emergency department with a fractured ulna and clavicle caused by a bicycle accident. The arm is placed in a cast, and the collarbone is immobilized via a sling. The patient wants to know how long he will need to wear the cast and sling. The nurse tells him that: 1) Broken bones typically take 4 to 8 weeks to heal. 2) Because the broken arm is in a cast, it will take about 4 weeks to heal, but the broken clavicle cannot be placed in a cast and thus will probably take 6 months to heal. 3) Broken bones take 2 to 4 weeks to heal. 4) A long bone such as those in the arm takes 8 to 12 weeks to heal, whereas the clavicle should heal in less than a month.

c. Applying heat to her ankle for 20 minutes at a time.

A coworker twisted her ankle going down the stairs. It is swollen and is painful when she bears weight on it. Which intervention would be the least helpful for healing this sprain? a. Avoiding bearing weight on her ankle. b. Wrapping her ankle with an elastic bandage. c. Applying heat to her ankle for 20 minutes at a time. d. Elevating her ankle on a pillow while she is lying down.

a. "Have you inserted anything under the cast to scratch your arm?"

A patient comes into the clinic with his arm in a cast. You notice a small amount of thick, light yellow drainage coming from under the cast, and it has an unpleasant odor. There is no drainage staining the cast, and no open areas of skin are visible at the edge of the cast. Which question is most appropriate to ask this patient? a. "Have you inserted anything under the cast to scratch your arm?" b. "Have you had an upper respiratory infection recently?" c. "Do you have a skin rash anywhere on your body?" d. "Is the edge of the cast irritating your skin?

2) Providing a moist heat pack

A school nurse is called to the gymnasium to care for a child who fell and twisted his ankle. The nurse determines that there is no obvious break and takes the child to the school clinic to notify his parents and provide initial treatment for a suspected sprain. Which of the following interventions would not be included in the plan of care? 1) Elevating the leg 2) Providing a moist heat pack 3) Wrapping the ankle with an elastic bandage 4) Applying ice

1) "The wrap helps shape the stump for the later use of a prosthetic limb."

A student nurse working on the rehabilitation unit asks why a residual limb must be wrapped in a certain way. Which of the following responses by the nurse is best? 1) "The wrap helps shape the stump for the later use of a prosthetic limb." 2) "The wrapping compresses the wound to reduce swelling." 3) "The wrapping helps protects the stump and reduces pain." 4) "Patients usually feel better if they don't have to see the end of the limb."

Emotionally

Amputation of a body part is an __ traumatic event. Not only does the patient need physical care, but he or she requires __ support as well. Physical care of the patient with an amputation is focused on rehabilitation, even immediately after surgery.

Skin breakdown or wounds

Applying Elastic Bandages Assess the patient's limb or stump for _or_.

Placement and Purpose

Applying Elastic Bandages Check the Physician's Order for __and__ of the elastic bandage

Trauma

Ilizarov frame It is also used in situations in which one leg has been left shorter than the other after __.

Skin insertion, Normal saline, Hydrogen peroxide

Skeletal traction Generally, orders for this care include cleansing the __ sites using sterile gauze saturated with __ or __.

Muscle spasm

Skin traction involves the use of ropes, pulleys, and weights to align bone ends after a fracture; it may be used to prevent severe __ due to displaced bones until surgery can be performed.

A Continuous Passive Motion (CPM)

Some nursing concerns after a total knee replacement are different than those after a total hip replacement. Very soon after surgery, flexion of the new knee joint begins. To accomplish this, a __ machine is used

4) "I need to keep a pillow between my legs when I'm sleeping."

The nurse caring for a patient who recently underwent total hip replacement recognizes teaching has been effective if the patient states, 1) "I will need Velcro shoes." 2) "I should limit the amount of time I spend walking." 3) "When I sit in a chair, I need to lean forward." 4) "I need to keep a pillow between my legs when I'm sleeping."

4) Bone scan

The nurse is providing care for a woman with a history of breast cancer who is being evaluated for spread of the cancer to the bone. Which of the following tests would most likely be ordered? 1) X-ray of the pelvis 2) Computed tomography (CT) scan of the chest 3) Magnetic resonance imaging (MRI) of the neck and spine 4) Bone scan

4) Hairline fracture of the tibia

The nurse would expect a patient with which of the following musculoskeletal conditions to require a program of ambulation developed by a physical therapist? 1) Severely sprained ankle 2) Comminuted fracture of the humerus 3) Pain caused by osteoarthritis of the hip joint 4) Hairline fracture of the tibia

Malodorous

What kind of discharge from under the cast is a sign of infection.

Skeletal traction

When __ is used, pins, screws, or tongs are surgically inserted into the bone. These devices, referred to as external fixators, require meticulous nursing care.

d. The head and neck of the femur and the acetabular cup

Which surfaces are replaced when a patient has a total hip replacement? a. The articular surfaces of the femur and the tibia. b. The posterior surface of the patella and the tibia. c. The acetabular cup and head of the tibia and fibula. d. The head and neck of the femur and the acetabular cup

b. "I can cross my legs when I am sitting in a chair, as long as my feet are elevated on a footstool.

You are caring for a patient with a fresh total hip replacement. Which statement would indicate that your patient needs more teaching? a. "I will sleep with the abductor pillow between my legs every night for several months." b. "I can cross my legs when I am sitting in a chair, as long as my feet are elevated on a footstool." c. "I need to use an extension gripper to pick up anything I drop." d. "I will sit in the recliner with the back slightly reclined when I am out of bed.

2) an Ilizarov frame.

A patient has suffered comminuted fractures of the tibia and fibula in both legs from being struck by a car. The nurse understands that the bones may best be immobilized during the months of the healing process with: 1) an immobilizer. 2) an Ilizarov frame. 3) a traction device. 4) a cast.

Even

Ilizarov frame By turning screws in the frame, the rings separate slightly; over time, the bone grows to fill in the gap. This allows for a very gradual increase in bone length to help the legs become more __.

Stabilize, Comminuted, Aligned

Ilizarov frame This fixator is used to __ small bone pieces, such as in a __ fracture, keeping the fragments __ while bone growth occurs

2, 3, 4

Which of the following devices is used for immobilization? SELECT ALL THAT APPLY. 1) Crutches 2) Splint 3) Traction 4) Abduction pillow 5) Continuous passive motion (CPM) machine

1, 5

For which of the following conditions would the use of an elastic bandage serve a specific purpose in treatment? Select all that apply. 1) Sprain 2) Fracture 3) Total knee replacement 4) Total hip replacement 5) Amputation

Prosthesis

It is important that the limb stump heal well and be shaped correctly to fit into a __, or artificial limb, such as an arm or a leg.

1) Leg fracture

The nursing student demonstrates understanding of the purpose of skin traction when she explains that it might be used to treat which condition? 1) Leg fracture 2) Leg amputation 3) Knee replacement 4) Sprained ankle

2) Magnetic resonance imaging (MRI)

A patient is diagnosed with a sprained knee. The nurse knows that what type of diagnostic testing will be used to determine whether there are torn ligaments? 1) X-ray 2) Magnetic resonance imaging (MRI) 3) Computed tomography (CT) 4) Assessment of distal circulation Feedback

b. This finding is normal for skeletal traction.

A patient is in skeletal traction for a comminuted fracture of the tibia. While giving pin care, you notice a small amount of serous drainage around each pin site. Which observation is most accurate? a. The drainage is a symptom of skin infection. b. This finding is normal for skeletal traction. c. This is an indication of pin dislocation. d. The drainage is an indication of a bone infection.

4) Restricting the movement of the patient's leg

A patient is scheduled for total hip replacement surgery. Anticipating the recovery process, the nurse recognizes which of the following will be an important aspect of nursing care specific to this type of patient? 1) Preventing the incision from becoming infected 2) Keeping the patient's leg elevated to avoid swelling 3) Making sure the patient follows the physical therapist's prescribed program of ambulation 4) Restricting the movement of the patient's leg

4) Ensure that two fingers can be slipped underneath the bandage at its proximal end.

Because of intractable poor circulation, a patient has had an amputation of the leg below the knee. After wrapping the amputated limb in an elastic bandage, the nurse should perform which of the following evaluations? 1) Assess the unamputated leg for edema. 2) Check the fingernails for capillary refill and color. 3) Touch the skin above the bandage and assess for temperature. 4) Ensure that two fingers can be slipped underneath the bandage at its proximal end.

Squared-off, Smooth, Rounded

If left to heal on its own, the stump will have a __ shape. To fit into the socket of a prosthetic limb, the stump must have a __,__ shape. That is the reason for wrapping the stump with an elastic bandage in the postoperative healing phase.

Type, Intensity

Impaired circulation The nurse should ask the patient to describe his or her pain in the affected limb, including the __ of pain and __ as rated on a 0 to 10 scale.

Numbness, Burning, or Tingling, Paper clip

Impaired circulation The nurse should ask the patient whether he or she is experiencing __,__,__ in the affected limb. The nurse can also test sensation in the affected and unaffected limbs by touching each with a __ and asking the patient to say when he or she feels the __ touching the limb.

Distal

Impaired circulation The nurse should compare the size of the __ aspect of the affected extremity to that of the unaffected extremity.

Capillary Refill, Distal

Impaired circulation The nurse should test __ in nail beds of fingers or toes __ to the surgical site or cast.

90, Dislocation

Patients who have had total hip replacement must not flex their hip joint more than __ degrees and must not adduct the operative leg to the midpoint of the body or beyond. Otherwise, the new femur head could pop out of the acetabular cup, causing __ of the hip joint. Therefore, the nurse must make sure that the patient restricts the movement of the leg during recovery.

Forward

Remind the patient to keep the affected foot slightly __, rather than bending the knee and holding the foot behind the crutches.

Pin-site

Skeletal traction Infections of the bone are very serious and sometimes quite difficult to treat. It is the nurse's responsibility to prevent such infections by performing __ care as ordered.

Flexion ,Tolerate

The __ of the knee by the CPM machine will probably be quite painful for the first 24 hours postoperatively. Effective pain management, including with relaxation exercises, is important to help the patient __ the exercise.

3) Effective management of pain will be necessary for the patient to tolerate repetitions with the machine.

The physician has ordered the use of a continuous passive motion (CPM) machine for a patient who has had a total knee replacement. The nurse knows that: 1) The CPM machine engages the muscles around the knee in active exercise. 2) The nurse needs to stand at the side of the bed to check the supported leg's alignment with the rest of the body. 3) Effective management of pain will be necessary for the patient to tolerate repetitions with the machine. 4) It is important for the patient to tighten the muscles around the knee while the machine flexes the knee so that they become stronger.

c. passive flexion and extension.

The purpose of the CPM machine is to provide: a. active abduction and adduction. b. active range of motion to all joints. c. passive flexion and extension. d. passive internal and external rotation.

A, B, C

The purpose of which of the following devices is to prevent flexion of an affected joint? a. Cast b. Immobilizer c. Splint d. Elastic bandages e. Traction f. Abductor pillow g. Ilizarov frame

RICE

The sprained joint must be supported and rested in order to heal. The acronym __ is used to help you remember treatment for a sprain:

3) The patient may be experiencing pain.

The student nurse is caring for a patient immediately after a knee replacement. The student notes that the patient's blood pressure and pulse are elevated. Which of the following is the best interpretation of these findings? 1) The patient may be in early stages of shock. 2) The patient may have suffered a heart attack while under the anesthetic. 3) The patient may be experiencing pain. 4) The patient may have bleeding within the surgical site.

1, 2, 3, 5

The student nurse is instructed to perform neurovascular checks on the patient who had surgery on the left leg, which is now in a well-wrapped splint. Which of the following would be included? SELECT ALL THAT APPLY. 1) Have the patient report the presence of sensation while the nurse touches the limb at various levels. 2) Compare the left foot with the right foot. 3) Test capillary refill in the toes on the left foot. 4) Have the patient touch his toes. 5) Ask the patient to rank his pain on a 1 to 10 scale.

1) The patient holds the affected leg with the knee bent and the foot behind the crutches.

The student nurse is spending a day in physical therapy and is observing a patient walk with crutches for the first time. Which of the following observations would require an intervention? 1) The patient holds the affected leg with the knee bent and the foot behind the crutches. 2) The patient uses his hands and wrist to hold on to the crutches and support his weight. 3) The patient leads with his unaffected leg when going up the steps. 4) The patient leads with his affected leg and crutches when going down the steps.

Ilizarov frame

This frame is composed of metal rings on the outside of the limb, with rods and wires that attach to those rings. The rods and wires also penetrate the skin and insert into the bone.

3) Malodorous discharge from the immobilized limb

When caring for a patient in a cast, the nurse would recognize which of the following signs and symptoms as indicating that the patient may have an infection? 1) Excessive itching under the cast 2) Swelling of the immobilized limb 3) Malodorous discharge from the immobilized limb 4) Patient's report of burning or tingling in the immobilized limb

2, 3, 4, 5

When performing a neurovascular check on a patient in a cast, the nurse looks for which of the following signs in the affected limb that may indicate impaired circulation? Select all that apply. 1) Decreased sensation 2) Edema 3) Cooler temperature 4) A sudden increase in pain5) Unequal pulse to that of other limbs

3) Crutches

Which of the following assistive devices for ambulation carries the most risk with its use and therefore requires the nurse to provide the most patient education? 1) Cane 2) Walker 3) Crutches 4) CPM machine

4) Diagnosing whether she will need to have her right knee replaced as wel

Which of the following is not a nursing diagnosis that the nurse would make when preparing a care plan for a patient who has had a total replacement of the left knee? 1) Diagnosing her level of pain and whether the pain management medications she has been given are effective 2) Diagnosing how impaired her mobility is postoperatively 3) Diagnosing whether she will be able to perform self-care after she gets home 4) Diagnosing whether she will need to have her right knee replaced as well