Chapter 40 Musculoskeletal Care Modalities

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 increases range of motion of the joint." - "CPM strengthens the muscles of the leg." - "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."

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 toes are stiff" -"My cast is still wet -"My pain is 3" -My toes are pink"

"My toes are stiff"

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 arthroscopy -Closed reduction of the left hip. -Open reduction and internal fixation of the left hip. -Left hip arthroplasty

Left hip arthroplasty

Which action by the nurse would be inappropriate for the client following casting? -Handle the cast with the palms of hands. -Protect the cast by covering with a sheet. -Petal and smooth the edges of the cast. -Circulate room air with a portable fan.

Protect the cast by covering with a sheet.

The nurse is caring for a patient who had a total hip replacement. What lethal postoperative complication should the nurse closely monitor for? -Pulmonary embolism -Atelectasis -Urinary tract infection -Hypovolemia

-Pulmonary embolism

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 -Elevate the casted extremity to heart level frequently -Do not attempt to scratch the skin under a cast -Cushioning rough edges of the cast with tape

Cover the cast with plastic to insulate it

A variety of complications can occur after a leg amputation. Which is not a possibility in the immediate postoperative period? -hematoma -hemorrhage -infection -osteomyelitis

osteomyelitis

A patient arrives in the emergency department with a suspected bone fracture of the right arm. How does the nurse expect the patient to describe the pain? -Similar to "muscle cramps" -Sharp and piercing -Sore and aching -A dull, deep, boring ache

-Sharp and piercing

Which action would be most important postoperatively for a client who has had a knee or hip replacement? -Encouraging expressions of anxiety. -Assisting in early ambulation. -Providing crutches to the client. -Using a continuous passive motion (CPM) machine.

Assisting in early ambulation.

Which term describes a surgical procedure to release constricting muscle fascia so as to relieve muscle tissue pressure? -Arthrodesis -Fasciotomy -Arthroplasty -Osteotomy

Fasciotomy

Which type of cast encloses the trunk and a lower extremity? -Short-leg -Hip spica -Body cast -Long-leg

Hip spica

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? -Osteomyelitis -Hypovolemic Shock -Atelectasis -Urinary Retention

Hypovolemic Shock

After a traumatic back injury, a client requires skeletal traction. Which intervention takes priority? -Restricting the client's fluid and fiber intake to reduce the movement required for bedpan use -Maintaining traction continuously to ensure its effectiveness -Monitoring the client for skin breakdown -Supporting the traction weights with a chair or table to prevent accidental slippage

Maintaining traction continuously to ensure its effectiveness

A client's fracture was reduced by surgically exposing the bone and realigning it. What type of treatment does the nurse identify this as? -Internal fixation -Open reduction -Buck's traction -Skeletal traction

Open reduction

Which orthopedic surgery is done to correct and align a fracture after surgical dissection and exposure of the fracture? -Open reduction -Total joint arthroplasty -Arthrodesis -Joint arthroplasty

Open reduction

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 -Risk for avascular necrosis of the joint -Situational low self-esteem -Disturbed body image

Risk for ineffective therapeutic regimen management

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

Short leg cast

Which is an inaccurate principle of traction -The weights hang freely -The client must be in good alignment in the center of the bed. -The weights are not removed unless intermittent treatment is prescribed. -Skeletal traction is interrupted to turn an deposition that client.

Skeletal traction is interrupted to turn an deposition that client.

A patient has a cast removed after bone healing takes place. What should the nurse instruct the patient to do after removal? (Select all that apply.) -Control swelling with elastic bandages, as directed. -Use friction to remove dead surface skin by rubbing the area with a towel. -Apply an emollient lotion to soften the skin. -Use a razor to shave the dead skin off. -Gradually resume activities and exercise.

Control swelling with elastic bandages, as directed. Apply an emollient lotion to soften the skin. Gradually resume activities and exercise.

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? -Osteotomy -Hemiarthroplasty -Arthrodesis -Total arthroplasty

Total arthroplasty

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." "I will wear a boot with weights attached." "Metal pins will go through my skin to the bone." "A belt will go around my pelvis and weights will be attached."

"Metal pins will go through my skin to the bone."

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? -More breathable -Longer lasting -Quicker drying -Better molding to the client

-Better molding to the client

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 of a bivalve cast -Cutting a cast window -Insertion of an external fixator -Removal of the cast

-Cutting a cast window

The client who had a total hip replacement was discharged home and developed acute groin pain in the affected leg, shortening of the leg, and limited movement of the fractured leg. The nurse interprets these findings as indicating which complication? -Dislocation of the hip -Contracture of the hip -Re-fracture of the hip -Avascular necrosis of the hip

-Dislocation of the hip

A patient had a total left hip arthroplasty. What clinical manifestation would indicate to the nurse that the prosthesis is dislocated? -Diminished peripheral pulses on the affected extremity -The patient has discomfort when moving in the bed. -The left leg is internally rotated. -The leg length is the same as the right leg.

-The left leg is internally rotated.

An older adult patient had a hip replacement. When should the patient begin with assisted ambulation with a walker? -72 hours -24 hours -2 to 3 weeks 1 week

24 hours

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 -Keeping the client from sliding to the foot of the bed -Keeping the ropes over the center of the pulley -Ensuring that the weights hang free at all times

Assessing the extremity for neurovascular integrity

A client is reporting pain following orthopedic surgery. Which intervention will help relieve pain? -Elevate the affected extremity and use cold applications. -Breathe deeply and cough every 2 hours until ambulation is possible. -Do ROM exercises as indicated -Apply anti-embolism stockings as indicated

Elevate the affected extremity and use cold applications.

To reduce the incidence of complications in a client in traction, which intervention should be included in the care plan? -Reduce fluid intake. -Remove the weights during linen changes. -Increase fiber intake. -Increase calorie intake.

Increase fiber intake.

A client is about to have a cast applied to the left arm. What will nurse alert the client to as the cast is applied? -Sensation of weakness -Increase in pain in the left arm -Arm being moved to various positions -Sensations of warmth or heat with application

Sensations of warmth or heat with application

Which is not a guideline for avoiding hip location after replacement surgery. -Put a pillow between the legs when sleeping. -The hip may be flexed to put on clothing such as pants, stockings, socks, or shoes, -Never cross the legs when seated. -Keep the knees apart at all times.

The hip may be flexed to put on clothing such as pants, stockings, socks, or shoes,

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." "You may cross your legs at the ankles only." "Use a raised toilet seat and high-seated chair." "It is okay to briefly flex the hip to put on your clothes."

"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."

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. -Adduct the legs by placing a pillow between the legs. -Place the client in high Fowler's position for meals. -Have the client bend forward to rise from the chair.

-Instruct the client to avoid internal rotation of the leg.

A client's cast is removed. The client is worried because the skin appears mottled and is covered with a yellowish crust. What advice should the nurse give the client to address the skin problem? -Scrub the area vigorously to remove the crust. -Apply lotions and take warm baths or soaks. -Avoid exposure to direct sunlight. -Consult a skin specialist.

Apply lotions and take warm baths or soaks.

A client with an arm cast reports pain. What nursing interventions should the nurse provide in order to reduce the incidence of complications? Select all that apply. -Assess for a pressure sore -Administer a prescribed analgesic to promote comfort and allay anxiety. -Assess the fingers for color and temperature. -Cut the cast with a cast saw -Determine the exact site of the pain.

Assess for a pressure sore Assess the fingers for color and temperature. Determine the exact site of the pain.

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? -Right shoulder slopes downward and droops inward -Client complains of tingling and numbness in the right shoulder. -Client complains of pain in the unaffected shoulder. -Right shoulder is elevated above the left.

Right shoulder slopes downward and droops inward

Which statement describes external fixation? -The surgeon secures the bone with metal screws, plates, rods, nails, or pins. A cast or other mode of immobilization is applied. -The bone is surgically exposed and realigned. -The bone is restored to its normal position by external manipulation. -The surgeon inserts metal pins into the bone or bones from outside the skin surface and then attaches a compression device to the pins.

The surgeon inserts metal pins into the bone or bones from outside the skin surface and then attaches a compression device to the pins.

The nurse is checking the traction apparatus for a client in skin traction. Which finding would require the nurse to intervene? -Pulleys without evidence of the obstruction -Body aligned opposite to line of traction pull -Ropes freely moving over pulleys -Weights hanging and touching the floor

Weights hanging and touching the floor

A client has a Fiberglass cast on the right arm. Which action should the nurse include in the care plan? -Fingers on the left hand are swollen and cool -Presence of a normal popliteal pulse -Minimal pain in the left arm -Cast edges are rough, with skin irritation present

Fingers on the left hand are swollen and cool

The nurse is very concerned about the potential debilitating complication of peroneal nerve injury. What symptom does the nurse recognize as a result of that complication? -Deep vein thrombosis (DVT) -Permanent paresthesias -Footdrop -Infection

Footdrop

The nurse is admitting a client who is to undergo an open reduction with internal fixation for a fractured femur. About which comment should the nurse be most concerned? -" The surgeon can see the bones when putting them in correct position." -"A joint replacement or bone graft is not necessary." -"The surgeon is planning to use a metal plate and screws to fix my hip." -"The surgeon is planning to use a metal plate and screws to fix my hip." -" I was worried I would have an incision and scar."

I was worried I would have an incision and scar."

Which statement by a staff nurse on the orthopedic floor indicates the need for further staff education? -"The client is receiving physical therapy twice per day, so the client doesn't need a continuous passive motion device." -"The continuous passive motion device can decrease the development of adhesions." -"Monitoring skin integrity is important while the continuous passive motion device is in place." -"Bleeding is a complication associated with the continuous passive motion device."

"The client is receiving physical therapy twice per day, so the client doesn't need a continuous passive motion device."

Which device is designed specifically to support and immobilize a body part in a desired position? -Continuous passive motion (CPM) device -Brace -Splint -Trapeze

Splint

A nurse is given 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 -Exercising joints above and below the cast, as ordered -Using crutches properly -Reporting signs of impaired circulation

Reporting signs of impaired circulation

A hip spica cast: -is a short or long leg cast reinforced for strength. -encloses the trunk and a lower extremity. -encircles the trunk. -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.

encloses the trunk and a lower extremity.

The nurse is caring for a client who sustained rib fractures in an automobile accident. What symptoms does the nurse recognize as a complication of rib fractures and should immediately be reported to the physician? -Heart rate of 94 beats/minute -Client complains of pain in the affected rib area when taking a deep breath -Blood pressure of 140/90 mm Hg -Crackles in the lung bases

-Crackles in the lung bases

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? -Assess the client's level of consciousness. -Teach the client how to prevent problems caused by immobility. -Remove the traction at least every 8 hours. -Apply the traction straps snugly.

-Teach the client how to prevent problems caused by immobility.

A patient had a total hip replacement. What recommended leg position should the nurse ensure is maintained to prevent prosthesis dislocation? -Internal rotation -Adduction -Abduction -Flexion

Abduction

A client with a fractured ankle is having a fiberglass cast applied. The client starts yelling, "My leg is burning, take it off." What action by the nurse is most appropriate? -Administer antianxiety and pain medication. -Call for assistance to hold the client in the required position until the cast has dried. -Remove the cast immediately, notifying the physician. -Explain that the sensation being felt is normal and will not burn the client.

Explain that the sensation being felt is normal and will not burn the client.

A client has a cast that extends from below the elbow to the palmar crease and is secured around the base of the thumb. The thumb is also casted. the nurse identifies this as which type of cast? -Gauntlet Cast -Spica Cast -Short Arm Cast -Body Cast

Gauntlet Cast

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? "It is best if an orthopedic doctor applies the cast." "A splint is applied when more swelling is expected at the site of injury." "Not all fractures require a cast." "You would have to stay here much longer because it takes a cast longer to dry."

"A splint is applied when more swelling is expected at the site of injury."

A client is seen in the emergency department for an injury acquired from falling off a bicycle and fracturing the arm. The client also has a long laceration that has been sutured in the same area. The client asks the nurses why a splint is applied and not a cast. What is the best explanation by the nurse? -"You will be able to wear the splint longer than you would a cast." -"The arm does not require the same immobilization that a leg fracture would." -"We will need to monitor the status of the laceration to be sure it does not get infected." -" The splint is less expensive than the cast."

"We will need to monitor the status of the laceration to be sure it does not get infected."

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.) -Decreased sensory function -Capillary refill less than 3 seconds -Loss of motion -2+ peripheral pulses in the affected distal pulse -Excruciating pain

-Decreased sensory function -Loss of motion -Excruciating pain

The nurse is caring for a client with a spica cast. What is the nurse's priority intervention? -Keep the cast clean and dry. -Promote elimination with a regular bedpan. -Position the client on the affected side. -Keep the legs in abduction.

-Keep the cast clean and dry.

A client has a fiberglass cast on the right arm. Which action should the nurse include in the care plan?

Assessing movement and sensation in the fingers of the right hand

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 immobilizing the knee joint -It prevents infection and controls edema and bleeding -It promotes healing by increasing circulation and movement of the knee joint.

It promotes healing by increasing circulation and movement of the knee joint

The nurse assesses a client after total right hip arthroplasty and observes a shortening of the extremity. The client reports severe pain in the right side of the groin. why is the priority action of the nurse? -Apply Bucks traction. -Notify the health care provider. -Bend the knee and rotate the knee internally. -Externally rotate the extremity.

Notify the health care provider.

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

Apply ant-embolism stockings