Musculoskeletal

The community health nurse found an elderly female client lying in the snow. The client was unable to move the right leg because of a fracture. What action should the nurse take first? 1. Immobilize the fracture in its present position. 2. Elevate the leg on whatever is available. 3. Realign the fracture ends. 4. Reduce the fracture.

1. Initial treatment of obvious and suspected fractures includes immobilizing and splinting the limb. Any attempt to realign or reset the fracture at the stem may cause further injury and complications. The leg may be elevated only after immobilization.

A client who is receiving acetaminophen (Tylenol) for osteoarthritis complains of continuing pain. The health care provider prescribes celecoxib (Celebrex). Which medication instruction should the nurse provide to this client? 1. Report black and tarry stools to the health care provider. 2. Use a stool softener or fiber laxative daily to prevent constipation. 3. If you miss a dose, take a double dose the next day. 4. Don't take the medication with dairy products.

1. Black and tarry stools are a sign of gastrointestinal (GI) bleeding and may necessitate a medication change. Dairy products help reduce GI irritation. The celecoxib dose should never be doubled. Constipation isn't an adverse effect of this drug.

A 20-year-old client developed osteomyelitis 2 weeks after a fishhook was removed from the client's foot. Which rationale best explains the expected long-term antibiotic therapy needed? 1. Bone has poor circulation. 2. Tissue trauma requires antibiotics. 3. Feet are normally more difficult to treat. 4. Fishhook injuries are highly contaminated.

1. Bone has very poor blood circulation, making it difficult to treat an infection in the bone. This requires the long-term use of intravenous (I.V.) antibiotics to make sure the infection is cleared. Tissue trauma does not always require antibiotics, at least not long term. Feet are not more difficult to treat than other parts of the body unless the client has a circulatory problem or diabetes mellitus. Fishhooks may not be any more contaminated than another instrument that caused an injury.

The nurse is obtaining a health history from a client who has been taking ibuprofen (Motrin). What is (are) the most important question(s) for the nurse to ask the client? Select all that apply. 1. "How often do you take this medication?" 2. "Have you had any difficulty with breathing?" 3. "Do you monitor your blood pressure regularly?" 4. "Have you ever had tarry, black stools?" 5. "Have you ever vomited blood?"

1, 2, 4, and 5. Questions 4 and 5 are appropriate for the client who is taking ibuprofen because the medication can lead to irritation of the gastrointestinal (GI) mucosa, which can increase the risk of a GI bleed and vomiting. Knowing how often the client takes the medication is important because the client should not exceed 3,600 mg/day. If the client exceeds the medication amount, this can lead to renal failure, which will cause the blood pressure to increase. If the client has a history of respiratory problems, ibuprofen can increase the risk for developing hypersensitivity reactions.

The nurse is assessing a client with a hemorrhage from compartment syndrome. Which of the following symptoms would the nurse expect to find? Select all that apply. 1. Edema 2. Increased venous pressure 3. Decreased venous circulation 4. Increased arterial circulation

1, 2, and 3. The hemorrhage in compartment syndrome causes edema, increased venous pressure, and decreased venous and arterial circulation.

A client is diagnosed with fat emboli. Which signs and symptoms would the nurse expect to find during assessment? 1. Tachypnea, tachycardia, shortness of breath, and paresthesia 2. Paresthesia, bradypnea, bradycardia, and petechial rash on chest and neck 3. Bradypnea, bradycardia, shortness of breath, and petechial rash on chest and neck 4. Tachypnea, tachycardia, shortness of breath, and petechial rash on chest and neck

4. Signs and symptoms of fat emboli include tachypnea, tachycardia, shortness of breath, and a petechial rash on the chest and neck. The fat molecules enter the venous circulation and travel to the lung, obstructing pulmonary circulation. Bradycardia, bradypnea, and paresthesia are not usual symptoms.

Which statement by the client who recently had a cast applied indicates that the nurse's teaching has been effective? 1. "Heat is a normal sensation as a cast dries." 2. "I'll call my health care provider if I feel any heat." 3. "The cast will need to be removed if I feel any heat." 4. "The heat I feel is most likely caused by an infection."

1. Normally, as the cast dries, a client may complain of heat from the cast. Offer reassurance. The cast will not need to be removed, and the heath care provider does not need to be notified. Heat from the cast is not a sign of infection.

The nurse is collaborating with the orthopaedic technician regarding interventions to reduce the roughness of a cast. What is the best intervention? 1. Petal the edges. 2. Elevate the limb. 3. Break off the rough area. 4. Distribute pressure evenly.

1. Petaling the edges will reduce the roughness of the cast. Elevating the limb will prevent swelling. Never break a rough area off the cast. Distributing pressure evenly will prevent pressure ulcers.

A nurse is caring for the client who is 2 days postoperative and complaining of severe pain in the left leg. The nurse administers the prescribed morphine sulfate, 2 mg I.V. The client continues to complain of severe pain. The nurse assesses the client's left leg and finds the extremity cool to touch with absent pulses and a capillary refill greater than 3 seconds. What is the priority action of the nurse? 1. Notify the health care provider. 2. Document the clinical findings. 3. Readminister the prescribed morphine sulfate. 4. Reassess the left lower extremities within 1 hour.

1. Skin cool to touch, no pulse, and capillary refill greater than 3 seconds are indications that the client's circulation is impaired. There are several complications that can impede circulation such as compartment syndrome or deep vein thrombosis (DVT), which requires immediately action to prevent damage to the nerves and tissues and necrosis. These complications can lead to loss of the leg. The nurse needs to collaborate with the health care provider for additional plans of care. Pain that is caused by tissue ischemia will not be relieved by morphine sulfate. Reassessing the left leg within 1 hour is delay in care and can cause more complications, which can lead to an irreversible outcome for the client. CN: Physiological integrity;

The nurse is caring for a 70-year-old client who has undergone a right total hip replacement. The nurse is aware that the client should be repositioned: 1. every 1 to 2 hours, from the unaffected side to the back. 2. every 4 to 6 hours, from the unaffected side to the back. 3. every 1 to 2 hours, from the affected side to the back. 4. every 4 to 6 hours, from the affected side to the back.

1. The client should be turned at least every 2 hours and always from the unaffected side to the back. The client should never be placed on the affected side. Turning the client every 4 to 6 hours places her at greater risk for skin breakdown.

A nurse has instructed a client to accurately measure the circumference of both calves each morning and to report any increase in size. The nurse determines that teaching has been effective when the client makes which statement? 1. "I'll use a measuring tape to check circumference." 2. "I'll use the standardized chart for limb circumference." 3. "I only have to call if one leg is significantly larger than the other." 4. "I can measure my calves either near the knee or closer to the ankle."

1. The correct method for measuring calf circumference is to use a measuring tape: place the tape at the level where the calf circumference is largest and measure at the same place each time. The client was instructed to report any increase in circumference. A significant increase in calf circumference size might be unilateral or bilateral. There's no standardized chart for limb circumference.

A client has just returned from the postanesthesia care unit after undergoing internal fixation of a left femoral neck fracture. The nurse should place the client in which position? 1. The client should be positioned on his back with two pillows between his legs. 2. The client should be positioned on the left side with his right knee bent. 3. The client should be positioned on the right side with his left knee bent. 4. The client should be sitting at a 90-degree angle.

1. The operative leg must be kept abducted to prevent dislocation of the hip. Placing the client on the left or right side with knee bent does not promote abduction. Acute flexion of the operated hip may cause dislocation. The head of the bed may be raised 35 to 49 degrees.

A client is admitted to the emergency department with a foot fracture, and a brace is applied. The nurse determines that teaching about the brace has been effective when the client makes which statement? 1. "The brace will act as a splint." 2. "The brace will allow for movement." 3. "The brace will help to prevent infection." 4. "The brace will encourage direct contact."

1. The purpose of the brace is to act as a splint, maintain immobility, and prevent direct contact. A brace does not prevent infection.

A client has developed a fat embolus. The nurse is aware that the treatment of choice would be which of the following? 1. Antibiotics, I.V. fluids, steroids, and oxygen 2. Theophylline (Theo-24), morphine, oxygen, and I.V. fluids 3. Morphine (Duramorph), oxygen, I.V. fluids, and antibiotics 4. Albuterol (AccuNeb), oxygen, I.V. fluids, and steroids

1. Treatment of a fat embolus may include oxygen, I.V. fluids, steroids to counteract inflammation in the lungs and correct cerebral edema, and antibiotics to prevent infection. Albuterol, morphine, and theophylline aren't commonly used to treat fat emboli.

A client with a right hip fracture is complaining of left-sided leg pain and edema and has a positive Homans' sign. Based on the clinical findings, which of the following potential complications is a priority for the nurse to address? 1. Deep vein thrombosis (DVT) 2. Pulmonary embolism 3. Fat emboli 4. Infection

1. Unilateral leg pain and edema with a positive Homans' sign (not always present) might be symptoms of DVT. Symptoms of fat emboli include restlessness, tachypnea, and tachycardia and are more common in long bone injuries. It is unlikely an infection would occur on the opposite side of the fracture without cause. Tachycardia, chest pain, and shortness of breath may be symptoms of a pulmonary embolism.

A nurse witnessed an accident. Which of the following interventions would apply to a client with a suspected fracture at the scene of the accident? Select all that apply. 1. Do not move the client. 2. Immobilize the extremity. 3. Move the client to safety immediately. 4. Sit the client up to facilitate the airway.

2 and 3. At the scene of an accident, a client with a suspected fracture should have the extremity immobilized and be moved to safety. If the client is in a safe place, do not try to move him. Never try to sit the client up; this could make the fracture worse.

A client is in the emergency department with a suspected fracture of the right hip. Which assessment(s) should the nurse expect to find? Select all that apply. 1. The right leg is longer than the left leg. 2. The right leg is shorter than the left leg. 3. The right leg is externally rotated. 4. The right leg is internally rotated. 5. The right leg is abducted. 6. The right leg is adducted.

2, 3, and 6. In a hip fracture, the affected leg is shorter, adducted, and externally rotated.

A nurse is performing a neurovascular assessment. It is most important for the nurse to include which of the following in the assessment? 1. Orientation, movement, pulses, and warmth 2. Capillary refills, movement, pulses, and warmth 3. Orientation, pupillary response, temperature, and pulses 4. Respiratory pattern, orientation, pulses, and temperature

2. A correct neurovascular assessment should include capillary refill, movement, pulses, and warmth. Neurovascular assessment involves nerve and blood supply to an area. Respiratory pattern, orientation, temperature, and pupillary response aren't part of a neurovascular examination.

Which of the following clinical manifestations would lead the nurse to suspect that the client has a dislocation of the left hip? 1. Pain relieved with pressure 2. Pain in the inguinal area, abnormal gait 3. Internal rotation of the knee, abduction of the leg 4. Pain in the hip, the thigh appears longer than the unaffected leg

2. A dislocated hip will create problems with walking, and pain is often due to a pinched nerve in the joint. Pressure should not be applied to a painful joint or fracture unless there's hemorrhage. The leg is usually adducted and shortened.

A client asks the nurse to explain the reason why a plaster cast cannot get wet. What would be the nurse's best response? 1. A wet cast can cause a foul odor. 2. A wet cast will weaken or be destroyed. 3. A wet cast is heavy and difficult to maneuver. 4. It is okay to get the cast wet, just use a hair dryer to dry it off.

2. A wet cast will weaken or be destroyed. A foul odor is a sign of infection. It's never okay to get a cast wet. Fiberglass casts do not lose integrity or strength when wet or damp.

The nurse is assessing a client and determines that which of the following is a risk factor for traction-related complications? 1. Coronary artery disease 2. Diabetes mellitus 3. Hypertension 4. Hip fracture

2. Because people with diabetes commonly have microvascular compromise and delayed wound healing, they need careful monitoring for early signs of skin breakdown. The other conditions do not increase the risk of traction-related complications.

A client with a femoral fracture is in skeletal traction. During the initial shift assessment, the nurse finds that the weight used in traction is heavier than specified by the nursing care plan. Which action should the nurse take first? 1. Ask the health care provider during rounds if the order for the weight was changed. 2. Check the health care provider's orders to see if the orders included a weight change. 3. Assume that if the weight was changed, the health care provider ordered it. 4. Remove the weight and replace it with the weight specified in the plan.

2. First, the nurse should check the physician's orders to see if a weight change was ordered. If it was, the nurse responsible for ensuring implementation of the care plan should investigate why the change was not incorporated in the plan.

A client comes to the emergency department complaining of dull, deep bone pain unrelated to movement. The client asks the nurse if this could be a fracture. The best response by the nurse is: 1. "These are classic symptoms of a fracture." 2. "Fracture pain is sharp and related to movement." 3. "Fracture pain is sharp and unrelated to movement." 4. "Fracture pain is dull and deep and related to movement."

2. Fracture pain is sharp and related to movement. Pain that is dull and deep and unrelated to movement is not typical of a fracture.

The nurse is instructing a nursing assistant on the proper care of a client in Buck's extension traction following a fracture of the left fibula. Which of the following observations would indicates that teaching has been effective? 1. The leg in traction is kept externally rotated. 2. The weights are allowed to hang freely over the end of the bed. 3. The nursing assistant instructs the client to perform ankle rotation exercises. 4. The nursing assistant lifts the weights when assisting the client to move up in bed.

2. In Buck's traction, the weights should hang freely without touching the bed or floor. Lifting the weights would break the traction. The client should be moved up in bed, allowing the weight to move freely along with the client. The leg should be kept in straight alignment. Performing ankle rotation exercises could cause the leg to go out of alignment.

Which nursing intervention would be appropriate for a client in traction? 1. Add and remove weights as the client wants. 2. Assess the pin sites every shift and as needed. 3. Make sure the knots in the rope catch on the pulley. 4. Give range of motion (ROM) to all joints, including those immediately proximal and distal to the fracture, every shift.

2. Nursing care for a client in traction may include assessing pin sites every shift and as needed and making sure the knots in the rope do not catch on the pulley. Add and remove weights as the health care provider orders, and give ROM to all joints, except those immediately proximal and distal to the fracture, every shift.

A nurse is assessing a client who is experiencing new-onset signs and symptoms of paresthesia. What is the most appropriate question for the nurse to ask the client? 1. "Have you had any changes in range of motion (ROM)?" 2. "Do you have any numbness and tingling?" 3. "Do you have any pain and blanching?" 4. "How long have you had fever and chills?"

2. Paresthesia is described as numbness and tingling. It is not associated with fever and chills or changes in ROM, nor is it described as pain or blanching.

A client in skeletal traction complains of pain and received a dose of an analgesic 1 hour ago. The nurse educates and offers the client an alternative pain-management measure. Which of the following actions should be implemented based on the nurse's scope of practice? 1. Acupressure and shiatsu 2. Relaxation and imagery 3. Hypnosis and therapeutic touch 4. Swedish massage and the Feldenkrais method

2. Relaxation and imagery are effective adjuncts to pharmacological pain management that the nurse can implement without a physician's order. Although the other therapies may promote pain management, they require special training or certification.

A client has been treated for compartment syndrome by undergoing a fasciotomy. Which nursing diagnosis has the highest priority for this client? 1. Chronic pain 2. Risk for infection 3. Impaired gas exchange 4. Decreased cardiac output

2. Risk for infection is the most appropriate diagnosis following a fasciotomy. A fasciotomy involves the excision of the fascia and leaving the wound unsutured. The wound is covered with dressings that are moistened with sterile saline. The client may develop infection in this open wound. Although there is pain involved, the pain should decrease due to the surgical decompression of the fascia. Gas exchange and cardiac output should not be affected by the fasciotomy.

A high-protein diet is ordered for a client recovering from a fracture. The nurse explains to the client that which of the following is the reason for this diet? 1. Protein promotes gluconeogenesis. 2. Protein has anti-inflammatory properties. 3. Protein promotes cell growth and bone union. 4. Protein decreases pain medication requirements.

3. High-protein intake promotes cell growth and bone union. Protein does not decrease pain medication requirements, have anti-inflammatory properties, or promote gluconeogenesis.

The nurse is caring for a client diagnosed with a fracture. The health care provider ordered a high-protein diet. The nurse explains to the client that the high-protein diet is ordered for which of the following reasons? 1. Protein promotes gluconeogenesis. 2. Protein has anti-inflammatory properties. 3. Protein promotes cell growth and bone union. 4. Protein decreases pain medication requirements.

3. High-protein intake promotes cell growth and bone union. Protein does not promote gluconeogenesis, exert anti-inflammatory properties, or decrease pain medication requirements.

Which of the following clinical manifestations would lead the nurse to suspect a fat embolus in a client who has a left femur fracture? 1. Dyspnea 2. Sudden headache 3. Numbness in the left leg 4. Muscle spasm in the left thigh

1. A fat embolism usually presents as an acute respiratory distress. Symptoms include chest pain, cyanosis, dyspnea, tachypnea, and apprehension. A sudden headache is not a symptom of a fat embolism. Muscle spasms in the left thigh are a neuromuscular response of the local muscle around the femoral fracture. Numbness would be a neurovascular response.

A client with a left arm cast complains of a foul odor. What is the appropriate action by the nurse? 1. Assess further because this may be a sign of an infection. 2. Teach the client proper cast care, including hygiene measures. 3. This is normal, especially when a cast is in place for a few weeks. 4. Assess further because this may be a sign of neurovascular compromise.

1. A foul odor from a cast may be a sign of an infection. The nurse needs to assess for fever, malaise, and, possibly, an elevation in white blood cells. Odor from a cast is never normal, and it is not a sign of neurovascular compromise, which would include decreased pulses, coolness, and paresthesia.

The nurse is assessing a client who is admitting for a long bone fracture. Which assessment finding would be noted as a life-threatening complication? 1. Fat emboli 2. Bone emboli 3. Serous emboli 4. Platelet emboli

1. A life-threatening complication of long bone fractures is the development of fat emboli. Bone or platelet emboli are rare occurrences and infrequently associated with long bone fractures. There are no emboli known as serous emboli.

Which of the following instructions should the nurse include in the preoperative teaching for a client scheduled for closed spine surgery? 1. An endoscope is used to perform the surgery. 2. Intense physical therapy is needed after the procedure. 3. There is a greater associated risk with closed spine surgery. 4. Recovery time is twice as long as with open spine surgery.

1. Closed spine surgery uses endoscopy to fix a herniated disk. It is less risky than open surgery and has a shorter recovery time; it is commonly done as a same-day surgical procedure. Physical therapy may be less intensive or not needed at all.

The nurse is teaching a client diagnosed with degenerative joint disease about the condition. The nurse recognizes teaching has been effective when the client makes which statement? 1. "It is a noninflammatory joint disease." 2. "It is an immune-mediated joint disease." 3. "It is a joint inflammation after a viral infection." 4. "It is a joint inflammation related to systemic infections."

1. Degenerative joint disease is joint disease due to the noninflammatory wear and tear on joints and is often seen in athletes. It is not immune-mediated, inflammatory, or caused by systemic infections.

A client has developed compartment syndrome following application of a cast from a fractured tibia. The nurse is aware that the priority goal of intervention is to: 1. prevent tissue death, which can occur within 2 to 4 hours. 2. decrease the swelling in the extremity. 3. prevent further complications. 4. decrease the level of pain.

1. Following development of compartment syndrome, there is an increase in pressure within the affected compartment that compromises circulation to the muscle tissue and to nerves. This may lead to death of these tissues and can occur within 2 to 4 hours. Decreasing pain levels, preventing further complication, and decreasing the swelling in the affected extremity are important goals of treatment, but they are not the priority of treatment.

A 25-year-old male client has just had a plaster cast applied to the right forearm following the reduction of a closed radius fracture due to an in-line skating accident. What is the priority assessment for the nurse to perform? 1. Sensation and movement of the fingers 2. Whether the client is having any pain 3. Whether the cast is completely dry 4. Whether the cast needs petaling

1. Neurovascular checks are most important because they are used to determine if any impairment exists after cast application and reduction of the fracture. Checking to see if the cast is completely dry isn't the nurse's highest priority. Petaling to smooth the cast edge is done when the cast is completely dry.

The health care provider has just removed the cast from a 20-year-old client's lower leg. During the removal, a small superficial abrasion occurred over the ankle. Which statement by the client indicates the need for additional client teaching? 1. "The dry, peeling skin will go away by itself." 2. "I must use a moisturizing lotion on the dry areas." 3. "I can wash the abrasion on my ankle with soap and water." 4. "I will wait until the abrasion is healed before I go swimming."

2. The dry, peeling skin will heal in a few days with normal cleaning; therefore, lotions are unnecessary. Vigorous scrubbing isn't necessary. Washing the abrasion and delaying swimming until healing are correct procedures to follow after removal of a cast.

A 70-year-old male client is admitted to the medical-surgical unit with a fractured femur. The client is placed in Russell's traction. The client asks the nurse to help him with back care. The most appropriate intervention by the nurse is: 1. telling the client that he can't have back care while he's in traction. 2. telling the client to use the trapeze to lift his back off the bed. 3. supporting the weight to give the client more slack to move. 4. removing the weight to give the client more slack to move.

2. The traction must not be disturbed to maintain correct alignment. Therefore, the client should use the trapeze to lift his back off of the bed. The client can have back care as long as he uses the trapeze and does not disturb the alignment. The weight should not be moved without a health care provider's order; it should hang freely without touching anything.

A client is receiving nutritional counseling following an application of a plaster cast for a fracture. The client asks the nurse why vitamin D intake is important. What is the best response by the nurse? 1. Absorption and use of potassium and phosphorus 2. Absorption and use of calcium and phosphorus 3. Excretion of calcium and phosphorus 4. Excretion of potassium and calcium

2. Vitamin D increases the absorption and use of calcium and phosphorus. Vitamin D does not affect potassium, nor does it reduce the absorption or affect the excretion of calcium and phosphorus.

The nurse is caring for a client with skeletal traction to the right leg. The client complains of severe right leg pain. Which action should the nurse perform first? 1. Perform pin care. 2. Notify the health care provider. 3. Check the client's alignment in bed. 4. Remove the weights from the traction.

3. A client who complains of severe leg pain may need realignment to ease some pressure on the fracture site. If this is ineffective, then the physician may need to be notified. The weights ordered may be too heavy, but the nurse can't remove them without a physician's order. Performing pin care isn't appropriate at this time.

While caring for a client after a left hip replacement, the nurse determines that discharge teaching has been effective when the client states: 1. "I must remain on bed rest." 2. "I have no activity restrictions." 3. "I am allowed limited weight bearing." 4. "I cannot bear any weight for 2 months."

3. After a hip replacement, the client's activity is usually ordered as limited weight bearing. The client is allowed to move with restrictions for approximately 2 to 3 months. The hip should not be flexed more than 90 degrees. Abduction past the midline of the body is prohibited. Progressive weight bearing reduces the complications of immobility.

The nurse is assisting the health care provider with the application of a cast. Which of the following nursing interventions would be included in the immediate cast care? 1. Rest the cast on the bedside table. 2. Dispose of the plaster water in the sink. 3. Support the cast with the palms of the hands. 4. Wait until the cast dries before cleaning the surrounding skin.

3. After helping the health care provider to apply a cast, support it with the palms of the hands; do not rest the cast on a hard or sharp surface. Dispose of the plaster water in a sink with a plaster trap or in a garbage bag. Clean the surrounding skin before the cast dries.

After surgical repair of the client's hip, which of the following positions would be best for this client? 1. Prone 2. Adduction 3. Abduction 4. Subluxated

3. After surgical repair of the hip, the desired position of the legs and hips is abduction. Adduction, prone, or subluxated positions do not keep the prosthesis within the acetabulum.

A client has a knee-high cast removed 6 weeks after suffering an ankle fracture. Palpation reveals a hard, nontender lump at the fracture site. How should the nurse interpret this finding? 1. Abnormal; the bone may have healed in misalignment, possibly from the short leg cast 2. Abnormal; remodeling should have occurred by now, so the findings suggest malunion 3. Normal; callus formation normally occurs at this stage and may feel like a lump on the bone 4. Normal; swelling and bruising may persist after a traumatic fracture

3. Callus formation is a normal stage of bone repair. It is characterized by an overgrowth of bone that is reabsorbed gradually during the remodeling stage. This deformity is painless, whereas misalignment and malunion typically cause pain. Swelling and bruising should have disappeared by this time.

The trauma nurse is caring for a client who was involved in an automobile accident. The trauma nurse would assess the client for which of the following classic fractures? 1. Brachial and clavicle 2. Brachial and humerus 3. Humerus and clavicle 4. Occipital and humerus

3. Classic fractures that occur with trauma are those of the humerus and clavicle. There are no brachial bones, and occipital bones are not involved in a traumatic injury.

The nurse is preparing the client for discharge. Which of the following discharge instructions should the nurse provide to the client after hip surgery? 1. "Do not flex the hip more than 30 degrees, do not cross your legs, and get help putting on your shoes." 2. "Do not flex the hip more than 60 degrees, do not cross your legs, and get help putting on your shoes." 3. "Do not flex the hip more than 90 degrees, do not cross your legs, and get help putting on your shoes." 4. "Do not flex the hip more than 120 degrees, do not cross your legs, and get help putting on your shoes."

3. Discharge instructions should include not flexing the hip more than 90 degrees, not crossing the legs, and getting help to put on shoes. These restrictions prevent dislocation of the new prosthesis.

A nurse is caring for a client with a femoral shaft fracture. Which of the following assessment findings is serious and warrants immediate intervention by nurse? 1. Decreased urine output 2. Constipation 3. Hemorrhage 4. Pain

3. Femoral shaft fractures may cause hemorrhage, with as much as 1,000 to 1,500 ml of blood loss. Constipation and decreased urine output aren't direct complications of a fracture. Pain may occur, but it can be controlled with analgesia.

A client is receiving discharge teaching on early signs and symptoms of compartment syndrome to report to the health care provider. The nurse recognizes that teaching has been effective when the client makes which statement? 1. "I will contact my health care provider when I notice redness." 2. "I will contact my health care provider when I notice swelling." 3. "I will contact my health care provider when I have numbness and tingling." 4. "I will contact my health care provider when I notice a change in my skin color."

3. Numbness and tingling is known as paresthesia, which is the earliest sign of compartment syndrome. Pain, heat, and swelling are also signs and symptoms of compartment syndrome, but they occur after paresthesia, making them late signs and symptoms. Skin pallor isn't a sign of compartment syndrome.

The nurse is assessing a client's response to skeletal traction applied to the lower extremity. Which finding would be considered to be normal? 1. Coolness and pallor below the fracture level 2. Moderate to severe muscle spasms around the fracture area 3. Serous drainage and crust formation at the pin insertion site 4. Erythema and swelling immediately around the pin insertion site

3. Serous drainage around the pin insertion site is a normal finding; some institutions do not recommend crust removal because of its protective nature. A pale extremity may indicate arterial compromise. Erythema and swelling signal infection. Severe muscle spasms may indicate improper alignment of the body or traction.

The nurse is caring for a client who has returned to the unit following the application of a cast for a fracture of the right ulna. The client is now complaining of severe pain, numbness, and tingling of the right arm. What is the most important action of the nurse? 1. Administer acetaminophen (Tylenol) as prescribed. 2. Lower the arm below the level of the heart. 3. Immediately report the client's symptoms. 4. Apply a heating pad.

3. Severe pain, numbness, and tingling are symptoms of impaired circulation due to compartment syndrome, which is a medical emergency. Don't give analgesics until the client has been assessed and treated. Lowering the arm below the level of the heart and applying heat will decrease venous outflow and impair the circulation even more.

A client with a torn meniscus caused by a football injury arrives at the outpatient surgery clinic for an arthroscopic meniscectomy. What is the most important information for the nurse to give the client? 1. Exactly how the procedure will be performed 2. Avoidance of weight bearing for 2 weeks after the surgery 3. Postoperative exercises, such as straight-leg raising and quadriceps setting 4. The possibility of severe postoperative pain for 24 to 48 hours after surgery

3. The best time to teach about postoperative care is preoperatively. Straight-leg raising and quadriceps setting exercises help maintain the strength of the affected extremity. The health care provider, not the nurse, should explain the surgical procedure. Weight bearing may begin as soon as the day of surgery. Usually, pain is mild to moderate after arthroscopic surgery.

The nurse is caring for a client with low back pain. Which action may the nurse delegate to the nursing assistant? 1. Assess pain level. 2. Palpate the abdomen for distension. 3. Reposition the client from side-lying to back. 4. Assess the client's skin for skin breakdown.

3. The nursing assistant is able to perform routine tasks. The registered is responsible for assessment, teaching, and evaluation of clients.

The nurse is evaluating a client on crutches using a three-point gait. Which assessment made by the nurse would indicate that the client is using the crutches appropriately? 1. The client is placing weight on the feet. 2. The client is placing weight on the axillary areas. 3. The client is placing weight on the palms of the hands. 4. The client is placing weight on the palms and axillary areas.

3. To avoid damage to the brachial plexus nerves in the axilla, the palms of the hands should bear the client's weight. Minimal weight should be placed on the affected leg.

A nurse is providing care for a client with a leg cast. To help prevent foot drop, which action by the nurse would be the most appropriate? 1. Encouraging bed rest 2. Supporting the foot with 45 degrees of flexion 3. Supporting the foot with 90 degrees of flexion 4. Placing a stocking on the foot to provide warmth

3. To prevent foot drop in a leg with a cast, the foot should be supported with 90 degrees of flexion. Bed rest can cause foot drop. Keeping the extremity warm will not prevent foot drop.

The nurse is caring for a client with compartment syndrome. The nurse anticipates that the client may require which measure? 1. Casting 2. Amputation 3. Fasciotomy 4. Observation; no treatment necessary

3. Treatment of compartment syndrome includes fasciotomy, which involves cutting the fascia over the affected area to permit muscle expansion. Amputation and casting are not treatments for compartment syndrome.

The nurse suspects that a client with a recent fracture has developed compartment syndrome. The assessment of the client may find which symptom? 1. Body-wide decrease in bone mass 2. A growth in and around the bone tissue 3. Inability to perform active movement; pain with passive movement 4. Inability to perform passive movement; pain with active movement

3. With compartment syndrome, the client cannot perform active movement, and pain occurs with passive movement. Osteoporosis brings a body-wide decrease in bone mass. A bone tumor shows growth in and around the bone tissue.

A client asks the nurse what is the purpose of applying a cold pack to a sprained ankle. What is the best response by the nurse? 1. "It decreases pain and increases circulation." 2. "It numbs the nerves and dilates the blood vessels." 3. "It promotes circulation and reduces muscle spasm." 4. "It constricts local blood vessels and decreases swelling."

4. Application of a cold pack causes the blood vessels to constrict, which reduces the leakage of fluid into the tissues and prevents swelling. It may have an effect on muscle spasms. Cold therapy may reduce pain by numbing the nerves and tissues. Cold therapy doesn't promote circulation or dilate the blood vessels.

The nurse is caring a client who has been admitted to the hospital with a musculoskeletal injury. Cold therapy is ordered for which of the following reasons? 1. It promotes analgesia and circulation. 2. It numbs the nerves and dilates the vessels. 3. It promotes circulation and reduces muscle spasms. 4. It causes local vasoconstriction and prevents edema or muscle spasm.

4. Cold causes the blood vessels to constrict, which reduces the leakage of fluid into the tissues and prevents swelling and muscle spasms. Cold therapy may reduce pain by numbing the nerves and tissues. Heat therapy promotes circulation, enhances flexibility, reduces muscle spasms, and also provides analgesia.

A client with lactose intolerance requires dietary teaching. Which foods should the nurse advise the client to eat to ensure adequate calcium intake? 1. Cheese and yogurt 2. Beef liver and broccoli 3. Bananas and avocados 4. Collard greens and spinach

4. Dark green, leafy vegetables are the best nondairy sources of calcium. Bananas and avocados are good sources of vitamin K. Beef liver and broccoli supply iron. Cheese and yogurt are dairy products, which this client should avoid because of the lactose intolerance.

A client is being discharged from the emergency department after cast application for a tibial fracture. The nurse is aware that the client is at risk for ineffective breathing pattern related to long bone fracture secondary to fat embolus. Based on this diagnosis, which instruction should the nurse provide for this client? 1. Cough and deep breathe at least every 2 hours. 2. Restrict your fluid intake to 1 L per day. 3. Keep the leg elevated and apply ice for the first 24 to 48 hours. 4. Call the physician at once if you experience apprehensiveness, shortness of breath, fever, or palpitations.

4. Fat embolism is a complication of a long bone fracture. Signs and symptoms include apprehension; altered mental status; respiratory distress; tachycardia; tachypnea; fever; and petechiae over the neck, upper arms, and chest. Coughing and deep-breathing exercises as well as leg elevations with ice applications can help prevent other complications of a long bone fracture but have no effect on fat emboli. The client should also be instructed that drinking plenty of fluids to stay well hydrated will help him avoid embolic complications.

What discharge information should be given to a client with a cast? 1. Use powder under the cast as needed. 2. Itching under the cast indicates infection. 3. Keep the extremity in a dependent position. 4. Report fever and foul odors around the cast.

4. Fever, foul odor, and warmth over a specific area of the cast after it is dry may be signs of infection. Itchy skin results from dry skin, and powder should not be used. The extremity should be elevated for 24 to 48 hours.

The nurse is performing a neurovascular assessment on a client who was admitted with a right fractured femur. The nurse noticed that the pulses are not palpable. What is the most important action of the nurse? 1. Alert the charge nurse immediately. 2. Reassesses the pulses again in 1 hour. 3. Notify the health care provider immediately. 4. Verify the clinical findings with a Doppler ultrasonography.

4. If pulses are not palpable, verify the assessment with Doppler ultrasonography. If pulses cannot be found with Doppler ultrasonography, immediately notify the physician.

Which statement best explains an open reduction of a fractured femur? 1. Traction will be used. 2. A cast will be applied. 3. Crutches will be used after surgery. 4. Some form of screw, plate, nail, or wire is usually used to maintain alignment.

4. Open reduction means that the tissue must be surgically opened and the fractured bones realigned. To maintain proper alignment, a screw, plate, nail, or wire is inserted to prevent the bones from separating. Although traction may have been used before surgery, it won't be needed any longer once the fracture is reduced. A cast or crutches may be used after surgery, but the question asks specifically about the surgical procedure.

A client has an above-the-knee amputation 4 days after a traumatic injury. Which nursing diagnosis is most appropriate? 1. Risk for impaired skin integrity related to decreased peripheral circulation 2. Decreased cardiac output related to shock caused by decreased fluid volume 3. Impaired gas exchange related to fat embolism caused by surgical removal of bone and tissue 4. Acute pain related to phantom limb pain caused by surgical removal of leg after traumatic injury

4. Phantom limb pain is common after limb amputation and may be more severe with traumatic injury. Because the limb was severed traumatically rather than removed because of poor circulation, peripheral circulation should be adequate. Fat embolism is more typical with long bone fractures. The risk of shock is relatively low on the fourth postoperative day.

Which of the following symptoms are considered signs of a fracture? 1. Tingling, coolness, and loss of pulses 2. Loss of sensation, redness, and coolness 3. Coolness, redness, and new site of pain 4. Redness, warmth, and pain at the site of injury

4. Signs of a fracture may include redness, warmth, numbness or loss of sensation, and new site of pain. Coolness, tingling, and loss of pulses are signs of a vascular problem.

The emergency room nurse is caring for a 20-year-old female client who is complaining of severe pain to the right upper arm. The nurse suspects domestic abuse. Which of the following X-ray findings would indicate the need for additional investigation? 1. Longitudinal fracture 2. Transverse fracture 3. Oblique fracture 4. Spiral fracture

4. Spiral fractures are commonly seen in the upper extremities and are related to physical abuse. Longitudinal and oblique fractures generally occur with trauma. A transverse fracture commonly occurs with such bone diseases as osteomalacia and Paget's disease.

Which nursing diagnosis is appropriate for a client with diabetes who is placed in skeletal traction after a motor vehicle collision? 1. Imbalanced nutrition: Less than body requirements related to malabsorption of nutrients 2. Risk for injury related to subluxation of the joint above the pin insertion site 3. Risk for autonomic dysreflexia related to bed rest 4. Risk for infection related to the skeletal pin

4. This client has a significant risk of osteomyelitis secondary to the skeletal pin. A dangerous bone infection that's hard to eradicate, osteomyelitis should be prevented at all costs—especially in a client with diabetes, who is already prone to infection. Based on the information provided, the other nursing diagnoses aren't appropriate.

Which of the following interventions would help prevent deep vein thrombosis (DVT) after hip surgery? 1. Bed rest 2. Egg crate mattress 3. Vigorous pulmonary care 4. Subcutaneous heparin and pneumatic compression boots

4. To prevent DVT after hip surgery, subcutaneous heparin and pneumatic compression boots are used. Bed rest can cause DVT. Egg crate mattresses and pulmonary care do not prevent DVT.

The nurse is aware that elevating a limb with a cast will prevent swelling. Which of the following actions best describes how this should be done? 1. Place the limb with the cast close to the body. 2. Place the limb with the cast at the level of the heart. 3. Place the limb with the cast below the level of the heart. 4. Place the limb with the cast above the level of the heart.

4. To reduce swelling, place the limb with the cast above the level of the heart. To elevate a cast, the limb may need to be extended from the body. Placing it below or at the level of the heart will not reduce swelling.

The nurse is caring for a client who has been placed in traction prior to surgery. The client asks the nurse what is the purpose of the traction. What is the best response by the nurse? 1. "Traction allows for more activity." 2. "Traction will help prevent skin breakdown." 3. "Traction helps with repositioning while in bed." 4. "Traction helps to prevent trauma and overcome muscle spasms."

4. Traction prevents trauma and overcomes muscle spasms. Traction doesn't help in preventing skin breakdown, repositioning the client, or allowing the client to become active.