Chapter 41: Musculoskeletal Care Modalities

The nurse is providing instructions to the client who is being prepared for skeletal traction. Which statement by the client indicates teaching was effective? a) "Metal pins will go through my skin to the bone." b) "I will wear a boot with weights attached." c) "A belt will go around my pelvis and weights will be attached." d) "The traction can be removed once a day so I can shower."

"Metal pins will go through my skin to the bone." Explanation: In skeletal traction, metal rods or pins are used to apply continuous traction directly to the bone. Weights are used to apply the traction. Casts, external fixators, or splints are used when the traction is discontinued.

The nurse is caring for a client with a spica cast. A priority nursing intervention is to: a) Promote elimination with a regular bedpan. b) Keep the legs in abduction. c) Keep the cast clean and dry. d) Position the client on the affected side.

Keep the cast clean and dry. Explanation: Keeping the cast clean and dry around the perineal opening is a priority. A spica cast has a built-in abduction bar. The client should be positioned on the unaffected side every 2 hours and prone twice a day. A fracture bedpan is easier to use for the client with a spica cast.

Which of the following orthopedic surgeries is done to correct and align a fracture after surgical dissection and exposure of the fracture? a) Open reduction b) Joint arthroplasty c) Arthrodesis d) Total joint arthroplasty

Open reduction Explanation: An open reduction is the correction and alignment of the fracture after surgical dissection and exposure of the fracture. Arthrodesis is immobilizing fusion of a joint. A joint arthroplasty or replacement is the replacement of joint surfaces with metal or synthetic materials. A total joint arthroplasty is the replacement of both the articular surfaces within a joint with metal or synthetic materials

A patient has a long leg cast applied. Where does the nurse understand a common pressure problem may occur? a) Posterior tibialis b) Popliteal artery c) Peroneal nerve d) Dorsalis pedis

Peroneal nerve Explanation: The nurse assesses circulation by observing the color, temperature, and capillary refill of the exposed toes. Nerve function is assessed by observing the patient's ability to move the toes and by asking about the sensations in the foot. Numbness, tingling, and burning may indicate peroneal nerve injury resulting from pressure at the head of the fibula.

Which of the following statements is accurate regarding care of a plaster cast? a) The cast can be dented while it is damp. b) The cast will dry in about 12 hours. c) The cast must be covered with a blanket to keep it moist during the first 24 hours. d) A dry plaster cast is dull and gray.

The cast can be dented while it is damp. Explanation: The cast can be dented while it is damp. A dry plaster case is white and shiny. The cast will dry in 24 to 72 hours. A freshly applied cast should be exposed to circulating air to dry and should not be covered with clothing or bed linens or placed on plastic-coated mats or bedding

All of the following are guidelines for avoiding hip dislocation after replacement surgery. Select the answer that is not. a) Never cross the legs when seated. b) Put a pillow between the legs when sleeping. c) Keep the knees apart at all times. d) You may flex at the hip to put on clothing such as pants, stockings, socks, or shoes.

You may flex at the hip to put on clothing such as pants, stockings, socks, or shoes. Explanation: "Do not flex at the hip to put on clothing such as pants, stockings, socks, or shoes" is the correct guideline. Keep the knees apart at all times. Put a pillow between the legs when sleeping. Never cross the legs when seated

A client has a plaster cast applied to the left leg. Which of the following comments by the client following the procedure should the nurse address first? a) "My toes are pink." b) "My pain is a 3." c) "My toes are stiff." d) "My cast is still wet."

"My toes are stiff." Explanation: Compartment syndrome is characterized by neurovascular compromise. Stiffness of the toes may be a preliminary finding that the client is having trouble with motor function.

The client who had a total hip replacement was discharged home and developed acute groin pain in the affected leg, shortening of the leg, and limited movement of the fractured leg. The nurse interprets these findings as indicating which of the following complications? a) Re-fracture of the hip b) Avascular necrosis of the hip c) Contracture of the hip d) Dislocation of the hip

Dislocation of the hip Explanation: Manifestations of a dislocated hip prosthesis are increased pain at the surgical site, acute groin pain in the affected leg, shortening of the leg, abnormal external or internal rotation, and limited movement of the fractured leg. The client may report a "popping" sensation in the hip.

The nurse is caring for a client who had a total knee replacement 3 days ago. Which nursing assessment finding requires immediate attention by the nurse? a) Previous shift urine output = 500 ml b) Crackles that clear with coughing c) Drainage from wound suction device = 100 ml d) Hypoactive bowel sounds

Drainage from wound suction device = 100 ml Explanation: Drainage from a wound suction device should be less than 25 ml 48 hours after surgery; 100 ml is an excessive amount and may necessitate opening of the wound to remove the blood.

A client has a cast that extends from below the elbow to the palmar crease and is secured around the base of the thumb. The thumb is also casted. The nurse identifies this as which type of cast? a) Body cast b) Gauntlet cast c) Spica cast d) Short arm cast

Gauntlet cast Explanation: A gauntlet cast is a short arm cast that extends from below the elbow to the palmar crease and is secured around the base of the thumb, with the thumb also being casted. A short arm cast extends from below the elbow to the palmar crease and is secured around the base of the thumb. A body cast is a larger form of a cylinder cast that encircles the trunk from about the nipple line to the iliac crests. A hip spica cast surrounds one or both legs and the trunk. It may be strengthened by a bar that spans a casted area between the legs.

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 Farenheit, 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? a) Osteomyelitis b) Urinary retention c) Atelectasis d) Hypovolemic shock

Hypovolemic shock Explanation: Indicators of hypovolemic shock include a heart rate greater than 100 beats per minute, a blood pressure less than 90/60 mm Hg, and urine output less than 30 ml per hour.

The nurse is preparing a client for a hip replacement with the use of porous-coated cementless joint components. What does the nurse know is the benefit of this type of component? a) It prevents the client from developing infection related to the application of cement in the joint spaces. b) It allows the bone to grow into the prosthesis and securely fix the joint replacement in place. c) The component is less expensive because there is no cement used. d) The client will not reject the prosthesis because there is no cement on the prosthetics.

It allows the bone to grow into the prosthesis and securely fix the joint replacement in place. Explanation: Porous-coated cementless joint components are used to allow the bone to grow into the prosthesis and thus securely fix the joint replacement in place. The prosthesis is not less expensive and cost is not a factor in reconstruction. The client may still have a local or systemic reaction to the prostheses even if it does not have cement.

A client is seen in the orthopedic clinic for complaints of severe pain in the left hip. After a series of diagnostic tests, the client is diagnosed with severe degenerative joint disease of the left hip and suggested to have the hip reconstructed. What procedure will the nurse schedule the client for? a) Open reduction and internal fixation of the left hip. b) Left hip arthroscopy c) Left hip arthroplasty d) Closed reduction of the left hip.

Left hip arthroplasty Explanation: Clients with arthritis, trauma, hip fracture, or a congenital deformity may have an arthroplasty, or reconstruction of the joint. This procedure uses an artificial joint that restores previously lost function and relieves pain. An arthroscopy is not used to reconstruct a diseased hip. A closed reduction is not an invasive surgical procedure and would not be used to reconstruct the hip. An open reduction and internal fixation is not the treatment for reconstruction of the hip related to a diseased hip

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? a) Total arthroplasty b) Osteotomy c) Arthrodesis d) Hemiarthroplasty

Total arthroplasty Explanation: A total arthroplasty is a replacement of both articular surfaces within one joint. An arthrodesis is a fusion of a joint for stabilization and pain relief and is usually done on a wrist or knee. A hemiarthroplastyis the replacement of one of the articular surfaces in a joint, such as the femoral head but not the acetabulum. An osteotomy is the cutting and removal of a wedge of bone to change the bone's alignment, thereby improving function and relieving pain.

The client displays manifestations of compartment syndrome. The nurse expects the client to be scheduled for: a) A fasciotomy b) A total hip replacement c) An open reduction d) A total knee replacement

A fasciotomy Explanation: A treatment option for compartment is fasciotomy.

A 12-year-old girl fractured her right leg several weeks ago while skiing and is returning to the orthopedist to have her cast removed. What is of primary importance in your nursing management during cast removal? a) All options are correct. b) Assuring the cast cutter blade is sharp c) Assuring pedal pulses are present d) Assuring the client she won't be cut

Assuring the client she won't be cut Explanation: Casts are removed with a mechanical cast cutter. Cast cutters are noisy and frightening, and the client needs reassurance that the machine will not cut into the skin.

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? a) Balanced suspension b) Crutchfield tongs c) Buck's d) Thomas splint

Buck's Explanation: An example of skin traction is Buck's traction. Crutchfield tongs, a Thomas splint, or balanced suspension traction are types of skeletal traction.

A client is about to have a cast applied to his left arm. The nurse would alert the client to which of the following as the cast is applied? a) Arm being moved to various positions b) Sensation of warmth or heat with application c) Increased in pain in left arm d) Sensation of weakness

Sensation of warmth or heat with application Explanation: When a cast is applied, the client needs to be aware that he may feel a sensation of warmth or heat due to the material being mixed with water. The client should not feel an increase in pain during the application. The arm will be held in place to ensure proper alignment during the application. The client should not feel weakness in the extremity. This is more commonly experiences after a cast is removed.

Which of the following statements is accurate regarding care of a plaster cast? a) The cast will dry in about 12 hours. b) The cast must be covered with a blanket to keep it moist during the first 24 hours. c) The cast can be dented while it is damp. d) A dry plaster cast is dull and gray.

The cast can be dented while it is damp. Explanation: The cast can be dented while it is damp. A dry plaster case is white and shiny. The cast will dry in 24 to 72 hours. A freshly applied cast should be exposed to circulating air to dry and should not be covered with clothing or bed linens or placed on plastic-coated mats or bedding.

The nurse is taking care of a client who underwent a leg amputation. What teachings should the nurse offer such a client to prevent abduction deformity? Choose all correct options. a) Advise the client who is lying on the stomach to adduct the stump so it presses against the other leg. b) Advise the client to use antiembolism stockings on both legs. c) Advise the client to place pillows between the legs. d) Advise the client to use a trochanter roll.

• Advise the client to use a trochanter roll. • Advise the client who is lying on the stomach to adduct the stump so it presses against the other leg. Explanation: Use a trochanter roll to prevent external rotation of the hip and knee. Avoid placing pillows between the legs. These measures prevent abduction deformity. If the client is lying on the stomach, the nurse should advise the client to adduct the stump so it presses against the other leg. Adduction stretches flexor muscles and prevents abduction deformity. The client should only use an antiembolism stocking on the unaffected leg.

A patient 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? a) "This will allow for the strength in the arm to remain consistent." b) "The joint above the fracture and below the fracture must be immobilized." c) "The method will allow for the fastest healing time and the greatest mobility." d) "When a spica cast is ordered, the arm must be immobilized."

"The joint above the fracture and below the fracture must be immobilized." Explanation: Generally, the joints proximal and distal to the fracture are immobilized to promote healing. The purpose is not for the strength to remain consistent, most patients will lose strength. A spica cast would not be ordered for an ulnar fracture. Although immobilizing the joints above and below fractures may aide in healing time, it does not allow for increased mobility

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? a) Apply lotions and take warm baths or soaks. b) Avoid exposure to direct sunlight. c) Consult a skin speciaqlist. d) Scrub the area vigorously to remove the crust.

Apply lotions and take warm baths or soaks. Explanation: The client should be advised to apply lotions and take warm baths or soaks. This will help in softening the skin and removing debris. The client usually sheds this residue in a few days so the client need not consult a skin specialist. It is not advisable to scrub the area vigorously. The client need not avoid exposure to direct sunlight because the area is not photosensitive.

A variety of complications can occur after a leg amputation. All of the following are possibilities in the immediate postoperative period, except? a) Infection b) Osteomyelitis c) Hemorrhage d) Hematoma

Osteomyelitis Explanation: Chronic osteomyelitis may occur after persistent infection in the late postoperative period. Hematoma, hemorrhage, and infection are potential complications in the immediate postoperative period.

Which action by the nurse would be inappropriate for the client following casting? a) Petal and smooth the edges of the cast. b) Handle the cast with the palms of hands. c) Protect the cast by covering with a sheet. d) Circulate room air with a portable fan.

Protect the cast by covering with a sheet. Explanation: The nurse performs actions to facilitate drying of the cast. The cast should be exposed to air. Portable fans can be used to dry the cast. Pressure on the cast should be avoided.

Which of the following principles apply to the patient in traction? a) Skeletal traction is never interrupted. b) Knots in the ropes should touch the pulley. c) Weights are removed routinely. d) Weights should rest on the bed.

Skeletal traction is never interrupted. Explanation: Skeletal traction is applied directly to the bone and is never interrupted. In order to be effective, the weights must hang freely and not rest on the bed or floor. Knots in the rope or the footplate must not touch the pulley or the foot of the bed. Traction must be continuous to be effective in reducing and immobilizing fractures.

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? a) Remove the traction at least every 8 hours. b) Apply the traction straps snugly. c) Teach the client how to prevent problems caused by immobility. d) Assess the client's level of consciousness.

Teach the client how to prevent problems caused by immobility. Explanation: By teaching the client about prevention measures, the nurse can help prevent problems caused by immobility, such as hypostatic pneumonia, muscle contracture, and atrophy. The nurse applies traction straps for skin traction — not skeletal traction. For a client in skeletal traction, the nurse should assess the affected limb, rather than assess the level of consciousness. Removing skeletal traction is the physician's responsibility — not the nurse's.

All of the following are guidelines for avoiding hip dislocation after replacement surgery. Select the answer that is not. a) Never cross the legs when seated. b) Keep the knees apart at all times. c) Put a pillow between the legs when sleeping. d) You may flex at the hip to put on clothing such as pants, stockings, socks, or shoes.

You may flex at the hip to put on clothing such as pants, stockings, socks, or shoes. Explanation: "Do not flex at the hip to put on clothing such as pants, stockings, socks, or shoes" is the correct guideline. Keep the knees apart at all times. Put a pillow between the legs when sleeping. Never cross the legs when seated.

Which actions by the nurse demonstrate an understanding of caring for a patient in traction? Select all that apply. a) Placing a trapeze on the bed b) Removing skeletal traction to turn and reposition the patient c) Assessing pain level frequently d) Assessing patient's alignment in the bed e) Ensuring that the weights are hanging freely

• Placing a trapeze on the bed • Assessing patient's alignment in the bed • Ensuring that the weights are hanging freely • Assessing pain level frequently Correct Explanation: The weights must hang freely with the patient in good alignment in the center of the bed. The nurse should frequently monitor pain, as uncontrolled pain may be a sign of a complication. The patient will be able to assist with alignment and bed mobility if a trapeze is placed on the bed. Skeletal traction should never be interrupted