CH 51 Care Musculoskeletal Trauma

A client has sustained a fracture of the left tibia. The extremity is immobilized using an external fixation device. Which postoperative instruction does the nurse include in this client's teaching plan? A) "Use pain medication as prescribed to control pain." B) "Clean the pin site when any drainage is noticed." C) "Wear the same clothing that is normally worn." D) "Apply bacitracin (Neosporin) if signs or symptoms of infection develop around pin sites."

A ; The client should be taught the correct use of prescribed pain medication to control pain adequately. Pin sites must be cleaned at least every 8 hours and as needed to reduce the risk for infection, not when any drainage is noticed. The client will have to adjust the type of clothing worn while the fixation device is in place. If signs and symptoms of infection develop around the pin sites, the client must notify the health care provider immediately. Infection at the pin sites places the client at risk for osteomyelitis.

A client's left arm is placed in a plaster cast. Which assessment does the nurse perform before the client is discharged? A) Assess that the cast is dry. B) Ensure that the client has 4 × 4 gauze to take home for placement between the cast and the skin. C) Check the fit of the cast by inserting a tongue blade between the cast and the skin. D) Ensure that the capillary refill of the left fingernail beds is longer than 3 seconds.

A;

A client has undergone an elective below-the-knee amputation of the right leg as a result of severe peripheral vascular disease. In postoperative care teaching, the nurse instructs the client to notify the health care provider if which change occurs? A) Observation of a large amount of serosanguineous or bloody drainage B) Mild to moderate pain controlled with prescribed analgesics C) Absence of erythema and tenderness at the surgical site D) Ability to flex and extend the right knee

A; A large amount of serosanguineous or bloody drainage may indicate hemorrhage or, if an incision is present, that the incision has opened. This requires immediate attention. Mild to moderate pain controlled with prescribed analgesics would be a normal finding for this client. Absence of erythema and tenderness of the surgical site would also be normal findings for this client. The client should be able to flex and extend the right knee (limb) after surgery.

An older adult client has had an open reduction and internal fixation of a fractured right hip. Which intervention does the nurse implement for this client? A) Keep the client's heels off the bed at all times. Correct B) Re-position the client every 3 to 4 hours. C) Administer preventive pain medication before deep-breathing exercises. D) Prohibit the use of antiembolic stockings.

A; Because the client is an older adult and is more at risk for skin breakdown because of impaired circulation and sensation, the client's heels must be kept off the bed at all times to avoid constant pressure on this sensitive area. Re-positioning the older adult client must be done every 2 hours, not every 3 to 4 hours, to prevent skin breakdown and to inspect the skin for any signs of breakdown. Pain medication would not be administered for deep-breathing exercises because this client typically would not experience pain upon breathing. Antiembolic stockings are not contraindicated for older adults; rather, they help prevent deep vein thrombosis.

Which intervention does the nurse suggest to a client with a leg amputation to help cope with loss of the limb? A) Talking with an amputee close to the client's age who has had the same type of amputation B) Drawing a picture of how the client sees him- or herself C) Talking with a psychiatrist about the amputation D) Engaging in diversional activities to avoid focusing on the amputation

A; Meeting with someone of a comparable age who has gone through a similar experience will help the client cope better with his or her own situation. Drawing a picture is not therapeutic and may cause more harm than good. Unless the client is having serious maladjustment problems or has a coexisting psychological disorder, meeting with a psychiatrist should not be necessary. Diversional activities do not help the client deal with loss of the limb.

A client with a compound fracture of the left femur is admitted to the emergency department after a motorcycle crash. Which action is most essential for the nurse to take first? A) Check the dorsalis pedis pulses. B) Immobilize the left leg with a splint. C) Administer the prescribed analgesic. D) Place a dressing on the affected area.

A; The first action should be to assess the circulatory status of the leg because the client is at risk for acute compartment syndrome, which can begin as early as 6 to 8 hours after an injury. Severe tissue damage can also occur if neurovascular status is compromised. Immobilization will be needed, but the nurse must assess the client's condition first. Administering an analgesic and placing a dressing on the affected area should both be done after the nurse has assessed the client.

A rock climber has sustained an open fracture of the right tibia after a 20-foot (6 meter) fall. The nurse plans to assess the client for which potential complications? (Select all that apply.) A. - Acute compartment syndrome (ACS) B. - Fat embolism syndrome (FES) C. - Congestive heart failure D. - Urinary tract infection (UTI) E. - Osteomyelitis

A; acute compartment syndrome (ACS), fat embolism syndrome (FES), osteomyelitis

A client with an open fracture of the left femur is admitted to the emergency department after a motorcycle crash. Which action is most essential for the nurse to take first? A. - Check the dorsalis pedis pulses. B. - Immobilize the left leg with a splint. C. - Administer the prescribed analgesic. D. - Place a dressing on the affected area.

A; check the dorsals pedis pulses

An older adult client has had an open reduction and internal fixation of a fractured right hip. Which intervention does the nurse implement for this client? A. - Keep the client's heels off the bed at all times. B. - Reposition the client every 3 to 4 hours. C. - Administer preventive pain medication before deep-breathing exercises. D. - Prohibit the use of antiembolic stockings.

A; keep the client's heels off the bed at all times

A client sustains a fracture of one arm and the provider applies a plaster cast to the extremity. What will the nurse teach the client to do during the first 24 hours after discharge from the emergency department? A. - Monitor neuromuscular status for decreased circulation and sensation in the extremity. B. - Apply a heating pad for 15 to 20 minutes four times daily to help with pain. C. - Check the fit of the cast by inserting a tongue blade between the cast and the skin. D. - Keep the cast covered with a soft towel to help it to dry quickly.

A; monitor neuromuscular status for decreased circulation and sensation in the extremity

A client has undergone an elective below-the-knee amputation of the right leg as a result of severe peripheral vascular disease. In postoperative care teaching, the nurse instructs the client to notify the health care provider immediately if which change occurs? A. - Observation of a large amount of serosanguineous or bloody drainage B. - Mild to moderate pain controlled with prescribed analgesics C. - Absence of erythema and tenderness at the surgical site D. - Ability to flex and extend the right knee

A; observation of a large amount of serosanguineous or bloody drainage

Which intervention does the nurse suggest to a client who has undergone a leg amputation to help cope with loss of the limb? A. - Talking with an amputee close to the client's age who has a similar amputation B. - Drawing a picture of how the client sees him- or herself C. - Talking with a psychiatrist about the amputation D. - Engaging in diversional activities to avoid focusing on the amputation

A; talking with an amputee close to the client's age who has a similar amputation

A client has sustained a fracture of the left tibia. The extremity is immobilized using an external fixation device. Which postoperative instruction does the nurse include in this client's teaching plan? A. - "Use pain medication as prescribed to control pain." B. - "Clean the pin site when any drainage is noticed." C. - "Wear the same clothing that is normally worn." D. - "Apply bacitracin (Neosporin) if signs or symptoms of infection develop around pin sites."

A; use pain medication as prescribed to control pain

A client with peripheral vascular disease will undergo a Syme amputation. What will the nurse teach this patient when providing education about this procedure? A. - "You will be able to bear weight without needing a prosthesis." B. - "This type of procedure results in more pain than others." C. - "The surgeon will remove both the foot and ankle." D. - "This is an above-the-knee type of amputation."

A; you will be able to bear weight without needing a prosthesis

The nurse anticipates providing collaborative care for a client with a traumatic amputation of the right hand with which health care team members? (Select all that apply.) A) Occupational therapist B) Physical therapist C) Psychologist D) Respiratory therapist E) Speech therapist

ABC; An occupational therapist and a physical therapist will help to enable the client to become more independent in performing activities of daily living. An amputation can be traumatic to the client; loss of a body part should not be underestimated because the client may experience an altered self-concept, so counseling support with a psychologist should be made available to the client. The client does not have a respiratory condition that warrants collaborative care with a respiratory therapist. A speech therapist is not indicated because the client does not have speech impairment.

The nurse anticipates providing collaborative care for a client with a traumatic amputation of the right hand with which health care team members? (Select all that apply.) A. - Occupational therapist B. - Physical therapist C. - Psychologist D. - Respiratory therapist E. - Speech therapist

ABC; occupational therapist, physical therapist, psychologist

A rock climber has sustained an open fracture of the right tibia after a 20-foot fall. The nurse plans to assess the client for which potential complications? (Select all that apply.) A) Acute compartment syndrome (ACS) B) Fat embolism syndrome (FES) C) Congestive heart failure D) Urinary tract infection (UTI) E) Osteomyelitis

ABE; ACS is a serious condition in which increased pressure within one or more compartments reduces circulation to the area. A fat embolus is a serious complication in which fat globules are released from yellow bone marrow into the bloodstream within 12 to 48 hours after the injury. FES usually results from long bone fracture or fracture repair, but is occasionally seen in clients who have received a total joint replacement. Bone infection, or osteomyelitis, is most common in open fractures. Congestive heart failure is not a potential complication for this client; pulmonary embolism is a potential complication of venous thromboembolism, which can occur with fracture. The client is at risk for wound infection resulting from orthopedic trauma, not a UTI.

A client has a grade III open fracture of the right tibia. To prevent infection, which intervention does the nurse implement? A. - Apply bacitracin (Neosporin) ointment to the site daily with a sterile cotton swab. B. - Use strict aseptic technique when cleaning the site. C. - Leave the site open to the air to keep it dry. D. - Assist the client to shower daily and pat the wound site dry.

B;

Which statement indicates to the nursing instructor that the nursing student understands the normal healing process of bone after a fracture? A. - "A callus is quickly deposited and transformed into bone." B. - "A hematoma forms at the site of the fracture." C. - "Cellular and vascular proliferation surround the fracture site." D. - "Granulation tissue reabsorbs the hematoma and deposits new bone."

B;

The client has sustained a traumatic amputation of the left arm after a machine accident. In what order should the following nursing actions be taken? 1. Apply direct pressure to the amputated site. 2. Elevate the extremity above the client's heart. 3. Assess the client for breathing problems. 4. Examine the amputation site. A. - 2, 4, 3, 1 B. - 3, 4, 1, 2 C. - 1, 4, 3, 2 D. - 4, 1, 2, 3

B; 3,4,1,2

The nurse admits an older adult client who sustained a left hip fracture and is in considerable pain. The nurse anticipates that the client will be placed in which type of traction? A) Balanced skin traction B) Buck's traction C) Overhead traction D) Plaster traction

B; Buck's traction may be applied before surgery to help decrease pain associated with muscle spasm. Balanced skin traction is indicated for fracture of the femur or pelvis. Overhead traction is indicated for fracture of the humerus with or without involvement of the shoulder and clavicle. Plaster traction is indicated for wrist fracture.

The client has sustained a traumatic amputation of the left arm after a machine accident. In what order should the following nursing actions be taken? 1. Apply direct pressure to the amputated site. 2. Elevate the extremity above the client's heart. 3. Assess the client for breathing problems. 4. Examine the amputation site. A) 2, 4, 3, 1 B) 3, 4, 1, 2 C) 1, 4, 3, 2 D) 4, 1, 2, 3

B; First, the airway must be assessed for breathing problems. Second, the nurse should examine the amputation site. Third, the nurse should apply direct pressure to the amputated site. Finally, the extremity should be elevated above the client's heart to decrease bleeding.

Which statement indicates to the nursing instructor that the nursing student understands the normal healing process of bone after a fracture? A) "A callus is quickly deposited and transformed into bone." B) "A hematoma forms at the site of the fracture." C) "Calcium and vascular proliferation surround the fracture site." D) "Granulation tissue reabsorbs the hematoma and deposits new bone."

B; In stage 1, within 24 to 72 hours after a fracture, a hematoma forms at the site of the fracture because bone is extremely vascular. This then prompts the formation of fibrocartilage, providing the foundation for bone healing. Stage 2 of bone healing occurs within 3 days to 2 weeks after the fracture, when granulation tissue begins to invade the hematoma. Stage 3 of bone healing occurs as a result of vascular and cellular proliferation. In stage 4 of a healing fracture, callus is gradually reabsorbed and transformed into bone.

The nurse refers a client with an amputation and the client's family to which community resource? A) American Amputee Society (AAS) B) Amputee Coalition of America (ACA) C) Community Workers for Amputees (CWA) D) National Amputee of America Society (NAAS)

B; The ACA is an available resource for clients with amputations and supports them and their families. The AAS, CWA, and NAAS do not exist.

Which information about a client who was admitted with pelvic and bilateral femoral fractures after being crushed by a tractor is most important for the nurse to report to the health care provider? A) Thighs have multiple oozing abrasions. B) Serum potassium level is 7 mEq/L. C) The client is describing pain as level 4 (0-to-10 scale). D) Hemoglobin level is 12.0 g/dL.

B; The elevated potassium level may indicate that the client has rhabdomyolysis and acute tubular necrosis caused by the crush injury. Further assessment and treatment are needed immediately to prevent further kidney damage or cardiac dysrhythmias. Thighs having multiple oozing abrasions with a pain level of 4 are not unusual for a client with this type of injury. A hemoglobin level of 12.0 g/dL is a normal finding.

A client has a grade III compound fracture of the right tibia. To prevent infection, which intervention does the nurse implement? A) Apply bacitracin (Neosporin) ointment to the site daily with a sterile cotton swab. B) Use strict aseptic technique when cleaning the site. Correct C) Leave the site open to the air to keep it dry. D) Assist the client to shower daily and pat the wound site dry.

B; Using aseptic technique is the best way to prevent infection. Chlorhexidine (Hibiclens), 2 mg/mL solution, is the better cleansing solution for pin site care, not Neosporin ointment. A wound of this type should be kept covered, not left open to the air. The wound site of a compound fracture must not be exposed to a shower; this practice violates maintaining aseptic technique.

The nurse admits an older adult client who sustained a left hip fracture and is in considerable pain. The nurse anticipates that the client will be placed in which type of traction prior to surgical repair? A. - Balanced skin traction B. - Buck's traction C. - Overhead traction D. - Plaster traction

B; buck's traction

A client is in skeletal traction. Which nursing intervention ensures proper care of this client? A) Ensure that weights are attached to the bed frame or placed on the floor. B) Ensure that pins are not loose, and tighten as needed. C) Inspect the skin at least every 8 hours. D) Remove the traction weights only for bathing.

C; The client's skin should be inspected every 8 hours for signs of irritation, inflammation, or actual skin breakdown. Weights are not allowed to be placed on the floor; weights should hang freely at all times. Pin sites should be checked for signs and symptoms of infection and for security in their position to the fixation and the client's extremity. However, the nurse does not adjust the pins. Any loose pin site or alteration must be reported to the health care provider. Weights must never be removed without a request from the health care provider.

A client has sustained a rotator cuff tear while playing baseball. The nurse anticipates that the client will receive which immediate conservative treatment? A) Surgical repair of the rotator cuff B) Prescribed exercises of the affected arm C) Immobilizer for the affected arm D) Patient-controlled analgesia with morphine

C; The conservative treatment for this client is to place the injured arm in an immobilizer. Surgical intervention is not considered conservative treatment. Exercises are prohibited immediately after a rotator cuff injury. The client with a rotator cuff injury is treated primarily with nonsteroidal anti-inflammatory drugs to manage pain.

The nurse is instructing a local community group about ways to reduce the risk for musculoskeletal injury. What information does the nurse include in the teaching plan? A) "Avoid contact sports." B) "Avoid rigorous exercise." C) "Wear helmets when riding a motorcycle." D) "Avoid driving in inclement weather."

C; Those who ride motorcycles or bicycles should wear helmets to prevent head injury. Telling the general public to avoid contact sports or to avoid driving in inclement weather is not realistic. Telling the general public to avoid rigorous exercise is not only unrealistic, it is also opposed to what many health care professionals recommend to maintain health.

A client has sustained a rotator cuff tear while playing baseball. The nurse anticipates that the client will receive which immediate conservative treatment? A. - Surgical repair of the rotator cuff B. - Prescribed exercises of the affected arm C. - Activity limitations for the affected arm D. - Patient-controlled analgesia with morphine

C; activity limitations for the affected arm

A client is in skeletal traction. Which nursing intervention ensures proper care of this client? A. - Ensure that weights are placed on the floor. B. - Ensure that pins are not loose and tighten as needed. C. - Inspect the skin at least every 8 hours. D. - Remove the traction weights only for bathing.

C; inspect the skin at least every 8 hours

A client undergoes a surgical amputation of a lower extremity after a motor vehicle crash. The client's vital signs are stable. What is a priority nursing action in the early postoperative period to help prevent complications in this client? A. - Fitting the client with a prosthetic device B. - Inspecting the limb stump daily for signs of skin breakdown C. - Positioning and range-of-motion of the affected extremity D. - Teaching the client and family how to apply shrinker stockings

C; positioning and range-of-motion of the affected extremity

The nurse is instructing a local community group about ways to reduce the risk for musculoskeletal injury. What information does the nurse include in the teaching plan? A. - "Avoid contact sports." B. - "Avoid rigorous exercise." C. - "Wear helmets when riding a motorcycle." D. - "Avoid driving in inclement weather."

C; wear helmets when riding a motorcycle

A client is recovering from an above-the-knee amputation resulting from peripheral vascular disease. Which statement indicates that the client is coping well after the procedure? A) "My spouse will be the only person to change my dressing." B) "I can't believe that this has happened to me. I can't stand to look at it." C) "I do not want any visitors while I'm in the hospital." D) "It will take me some time to get used to this."

D;

An older adult client has multiple tibia and fibula fractures of the left lower extremity after a motor vehicle crash. Which pain medication does the nurse anticipate will be requested for this client? A) Cyclobenzaprine (Flexeril) B) Ibuprofen (Advil) C) Meperidine (Demerol) D) Patient-controlled analgesia (PCA) with morphine

D;

A client with a fracture asks the nurse about the difference between a compound fracture and a simple fracture. Which statement by the nurse is correct? A) "Simple fracture involves a break in the bone, with skin contusions." B) "Compound fracture does not extend through the skin." C) "Simple fracture is accompanied by damage to the blood vessels." D) "Compound fracture involves a break in the bone, with damage to the skin."

D; A compound fracture involves a break in the bone with damage to the skin. A simple fracture does not extend through the skin. A compound fracture is accompanied by damage to blood vessels.

The nurse prepares to perform a neurovascular assessment on a client with closed multiple fractures of the right humerus. Which technique does the nurse use? A) Inspect the abdomen for tenderness and bowel sounds. B) Auscultate lung sounds. C) Assess the level of consciousness and ability to follow commands. D) Assess sensation of the right upper extremity.

D; Assessing sensation of the right upper extremity is part of a focused neurovascular assessment for the client with multiple fractures of the right humerus. Inspecting the abdomen and auscultating lung sounds of the client with multiple fractures are not part of a focused neurovascular assessment. Because the client does not have a head injury, assessing the client's level of consciousness and ability to follow commands is not part of a focused neurovascular assessment.

A client is brought to the emergency department via ambulance after a motor vehicle crash. What condition does the nurse assess for first? A) Bleeding B) Head injury C) Pain D) Respiratory distress

D; The client should first be assessed for respiratory distress, and any oxygen interventions instituted accordingly. Bleeding is the second assessment priority, head injury is the third assessment priority, and pain is the fourth assessment priority in this case.

Which nursing action does the nurse on the orthopedic unit plan to delegate to unlicensed assistive personnel (UAP)? A) Remove the wound drain for a client who had an open reduction of a hip fracture 3 days ago. B) Assess for bruising on a client who is receiving warfarin (Coumadin) to prevent deep vein thrombosis. C) Teach a client with a right ankle fracture how to use crutches when transferring and ambulating. D) Check the vital signs for a client who was admitted after a total knee replacement 3 hours ago.

D; Vital sign assessment is a skill that is within the role of the UAP. Removing a wound drain, assessment, and client teaching are nursing actions that require broader education and are within the scope of practice of licensed nursing staff.

A client with a fracture asks the nurse about the difference between an open fracture and a simple fracture. Which statement by the nurse is correct? A. - "Simple fracture involves a break in the bone, with skin contusions." B. - "An open fracture does not extend through the skin." C. - "Simple fracture has an increased risk for infection and emboli." D. - "An open fracture involves a break in the bone, with damage to the skin."

D; an open fracture involves a break in the bone, with damage to the skin

Which nursing action does the nurse on the orthopedic unit plan to delegate to unlicensed assistive personnel (UAP)? A. - Removing the wound drain for a client who had an open reduction of a hip fracture 3 days ago. B. - Assessing for bruising on a client who is receiving warfarin (Coumadin) to prevent deep vein thrombosis. C. - Teaching a client with a right ankle fracture how to use crutches when transferring and ambulating. D. - Checking the vital signs for a client who was admitted after a total knee replacement 3 hours ago.

D; checking the vital signs for a client who was admitted after a total knee replacement 3 hours ago

A client is recovering from an above-the-knee amputation resulting from peripheral vascular disease. Which statement indicates that the client is coping well after the procedure? A. - "My spouse will be the only person to change my dressing." B. - "I can't believe that this has happened to me. I can't stand to look at it." C. - "I do not want any visitors while I'm in the hospital." D. - "It will take me some time to get used to this."

D; it will take me some time to get used to this

The nurse performs a neurovascular assessment on a client with closed multiple fractures of the right humerus who is experiencing increased pain even with maximum ordered doses of morphine. The nurse notes distal capillary refill of 3 seconds and coolness of the hand and fingers. The client reports numbness of the hand and is unable to wiggle the thumb. Which nursing action is indicated? A. - Elevate the extremity. B. - Apply an ice pack to the extremity. C. - Reposition the extremity and recheck in 15-20 minutes. D. - Notify the provider of these findings.

D; notify the provider of these findings

An older adult client has multiple tibia and fibula fractures of the left extremity after a motor vehicle crash. Which pain medication does the nurse anticipate will be requested for this client? A. - Cyclobenzaprine (Flexeril) B. - Ibuprofen (Advil) C. - Meperidine (Demerol) D. - Patient-controlled analgesia (PCA) with morphine

D; patient-controlled analgesia (PCA) with morphine

Which information about a client who was admitted with a pelvic fracture after being crushed by a tractor is most important for the nurse to assess to monitor for serious complications from this type of injury? A. - Skin to evaluate lacerations and abrasions. B. - Lungs for bilateral normal breath sounds C. - Pain score and level of alertness D. - Urine dipstick for the presence of red blood cells.

D; urine dipstick for the presence of red blood cells