Chapter 37 MS2 CP
A client with a recent left above-the-knee amputation states, "I can feel pain in my left toes." Which is the best response by the nurse?
"Describe the pain and rate it on the pain scale."
The nurse is providing instructions to the client who is being prepared for skeletal traction. Which statement by the client indicates teaching was effective?
"Metal pins will go through my skin to the bone."
Which instruction should the nurse include when teaching the client following hip replacement surgery? (Select all that apply.)
"Place pillows between your legs when you lay on your side." "Avoid bending forward when sitting in a chair." "Use a raised toilet seat and high-seated chair."
When is it advisable for the nurse to apply heat to a sprain or a contusion?
After 2 days
A client has returned to the postsurgical unit from the PACU after an above-the-knee amputation of the right leg. Results of the nurse's initial postsurgical assessment were unremarkable but the client has called out. The nurse enters the room and observes copious quantities of blood at the surgical site. What should be the nurse's initial action?
Apply a tourniquet.
Which nursing intervention is appropriate for monitoring the client for the development of Volkmann's contracture?
Assess the radial pulse.
An x-ray demonstrates a fracture in which a bone has splintered into several pieces. Which type of fracture is this?
Comminuted
A client who has extremity right wrist fracture complains of severe burning pain, frequent changes in the skin from hot and dry to cold, and feeling clammy skin that is shiny and growing more hair in the injured extremity. The nurse should anticipate providing care for what complication?
Complex regional pain syndrome
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?
Compound
A client with a fractured distal left radius reports discomfort at the cast site, with pain specifically in the upper forearm. What would the nurse expect the physician to do?
Cut a cast window.
Which of the following disorders results in widespread hemorrhage andmicrothrombosis with ischemia?
Disseminated intravascular coagulation (DIC)
The primary nursing intervention that will control swelling while treating a musculoskeletal injury is:
Elevate the affected area.
A client comes to the orthopedic clinic and reports having pain that radiates down the forearm and being unable to grasp objects firmly. What does the nurse suspect is occurring with the client?
Epicondylitis
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:
Femoral neck.
A nurse is caring for a client with a cast on the left arm after sustaining a fracture. Which assessment finding is most significant for this client?
Fingers on the left hand are swollen and cool
Which term refers to a break in the continuity of a bone?
Fracture
A patient in pelvic traction needs circulatory status assessed. How should the nurse assess for a positive Homans' sign?
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?
Hypovolemic
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?
Impacted
A client has come to the orthopedic clinic for a follow-up appointment 6 weeks after fracturing their ankle. Diagnostic imaging reveals that bone union is not taking place. What factor may have contributed to this complication?
Inadequate immobilization
To reduce the incidence of complications in a client in traction, which intervention should be included in the care plan?
Increase fiber intake.
Which intervention should the nurse implement with the client who has undergone a hip replacement?
Instruct the client to avoid internal rotation of the leg.
A client undergoes open reduction with internal fixation to treat an intertrochanteric fracture of the right hip. The nurse should include which intervention in the postoperative care plan?
Keeping a pillow between the client's legs at all times
A client is seen in the orthopedic clinic for complaints of severe pain in the left hip. After a series of diagnostic tests, the client is diagnosed with severe degenerative joint disease of the left hip and suggested to have the hip reconstructed. What procedure will the nurse schedule the client for?
Left hip arthroplasty
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?
Numbness and burning of the foot
A client is brought to the emergency department after injuring the right arm in a bicycle accident. The orthopedic surgeon tells the nurse that the client has a greenstick fracture of the arm. What does this mean?
One side of the bone is broken and the other side is bent.
A client sustains an injury to the ligaments surrounding a joint. What will the nurse identify this injury as?
Sprain
A client's left leg is in skeletal traction with a Thomas leg splint and Pearson attachment. Which intervention should the nurse include in this client's care plan?
Teach the client how to prevent problems caused by immobility.
A client is diagnosed with a first-degree strain of the left ankle related to running 5 miles daily. How would the nurse differentiate the first-degree strain from other strains and sprains?
The client has some edema of the left ankle with muscle spasms but is able to walk without assistive devices.
An elite high school football player has been diagnosed and treated for a shoulder dislocation. What should the nurse emphasize during health education to facilitate the player's rejoining the team?
The importance of adhering to the prescribed treatment and rehabilitation regimen
A nurse is caring for a client in skin traction. In order to prevent bony fragments from moving against one another, the nurse should caution the client against performing what action?
Turning from side to side
A patient falls while skiing and sustains a supracondylar fracture. What does the nurse know is the most serious complication of a supracondylar fracture of the humerus?
Volkmann's ischemic contracture
The nurse is checking the traction apparatus for a client in skin traction. Which finding would require the nurse to intervene?
Weights hanging and touching the floor
After surgery to treat a hip fracture, a client returns from the postanesthesia care unit to the medical-surgical unit. Postoperatively, how should the nurse position the client?
With the leg on the affected side abducted
The type of fracture described as having one side of the bone broken and the other side bent would be:
greenstick.
The nurse is monitoring a patient who sustained an open fracture of the left hip. What type of shock should the nurse be aware can occur with this type of injury?
hypovolemic
A nurse is assigned to support a patient while a cast is being applied to treat a greenstick fracture. The nurse documents that this fracture is classified as what type of fracture?
incomplete
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?
joint manipulation and immobilization
A fracture is considered pathologic when it
occurs through an area of diseased bone.
A variety of complications can occur after a leg amputation. Which is not a possibility in the immediate postoperative period?
osteomyelitis
Which nursing intervention is essential in caring for a client with compartment syndrome?
Removing all external sources of pressure, such as clothing and jewelry
Six weeks after an above-the-knee amputation (AKA), a client returns to the outpatient office for a routine postoperative checkup. During the nurse's assessment, the client reports pain in the missing limb. Which action(s) will the nurse inform the client to perform to reduce the discomfort? Select all that apply.
Take opioid analgesics as prescribed. Take beta blockers as prescribed
A client had an above-the-knee amputation of the left leg related to complications from peripheral vascular disease. The nurse enters the client's room and observes the dressing and bed covers saturated with blood. What is the first action by the nurse?
Apply a tourniquet.
A client is brought to the emergency department after being struck with a baseball bat on the upper arm while diving for a pitched ball. Diagnostic tests reveal that the humerus is not broken but that the client has suffered another type of injury. What type of injury would the physician likely diagnose?
contusion
Which evaluation finding requires follow up by the nurse caring for a client with a total knee replacement? Select all that apply.
C. 650 ml bloody drainage in drain woundD. Knee flexion at 30 degrees
The nurse is assigned to care for a client who has had an open reduction and internal fixation of a fractured right femur 2 days ago. The nurse is listening to the client's lungs and, when moving the gown, observes petechial hemorrhages on the skin of the chest. What is the first action by the nurse?
Call the physician to inform them of the findings.
A client who is undergoing skeletal traction reports pressure on bony areas. Which action would be most appropriate to provide comfort for the client?
Changing the client's position within prescribed limits.
The nurse is assisting with the application of a cast. What will the nurse expect to be done first?
Cleaning the skin surface.
A client who has undergone a lower limb amputation is preparing to be discharged home. What outcome is necessary prior to discharge?
Client can demonstrate safe use of assistive devices.
A client was playing softball and dislocated four fingers when diving for a ball. The physician manipulated the fingers into alignment and applied a splint to maintain alignment. What type of procedure does the nurse document this as?
Closed reduction
Which of the following type of fracture is associated with osteoporosis?
Compression
A client comes to the emergency department and reports localized pain and swelling in the lower leg. Ecchymotic areas are noted. History reveals that the client got hit in the leg with a baseball bat. What will the nurse most likely suspect?
Contusion
A client was climbing a ladder, slipped on a rung, and fell on the right side of the chest. X-ray studies reveal three rib fractures, and the client reports pain with inspiration. What is the anticipated treatment for this client?
Coughing and deep breathing with pillow splinting
Which would be contraindicated as a component of self-care activities for the client with a cast?
Cover the cast with plastic to insulate it
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
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?
Difficulty lying on affected side
The nurse caring for a client, who has been treated for a hip fracture, instructs the client not to cross their legs and to have someone assist with tying their shoes. Which additional instruction should the nurse provide to client?
Do not flex the hip more than 90 degrees.
A client with a fracture develops compartment syndrome that requires surgical intervention. What treatment will the nurse would most likely prepare the client for?
Fasciotomy
A patient sustained an open fracture of the femur 24 hours ago. While assessing the patient, the nurse observes the patient is having difficulty breathing, and oxygen saturation decreases to 88% from a previous 99%. What does the nurse understand is likely occurring with this patient?
Fat emboli
A client is brought in by ambulance to the emergency department after being involved in a motorcycle accident. The client has an open fracture on his tibia. The wound is highly contaminated and there is extensive soft- tissue damage. How would this client's fracture likely be graded?
Grade III
Which term refers to a fracture in which one side of a bone is broken and the other side is bent?
Greenstick
A client has just undergone a leg amputation. What will the nurse closely monitor the client for during the immediate postoperative period?
Hematoma
A client who was in a motor vehicle crash is diagnosed with a stable T7 spinal fracture with no neurologic deficits. Which nursing intervention should the nurse implement?
Maintain bed rest with the head of the bed at 20 degrees.
An older adult client experienced a fall and requires treatment for a fractured hip. Which factor(s) does the nurse identify may have contributed to the fall in this client? Select all that apply.
Medication effects Loss of visual acuity Muscle weakness Slowed reflexes
A client with metastatic bone cancer sustained a left hip fracture without injury. What type of fracture does the nurse understand occurs without trauma or fall?
Pathologic fracture
Elderly clients who fall are most at risk for which injuries?
Pelvic fractures
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?
Prevent internal rotation of the affected leg.
Which of the following is an inappropriate nursing diagnosis for the client following casting?
Risk for deficient knowledge: procedure
An elderly client's hip joint is immobilized prior to surgery to correct a femoral head fracture. What is the nurse's priority assessment?
Signs of neurovascular compromise
Which device is designed specifically to support and immobilize a body part in a desired position?
Splint
A client reports pain in the right knee, stating, "My knee got twisted when I was going down the stairs." The client was diagnosed with an injury to the ligaments and tendons of the right knee. Which terminology, documented by the nurse, best reflects the injury?
Sprain
Which term refers to an injury to ligaments and other soft tissues surrounding a joint?
Sprain
The nurse suspects "compartment syndrome" for a casted extremity. What characteristic symptoms would the nurse assess that would confirm these suspicions? (Select all that apply.)
a) Excruciating painc) Decreased sensory functiond) Loss of motion
A client with a fractured femur is admitted to the nursing unit. Which assessment finding requires follow up by the nurse? Select all that apply.
a.) T 101.2 degrees F; HR 110; RR 28; pulse oximetry 90%b.) "I cannot seem to catch my breath."d.) Dorsoplantar weak and unequal bilaterallye.) "I have a pins-and-needles sensation in my toes."
A group of students are reviewing information about cast composition in preparation for a discussion on the advantages and disadvantages of each. The students demonstrate understanding of the topic when they cite which of the following as an advantage of a plaster cast?
better molding
When the client who has experienced trauma to an extremity reports severe burning pain, vasomotor changes, and muscles spasms in the injured extremity, the nurse recognizes that the client is likely demonstrating signs of
complex regional pain syndrome.
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
Arthrodesis is:
fusion of a joint (most often the wrist or knee) for stabilization and pain relief.
A client has been in a motor vehicle collision. Radiographs indicate a fractured humerus; the client is awaiting the casting of the upper extremity and admission to the orthopedic unit. What is the primary treatment for musculoskeletal trauma?
immobilization
The clinic nurse is caring for a client with an injured body part that does not require rigid immobilization. What method of immobilization would the nurse expect the health care provider to use on a short-term basis?
splint
A client is experiencing pain, joint instability, and difficulty walking due to an injury to the knee ligaments. The injury was judged not to require surgery. Which intervention would not be included in this client's care?
traction
A client in the emergency department is being treated for a wrist fracture. The client asks why a splint is being applied instead of a cast. What is the best response by the nurse?
"A splint is applied when more swelling is expected at the site of injury."
A client is being prepared for a total hip arthroplasty, and the nurse is providing relevant education. The client is concerned about being on bed rest for several days after the surgery. The nurse should explain what expectation for activity following hip replacement?
"The physical therapist will likely help you get up using a walker the day after your surgery."
A client returns to the nursing unit following an open reduction with internal fixation of the right hip. Which nursing interventions would be appropriate for the prophylactic treatment of deep vein thrombosis? Select all that apply.
- Increasing fluid intake - Maintaining antiembolic stockings - Administering enoxaparin
A 14-year-old client is treated in the emergency room for an acute knee sprain sustained during a soccer game. The nurse reviews discharge instructions with the client's parent. The nurse instructs the parent that the acute inflammatory stage will last how long?
24 to 48 hours
Upon reporting to work and receiving report, a nurse has been assigned to provide care for three clients. Each of the clients has called out to the nurses' station requesting assistance. Which client should the nurse see first?
A 32-year-old male, who had a plaster cast applied to his leg 2 hours ago, who complains that the cast feels as if it's getting tighter
The client displays manifestations of compartment syndrome. What treatment will the nurse expect the client to be scheduled for?
A fasciotomy
A patient had a total hip replacement. What recommended leg position should the nurse ensure is maintained to prevent prosthesis dislocation?
Abduction
When providing discharge teaching to a client with a fractured toe, the nurse should include which instruction?
Apply ice to the fracture site.
A nurse is caring for a client who is in skeletal traction. To prevent the complication of skin breakdown in a client with skeletal traction, what action should be included in the plan of care?
Assess the pin insertion site every 8 hours.
A client is transported to the emergency department for a femur fracture following a motor vehicle crash. What action by the nurse is the highest priority?
Assess vital signs and level of consciousness.
A nurse is caring for a client placed in traction to treat a fractured femur. Which nursing intervention has the highest priority?
Assessing the extremity for neurovascular integrity
A nurse is caring for a client who has sustained ligament and a meniscal injury to the knee. Which action would be most appropriate to allow the client to progress without causing further injury?
Assist with a gradual introduction of activity.
The orthopedic surgeon has prescribed balanced skeletal traction for a client. What advantage is conferred by balanced traction?
Balanced traction can be applied at night and removed during the day. Balanced traction allows for greater client movement and independence than other forms of traction.
A group of students is reviewing information about cast composition in preparation for a discussion on the advantages and disadvantages of each. The students demonstrate understanding of the topic when they cite which of the following as an advantage of a plaster cast?
Better molding to the client
