Chapter 40: Musculoskeletal Care Modalities

A client is brought to the emergency department by a softball team member who states the client and another player ran into each other, and the client is having severe pain in the right shoulder. What symptoms of a fractured clavicle does the nurse recognize? Client complains of tingling and numbness in the right shoulder. Right shoulder is elevated above the left. Client complains of pain in the unaffected shoulder. Right shoulder slopes downward and droops inward.

Correct response: Right shoulder slopes downward and droops inward. Explanation: The client with a fractured clavicle has restricted motion, and the affected shoulder appears to slope downward and droop inward. The client will have pain, not typically tingling and numbness in the right shoulder. Pain is not felt in the unaffected shoulder.

Which nursing action would help prevent deep vein thrombosis in a client who has had an orthopedic surgery? Instruct about using client-controlled analgesia, if prescribed Instruct about exercise, as prescribed Apply antiembolism stockings Apply cold packs

Correct response: Apply antiembolism stockings Explanation: Applying antiembolism stockings helps prevent deep vein thrombosis (DVT) in a client who is immobilized due to orthopedic surgery. Regular administration of analgesics controls and prevents escalation of pain, while ROM exercises help maintain muscle strength and tone and prevent contractions. On the other hand, cold packs are applied to help reduce swelling; cold does not prevent deep vein thrombosis.

Which is an inappropriate use of traction? Immobilize a fracture Decrease space between opposing structures Reduce deformity Minimize muscle spasms

Correct response: Decrease space between opposing structures Explanation: Traction is done to increase the space between opposing surfaces. Traction is used to minimize muscle spasms, to reduce, align, and immobilize fractures, and to reduce deformity.

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? Tell the client that this noncompliance will be reported to the health care provider. Discuss the complications that the client may experience if there is lack of cooperation with the care plan. Do nothing because the client has the ultimate right to determine the degree of participation. Document the client's refusal to ambulate.

Correct response: Discuss the complications that the client may experience if there is lack of cooperation with the care plan. Explanation: The nurse should discuss the care plan and its rationale with the client. Calling the health care provider to report the client's noncompliance won't alter the client's degree of participation and shouldn't be used to force the client to comply. Doing nothing isn't acceptable. Although the client does have the right to make choices, it's the nurse's responsibility to provide education to help the client make informed decisions. Although the nurse should ultimately document the client's refusal, the nurse should first discuss the care plan with the client.

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 Presence of a normal popliteal pulse Cast edges are rough, with skin irritation present Minimal pain in the left arm

Correct response: Fingers on the left hand are swollen and cool Explanation: Swollen and cool fingers on the left hand are the most significant assessment findings. They represent altered circulation to the hand caused by the cast. A normal radial, not popliteal, pulse should be present in the left arm; the popliteal pulse is found on the leg. Skin irritation is an abnormal assessment finding but it isn't as significant as altered circulation. Minimal pain in the left arm is expected.

A patient in pelvic traction needs circulatory status assessed. How should the nurse assess for a positive Homans' sign? 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. Have the patient plantar flex both feet while the nurse performs the blanch test on all of the patient's toes. Have the patient squeeze the nurse's hands with his or her hands to evaluate any difference in strength.

Correct response: Have the patient extend each leg and dorsiflex each foot to determine if pain or tenderness is present in the lower leg. Explanation: The nurse should assess for pain on passive flexion of each foot, which could indicate deep vein thrombosis.

Which is a benefit of a continuous passive motion (CPM) device when applied after knee surgery? It provides active range of motion. It promotes healing by increasing circulation and movement of the knee joint. It promotes healing by immobilizing the knee joint. It prevents infection and controls edema and bleeding.

Correct response: It promotes healing by increasing circulation and movement of the knee joint. Explanation: A CPM device applied after knee surgery promotes healing by increasing circulation and movement of the knee joint.

A client has undergone an external fixation. Which actions would be the priority for this client? Maintaining pin care. Planning the client's diet. Monitoring the client's urine output. Monitoring the client's blood pressure.

Correct response: Maintaining pin care. Explanation: Pin care is a priority for a client with external fixation, because pin sites are entry points for infection. The nurse should also monitor redness, drainage, and tenderness at the site. Planning the client's diet and monitoring the client's urine output and blood pressure, although necessary, are not as important as maintaining pin care.

The nurse is caring for a client who lives alone and had a total knee replacement. An appropriate nursing diagnosis for the client is: Risk for ineffective therapeutic regimen management Disturbed body image Situational low self-esteem Risk for avascular necrosis of the joint

Correct response: Risk for ineffective therapeutic regimen management Explanation: The client without adequate support and resources is at risk for ineffective therapeutic regimen management. A total knee replacement may be used to treat avascular necrosis. While an orthopedic client is at risk for disturbed body image and situational low self-esteem, there is no evidence that these exist for this client.

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? Short leg cast Long leg cast Walking cast Hip spica cast

Correct response: Short leg cast Explanation: A short leg cast extends from below the knee to the base of the toes. The foot is flexed at a right angle in a neutral position. A long leg cast extends from the junction of the upper and middle third of the thigh to the base of the toes. The knee may be slightly flexed. A walking cast is a short or long leg cast reinforced for strength. A hip spica cast encloses the trunk and a lower extremity.

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? physical therapy discontinue use of crutches cold compresses to leg for swelling No options are correct.

Correct response: physical therapy Explanation: For some time, the limb will need support. An elastic bandage may be wrapped on a leg, the client may use a cane, and an arm may be kept in a sling until progressive active exercise and physical therapy help the client regain normal strength and motion.