Chapter 62- Musculoskeletal Trauma and Orthopedic Surgery

After bring hospitalized for 3 days with a right femur fraction, a patient suddenly develops SOB and tachypnea. The patient tells the nurse, "I feel like I am going to die!" Which action should the nurse take first? a. stay with the patient and offer reassurance b. administer prescribed PRN O2 at 4L/min c. check the patient's legs for swelling or tenderness d. notify the health care provider about the symptoms

ANS B The patient's clinical manifestations and history are consistent with a pulmonary embolism, and the first action should be adequate oxygenation

Which action should the nurse take to evaluate the effectiveness of Buck's traction for a patient who has an intracapsular fraction to the right femur? a. assess for hip pain b. check for contractures c. palpate peripheral pulses d. monitor for hip dislocation

ANS: A Buck's traction is used to reduce painful spasms

A patient with a right lower leg fracture will be discharged home with an external fixation device in place. Which statement should the nurse include in discharge teaching? a. "Check and clean the pin insertion site daily." b. "Remove the external fixator for your shower." c. "Remain on bed rest until bone healing is complete." d. "Take prophylactic antibiotics until the fixator is removed."

ANS: A Pin insertion site should be cleaned daily to decrease risk of infection at the site

What should the occupational health nurse advise a patient whose job involves many hours of typing? a. obtain a keyboard pad to support the wrist b. do stretching exercises before starting work c. wrap the wrists with compression bandages every morning d. avoid using NSAIDs

ANS: A Repetitive strain injuries caused by prolonged work at a keyboard can be prevented by using a pad to keep the wrists in a straight position

For a patient who has had right hip arthroplasty, which nursing action can the nurse delegate to the unlicensed assistive personnel? a. reposition the patient every 1-2 hours b. assess for skin irritation on the patient's back c. teach the patient quadriceps-setting exercises d. determine the patient's pain intensity and tolerance

ANS: A Repositioning of orthopedic patients is within the scope of a UAP after they have been trained and evaluated in this skill

A patient who has had open reduction and internal fixation of a hip fracture tells the nurse that he is ready to get out of bed for the first time. Which action should the nurse take? a. check the patients prescribed weight bearing status b. use a mechanical life to transfer the patient to the chai c. decrease the pain medication before getting the patient up d. have the unlicensed assistive personnel transfer the patient

ANS: A The nurse should be familiar with the weight bearing orders for the patient before attempting to transfer

A patient undergoes left AKA with an immediate prosthetic fitting. What should the nurse do when the patient arrives on the orthopedic unit after surgery? a. assess the surgical site for hemorrhage b. remove the prothesis and wrap the site c. place the patient in a side-lying position d. keep the residual limb elevated on a pillow

ANS: A The nurse should monitor for postoperative hemorrhage

A patient who had an open reduction internal fixation of the left lower leg fractures continues to report severe pain in the leg 15 minutes after receiving IV morphine. The nurse determines pulses are faintly palpable and the foot is cool to the touch. Which action should the nurse take next? a. notify the health care provider b. assess the incision for redness c. reposition the left leg on pillows d. check the patient's BP

ANS: A The patient's clinical manifestations suggest compartment syndrome and delay in diagnosis and treatment may lead to severe functional impairment

Which action should the urgent care nurse take for a patient with a possible knee meniscus injury? a. encourage bed rest for 24-48hrs b. apply an immobilizer to the affected leg c. avoid palpitation or movement of the knee d. administer intravenous opioids for pain management

ANS: B A knee immobilizer may be used for several days after a meniscus injury to stabilize the knee and minimize pain

A 60 yr old patient had and open reduction and internal fixation for a displaced tibial fracture. What should the nurse identify as the priority patient problem? a. acute pain b. risk for infection c. activity intolerance d. risk for constipation

ANS: B A patient having ORIF is at risk for problems such as wound infection and ostemyelitis

The day after having a right BKA, the patient reports pain in the missing right foot. Which action is most important for the nurse to take? a. explain the reasons for the pain b. administer prescribed analgesics c. reposition the patient to assure good alignment d. tell the patient that the pain will diminish over time

ANS: B Acute phantom limb sensation is treated as any other type of postoperative pain would be treated

The nurse should instruct a patient with a nondisplaced fractured left radius that the cast will need to remain in place for what amount of time? a. two weeks b. at least six weeks c. until swelling of the wrist has resolved d. until x-rays show complete bone union

ANS: B Bone healing starts immediately after the injury, but because ossification does not begin until after 3 weeks of injury, the cast will need to be worn another 3 weeks

After change of shift report, which patient should the nurse assess first? a. patient with a repaired mandibular fracture who is reporting facial pain b. patient with repaired right femoral shaft fracture who reports tightness in the calf c. patient with an unrepaired Colles' fracture who has right wrist swelling and deformity d. patient with an unrepaired intracapsular left hip fracture whose leg is externally rotated

ANS: B Calf swelling after a femoral shaft fracture suggests possible DVT or compartment syndrome

Which information about a patient with a lumbar vertebral compression fracture should the nurse immediately report to the health care provider? a. patient declines to be turned due to back pain b. patient has been incontinent of urine and stool c. patient reports lumbar area tenderness to palpation d. patinet frequently uses oral corticosteroids to treat asthma

ANS: B Changes in bowel or bladder function indicate possible spinal cord compression and should be reported immediately because surgical intervention may be needed

A patient who is to have no weight bearing on the left leg is learning to use crutches. Which observation by the nurse indicates that the patient can safely ambulate independently? a. the patient moves the right crutch with the right leg and then the left crutch with the left leg b. the patient advances the left leg and both crutches together and then advances the right leg c. the patient uses the bedside chair to assist in balance as needed when ambulating in the room d. the patient keeps the padded area firmly in the axillary area when ambulating

ANS: B Patients are usually taught to move the crutches and the injured leg forward at the same time and then move the unaffected leg

A tennis player has an arthroscopic repair of a rotator cuff injury performed in same day surgery. Which information will the nurse include in postoperative teaching? a. "You will not be able to serve a tennis ball again." b. "You will begin work with a physical therapist tomorrow." c. "Keep the shoulder immobilizer on the first 4 days to minimize pain." d. "The surgeon will use the drop arm test to determine the success of surgery."

ANS: B Physical therapy after a rotator cuff repair begins on the first postoperative day to prevent "frozen shoulder".

A patient who arrives at the ED with severe left knee pain is diagnosed with a patellar dislocation. What should the nurse's initial focus for patient teaching? a. use of knee immobilizer b. monitored anesthesia care c. physical activity restrictions d. performance of gentle knee flexion

ANS: B The first goal of interprofessional management is realignment of the knee to its original anatomic position, which will require anesthesia or monitored care, formally called conscious sedation

Which information should the nurse include in discharge teaching for a patient who has had a repair of a fractured mandible? a. administration of nasogastric tube feedings b. how and when to cut the immobilizing wires c. the importance of high fiber foods in the diet d. the use of sterile technique for dressing changes

ANS: B The jaw will be wired for stabilization, and the patient should know what emergency situations require the wires to be cut to protect the airway

Which statement by a patient who has had AKA indicates the nurse's discharge teaching has been effective? a. "I should elevate my residual limb on a pillow 2 or 3 times a day." b. "I should lie flat on my abdomen for 30 min 3 to 4 times a day." c. "I should change the limb sock when it becomes soiled each week." d. "I should use lotion on the stump to prevent skin drying and cracking."

ANS: B The patient lies in the prone position several times daily to prevent flexion contractures of the hip

Before assisting a patient with ambulation 2 days after a total hip arthroplasty, which action is most important for the nurse to take? a. observe output from the surgical drain b. administer prescribed pain medication c. instruct the patient about benefits of early ambulation d. change the dressing and document the wound appearance

ANS: B The patient should be adequately medication for pain before any attempt to ambulate.

The second day after admission with a fractured pelvis, a patient suddenly develops confusion. Which action should the nurse take first? a. take the blood pressure b. check the O2 saturation c. assess patient orientation d. observe for facial asymmetry

ANS: B The patient's history and clinical manifestations suggest fat embolism. The most important assessment is oxygenation

The nurse is caring for a patinet who is using Buck's traction after a hip fracture. Which action can the nurse delegate to the unlicensed assistive personnel? a. remove and reapply traction periodically b. ensure the weight for the traction is hanging freely c. monitor the skin under the traction boot for redness d. check for intact sensation and movement in the affected leg

ANS: B UAP can be responsible for maintaining the integrity of the traction after it has been established

A patient arrived at the ED after tripping over a rug and falling at home. Which finding should the nurse identify as most important to communicate with the health care provider? a. there is bruising at the shoulder area b. the patient reports arm and shoulder pain c. the right arm appears shorter than the left d. there is decreased shoulder ROM

ANS: C A shorter limb after a fall indicates a possible dislocation, which is an orthopedic emergency

What should the nurse include when teaching older adults at the community recreation center about ways to prevent fractures? a. tack down scatter rugs on the floor at home b. expect most falls to happen outside the home in the yard c. buy shoes that provide good support and are comfortable to wear d. get instruction in ROM exercises from a physical therapist

ANS: C Comfortable shoes with good support will help decrease the risk for falls

Which discharge instruction should the emergency department nurse include for a patient with a sprained ankle? a. keep the ankle loosely wrapped with gauze b. apply a heating pad to reduce muscle spasms c. use pillows to elevate the ankle above the heart d. gently move the ankle through the ROM

ANS: C Elevation of the leg will reduce swelling and pain

Based on the information below for a patient in the ED, which action should the nurse take first? History: 23 yrs old, RLL injury Physical assessment: reports severe RLL pain, reports feeling SOB, bone protruding from RLL Diagnostic Exams: WBC 9400, Hgb 11.6, right leg x-ray-tibial fracture a. administer the prescribed morphine 4mg IV b. contact the operating room to schedule surgery c. check the patient's O2 saturation using pulse oximetry d. ask the patient the date of the last tetanus immunization

ANS: C Fat embolism can occur with a tibial fracture so checking the patient's O2 saturation should be the first action

Which patient statement indicates understanding of the nurse's teaching about a new short arm synthetic cast? a. "I can remove the cast in 4 wks using industrial scissors" b. "I should avoid moving my fingers until the cast is removed" c. "I will apply an ice pack to the cast over the fracture site off and on for 24 hrs" d. "I can use a cotton tipped applicator to rub lotion on any dry areas under the cast"

ANS: C Ice application for the first 24 hrs after a fracture will help reduce swelling and can be placed over the cast

Which information should the nurse include in discharge instructions for a patient with comminuted left forearm fractures and a sling-arm cast? a. keep the left shoulder elevated on a pillow or cushion b. avoid nonsteroidal antiinflammatory drugs c. call the health care provider for numbness of the hand d. keep the hand immobile to prevent soft tissue swelling

ANS: C Increased swelling or numbness may indicate increased pressure at the injury, and the health care provider should be notified immediately to avoid damage to nerves and other tissues

A patient is being discharged 4 days after hip arthroplasty using the posterior approach. Which patient action requires intervention by the nurse? a. using crutches with a swing to gait b. sitting upright on the edge of the bed c. leaning over to pull on shoes and socks d. bending over the sink while brushing teeth

ANS: C Leaning over would flex the hip at greater than 90 degrees and predispose the patient to hip dislocation

When a patient arrives in the ED with a facial fracture, which action should the nurse take first? a. assess for nasal bleeding and pain b. apply ice to the face to reduce swelling c. use a cervical collar to stabilize the spine d. check the patient's alertness and orientation

ANS: C Patients who have facial fractures are at risk for cervical spine injury and should be treated as so until ruled out

A patient is admitted to the ED with a left femur fracture. Which assessment finding by the nurse is most important to report to the health care provider? a. bruising of the left thigh b. reports severe thigh pain c. slow capillary refill of the left foot d. outward pointing toes on the left foot

ANS: C Prolonged capillary refill may indicate complications such as compartment syndrome

Which finding in a patient with Colles' fracture of the left wrist should the nurse identify as most important to communicate immediately to the health care provider? a. the patient reports severe pain b. swelling is noted around the wrist c. capillary refill of the fingers is slow d. the wrist has a deformed appearance

ANS: C Swelling, pain, and deformity are common findings with a Colle's fracture. Prolonged capillary refill indicates decreased circulation and risk for ischemia

A patient with a complex pelvic fracture from a motor vehicle crash is on bed rest. Which assessment finding should indicate to the nurse a potential complication of the fracture? a. the patient states the pelvis feels unstable b. the patient reports pelvic pain with palpation c. abdomen is distended, and bowel sounds are absent d. ecchymoses are visible across the abdomen and hips

ANS: C The abdominal distention and absent bowel sounds may be due to complications of pelvic fractures such as paralytic ileus or hemorrhage or trauma to the bladder, urethra, or colon

A patient who slipped and fell in the shower at home has a proximal left humerus fracture immobilized with a sling. Which intervention should the nurse include in the plan of care? a. use surgical net dressing to hang the arm from an IV pole b. immobilize the fingers of the left hand with gauze dressings c. assess the left axilla and change absorbent dressings as needed d. assist the patient in passive ROM for the right arm

ANS: C The axilla can become excoriated when a sling is used to support the arm, and the nurse should check the axilla and apply absorbent dressings to prevent this

A high school teacher with ulnar drift caused by RA is scheduled for arthroplasty of several joints in the left hand. Which patient statement to the nurse indicates a realistic expectation of the surgery? a. "This procedure will correct the deformities in my fingers." b. "I will not have to do as many hand exercises after the surgery." c. "I will be able to use my fingers with more flexibility to grasp things." d. "My fingers will appear more normal in size and shape after this surgery."

ANS: C The goal of hand surgery in RA is to restore function, not correct for cosmetic deformity or treat the underlying process

A pedestrian who was hit by a car is admitted to the ED with possible right lower leg fractures. What initial action should the nurse take? a. elevate the right leg b. splint the lower leg c. assess the pedal pulses d. verify tetanus immunization

ANS: C The initial nursing action should be assessment of the neurovascular condition of the injured leg

After the health care provider recommends amputation for a patient who has nonhealing ischemic foot ulcers, the patient tells the nurse that he would rather die than have an amputation. Which response by the nurse is best? a. "You are upset, but you may lose the foot anyway." b. "Many people are able to function with a foot prosthesis" c. "Tell me what you know about your options for treatment." d. "If you do not want an amputation, you do not have to have it."

ANS: C The initial nursing action should be to assess the patient's knowledge and feelings about the available options

The nurse is caring for a patient who has a pelvic fracture and an external fixation device. How should the nurse perform assessment of pressure areas and provide skin care to the patient's back? a. ask the patient to turn to the side independently b. defer back assessment until patient is ambulatory c. have the patient lift the back and buttocks using a trapeze d. roll the patient over to the side by pushing on the patient's hips

ANS: C The patient can lift the back slightly off the bed using a trapeze

After a motorcycle accident, a patient arrives to the ED with severe swelling of the left lower leg. Which action should the nurse take first? a. elevate the leg on two pillows b. apply a compression bandage c. assess the leg pulses and sensation d. place ice packs on the lower leg

ANS: C The initial action will be to assess circulation to the leg and observe for any evidence of injury such as fractures or dislocations

In which order should the nurse complete actions when care for a patient in the ED who has a right leg fracture? a. obtain x-rays b. check pedal pulses c. assess lung sounds d. take the BP e. apply splint to leg f. administer tetans prophylaxix

ANS: C, D, B, E, A, F The initial actions should be to ensure adequate airway, breathing, circulation and then followed by checking the neurovascular condition of the leg.

Which action should the nurse include in the plan of care for a patient who had a cemented right total knee arthroplasty? a. avoid extension of the knee beyond 120 degrees b. use a compression bandage to keep the right knee flexed c. teach about the need to avoid weight bearing of 4 wks d. start progressive knee exercises to obtain 90 degree flexion

ANS: D After a knee arthroplasty, active or passive flexion exercises are used to obtain a 90 degree flexion of the knee

A young adult arrives in the ED with ankle swelling and severe pain after twisting an ankle playing basketball. Which prescribed action will the nurse implement first? a. send the patient for ankle x-rays b. administer naproxen c. give acetaminophen with codiene d. wrap the ankle and apply an ice pack

ANS: D Immediate care after a sprain or strain injury includes application of cold and use of compression to minimize swelling

A patient has possible right carpal tunnel syndrome. What symptoms should the nurse expect with a positive Tinel's sign? a. weakness in the right little finger b. burning in the right elbow and forearm c. tremor when gripping with the right hand d. tingling in the right thumb and index finger

ANS: D Testing for Tinel's sign will cause tingling in the thumb and first three fingers of the affected hand in patient's who have carpal tunnel syndrome

A patient is to be discharged from the hospital 4 days after insertion of a femoral head prosthesis using a posterior approach. Which patient statement to the nurse indicates that additional teaching is needed? a. "I should not cross my legs while sitting." b. "I will use a toilet elevator in the toilet seat." c. "I will have someone else put on my socks and shoes." d. "I can sleep in any position that is comfortable to me."

ANS: D The patient needs to sleep in a position that prevents excessive internal rotation or flexion of the hip

A factory line worker has repetitive strain syndrome in the left elbow. What topic should the nurse plan to include in patient teaching? a. surgical options b. elbow injections c. wearing a left wrist splint d. modifying arm movements

ANS: D Treatment for repetitive strain syndrome includes changing the ergonomics of the activity