CH 47, Concepts of Care for Patients with Musculoskeletal Trauma

Which finding would indicate the presence of fat embolism syndrome (FES)? Select all that apply.

A. Decreased platelet count. D. Decreased red blood cell (RBC) count. E. Increased erythrocyte sedimentation rate (ESR)

Which clinical sign of complex regional pain syndrome CRPS is a manifestation of autonomic nervous system dysfunction seen in this complication?

A. Edema

Which emergency care intervention would be needed for a patient who accidently severed a finger at home? Select all that apply.

A. Elevate the extremity above the heart level. B. Apply direct pressure with dry gauze at the amputation site. C. Ensure the severed finger does not come in contact with water.

Which intervention would the nurse include in the plan of care for a patient in traction?

A. Ensure the weights are freely hanging at all times.

A 30-year-old patient sustains a fractured hip and experiences hypoxemia, dyspnea, and crackles. Which complication would the nurse suspect from these findings?

A. Fat embolism syndrome (FES)

Which organization would be an appropriate resource for a patient who is a veteran with an amputation? Select all that apply.

A. Hope for the Warrior. B. Wounded Warrior Project. C. Amputee Coalition of America (ACA).

Which instruction would the nurse include when teaching a patient about postoperative care after a leg amputation? Select all that apply.

A. How to wrap the limb. B. Range-of-motion exercises. C. How to turn independently if possible. D. Exercises to prepare the limb for prosthesis. F. How to inspect the area for signs of inflammation or skin breakdown.

Which complication would the nurse suspect in an older-adult patient recovering from hip replacement surgery who has a temperature of 98.6°F (37°C) and has developed acute onset confusion?

A. Infection

Which intervention would the nurse include in the plan of care for a patient in skeletal traction?

A. Inspect the skin at least every 8 hours.

Which assessment datum supports the nurse's conclusion of the absence of infection in a patient with extensive soft tissue damage due to a fracture? Select all that apply.

A. Lack of fever. B. Negative wound culture. E. No increase in white blood cell count.

The nurse is planning care for a patient with peripheral arterial disease who underwent a Syme amputation. Which action would the nurse take to prevent complications? Select all that apply.

A. Monitor the incision site. B. Assess the posterior tibial pulse. C. Administer pain medication. D. Perform active range of motion. E. Measure blood pressure and pulse.

The nurse would advise a patient with a lower extremity fracture to take a multivitamin with iron after eating to prevent which condition?

A. Nausea

Which health care team member would the nurse anticipate working with when providing collaborative care for a patient with a traumatic amputation of the right hand? Select all that apply.

A. Psychologist. C. Physical therapist. E. Occupational therapist.

Which physiologic process occurs in a patient with acute compartment syndrome (ACS)? Select all that apply.

A. Release of histamine. B. Pressure on nerve endings. E. Increase in compartment pressure.

Which intervention would be the priority when caring for a patient with complex regional pain syndrome (CRPS)?

A. Relieving pain

The nurse is caring for a patient who was brought to the urgent care center with a left wrist fracture sustained after a fall on the ice. After assessing the patient's airway and oxygenation, the nurse will take which action next?

A. Remove the patient's watch from the left arm.

Which advantage is seen with open reduction and external fixation over other surgical techniques? Select all that apply

A. Stabilizes comminuted fractures requiring bone grafting. C. Maintains closed fracture alignment not possible with a cast. D. Facilitates early ambulation and exercise while relieving pain. E. Promotes minimal blood loss compared with internal fixation.

In which stage of bone healing does fibrocartilage formation occur?

A. Stage 2

Which assessment datum would be a major concern to the nurse when caring for a patient with pelvic fractures? Select all that apply.

A. Venous oozing. C. Arterial bleeding. D. Hypovolemic shock.

Which information would the nurse include when providing discharge teaching to a patient who underwent vertebroplasty? Select all that apply.

A. Walk the day after discharge C. Monitor of the puncture site for infection.

The nurse is teaching a patient about extremity care after a cast has been removed. Which patient statement indicates a need for further teaching? Select all that apply.

B. "I should remove any dead skin by scrubbing the area slowly." E. "I should inform the nurse immediately if I have a decreased range of motion."

Which statement regarding a closed reduction for a dislocated clavicle is correct? Select all that apply.

B. "It is most commonly used for simple fractures." D. "The ends of the bones are manually pulled and realigned." E. "A commercial immobilizer is used to keep the bone in place."

Which statement is true regarding the various types of casting materials for immobilization? Select all that apply.

B. "Plaster is not commonly used for casting." C. "Fiberglass can dry and become rigid in minutes."

The nurse is teaching a patient with a left ankle fracture about the use of a cane for support. Which statement by the patient indicates the teaching was effective? Select all that apply.

B. "Using a hemi-cane will provide me with more support." C. "The top of the cane should be parallel to the stylus of my wrist."

Which patient is at risk for a fatigue fracture?

B. A patient who runs every day

Which method would the nurse use when performing a neurovascular assessment on a patient with multiple closed fractures of the right humerus?

B. Assess sensation of the right upper extremity.

Which class of drugs would be administered to a patient experiencing a constant, dull, burning, phantom limb pain (PLP)?

B. Beta blockers

Which step would the nurse take when assessing a patient with a fracture of the upper arm? Select all that apply.

B. Compares the upper extremities C. Asks about the cause of the fracture E. Supports the affected arm and flexes the elbow

Which physiologic change causes pallor in acute compartment syndrome?

B. Decreased oxygen to tissues

A 42-year-old male patient with type 1 diabetes mellitus (DM) and peripheral vascular disease (PVD) underwent a surgical amputation of all the toes on the left foot. Which patient problem would the nurse consider a safety priority when planning care for this patient?

B. Equilibrium

A patient who is 36 hours into recovering from a long-bone fracture begins to experience hypoxemia, dyspnea, and crackles. Which complication would the nurse anticipate incorporating into the plan of care?

B. Fat embolism syndrome (FES)

Which assessment finding typically indicates there is a fracture of the hip?

B. Groin pain

The incidence of which type of fracture is highest in older adults?

B. Hip

Which complication can result from a fracture? Select all that apply.

B. Infection. C. Hemorrhage. E. Inadequate arterial perfusion. F. Acute compartment syndrome

Which discharge teaching would the nurse provide to the patient who has undergone kyphoplasty?

B. Monitor the puncture site for infection.

Which condition is the biggest risk factor for hip fracture?

B. Osteoporosis

Which motor manifestation may be seen in a patient with complex regional pain syndrome (CRPS)?

B. Paresis

Which manifestation is usually seen in a fat embolism but not in a blood clot embolism?

B. Petechiae

Which action would the nurse take when a patient's end-tidal carbon dioxide level falls to 30 mm Hg and respiratory rate falls to 10 breaths/min during a closed reduction on a simple fracture?

B. Rub the patient's sternum, and encourage breathing.

The nurse is reviewing the plan of care for a patient who sustained a femoral neck fracture. Which cue indicates that the goal of maintaining the patient's peripheral circulation has been met?

C. Patient's pedal pulses are strong and palpable bilaterally.

Which condition would the nurse anticipate incorporating into the plan of care for a patient who underwent an above-the-knee amputation 2 months ago and reports intense burning pain, numbness, and tingling that worsens with stress and fatigue?

C. Phantom limb pain

Which term is used to describe the sensation that is felt in an amputated part immediately after surgery?

C. Phantom limb pain

Which part of the pelvis is non-weight bearing?

C. Pubic rami

During which stage of bone healing does callus form?

C. Stage 3

The nurse is implementing a plan of care to prevent neurovascular complications in a patient who experienced a right tibia/fibula fracture. Which action will the nurse take to promote circulation? Select all that apply.

C. Take jewelry off the patient's right hand. D. Splint the patient's arm from elbow to hand. E. Assess the patient's right hand temperature.

Which statement about the use of noninvasive techniques to assess the viability of a patient's limb is correct?

C. Transcutaneous oxygen pressure is reliable for predicting healing.

Which diagnosis would be a risk factor that may lead to a below-the-knee amputation (BKA)?

C. Type 1 diabetes mellitus

A patient with a fracture in which location would be examined while in a seated or a standing position?

C. Upper arm

Which postoperative instruction would the nurse include in a teaching plan for a patient who has an external fixation device on the lower extremity?

C. Use pain medication as prescribed to control pain.

Which procedure involves injecting bone cement through the skin directly into the fracture site to treat vertebral compression fractures?

C. Vertebroplasty

Which type of fracture is seldom immobilized by casting and requires surgical treatment with nails, rods, or screws?

C. Femoral

Which type of injury may require the use of Buck extension traction?

C. Fracture of the hip before surgery

Which type of fracture does not divide the bone into two portions because the break is through only part of the bone?

C. Incomplete

Which clinical sign of complex regional pain syndrome (CRPS) is a manifestation of the sensory perception abnormalities seen in this syndrome?

C. Intense burning pain

Which postoperative care would the nurse provide for an older-adult patient who has undergone hip repair surgery?

C. Monitor the patient frequently to prevent falls.

Which ambulatory care service would the nurse arrange for a patient to receive upper extremity rehabilitation after trauma?

C. Occupational therapy

Which condition increases a patient' s risk for hospital-acquired infection?

C. Open fractures

A patient reports a history of wrist pain after an attempt to break a fall by landing on the heel of the hand with an extended wrist. Which type of fracture would the nurse suspect?

A. Colles fracture

Which terms would the nurse use to describe a fracture that breaks across the entire width of the bone and the broken bone extends through the skin?

A. Complete and open

Which statement indicates a patient recovering from an above-knee amputation is coping well?

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

Which amount of weight is the maximum that should be used for the pulling force when Buck traction is applied?

A. 10 lb

Which statement correctly describes part of the normal healing process of a bone after a fracture?

A. A hematoma forms at the site of the fracture.

Which nursing intervention would the nurse anticipate incorporating into the plan of care for a patient who underwent kyphoplasty?

A. Applying ice pack to the insertion site

A patient' s left arm is placed in a plaster cast. Which assessment would the nurse perform before the patient is discharged?

A. Assess that the cast is dry.

Which action would the nurse take first when providing emergency care to a patient with an extremity fracture?

A. Assess the patient's airway, breathing, and circulation.

An older-adult patient who sustained a left hip fracture is in considerable pain. The nurse would anticipate that the patient will be placed in which type of traction?

A. Buck traction

Which action would the nurse take first when caring for a patient admitted to the emergency department with a compound fracture of the femur after a motorcycle crash?

A. Check the dorsalis pedis pulse.

Which statement about chronic complications from fractures is correct?

A. "Avascular necrosis is a chronic complication of fracture."

Which statement is correct regarding emergency care for extremity fractures? Select all that apply.

A. "Do not remove the patient's shoes." B. "Cut the clothing over the affected area." C. "Apply a splint above and below the fracture."

Which statement is correct regarding emergency care for extremity fractures? Select all that apply.

A. "Do not remove the patient's shoes." B. "Cut the clothing over the affected area." C. "Apply a splint above and below the fracture."

Which information would the nurse include when teaching a patient who has a short cast on the lower extremity about managing the fracture?

C. Elevate the affected leg on several pillows.

An older-adult patient who underwent an open reduction internal fixation (ORIF) reports constipation. Which drug would the nurse suspect may have caused this complication?

C. Oxycodone

Which nursing intervention is necessary for a patient who is in traction after a major leg injury? Select all that apply.

C. Ensure the weights are freely hanging at all times. D. Inspect the traction equipment every 8 to 12 hours. E. Monitor circulation every hour for the first 24 hours after traction is applied.

Which information would the nurse include when teaching a patient about caring for the extremity after cast removal?

C. Apply elastic bandages around the extremity.

Which complication would the nurse monitor for in a patient with a pelvic fracture? Select all that apply.

C. Arterial bleeding. D. Blood volume loss. E. Abdominal rigidity. F. Blood in urine and stoo.l

Which complication would the nurse monitor for in a patient with a displaced fracture of the femoral neck?

C. Avascular necrosis (AVN)

Which statement describes the reason a window may be cut on a cast?

C. "A window may be cut to inspect the skin."

The nurse is teaching a patient about compartment syndrome. Which statement made by the patient indicates the need for further instruction?

C. "It causes an absence of pulses."

While assessing a patient who recently suffered a broken tibia, the nurse notes the presence of edema, pale skin, and weakened pulse and the patient's report of severe pain. Which condition would the nurse anticipate incorporating into the plan of care?

C. Acute compartment syndrome

A patient with a fracture asks the nurse about the difference between a compound fracture and a simple fracture. Which statement by the nurse is correct?

D. "Compound fracture involves a break in the bone, with damage to the skin."

Which amount is the minimum weight permitted for the pulling force in skeletal traction?

D. 15 lb

Which time frame would be the estimated period for healing to take place for a 70-year-old patient who has an infected lower extremity fracture?

D. 90 days

Which statement is true regarding the differentiation between a fat embolism and a blood clot embolism?

D. A fat embolism is more likely to occur with fractures of the long bones.

A patient with a pelvic fracture is advised to undergo external fixation. Which part of the pelvis might have been involved in the fracture?

D. Acetabulum

Which bone fracture complication is also known as ischemia-edema cycle?

D. Acute compartment syndrome (ACS)

Which type of fracture is most commonly complicated by delayed union because of poor perfusion?

D. Both tibia and fibula

Which complication of fractures manifests as a clinical triad of sensory perception abnormalities, motor dysfunction such as paresis and muscle spasm, and autonomic nervous system abnormalities?

D. Complex regional pain syndrome (CRPS)

Which syndrome is described as a dysfunction of the central and peripheral nervous systems, leading to severe chronic pain?

D. Complex regional pain syndrome (CRPS)

The occupational nurse is teaching factory workers about the current recommendation for prehospital care for traumatic amputations. Which information would the nurse include in the teaching?

D. Ensure the severed part does not come in direct contact with water

Which physiologic change related to acute compartment syndrome is responsible for symptoms of flexed posture and unequal pulses in a patient?

D. Increased production of lactic acid

Which occurrence is an early manifestation of fat embolism syndrome (FES)?

D. Low arterial oxygen

Which organism is commonly responsible for hospital-acquired infections and is often the causative agent in osteomyelitis?

D. Methicillin-resistant Staphylococcus aureus (MRSA)

Which complication is associated with compartment syndrome?

D. Myoglobinuria renal failure

The nurse would instruct the patient who underwent a below-the-knee amputation to notify the health care provider if which change occurs after discharge?

D. Observation of a large amount of serosanguineous or bloody drainage

Which pain medication would the nurse anticipate incorporating into the plan of care for a patient with severe multiple fractures?

D. Patient-controlled analgesia (PCA) with morphine

Which description accurately defines a closed reduction?

D. Process where the ends of the bones are manually pulled and realigned

Which condition would the nurse assess for first in a patient admitted to the emergency department because of multiple injuries after a motor vehicle crash?

D. Respiratory distress

Which intervention would the nurse suggest to a patient with a leg amputation to help cope with loss of the limb?

D. Talking with an amputee close to the patient's age who has had the same type of amputation

The nurse is instructing a local community group about ways to reduce the risk for musculoskeletal injury. Which information would the nurse include in the teaching plan?

D. Wear helmets when riding a motorcycle