Musculoskeletal Quiz questions

Indicated

~appropriate or necessary

The nurse is assessing a client in skeletal traction. When evaluating the pin sites, the nurse would be most concerned with which finding? a.) pain upon palpation to the pin sites b.) thick, yellow drainage around the pin sites c.) clear, watery drainage around the pin sites d.) erythema around the pin sites

~b.) thick, yellow drainage around the pin sites

Contraindicated

~could cause harm

Non-essential

~doesnt change anything

CASE Presentation An 80 year old woman was admitted to the local community hospital following a motor vehicle crash. Her injuries include a left fractured hip, left compound wrist fractured wrist, and multiple contusions and lacerations. The nurse notes that preoperative Buck traction has been applied to the client's left leg with two weight of 5lbs (2.3kg) each. Her left lower arm has an external fixator to manage the open wound while the fracture heals. For each of the following indicate whether it is indicated, contraindicated, or non essential.... a.) Remove traction weights when turning the client b.) Assess pin sites of external fixator for s/s of infection c.) Take the client's temperature every hour d.) Check the cast to ensure that it is not too tight e.) Manage the client's pain with analgesia f.) Check all traction ropes and knots every shift for intactness

a.) contraindicated b.) indicated c.) non-essential d.) non-essential e.) indicated f.) indicated

A client with a diagnosis of diabetes mellitus has had a right below-knee amputation (BKA). Given the client's history of diabetes mellitus, which complication is the client at most risk for after surgery? a.) hemorrhage b.) edema of the residual limb c.) erythema of the incision d.) elevated glucose levels

a.) hemorrhage

The nurse is caring for a client being treated for a fat embolus after multiple fractures. Which data should the nurse evaluate as the most favorable indication of resolution of the fat embolism? a.) oxygen saturation (spO2) of 90% b.) arterial oxygen level of 60 mmhg c.) dyspnea on exertion only d.) clear mentation

d.) clear mentation

A client is scheduled to have a closed reduction of a right ankle fracture. The nurse determines the client understands the procedure when the client states that it involves which of the following? a.) using an arthroscope to realign the bones b.) realigning the bone using surgery c.) correcting the bone alignment using manual manipulation d.) inserting rods, pins, or other implantable devices

~c.) correcting the bone alignment using manual manipulation

A client sustains an injury to the left ankle when he fell down three steps. There was immediate swelling and pain from the injury, and the client was taken to the local emergency department. What initial test does the nurse anticipate the provider will order to rule out a fracture? a.) CT scan b.) DEXA scan c.) arthroplasty d.) X-ray

~d.) X-ray

CASE Presentation A 55 year old woman had a left total knee arthroplasty 2 days ago. The nurse is planning to provide health teaching for the client in preparation for her discharge. For each of the following indicate whether it is indicated, contraindicated, or non essential.... a.) "used the prescribed ambulatory aid such as walk" b.) use assistive/adaptive devices as needed (sock aides, shoehorns, dressing sticks, extenders) c.) use heat as needed to the operative hip to decrease pain and promote healing d.) do not bend hips more than 90 degrees" e.) "Follow up with all physical therapy appointments as prescribed" f.) Inspect your surgical incision every day for signs of infection g.) Do not put more weight on affected leg than allowed/instructed

a.) indicated b.) indicated c.) contraindicated d.) non-essential e.) indicated f.) indicated g.) indicated 6

A client had a left above the knee amputation today. For the first 24 hours postoperatively, the nurse performs which priority action to properly manage the surgical site? a.) elevate the residual limb b.) loosen the dressing every four hour c.) maintain the residual limb in a dependent position d.) change the dressing as often as needed

~a.) elevate the residual limb (promotes venous drainage, reduces swelling)

The nurse witnesses a vehicle hit a pedestrian. The victim is dazed and attempts to get up. The victim's leg appears fractured. Which intervention is priority for the nurse to take? a.) assist the victim to get up and move to the sidewalk b.) use the victim's shirt as a tourniquet for bleeding c.) stay with the victim and encourage him/her to remain as still as possible d.) attempt to reduce the fracture before paramedics arrive

~c.) stay with the victim and encourage him/her to remain as still as possible

CASE Presentation A 55 year old woman returns from the PACU after a left total knee arthroplasty. During surgery, she had epidural anesthesia and is currently receiving patient-controlled analgesia (PCA) morphine for surgical pain and acetaminophen for chronic joint pain. Choose the most likely options for the information missing from the table below by selecting from the lists of options provided. §The nurse should monitor postoperative clients who have a total knee arthroplasty under epidural anesthesia for common complications that can occur during their hospital stay, including_________1____________ and _______2___________. Nursing interventions that can help prevent these complications are to _________3__________, ________4______________ and ____5_________________. Options for 1&2 ~respiratory infection ~venous thromboembolism ~intestinal obstruction ~surgical knee dislocation ~urinary retention ~anemia Options for 3,4,&5 ~encourage fluids ~administer a stool softener ~maintain an abduction pillow or device ~ambulate the client early ~administer anticoagulant ~refer to resp. therapy

1.) ~venous thromboembolism 2.) urinary retention 3.) encourage fluids 4.) ambulate the client early 5.) administer anticoagulants

CASE Presentation An 80 year old woman as was admitted to the local community hospital following a motor vehicle crash. Her injuries included a left fractured hip and left compound fractured wrist, which were both surgically repaired 2 days ago. The client is alert and oriented x3; she gets out of bed to a chair with assistance at least two times a day. The nurse's note from the previous shift includes these comments regarding the client's skin assessment. Nurses note: 3/16/22 0600 Client has 1in (2.2cm) reddened area on coccyx that does not blanch. Both heels have bluish coloration and feet soft and "mushy". Superficial lacerations on her upper arms and chest are beginning to heal. Which of the following nursing actions are indicated for the client at this time? Select All that Apply A.) Teach the assistive personnel to avoid positioning the client in the supine position. B.) Limit the client's time sitting in a chair to no more than 1 hour at a time C.) While the client is in bed, position her heels to be off the bed at all times. D.) Teach the client and family to increase her nutritional intake of carbohydrates. E.) Consult with a registered dietician nutritionist for possible oral nutritional supplement. F.) Obtain a foot board or other device to prevent plantar flexion of her feet G.) Apply a pressure-reducing mattress overlay the client's bed.

~A.) Teach the assistive personnel to avoid positioning the client in the supine position. ~B.) Limit the client's time sitting in a chair to no more than 1 hour at a time ~C.) While the client is in bed, position her heels to be off the bed at all times. ~E.) Consult with a registered dietician nutritionist for possible oral nutritional supplement. ~G.) Apply a pressure-reducing mattress overlay the client's bed.

An 80 year old woman was admitted to the local community hospital following a MVA/MVC. Her injuries included a left fractured hip and a left compound fractured wrist, which were both surgically repaired 3 days ago. The client has been alert and oriented x3; she gets out of bed to a chair with assistance at least two times a day. The nurse documents these findings as part of the shift assessment. Which findings require a follow up by the RN? a.) Temperature- 100F/37.8C b.) Heart rate- 82 beats/min and regular c.) Respirations- 22breaths/min d.) Blood Pressure- 96/52 mm Hg e.) Left hip wound dry and staples intact f.) Redness around proximal end of left wrist incision g.) Reports feelings unusually tired today h.) Drowsy but easily awakened i.) States that her pain is currently a 2 ( on a 0-10 pain intensity scale)

~a.) Temperature- 100F/37.8C ~d.) Blood Pressure- 96/52 mm Hg ~f.) Redness around proximal end of left wrist incision ~g.) Reports feelings unusually tired today ~h.) Drowsy but easily awakened

An 84 year old who sustained a right fractured hip and right fractured tibia had an open reduction internal fixation (ORIF) for both fractures. For which of the following acute postoperative complications would the nurse monitor while the client is hospitalized? Select all that apply a.) Wound infection b.) Venous thromboembolism c.) Chronic osteomyelitis d.) Acute compartment syndrome e.) Ischemic bone necrosis f.) Fat embolism syndrome g.) Complex regional pain syndrome h.) Skeletal muscle atrophy

~a.) Wound infection ~b.) Venous thromboembolism ~d.) Acute compartment syndrome ~f.) Fat embolism syndrome (all others are chronic)

A client with a right arm cast for a fractured humerus states, " I haven't been able to straighten the fingers on my right hand since this morning and now they are tingling." What action should the nurse take first? a.) assess neurovascular status to the hand b.) ask the client to wiggle the fingers c.) encourage the client to take the prescribed analgesic d.) elevate the right arm on a pillow to reduce edema

~a.) assess neurovascular status to the hand (think compartment syndrome)

In a client with a dislocation, the nurse should initially perform neurovascular assessments a minimum of every 15 minutes until stable. Which complication do the assessments help the nurse to monitor for? a.) avascular necrosis b.) GI bleeding c.) fat embolisms d.) development of carpal tunnel syndrome

~a.) avascular necrosis

A client in skeletal traction for a right femur fracture reports pain in the affected limb. After assessing that the right foot is pale without a pulse, what should the nurse do next? Select all that apply? a.) ensure that the leg is not raised above the heart level b.) administer analgesics as ordered c.) release the traction d.) recheck the pulse in 1 hour e.) document the findings and notify the healthcare provider

~a.) ensure that the leg is not raised above the heart level ~e.) document the findings and notify the healthcare provider

Which cast care instructions should the nurse provide to a client who has just had a plaster cast applied to the right forearm? Select ALL that apply. a.) keep the cast clean and dry b.) keep the cast and limb elevated c.) expect numbness and tingling in the forearm until the cast dries d.) use a hair dryer set on warm to hot setting to help the cast to dry e.) use a soft padded object that will fit under the cast to scratch any skin f.) notify the provider should you smell any odor coming from the cast

~a.) keep the cast clean and dry b.) keep the cast and limb elevated ~f.) notify the provider should you smell any odor coming from the cast

If a dislocation is not treated promptly, tissue death due to anoxia can occur. How should the nurse document this poor outcome? a.) compartment syndrome b.) avascular necrosis c.) heterotrophic ossification d.) osteomyelitis

~b.) avascular necrosis

A client with open fracture is at risk for developing osteomyelitis. Which classic symptoms would the nurse assess for to detect development of this complication? Select all that apply? a.) decreased pain at the fracture site b.) elevated temps c.) acute respiratory distress d.) shortening of the affected extremity e.) increased swelling at the fracture site

~b.) elevated temps ~e.) increased swelling at the fracture site

A 55-year-old client arrives to the ER with a right leg fracture. An x-ray is performed and shows a closed tibia fracture. A closed reduction is performed and a cast is put in place. The patient is ordered Morphine 2 mg IV every 4-6 hours as needed for pain. The client calls on the call light report that the pain medication is not working and that it even hurts to slightly stretch the leg. What are the best responses by the nurse? Select all that apply: a.) reassure the client that this is normal and reposition the cast b.) notify the provider c.) perform a thorough neurovascular assessment check d.) elevate the extremity on pillows above the heart level e.) re-adjust the cast to ensure that it fits snuggly against the fracture f.) loosen and remove restrictive items

~b.) notify the provider ~c.) perform a thorough neurovascular assessment check ~f.) loosen and remove restrictive items

The nurse is caring for a client with a week-old cast. The client asks why the nurse touches the cast during an assessment. What is the most appropriate response by the nurse? a.) "I am making sure the cast is fully dried" b.) "I am evaluating the strength of the cast" c.) "I a feeling for the presence of a hot spot that might indicate infection" d.) "I am making sure that the cast is not too tight"

~c.) "I a feeling for the presence of a hot spot that might indicate infection"

The nurse is assessing the casted extremity of a client. Which sign is most indicative of infection? a.) dependent edema b.) diminished distal pulse c.) Prescence of a "hot spot" on the cast d.) coolness and pallor of the extremity

~c.) Prescence of a "hot spot" on the cast

A client with a femoral fracture is in Buck's traction. While making rounds, the nurse notices that the client's foot is touching the footboard of the bed. What is the most appropriate action by the nurse? a.) wedge a pillow between the footboard and the client's foot b.) praise the client for maintaining countertraction c.) center the client on the bed d.) ask the client to pull up in bed while holding onto the weights

~c.) center the client on the bed

Two hours after a child had a cast applied for a wrist fracture, the nurse assesses swelling in the hand. Ice has been applied continuously and the cast elevated higher than the heart. The child denies any increase in pain but does report numbness and tingling. Which action should the nurse prioritize first? a.) medicate the client for pain b.) elevate the extremity higher c.) notify the healthcare provider d.) obtain a brachial pulse

~c.) notify the healthcare provider (think compartment syndrome)