115 PrepU Chapter 37: Management of Patients with Musculoskeletal Trauma

Which nursing intervention is appropriate for monitoring the client for the development of Volkmann's contracture?

Assess the radial pulse.

Which intervention would the nurse implement with the client in a plaster cast? Select all that apply.

Handle wet cast with palms of hands. Trim, reshape, and smooth edges of cast.

A client comes to the emergency department and it is found that the client's radial head is partially dislocated. What is this partially dislocated radial head documented as?

Subluxation

The nurse is caring for a patient who had a total hip replacement. What lethal postoperative complication should the nurse closely monitor for?

pulmonary embolism

A client has sustained a right tibial fracture and has just had a cast applied. Which instruction should the nurse provide in client cast care?

"Keep your right leg elevated above heart level."

The nurse is providing instructions to the client who is being prepared for skeletal traction. Which statement by the client indicates teaching was effective?

"Metal pins will go through my skin to the bone."

An older adult patient had a hip replacement. When should the patient begin with assisted ambulation with a walker?

24 hours

Which action would be most important postoperatively for a client who has had a knee or hip replacement?

Assisting in early ambulation.

An x-ray demonstrates a fracture in which a bone has splintered into several pieces. Which type of fracture is this?

Comminuted

A nurse is preparing to discharge a client from the emergency department after receiving treatment for an ankle sprain. While providing discharge education, the nurse should encourage what action?

Keep an elastic compression bandage on the ankle.

Which factor inhibits fracture healing?

Local malignancy

Which of the following musculoskeletal injuries is manifested by acromioclavicular joint pain?

Rotator cuff tears

A client with a fractured femur is in balanced suspension traction. The client needs to be repositioned toward the head of the bed. During repositioning, what should the nurse do?

Maintain consistent traction tension while repositioning.

The nurse teaches the client which intervention to avoid hip dislocation after replacement surgery?

Never cross the affected leg when seated

The nurse is caring for a client who underwent a total hip replacement yesterday. What should the nurse do to prevent dislocation of the new prosthesis?

Protect the affected leg from internal rotation.

The nurse is caring for a client who lives alone and had a total knee replacement. An appropriate nursing diagnosis for the client is:

Risk for ineffective therapeutic regimen management

Which term refers to an injury to ligaments and other soft tissues surrounding a joint?

Sprain

Radiographic evaluation of a client's fracture reveals that a bone fragment has been driven into another bone fragment. The nurse identifies this as which type of fracture?

impacted

An important nursing assessment, post fracture, is to evaluate neurovascular status. Therefore, the nurse should check for:

capillary refill

A client comes to the emergency department and reports localized pain and swelling in the lower leg. Ecchymotic areas are noted. History reveals that the client got hit in the leg with a baseball bat. What will the nurse most likely suspect?

contusion

The nurse is monitoring a patient who sustained a fracture of the left hip. The nurse should be aware that which kind of shock can be a complication of this type of injury?

hypovolemic

Two days after surgery to amputate the left lower leg, a client reports pain in the missing extremity. Which action by the nurse is most appropriate?

Administer medication, as ordered, for the reported discomfort.

The nurse in an orthopedic clinic is caring for a new client. What sign or symptom would lead a nurse to suspect that a client has a rotator cuff tear?

Difficulty lying on affected side

A client with a fracture develops compartment syndrome that requires surgical intervention. What treatment will the nurse would most likely prepare the client for?

Fasciotomy

A nurse is caring for a client who underwent a total hip replacement. What should the nurse and other caregivers do to prevent dislocation of the new prosthesis?

Prevent internal rotation of the affected leg.

Six weeks after an above-the-knee amputation (AKA), a client returns to the outpatient office for a routine postoperative checkup. During the nurse's assessment, the client reports symptoms of phantom pain. What should the nurse tell the client to do to reduce the discomfort of the phantom pain?

Take opioid analgesics as prescribed.

A client's left leg is in skeletal traction with a Thomas leg splint and Pearson attachment. Which intervention should the nurse include in this client's care plan?

Teach the client how to prevent problems caused by immobility.

A client experienced an open fracture to the left femur during a horse-riding accident. For which complication is this client at highest risk?

infection

A fracture is considered pathologic when it

occurs through an area of diseased bone.

A client with a right leg fracture is returning to the orthopedist to have the cast removed. During cast removal, it is important for the nurse to assure:

the client that he or she won't be cut.

A client who was injured while playing basketball reports an extremely painful elbow, which is very edematous. What type of injury has the client experienced?

sprain

A client is treated in the emergency department for acute muscle strain in the left leg caused by trying a new exercise. During discharge preparation, the nurse should provide which instruction?

"Apply ice packs for the first 24 to 48 hours, then apply heat packs."

A client with an arm cast reports pain. What nursing interventions should the nurse provide in order to reduce the incidence of complications? Select all that apply.

Assess the fingers for color and temperature. Assess for a pressure sore Determine the exact site of the pain.

A client who has sustained a fracture reports an increase in pain and decreased function of the affected extremity. What will the nurse suspect?

Avascular necrosis

A patient has stepped in a hole in the yard, causing an ankle injury. The ankle is edematous and painful to palpation. How long should the nurse inform the patient that the acute inflammatory stage will last?

Between 24 and 48 hours

Two days after application of a cast to treat a fractured femur, the client reports severe, deep, and constant pain in the leg. What will the nurse suspect?

Compartment syndrome.

A client with a fractured ulna has a plaster cast applied to the forearm. Which action(s) will the nurse take when caring for the client and cast? Select all that apply.

Ensure a free flow of air around the cast. Test cast dryness with the palm of the hand. Determine the cast is dry when it is white and shiny.

A patient sustained an open fracture of the femur 24 hours ago. While assessing the patient, the nurse observes the patient is having difficulty breathing, and oxygen saturation decreases to 88% from a previous 99%. What does the nurse understand is likely occurring with this patient?

Fat emboli

Which is not one of the general nursing measures employed when caring for the client with a fracture?

cranial nerve assessment

A client has had surgical repair of a hip injury after joint manipulation was unsuccessful. After surgery, the nurse implements measures to prevent complications. Which complications is the nurse seeking to prevent? Select all that apply.

skin breakdown wound infection pneumonia

The client is admitted to the hospital with a diagnosis of left femoral neck fracture. Which treatment modality would the nurse expect the health care provider to order?

Buck's traction

A patient in pelvic traction needs circulatory status assessed. How should the nurse assess for a positive Homans' sign?

Have the patient extend each leg and dorsiflex each foot to determine if pain or tenderness is present in the lower leg.

The client returns to the nursing unit following an open reduction with internal fixation of the right hip. Nursing assessment findings include temperature 100.8 degrees Fahrenheit, heart rate 112 beats per minute, respiratory rate 28 breaths per minute, and blood pressure 86/58. There is no urine in the Foley catheter collection bag. The nurse interprets these findings as indicating which complication?

Hypovolemic shock

A client is having traction applied to a fractured left lower extremity prior to surgery. What outcomes does the nurse expect from the application of the traction for the client? Select all that apply.

Muscle spasms will be relieved. The bones of the left leg will be aligned. Immobilization of the left leg will be maintained.

A client broke his arm in a sports accident and required the application of a cast. Shortly following application, the client reported an inability to straighten his fingers and was subsequently diagnosed with Volkmann contracture. What pathophysiologic process caused this complication?

Obstructed arterial blood flow to the forearm and hand

A group of students are reviewing information about cast composition in preparation for a discussion on the advantages and disadvantages of each. The students demonstrate understanding of the topic when they cite which of the following as an advantage of a plaster cast?

better molding to the client

Which type of fracture involves a break through only part of the cross-section of the bone?

incomplete

The nurse is caring for a 24-year-old female client with a right tibial fracture treated with a cast 2 hours ago. The client now reports unrelenting pain, rated as 7/10, despite taking oxycodone, and decreased sensation in the right foot. A nursing assessment reveals the right foot is cooler and paler than the left foot, with delayed capillary refill and a weak pulse.

notify the orthopedic health care provider immediately bivalving of the cast