Chapter 40 - Musculoskeletal

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

never cross the affected leg while seated

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 severe osteoarthritis in the left hip and is having surgery to replace both articular surfaces of the hip. What type of surgical procedure will the nurse prepare the client for?

total arthroplasty

A client's fracture was reduced by surgically exposing the bone and realigning it. What type of treatment does the nurse identity this as?

open reduction

Which orthopedic surgery is done to correct and align a fracture after surgical dissection and exposure of the fracture?

open reduction

The nurse teaching the client with a cast about home care includes which instruction?

dry a wet fiberglass cast to avoid skin problems

A client who is undergoing skeletal traction reports pressure on bony areas. Which action would be most appropriate to provide comfort for the client?

change the client's position within perscribed limits

A client is about to have a cast applied to the left arm. What will nurse alert the client to as the cast is applied?

sensation of warmth or heat during application

A patient arrives in the emergency department with a suspected bone fracture of the right arm. How does the nurse expect the patient to describe the pain?

sharp and piercing

The nurse is preparing a client to have his cast cut off after having it for 6 weeks to treat a fractured tibia. What should the nurse inform the client prior to the cast being removed?

the skin may be covered in a yellowish crust that will shed in a few days

Following a total knee replacement, the surgeon orders a continuous passive motion (CPM) device. The client asks about the purpose of this treatment. What is the best response by the nurse?

CPM increases ROM of joint

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 nurse is caring for a client who recently underwent a total hip replacement. What is the best action by the nurse for client care?

Limit hip flexion of the client's hip when the client sits up.

A client is reporting pain following orthopedic surgery. Which intervention will help relieve pain?

Elevate effected extremity and use cold applications

Which is an inaccurate principle of traction?

skeletal traction is interrupted to turn and re-position the client

A client sustained a stable fracture of the cervical spine and is having skeletal traction applied. What type of traction does the nurse educate the client about?

Crutchfield tongs

A client has undergone an external fixation. Which actions would be the priority for this client?

maintaining pin care

A patient had a total hip replacement. What recommended leg position should the nurse ensure is maintained to prevent prosthesis dislocation?

abduction

Which is not a guideline for avoiding hip dislocation after replacement surgery.

the hip may be flexed to put on clothes such as pants, stockings, shoes, or socks

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 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

A variety of complications can occur after a leg amputation. Which is not a possibility in the immediate postoperative period?

osteomyelitis

A client with a right leg fracture is returning to the orthopedist to have the cast removed. What would the physician prescribe as further treatment?

physical therapy

Which action by the nurse would be inappropriate for the client following casting?

protect the cast by covering it with a sheet

A nurse is giving instructions to a client who's going home with a leg cast. Which teaching point is most critical?

reporting signs of impaired circulation

Which statement is accurate regarding care of a plaster cast?

the cast can be dented while it is wet

A client is seen in the emergency department for an injury acquired from falling off of a bicycle and fracturing the arm. The client also has a long laceration that has been sutured in the same area. The client asks the nurse why a splint is applied and not a cast. What is the best explanation by the nurse?

we will need to monitor the status of the laceration to ensure that it does not get infected

The client returns to the nursing unit following an open reduction with internal fixation of the right hip. Nursing assessment findings include temperature 42 degree Celsius, 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 of the following complications?

hypovolemic shock

The nurse assesses a clientafter total right hip arthroplasty and observes a shortening of the extremity. The client reports severe pain in the right side of the groin. What is the priority action of the nurse?

notify the healthcare provider

The nurse is caring for a client with an external fixator that requires pin care twice a day. The nurse observes that there is a new purulent drainage around one of the pins. What intervention should the nurse anticipate doing?

obtain a culture

Which nursing assessment finding indicates the client with traction has not met expected outcomes?

right calf warm and swollen

The client with a fractured femur is upset and agitated that skeletal traction will be necessary for 6 to 8 weeks. The client states, "How can I stay like this for weeks? I can't even move!" Based on these statements, the nurse would identify which of the following as the most appropriate nursing diagnosis?

ineffective coping related to prolonged inactivity

A client is brought to the emergency department by a softball team member who states the client and another player ran into each other, and the client is having severe pain in the right shoulder. What symptoms of a fractured clavicle does the nurse recognize?

right shoulder slopes downward and droops inward

Which is a benefit of a continuous passive motion (CPM) device when applied after knee surgery?

It promotes healing by increasing circulation and movement of the knee joint.

A client with a fractured distal left radius reports discomfort at the cast site, with pain specifically in the upper forearm. What would the nurse expect the physician to do?

cut a cast window

After undergoing surgery the previous day for a total knee replacement, a client states, "I am not ready to ambulate yet." What should the nurse do?

discuss the complications that the client may experience if there is lack of cooperation with the care plan.

An older female client who had a total hip replacement is to be discharged because her healing is almost complete. What would be most important for this client

exploring factors related to the client's home environment

A client diagnosed with a right ulnar fracture asks why the cast needs to go all the way up the arm. What is the best response by the nurse?

"the joint above and below the fracture must be immobilized"

A client has undergone a leg amputation. What teachings should the nurse offer such a client to prevent abduction deformity? Select all that apply.

Advise the client to use a trochanter roll. Advise the client to adduct the stump so it presses against the other leg when the client is lying on the stomach.

A group of students is studying for a test on traction. The students demonstrate understanding of the types of traction when they identify which of the following as an example of skin traction?

Buck's

The nurse is checking the traction apparatus for a client in skin traction. Which finding would require the nurse to intervene?

Weights hanging and touching the floor

The client displays manifestations of compartment syndrome. What treatment will the nurse expect the client to be scheduled for?

a fasciotomy

The nurse is assigned to care for a client who has had a total knee arthroplasty yesterday. What type of pharmacologic therapy does the nurse anticipate administering to this client to prevent complications related to the surgery?

anti-coagulation therapy

A client's cast is removed. The client is worried because the skin appears mottled and is covered with a yellowish crust. What advice should the nurse give the client to address the skin problem?

apply lotion and take warm baths or soaks

A client with a long arm cast continues to complain of unrelieved throbbing pain even after receiving opioid pain medication. Which is the priority action by the nurse?

assess for complications

A client has a Fiberglass cast on the right arm. Which action should the nurse include in the care plan?

assessing movement and sensation in the fingers of the right hand

A nurse is caring for a client with a cast on the left arm after sustaining a fracture. Which assessment finding is most significant for this client?

fingers of the left hand are cool and swollen

A client has just undergone a leg amputation. What will the nurse closely monitor the client for during the immediate postoperative period?

hemotoma

Which principle applies to the client in traction?

skeletal traction is never interrupted