Chapter 37: Management of Patients with Musculoskeletal Trauma PrepU
Following a total knee replacement, the surgeon orders a continuous passive motion (CPM) device. The client asks about the purpose of this treatment. What is the best response by the nurse? "CPM prevents injury by limiting flexion of the knee." "CPM delivers analgesic agents directly into the joint." "CPM increases range of motion of the joint." "CPM strengthens the muscles of the leg."
"CPM increases range of motion of the joint."
A client diagnosed with a right ulnar fracture asks why the cast needs to go all the way up the arm. What is the best response by the nurse? "The joint above the fracture and below the fracture must be immobilized." "This allows for the strength in the arm to remain consistent." "The method allows for the fastest healing time and the greatest mobility." "When a spica cast is ordered, the arm must be immobilized."
"The joint above the fracture and below the fracture must be immobilized."
The client displays manifestations of compartment syndrome. What treatment will the nurse expect the client to be scheduled for? A total hip replacement An open reduction A fasciotomy A total knee replacement
A fasciotomy
Two days after surgery to amputate the left lower leg, a client reports pain in the missing extremity. Which action by the nurse is most appropriate? Contact the health care provider. Administer medication, as ordered, for the reported discomfort. Do nothing because it isn't possible to have pain in a missing limb. Initiate a consult with a psychologist.
Administer medication, as ordered, for the reported discomfort.
A client with a fractured femur is placed in skeletal traction. Which intervention will increase client independence when moving in bed? Remind to use the heel of the unaffected foot to reposition. Instruct to use the elbows to reposition. Apply a trapeze to the bed frame. Remove the weights prior to repositioning.
Apply a trapeze to the bed frame.
Which nursing action would help prevent deep vein thrombosis in a client who has had an orthopedic surgery? Apply antiembolism stockings Instruct about exercise, as prescribed Apply cold packs Instruct about using client-controlled analgesia, if prescribed
Apply antiembolism stockings
The nurse is caring for a client who was involved in an automobile accident and sustained multiple trauma. The client has a Volkmann's contracture to the right hand. What objective data does the nurse document related to this finding? Extension of the fingers of the right hand Dislocation of the fingers Nodules on the knuckles of the third and fourth finger Claw-like deformity of the right hand without ability to extend fingers
Claw-like deformity of the right hand without ability to extend fingers
The femur fracture that commonly leads to avascular necrosis or nonunion because of an abundant supply of blood vessels in the area is a fracture of the: Shaft of the femur. Condylar area. Femoral neck. Trochanteric region.
Femoral neck.
A patient in pelvic traction needs circulatory status assessed. How should the nurse assess for a positive Homans' sign? Have the patient plantar flex both feet while the nurse performs the blanch test on all of the patient's toes. Have the patient extend each leg and dorsiflex each foot to determine if pain or tenderness is present in the lower leg. Have the patient squeeze the nurse's hands with his or her hands to evaluate any difference in strength. Have the patient extend both hands while the nurse compares the volume of both radial pulses.
Have the patient extend each leg and dorsiflex each foot to determine if pain or tenderness is present in the lower leg.
The nurse is monitoring a patient who sustained a fracture of the left hip. The nurse should be aware that which kind of shock can be a complication of this type of injury? Neurogenic Septic Hypovolemic Cardiogenic
Hypovolemic
The client returns to the nursing unit following an open reduction with internal fixation of the right hip. Nursing assessment findings include temperature 100.8 degrees Fahrenheit, heart rate 112 beats per minute, respiratory rate 28 breaths per minute, and blood pressure 86/58. There is no urine in the Foley catheter collection bag. The nurse interprets these findings as indicating which complication? Urinary retention Hypovolemic shock Osteomyelitis Atelectasis
Hypovolemic shock
Radiographic evaluation of a client's fracture reveals that a bone fragment has been driven into another bone fragment. The nurse identifies this as which type of fracture? Greenstick Compression Impacted Comminuted
Impacted
Which factor inhibits fracture healing? Local malignancy Maximum bone fragment contact Exercise Vitamin D
Local malignancy
A nurse is giving instructions to a client who's going home with a leg cast. Which teaching point is most critical? Avoiding walking on a leg cast without the health care provider's permission Reporting signs of impaired circulation Exercising joints above and below the cast, as ordered Using crutches properly
Reporting signs of impaired circulation
Which of the following is an inappropriate nursing diagnosis for the client following casting? Risk for impaired skin integrity Risk for deficient knowledge: procedure Risk for impaired tissue perfusion Risk for disuse syndrome
Risk for deficient knowledge: procedure
A client has severe osteoarthritis in the left hip and is having surgery to replace both articular surfaces of the hip. What type of surgical procedure will the nurse prepare the client for? Hemiarthroplasty Total arthroplasty Osteotomy Arthrodesis
Total arthroplasty
A client who has injured a hip in a fall cannot place weight on the leg and is in significant pain. After radiographs indicate intact yet malpositioned bones, what repair would the physician perform? heat and immobilization joint manipulation and immobilization ice and immobilization analgesia and immobilization
joint manipulation and immobilization
A client has sustained a right tibial fracture and has just had a cast applied. Which instruction should the nurse provide in client cast care? "Cover the cast with a blanket until the cast dries." "Keep your right leg elevated above heart level." "Use a knitting needle to scratch itches inside the cast." "A foul smell from the cast is normal."
"Keep your right leg elevated above heart level."
The nurse is providing instructions to the client who is being prepared for skeletal traction. Which statement by the client indicates teaching was effective? "The traction can be removed once a day so I can shower." "Metal pins will go through my skin to the bone." "I will wear a boot with weights attached." "A belt will go around my pelvis and weights will be attached."
"Metal pins will go through my skin to the bone."
A client has a plaster cast applied to the left leg. Which comment by the client following the procedure should the nurse address first? "My pain is a 3." "My toes are pink." "My toes are stiff." "My cast is still wet."
"My toes are stiff."
A client has a Fiberglass cast on the right arm. Which action should the nurse include in the care plan? Evaluating pedal and posterior tibial pulses every 2 hours Assessing movement and sensation in the fingers of the right hand Keeping the casted arm warm by covering it with a light blanket Avoiding handling the cast for 24 hours or until it is dry
Assessing movement and sensation in the fingers of the right hand
Which actions by the nurse demonstrate an understanding of caring for a client in traction? Select all that apply. Removing skeletal traction to turn and reposition the client Assessing the client's alignment in the bed Frequently assessing pain level Placing a trapeze on the bed Ensuring that the weights are hanging freely
Assessing the client's alignment in the bed Frequently assessing pain level Placing a trapeze on the bed Ensuring that the weights are hanging freely
An emergency department client is diagnosed with a hip dislocation. The client's family is relieved that the client has not suffered a hip fracture, but the nurse explains that this is still considered to be a medical emergency. What is the rationale for the nurse's statement? The client's pain will increase until the joint is realigned. Dislocation can become permanent if the process of bone remodeling begins. Avascular necrosis may develop at the site if it is not promptly resolved. The longer the joint is displaced, the more difficult it is to get it back in place.
Avascular necrosis may develop at the site if it is not promptly resolved.
A nurse is reviewing a client's activities of daily living prior to discharge from total hip replacement. The nurse should identify what activity as posing a potential risk for hip dislocation? Transferring from a sitting to standing position Lifting items above shoulder level Straining during a bowel movement Bending down to put on socks
Bending down to put on socks
A patient has stepped in a hole in the yard, causing an ankle injury. The ankle is edematous and painful to palpation. How long should the nurse inform the patient that the acute inflammatory stage will last? About 72 hours Less than 24 hours At least 1 week Between 24 and 48 hours
Between 24 and 48 hours
A client is admitted to the emergency room after being hit by a car while riding a bicycle. The client sustained a fracture of the left femur, and the bone is protruding through the skin. What type of fracture does the nurse recognize requires emergency intervention? Greenstick Spiral Compound Oblique
Compound
A client has a cast applied to the leg for treatment of a tibia fracture and also has a wound on the leg that requires dressing changes due to drainage. For what should the nurse prepare the client? Cutting a cast window Removal of the cast Cutting of a bivalve cast Insertion of an external fixator
Cutting a cast window
The nurse in an orthopedic clinic is caring for a new client. What sign or symptom would lead a nurse to suspect that a client has a rotator cuff tear? Minimal pain with movement Ability to stretch arm over the head Pain worse in the morning Difficulty lying on affected side
Difficulty lying on affected side
After undergoing surgery the previous day for a total knee replacement, a client states, "I am not ready to ambulate yet." What should the nurse do? Discuss the complications that the client may experience if there is lack of cooperation with the care plan. Tell the client that this noncompliance will be reported to the health care provider. Document the client's refusal to ambulate. Do nothing because the client has the ultimate right to determine the degree of participation.
Discuss the complications that the client may experience if there is lack of cooperation with the care plan.
A client is reporting pain following orthopedic surgery. Which intervention will help relieve pain? Apply antiembolism stockings as indicated. Elevate the affected extremity and use cold applications. Breathe deeply and cough every 2 hours until ambulation is possible. Do ROM exercises as indicated.
Elevate the affected extremity and use cold applications.
A client with arterial insufficiency undergoes below-knee amputation of the right leg. Which action should the nurse include in the postoperative care plan? Removing the pressure dressing after the first 8 hours Maintaining the client on complete bed rest Elevating the stump for the first 24 hours Applying heat to the stump as the client desires
Elevating the stump for the first 24 hours
A 68-year-old female client who had a below-the-knee amputation is to be discharged because her healing is almost complete. Which of the following would be most important for the nurse to discuss with this client? Exploring factors related to the client's home environment Urging her to keep the affected limb in an elevated position Advising the client to avoid red meat Educating the client about the effects of menopause
Exploring factors related to the client's home environment
Which term refers to a fracture in which one side of a bone is broken and the other side is bent? Avulsion Greenstick Oblique Spiral
Greenstick
Which nursing diagnosis takes highest priority for a client with a compound fracture? Activity intolerance related to weight-bearing limitations Impaired physical mobility related to trauma Imbalanced nutrition: Less than body requirements related to immobility Infection related to effects of trauma
Infection related to effects of trauma
A nurse is admitting a client to the unit who presented with a lower extremity fracture. What signs and symptoms would suggest to the nurse that the client may have a peroneal nerve injury? Inadequate capillary refill to the toes Pallor to the dorsal surface of the foot Visible cyanosis in the toes Numbness and burning of the foot
Numbness and burning of the foot
A nurse is caring for a client who underwent a total hip replacement. What should the nurse and other caregivers do to prevent dislocation of the new prosthesis? Keep the affected leg in a position of adduction. Keep the hip flexed by placing pillows under the client's knee. Prevent internal rotation of the affected leg. Use measures other than turning to prevent pressure ulcers.
Prevent internal rotation of the affected leg.
While assessing a client who has had knee replacement surgery, the nurse notes that the client has developed a hematoma at the surgical site. The affected leg has a decreased pedal pulse. What would be the priority nursing diagnosis for this client? Risk for Ineffective Peripheral Tissue Perfusion Unilateral Neglect Related to Hematoma Risk for Infection Disturbed Kinesthetic Sensory Perception
Risk for Ineffective Peripheral Tissue Perfusion
Which of the following musculoskeletal injuries is manifested by acromioclavicular joint pain? Epicondylitis Acute compartment syndrome Heterotopic ossification Rotator cuff tears
Rotator cuff tears
A client is having a cast applied for a fractured leg that extends from below the knee to the base of the toes. The foot is flexed at a right angle in a neutral position. What type of cast is the client having applied? Hip spica cast Long leg cast Short leg cast Walking cast
Short leg cast
Which may occur if a client experiences compartment syndrome in an upper extremity? Volkmann's contracture Subluxation Callus Whiplash injury
Volkmann's contracture
There are a variety of problems that can become complications after a fracture. Which is described as a condition that occurs from interruption of the blood supply to the fracture fragments after which the bone tissue dies, most commonly in the femoral head? avascular necrosis fat embolism shock pulmonary embolism
avascular necrosis
Which is not one of the general nursing measures employed when caring for the client with a fracture? cranial nerve assessment administering analgesics providing comfort measures assisting with ADLs
cranial nerve assessment
A client who has fallen and injured a hip cannot place weight on the leg and is in significant pain. After radiographs indicate intact but malpositioned bones, what would the physician diagnose? dislocation sprain fracture strain
dislocation
A client with a right leg fracture is returning to the orthopedist to have the cast removed. What would the physician prescribe as further treatment? discontinue use of crutches physical therapy No options are correct. cold compresses to leg for swelling
physical therapy
A client has been diagnosed with a muscle strain. What does the physician mean by the term "strain"? injuries to ligaments surrounding a joint injury resulting from a blow or blunt trauma stretched or pulled beyond its capacity subluxation of a joint
stretched or pulled beyond its capacity
