Chapt 42- Musculoskeletal Trauma

Which term refers to an injury to ligaments and other soft tissues surrounding a joint? Strain Dislocation Subluxation Sprain

D A sprain is caused by a wrenching or twisting motion. Dislocation refers to the separation of joint surfaces. Subluxation refers to partial separation or dislocation of joint surfaces. Strain refers to a muscle pull or tear.

Which is not one of the general nursing measures employed when caring for the client with a fracture? providing comfort measures administering analgesics assisting with ADLs cranial nerve assessment

D Cranial nerve assessment would only be carried out for head-related injuries or diseases. General nursing measures include administering analgesics, providing comfort measures, assisting with ADLs, preventing constipation, promoting physical mobility, preventing infection, maintaining skin integrity, and preparing client for self-care.

A female patient is sufficiently stable to be transferred from the PACU to the postsurgical unit following her total hip replacement surgery early this morning. When preparing to admit this patient, the nurse on the postsurgical unit should anticipate that the patient will require what positioning? With her legs slightly abducted In a high Fowler's position with knees elevated With a low head-of-bed and with her knees touching each other Supine with her knees slightly elevated

A Following total hip replacement surgery, the patient's legs should be slightly abducted to prevent dislocation of the joint. The patient's knees do not need to be elevated, and a high Fowler's position is avoided due to the risk of exceeding 90 degrees of flexion at the waist.

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? Keep the affected leg in a position of adduction. Use measures other than turning to prevent pressure ulcers. Prevent internal rotation of the affected leg. Keep the hip flexed by placing pillows under the client's knee.

C The nurse and other caregivers should prevent internal rotation of the affected leg. However, external rotation and abduction of the hip will help prevent dislocation of a new hip joint.

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 Sprain Strain Fracture

A The client's description of blunt trauma by a baseball bat and localized pain in conjunction with swelling and ecchymosis would most likely suggest a contusion. A fracture would be manifested by pain, loss of function, deformity, swelling, and spasm. A sprain would be manifested by pain and swelling; ecchymosis may appear later. A strain is characterized by inflammation, local tenderness, and muscle spasms.

Which term refers to the failure of fragments of a fractured bone to heal together? Nonunion Dislocation Malunion Subluxation

A When nonunion occurs, the client reports persistent discomfort and movement at the fracture site.

Which term refers to a break in the continuity of a bone? Subluxation Fracture Dislocation Malunion

B A fracture is a break in the continuity of the bone. A malunion occurs when a fractured bone heals in a misaligned position. Dislocation is a separation of joint surfaces. A subluxation is a partial separation or dislocation of joint surfaces.

Which of the following disorders results in widespread hemorrhage andmicrothrombosis with ischemia? Fat embolism syndrome (FES) Disseminated intravascular coagulation (DIC) Avascular necrosis (AVN) Complex regional pain syndrome (CRPS)

B DIC is a systemic disorder that results in widespread hemorrhage and microthrombosis with ischemia.

In the immediate postoperative period, which measure would best prevent a DVT? A. Adding a multivitamin to the patient's medication B. Early ambulation C. Measuring intake and output D. Lowering the legs below the level of the heart

B Early ambulation enhances venous return and is an appropriate intervention to prevent problems related to inactivity such as a DVT.

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? Cardiogenic Hypovolemic Neurogenic Septic

B In a client with a pelvic fracture, the nurse should be aware of the potential for hypovolemic shock resulting from hemorrhage. Cardiogenic shock, in which the heart cannot pump enough blood to meet the body's needs, often arises from severe myocardial infarction. Neurogenic shock is often a consequence of spinal cord injury and resulting loss of sympathetic nervous system function. Septic shock results from body-wide infection.

During assessment of a patient admitted to the emergency room after a motor vehicle collision, he becomes semiconscious and continues moaning with pain. His blood pressure has now decreased to 100/42, and his pulse has increased to 122. What is the most immediate life-threatening problem for this patient? A. Arrhythmias due to hypokalemia B. Hypovolemia C. Respiratory depression from pain medication D. Fat embolus to the lung

B Tachycardia and hypotension are associated with hypovolemia. Any patient with multitrauma is at risk for hypovolemia

A 23-year-old patient, experienced an open fracture of the left tibia with major soft tissue damage of his lower leg in a bicycle accident. Surgical reduction and fixation of the tibia were performed with debridement of nonviable tissue and drain placement in the damaged soft tissue. Which finding by the nurse would most likely indicate the development of the osteomyelitis? A. Tachycardia B. Elevated ESR C. Numbness in the left leg and toes D. Muscle spasms around the affected bone

B The erythrocyte sedimentation rate (ESR), is over 90% for patients who have confirmed osteomyelitis. However, a normal or slightly elevated ESR does not eliminate the diagnosis. In addition, the nurse assesses for pain over the affected bone.

A client who has injured a hip in a fall cannot place weight on the leg and is in significant pain. After radiographs indicate intact yet malpositioned bones, what repair would the physician perform? ice and immobilization joint manipulation and immobilization analgesia and immobilization heat and immobilization

B The physician manipulates the joint or reduces the displaced parts until they return to normal position, then immobilizes the joint with an elastic bandage, cast, or splint for several weeks.

A client has been diagnosed with a muscle strain. What does the physician mean by the term "strain"? injuries to ligaments surrounding a joint injury resulting from a blow or blunt trauma stretched or pulled beyond its capacity subluxation of a joint

C A strain is an injury to a muscle when it is stretched or pulled beyond its capacity.

Elderly clients who fall are most at risk for which injuries? Humerus fractures Wrist fractures Pelvic fractures Cervical spine fractures

C Elderly clients who fall are most at risk for pelvic and lower extremity fractures. These injuries are devastating because they can seriously alter an elderly client's lifestyle and reduce functional independence.

Which nursing intervention is essential in caring for a client with compartment syndrome? Wrapping the affected extremity with a compression dressing to help decrease the swelling Keeping the affected extremity below the level of the heart Removing all external sources of pressure, such as clothing and jewelry Starting an I.V. line in the affected extremity in anticipation of venogram studies

C Nursing measures should include removing all clothing, jewelry, and external forms of pressure (such as dressings or casts) to prevent constriction and additional tissue compromise. The extremity should be maintained at heart level (further elevation may increase circulatory compromise, whereas a dependent position may increase edema). A compression wrap, which increases tissue pressure, could further damage the affected extremity. There is no indication that diagnostic studies would require I.V. access in the affected extremity.

The nurse is providing health education for a male patient who is preparing to be discharged home following a recovery from total hip replacement surgery. When reviewing the guidelines for safe mobility and positioning to prevent injury, the nurse should teach the patient to: Perform sit-ups to build core muscle strength. Resume normal sexual activity after waiting 1 week. Perform stair-climbing to build muscle strength. Avoid crossing his legs for the next several months.

D At no time during the first 4 months should the patient cross the legs or flex the hip more than 90 degrees. Sexual intercourse can be resumed based upon surgeon recommendation (typically 3 to 6 months postoperatively). Stair-climbing is permitted as prescribed but is kept to a minimum for 3 to 6 months.

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? Initiate a consult with a psychologist. Do nothing because it isn't possible to have pain in a missing limb. Contact the health care provider. Administer medication, as ordered, for the reported discomfort.

D The sensation of pain and discomfort in an amputated extremity is known as phantom pain. Phantom pain is a normal occurrence after an amputation. It should be treated with medication. The nurse doesn't need to contact the health care provider at this time. Consultation with the psychologist isn't indicated, and the nurse shouldn't take this action without consulting the health care provider.

A nurse is caring for a client who is 72 hr post-op following an above-the-knee amputation. Which of the following actions should the nurse take? A. Elevate the residual limb on a soft pillow B. Assist the client to a prone position every 4 hr. C. Reapply a bandage to the residual limb every 12 hr. D. Appyl dressing to the site in a proximal-to-distal direction.

B This reduces the risk of flexion contractures; A flexion contracture is a bent (flexed) joint that cannot be straightened actively or passively.

An older adult man has been diagnosed with a femoral head fracture after falling outside his home, and his health care provider has chosen open reduction with internal fixation (ORIF). How should the nurse best explain this procedure to the patient? "The surgeon will give you an anesthetic and then apply a cast." "The surgeon will place plates or rods outside your hip and keep you in traction until your bones heal." "The surgeon will use a scope inserted through punctures in your skin to remove any bone fragments." "The surgeon will use pins and rods to keep your bones in place until they heal."

D With an open fracture, surgical intervention is needed to align the bone fragments. Internal fixation devices (metallic pins, wires, screws, plates, nails, or rods) are used to hold the bone fragments in position until bone healing occurs.

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 Amputation Bone graft Joint replacement

A Surgical treatment of compartment syndrome is achieved with a fasciotomy, a surgical incision of the fascia and separation of the muscle to relieve pressure and restore tissue perfusion. Bone graft, joint replacement or amputation may be done for a client who experiences avascular necrosis.

A client sustains an injury to the ligaments surrounding a joint. What will the nurse identify this injury as? Contusion Sprain Fracture Strain

B A sprain is an injury to the ligaments surrounding a joint. A strain is an injury to a muscle when it is stretched or pulled beyond its capacity. A contusion is a soft tissue injury resulting from a blow or blunt trauma. A fracture is a break in the continuity of a bone.

A nurse is caring for a client who is 72 hr post-op following an above-the knee amputation and reports phantom limb pain. Which of the following actions should the nurse take? A. Remind the client that the surgery removed the limb. B. Change the dressing on the client's residual limb. C. Request a Rx for gabapentin for client. D. Elevate the client's residual limb above the heart level.

C Gabapentin is an oral antiepileptic medication that is effective for treating sharp, burning, phantom limb pain.

A nurse who provides care on a reconstructive orthopedic unit has walked past the room of a patient who is receiving balanced suspension traction for the treatment of a femoral head fracture. The nurse observes a nursing assistant lifting the suspended weights to facilitate positioning a bedpan under the patient. How should the nurse best follow-up this observation? A. Ensure the nursing assistant knows that such transfers must be performed quickly and efficiently. B. Assess the patient for the ability to transfer to a commode rather than using a bedpan. C. Teach the nursing assistant that weights should not be removed from traction, except in an emergency. D. Teach the nursing assistant to apply temporary weights to compensate for positional changes.

C The nurse must never remove weights from skeletal traction unless a life-threatening situation occurs. Removal of the weights completely defeats their purpose and may result in injury to the patient.

A nurse is assessing a client who has a fractured left femur and is in skeletal traction. Which of the following findings should the nurse report to the provider? A. Ecchymosis of thigh B. Serous drainage at the pin site C. Chest petechiae D. Muscle spasms in the left leg

C This could indicate fat embolism syndrome. Patients with fracture of the long bones are at increased risk of fat emboli. Chest petechiae could be sign of fat embolism.

A client undergoes open reduction with internal fixation to treat an intertrochanteric fracture of the right hip. The nurse should include which intervention in the postoperative care plan? Maintaining the client in semi-Fowler's position Turning the client from side to side every 2 hours Performing passive range-of-motion (ROM) exercises on the client's legs once each shift Keeping a pillow between the client's legs at all times

D After open reduction with internal fixation, the client must keep the affected leg abducted at all times; placing a pillow between the legs reminds the client not to cross the legs and to keep the leg abducted. Passive or active ROM exercises shouldn't be performed on the affected leg during the postoperative period, because this could damage the operative site and cause hip dislocation. Most clients should be turned to the unaffected side, not from side to side. After open reduction with internal fixation, the client must avoid acute flexion of the affected hip to prevent possible hip dislocation; therefore, semi-Fowler's position should be avoided.

A nurse is caring for a client who had a below-the-knee amputation for gangrene of the right foot. The client reports sensations of burning and crushing pain in the toes of the right foot. Which of the following statements should the nurse make? A. This type of pain usually decreases over time as the limb becomes less sensitive. B. Try to look at the surgical wound as a reminder the limb is gone. C. Use cold compress to decrease pain sensations D. Grief over the lost limb can sometimes cause denial that the limb is really gone.

A The client is experiencing limb pain, a frequent complication following amputation. The nurse should instruct the client that the sensation should decrease over time.

There are a variety of problems that can become complications after a fracture. Which is described as a condition that occurs from interruption of the blood supply to the fracture fragments after which the bone tissue dies, most commonly in the femoral head? fat embolism avascular necrosis pulmonary embolism shock

B Avascular necrosis is described as a condition that occurs from interruption of the blood supply to the fracture fragments after which the bone tissue dies, most commonly in the femoral head.

Six weeks after an above-the-knee (AKA) amputation, a patient returns to the outpatient office for a routine postoperative checkup. During the nurse's assessment, the patient reports symptoms of phantom pain. To reduce the discomfort of the phantom pain, the nurse should tell the patient to: Apply hot compresses to the area of the amputation. Avoid rehabilitation exercises until the pain subsides. Comfortably increase his level of activity. Assess for a pulse in the extremity of the amputation every 4 to 6 hours.

C Keeping the patient active helps decrease the occurrence of phantom pain. Early intensive rehabilitation and stump desensitization with kneading massage brings relief. Hot compresses should be avoided as the extreme heat can compromise the tissue integrity of the area of healing. It is not necessary for the patient to assess a pulse in the affected extremity every 4 to 6 hours if experiencing phantom pain, as the cause of the pain is unknown.

A 73-year-old patient is placed in skeletal traction prior to surgery for an ORIF of fractured femur. She develops chest pain, tachypnea, and tachycardia the second day in traction. What additional symptom would indicate her symptoms are related to a fat emboli rather than a pulmonary thromboembolic event? A. Hypotension B. Restlessness C. Petechiae of the anterior chest wall D. Warm, reddened areas in her leg

C Specific symptoms associated with fat emboli are pulmonary distress, mental status changes, and a petechial rash that develops from 6 to 72 hours after injury.

Which nursing intervention is appropriate for monitoring the client for the development of Volkmann's contracture? Assess mobility of the shoulder. Assess capillary refill in the toes. Assess the radial pulse. Assess for paresthesia in the toes.

C Volkmann's contracture is a type of acute compartment syndrome that occurs with a supracondylar fracture of the humerus. The nurse assesses neurovascular function of the hand and forearm.

A client with a right below-the-knee amputation is being transferred from the postanesthesia care unit to a medical-surgical unit. What is the highest priority nursing intervention by the receiving nurse? Ensure that a large tourniquet is in the room. Document the receiving report from the transferring nurse. Delegate the gathering of enough pillows for proper positioning and comfort. Review the physician's orders for type and frequency of pain medication.

A A tourniquet is a device that is used to apply pressure to a limb or extremity in order to stop the flow of blood.T he client with an amputation is at risk for hemorrhage. A tourniquet should be placed in plain sight for use if the client hemorrhages.

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 Pneumonia Cardiac tamponade Spontaneous pneumothorax

A After fracture of long bones or pelvic bones, or crush injuries, fat emboli frequently form. Fat embolism syndrome (FES) occurs when fat emboli cause morbid clinical manifestations. The classic triad of clinical manifestations of FES include hypoxemia, neurologic compromise, and a petechial rash

A 22-year-old man is admitted to the emergency department with a crush injury to both lower legs. He was pinned under a car for 3 hours. On admission, his vital signs are stable; he is alert and oriented and complaining of extreme pain in his legs. Popliteal pulses are strong; pedal and posterior tibial pulses are weak. The ankle and feet appear dusky; the skin is tense, but the skin envelope is not broken. X-rays show no broken bones. Based upon these data, what interventions are most appropriate? A. Notify the provider and anticipate that a stat V˙/Q˙ scan will be performed to rule out fat emboli. B. Notify the provider and prepare to set up skin traction to decrease the pressure on the calf muscle. C. Notify the provider and anticipate that the provider will measure the pressure in the compartment and possibly perform a fasciotomy if elevated pressure is noted. D. Notify the provider and prepare to give IV antibiotics stat to decrease the risk of osteomyelitis.

C Compartment syndrome is defined as increasing pressure between bone and fascia of the limb and often presents with complaints of extreme pain unrelieved by pain medication, pain on passive extension, paresthesis and pulselessness. However, pulselessness presents late in this disorder. The patient symptoms suggest compartment syndrome. The provider should be notified immediately as a delay in diagnosis and treatment of compartment syndrome can lead to permanent nerve and muscle damage. Compartment pressure monitoring is useful in diagnosing this complication.

Which general nursing measure is used for a client with a fracture reduction? Examine the abdomen for enlarged liver or spleen Assist with intake of immune-enhancing tube feeding formulas Encourage participation in ADLs Promote intake of omega-3 fatty acids

C General nursing measures for a client with a fracture reduction include administering analgesics, providing comfort measures, encouraging participation in ADLs, promoting physical mobility, preventing infection, maintaining skin integrity, and preparing the client for self-care.

A patient has sustained a long bone fracture. The nurse is preparing a care plan for this patient. Which nursing action should the nurse include in the care plan to enhance fracture healing? Avoid prolonged immobilization of the fracture fragments. Administer high doses of corticosteroids. Monitor color, temperature, and pulses of the affected extremity. Limit weight-bearing and exercising during the recovery.

C The nurse should include monitoring for sufficient blood supply by assessing the color, temperature, and pulses of the affected extremity as adequate blood supply enhances the healing of a fracture. Factors that inhibit fracture healing include inadequate or lack of immobilization of the fracture fragments and administration of corticosteroids. Weight-bearing exercises are encouraged for patients with long bone fractures.

A patient is recovering in the hospital following a total hip replacement that was performed 2 days ago. In an effort to prevent the common complications associated with the surgical procedure, the nurse should implement which of the following interventions, as ordered? Intermittent urinary catheterization to prevent urinary retention Provision of a low-fiber, high-calorie diet Application of sequential compression devices Passive range-of-motion (ROM) exercises with the affected leg

C The risk of venous thromboembolism is particularly great after reconstructive hip surgery. The nurse encourages the patient to consume adequate amounts of fluids, to perform ankle and foot exercises hourly while awake, and to use elastic stockings and sequential compression devices as prescribed. Passive ROM is not performed due to the high risk of injury. A low-fiber diet is not indicated, and intermittent catheterization is not used as a preventative measure.