Chapter 42: Management of Patients With Musculoskeletal Trauma

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? a) Prevent internal rotation of the affected leg. b) Keep the affected leg in a position of adduction. c) Use measures other than turning to prevent pressure ulcers. d) Keep the hip flexed by placing pillows under the client's knee.

Prevent internal rotation of the affected leg. Explanation: The nurse and other caregivers should prevent internal rotation of the affected leg. However, external rotation and abduction of the hip will help prevent dislocation of a new hip joint. Postoperative total hip replacement clients may be turned onto the unaffected side. The hip may be flexed slightly, but it shouldn't exceed 90 degrees. Maintenance of flexion isn't necessary. (Chapter 42: Management of Patients With Musculoskeletal Trauma - Page 1204)

The RICE acronym is helpful for remembering treatment interventions for musculoskeletal injuries. Which of the following are components of the RICE acronym? Select all that apply. - Edema - Ice - Corticosteroids - Elevation - Compression - Rest

- Ice - Elevation - Compression - Rest Explanation: The acronym RICE stands for Rest, Ice, Compression, and Elevation. Edema and corticosteroids are not part of the RICE acronym. (Chapter 42: Management of Patients With Musculoskeletal Trauma - Page 1186)

A client is to undergo surgery to repair a ruptured Achilles tendon and application of a brace. The client demonstrates understanding of activity limitations when stating that a brace must be worn for which length of time? a) 14 to 16 weeks b) 2 to 4 weeks c) 6 to 8 weeks d) 10 to 12 weeks

6 to 8 weeks Explanation: Following surgical repair for a ruptured Achilles tendon, the client wears a brace or cast for 6 to 8 weeks. (Chapter 42: Management of Patients With Musculoskeletal Trauma - Page 1189)

Many orthopedic-related injuries occur while participating in sports or in the workplace. Which elements would be included in client and family teaching aiming at prevention? a) Use proper equipment at work and during participation in athletic activities. b) Exercise regularly to maintain joint and muscle strength. c) All options are correct. d) At work, look at ways to modify the environment to prevent injury.

All options are correct. Explanation: Use proper equipment at work and during participation in athletic activities. At work, look at ways to modify the environment to prevent injury. Exercise regularly to maintain joint and muscle strength.

A client sustains an injury to the ligaments surrounding a joint. What will the nurse identify this injury as? a) Contusion b) Strain c) Fracture d) Sprain

Sprain Explanation: A sprain is an injury to the ligaments surrounding a joint. A strain is an injury to a muscle when it is stretched or pulled beyond its capacity. A contusion is a soft tissue injury resulting from a blow or blunt trauma. A fracture is a break in the continuity of a bone. (Chapter 42: Management of Patients With Musculoskeletal Trauma - Page 1186)

A fracture is considered pathologic when it a) occurs through an area of diseased bone. b) involves damage to the skin or mucous membranes. c) results in a fragment of bone being pulled away by a ligament or tendon and its attachment. d) presents as one side of the bone being broken and the other side being bent.

occurs through an area of diseased bone. Explanation: Pathologic fractures can occur without the trauma of a fall. An avulsion fracture results in a fragment of bone being pulled away by a ligament or tendon and its attachment. A greenstick fracture presents as one side of the bone being broken and the other side being bent. A compound fracture involves damage to the skin or mucous membranes. (Chapter 42: Management of Patients With Musculoskeletal Trauma - Page 1190)

A client undergoes a total hip replacement. Which statement made by the client indicates to the nurse that the client requires further teaching? a) "The occupational therapist is showing me how to use a sock puller to help me get dressed." b) "I don't know if I'll be able to get off that low toilet seat at home by myself." c) "I need to remember not to cross my legs. It's such a habit." d) "I'll need to keep several pillows between my legs at night."

"I don't know if I'll be able to get off that low toilet seat at home by myself." Explanation: The client requires additional teaching if he is concerned about using a low toilet seat. To prevent hip dislocation after a total hip replacement, the client must avoid bending the hips beyond 90 degrees. The nurse should instruct the client to use assistive devices, such as a raised toilet seat, to prevent severe hip flexion. Using an abduction pillow or placing several pillows between the legs reduces the risk of hip dislocation by preventing adduction and internal rotation of the legs. Teaching the client to avoid crossing the legs also reduces the risk of hip dislocation. A sock puller helps a client get dressed without flexing the hips beyond 90 degrees. (Chapter 42: Management of Patients With Musculoskeletal Trauma - Page 1204)

Which nursing intervention is appropriate for monitoring the client for the development of Volkmann's contracture? a) Assess capillary refill in the toes. b) Assess for paresthesia in the toes. c) Assess mobility of the shoulder. d) Assess the radial pulse.

Assess the radial pulse. Explanation: Volkmann's contracture is a type of acute compartment syndrome that occurs with a supracondylar fracture of the humerus. The nurse assesses neurovascular function of the hand and forearm. (Chapter 42: Management of Patients With Musculoskeletal Trauma - Page 1199)

A client who has sustained a fracture reports an increase in pain and decreased function of the affected extremity. What will the nurse suspect? a) Avascular necrosis b) Hypovolemic shock c) Infection d) Pulmonary embolism

Avascular necrosis Explanation: Avascular necrosis refers to the death of the bone from insufficient blood supply, typically manifested by complaints of increased pain and decreased function. Fever or redness, purulent drainage, and swelling of the site would suggest infection. Respiratory distress would suggest a pulmonary embolism. Changes in vital signs, level of consciousness, and signs and symptoms of fluid loss would suggest hypovolemic shock. (Chapter 42: Management of Patients With Musculoskeletal Trauma - Page 1186)

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? a) About 72 hours b) Between 24 and 48 hours c) Less than 24 hours d) At least 1 week

Between 24 and 48 hours Explanation: After the acute inflammatory stage (e.g., 24 to 48 hours after injury), intermittent heat application (for 15 to 30 minutes, four times a day) relieves muscle spasm and promotes vasodilation, absorption, and repair. (Chapter 42: Management of Patients With Musculoskeletal Trauma - Page 1186)

Which assessment findings would the nurse expect to find in the postoperative client experiencing fat embolism syndrome? (PICTURES) a) Column A b) Column B c) Column C d) Column D

Column B Explanation: Fat embolism syndrome is characterized by fever, tachycardia, tachypnea, and hypoxia. Arterial blood gas findings include a partial pressure of oxygen (PaO2) less than 60 mm Hg, with early respiratory alkalosis and later respiratory acidosis. (Chapter 42: Management of Patients With Musculoskeletal Trauma - Page 1193)

An x-ray demonstrates a fracture in which a bone has splintered into several pieces. Which type of fracture is this? a) Comminuted b) Compound c) Impacted d) Depressed

Comminuted Explanation: A comminuted fracture may require open reduction and internal fixation. A compound fracture is one in which damage also involves the skin or mucous membranes. A depressed fracture is one in which fragments are driven inward. An impacted fracture is one in which a bone fragment is driven into another bone fragment. (Chapter 42: Management of Patients With Musculoskeletal Trauma - Page 1189-1190)

Two days after application of a cast to treat a fractured femur, the client reports severe, deep, and constant pain in the leg. What will the nurse suspect? a) Compartment syndrome. b) Infection. c) Phlebitis. d) Chronic venous insufficiency.

Compartment syndrome. Explanation: Compartment syndrome refers to the compression of nerves, blood vessels, and muscle within a closed space. This leads to tissue death from lack of oxygenation. (Chapter 42: Management of Patients With Musculoskeletal Trauma - Page 1194)

Which of the following would lead a nurse to suspect that a client has a rotator cuff tear? a) Ability to stretch arm over the head b) Minimal pain with movement c) Pain worse in the morning d) Difficulty lying on affected side

Difficulty lying on affected side Explanation: Clients with a rotator cuff tear experience pain with movement and limited mobility of the shoulder and arm. They especially have difficulty with activities that involve stretching their arm above their head. Many clients find that the pain is worse at night and that they are unable to sleep on the affected side. (Chapter 42: Management of Patients With Musculoskeletal Trauma - Page 1187)

The nurses 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? a) Do not flex the hip more than 30 degrees. b) Do not flex the hip more than 120 degrees. c) Do not flex the hip more than 60 degrees. d) Do not flex the hip more than 90 degrees.

Do not flex the hip more than 90 degrees. Explanation: Proper alignment and supported abduction are encouraged for hip repairs. Flexion of the hip more than 90 degrees can cause damage to the a repaired hip fracture. By telling the patient to not to cross their legs, the leg stays in a the abducted position allowing for the hip to heal in the proper position. Having someone assist with the shoes does not allow for the hip to flex more than 90 degrees. (Chapter 42: Management of Patients With Musculoskeletal Trauma - Page 1205)

Which nursing intervention is appropriate for a client with a closed-reduction extremity fracture? a) Encourage participation in ADLs b) Use frequent dependent positioning to prevent edema c) Promote intake of omega-3 fatty acids d) Administer prescribed enema to prevent constipation

Encourage participation in ADLs Explanation: General nursing measures for a client with a fracture reduction include administering analgesics, providing comfort measures, encouraging participation with ADLs, promoting physical mobility, preventing infection, maintaining skin integrity, and preparing the client for self-care. Omega-3 fatty acids have no implications on the diet of a client with a fracture reduction. Dependent positioning may increase edema because the extremity is below the level of the heart. While some pain medications may contribute to constipation, this intervention would be reserved for a client experiencing constipation and not as a preventative measure. (Chapter 42: Management of Patients With Musculoskeletal Trauma - Page 1192)

The client has suffered a comminuted fracture. Which image best depicts this type of fracture? PICTURES

Explanation: A comminuted fracture (Option A) is a bone that has splintered into several fragments. A fracture in which a bone fragment is driven into another bone fragment is called an impacted fracture (Option B). A transverse fracture (Option C) results in a break straight across the bone shaft. A fracture involving damage to the skin or mucous membranes is called an open or compound fracture (Option D). (Chapter 42: Management of Patients With Musculoskeletal Trauma - Page 1190)

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? a) Spontaneous pneumothorax b) Cardiac tamponade c) Pneumonia d) Fat emboli

Fat emboli Explanation: After fracture of long bones or pelvic bones, or crush injuries, fat emboli frequently form. Fat embolism syndrome (FES) occurs when fat emboli cause morbid clinical manifestations. The classic triad of clinical manifestations of FES include hypoxemia, neurologic compromise, and a petechial rash (NAON, 2007), although not all signs and symptoms manifest at the same time (Tzioupis & Giannoudis, 2011). The typical first manifestations are pulmonary and include hypoxia and tachypnea. (Chapter 42: Management of Patients With Musculoskeletal Trauma - Page 1193)

The client with a fractured left humerus reports dyspnea and chest pain. Pulse oximetry is 88%. Temperature is 100.2 degrees Fahrenheit (38.5 degrees Centigrade); heart rate is 110 beats per minute; respiratory rate is 32 breaths per minute. The nurse suspects the client is experiencing: a) Fat embolism syndrome b) Complex regional pain sydrome c) Compartment syndrome d) Delayed union

Fat embolism syndrome Explanation: The clinical manifestations described in the scenario are characteristic of fat embolism syndrome. (Chapter 42: Management of Patients With Musculoskeletal Trauma - Page 1193)

While riding a bicycle on a narrow road, the patient was hit from behind and thrown into a ditch, sustaining a pelvic fracture. What complications does the nurse know to monitor for that are common to pelvic fractures? a) Thrombophlebitis and infection b) Paresthesia and ischemia c) Paralytic ileus and a lacerated urethra d) Hemorrhage and shock

Hemorrhage and shock Explanation: Hemorrhage and shock are two of the most serious consequences that may occur in a pelvic fracture. (Chapter 42: Management of Patients With Musculoskeletal Trauma - Page 1201)

Which factor inhibits fracture healing? a) Age of 35 years b) Increased vitamin D and calcium in the diet c) History of diabetes d) Immobilization of the fracture

History of diabetes Explanation: Factors that inhibit fracture healing include diabetes, smoking, local malignancy, bone loss, extensive local trauma, age greater than 40, and infection. Factors that enhance fracture healing include proper nutrition, vitamin D and calcium, exercise, maximum bone fragment contact, proper alignment, and immobilization of the fracture. (Chapter 42: Management of Patients With Musculoskeletal Trauma - Page 1193)

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? a) Greenstick b) Compression c) Impacted d) Comminuted

Impacted Explanation: An impacted fracture is one in which a bone fragment is driven into another bone fragment. A comminuted fracture is one in which the bone has splintered into several fragments. A compression fracture is one in which bone has been compressed. A greenstick fracture is one in which one side of the bone is broken and the other side is bent. (Chapter 42: Management of Patients With Musculoskeletal Trauma - Page 1190)

Which factor inhibits fracture healing? a) Exercise b) Local malignancy c) Vitamin D d) Maximum bone fragment contact

Local malignancy Explanation: Factors that inhibit fracture healing include local malignancy, bone loss, and extensive local trauma. Factors that enhance fracture healing include proper nutrition, vitamin D, exercise, and maximum bone fragment contact. (Chapter 42: Management of Patients With Musculoskeletal Trauma - Page 1193)

Which term refers to the failure of fragments of a fractured bone to heal together? a) Dislocation b) Malunion c) Nonunion d) Subluxation

Nonunion Explanation: When nonunion occurs, the client reports persistent discomfort and movement at the fracture site. Dislocation refers to the separation of joint surfaces. Subluxation refers to partial separation or dislocation of joint surfaces. Malunion refers to growth of the fragments of a fractured bone in a faulty position, forming an imperfect union. (Chapter 42: Management of Patients With Musculoskeletal Trauma - Page 1196)

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? a) Pathologic fracture b) Transverse fracture c) Compound fracture d) Impacted fracture

Pathologic fracture Explanation: A pathologic fracture is a fracture that occurs through an area of diseased bone and can occur without trauma or a fall. An impacted fracture is a fracture in which a bone fragment is driven into another bone fragment. A transverse fracture is a fracture straight across the bone. A compound fracture is a fracture in which damage also involves the skin or mucous membranes. (Chapter 42: Management of Patients With Musculoskeletal Trauma - Page 1190)

Elderly clients who fall are most at risk for which injuries? a) Cervical spine fractures b) Wrist fractures c) Pelvic fractures d) Humerus fractures

Pelvic fractures Explanation: Elderly clients who fall are most at risk for pelvic and lower extremity fractures. These injuries are devastating because they can seriously alter an elderly client's lifestyle and reduce functional independence. Wrist fractures usually occur with falls on an outstretched hand or from a direct blow. Such fractures are commonly found in young men. Humerus fractures and cervical spine fractures aren't age-specific. (Chapter 42: Management of Patients With Musculoskeletal Trauma - Page 1203)

Which nursing diagnosis takes highest priority for a client with a compound fracture? a) Activity intolerance related to weight-bearing limitations b) Impaired physical mobility related to trauma c) Imbalanced nutrition: Less than body requirements related to immobility d) Risk for infection related to effects of trauma

Risk for infection related to effects of trauma Explanation: A compound fracture involves an opening in the skin at the fracture site. Because the skin is the body's first line of defense against infection, any skin opening places the client at risk for infection. Imbalanced nutrition: Less than body requirements is rarely associated with fractures. Although Impaired physical mobility and Activity intolerance may be associated with any fracture, these nursing diagnoses don't take precedence because they aren't as life-threatening as infection. (Chapter 42: Management of Patients With Musculoskeletal Trauma - Page 1192)

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? a) Sprain b) Strain c) Dislocation d) Subluxation

Sprain Explanation: A sprain is an injury to the ligaments and tendons surrounding a joint, usually caused by a wrenching or twisting motion. Dislocation refers to the separation of joint surfaces. Subluxation refers to partial separation or dislocation of joint surfaces. Strain refers to a muscle pull or tear. (Chapter 42: Management of Patients With Musculoskeletal Trauma - Page 1186)

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? a) enhancing complications b) external rotation c) surgical repair d) immobilization

immobilization Explanation: Treatment of musculoskeletal trauma involves immobilization of the injured area until it has healed. (Chapter 42: Management of Patients With Musculoskeletal Trauma - Page 1186)

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? a) ice and NSAIDs b) traction c) limited weight bearing d) joint immobilization

traction Explanation: Joint immobilization, limited weight bearing, ice, and NSAIDs would be included in the initial treatment. Traction is not required because there is no break, and surgery is not required. (Chapter 42: Management of Patients With Musculoskeletal Trauma - Page 1188)

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? a) Fracture b) Strain c) Sprain d) Contusion

Contusion Explanation: The client's description of blunt trauma by a baseball bat and localized pain in conjunction with swelling and ecchymosis would most likely suggest a contusion. A fracture would be manifested by pain, loss of function, deformity, swelling, and spasm. A sprain would be manifested by pain and swelling; ecchymosis may appear later. A strain is characterized by inflammation, local tenderness, and muscle spasms. (Chapter 42: Management of Patients With Musculoskeletal Trauma - Page 1185)

Which type of fracture is one in which the skin or mucous membrane extends to the fractured bone? a) Compound b) Complete c) Incomplete d) Simple

Compound Explanation: A compound fracture is one in which the skin or mucous membrane wound extends to the fractured bone. A complete fracture involves a break across the entire cross section of the bone and is frequently displaced. An incomplete fracture involves a break through only part of the cross section of the bone. A simple fracture is one that does not cause a break in the skin. (Chapter 42: Management of Patients With Musculoskeletal Trauma - Page 1189)

A patient sustains a fracture of the arm. When does the nurse anticipate pendulum exercise should begin? a) As soon as tolerated, after a reasonable period of immobilization b) In 2 to 3 weeks, when callus ossification prevents easy movements of bony fragments c) In about 4 to 5 weeks, after new bone is well established d) In 2 to 3 months, after normal activities are resumed

As soon as tolerated, after a reasonable period of immobilization Explanation: Many impacted fractures of the surgical neck of the humerus are not displaced and do not require reduction. The arm is supported and immobilized by a sling and swathe that secure the supported arm to the trunk (Fig. 43-10). Limitation of motion and stiffness of the shoulder occur with disuse. Therefore, pendulum exercises begin as soon as tolerated by the patient. In pendulum or circumduction exercises, the physical therapist instructs the patient to lean forward and allow the affected arm to hang in abduction and rotate. These fractures require approximately 4 to 10 weeks to heal, and the patient should avoid vigorous arm activity for an additional 4 weeks. Residual stiffness, aching, and some limitation of ROM may persist for 6 months or longer (NAON, 2007). (Chapter 42: Management of Patients With Musculoskeletal Trauma - Page 1199)

A client with a traumatic amputation of the right lower leg is refusing to look at the leg. Which action by the nurse is most appropriate? a) Encourage the client to perform range-of-motion (ROM) exercises to the right leg. b) Provide wound care without discussing the amputation. c) Provide feedback on the client's strengths and available resources. d) Request a referral to occupational therapy.

Provide feedback on the client's strengths and available resources. Explanation: The nurse should encourage the client to look at, and assist with, care of the residual limb. Providing feedback on the client's strengths and resources may allow the client to start to adapt to the body image and lifestyle change. The nurse should also allow time for the client to discuss their feelings related to the amputation. Requesting a referral to occupational therapy and encouraging the client to perform ROM exercises are appropriate but do not address the emotional aspect of losing an extremity. (Chapter 42: Management of Patients With Musculoskeletal Trauma - Page 1217)

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? a) Avascular necrosis of bone b) Heterotrophic ossification c) Complex regional pain syndrome d) Reaction to an internal fixation device

Complex regional pain syndrome Explanation: The symptoms reported by the client are consistent with complex regional pain syndrome. Avascular necrosis is manifested by pain and limited movement. Pain and decreased function are the prime indicators of reaction to an internal fixation device. Heterotrophic ossification causes muscular pain and limited muscular contraction and movement. (Chapter 42: Management of Patients With Musculoskeletal Trauma - Page 1197)

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? a) The fracture results from an underlying bone disorder. b) The fracture line extends through the entire bone substance. c) Bone fragments are separated at the fracture line. d) One side of the bone is broken and the other side is bent.

One side of the bone is broken and the other side is bent. Explanation: In a greenstick fracture, one side of the bone is broken and the other side is bent. A greenstick fracture also may refer to an incomplete fracture in which the fracture line extends only partially through the bone substance and doesn't disrupt bone continuity completely. (Other terms for greenstick fracture are willow fracture and hickory-stick fracture.) The fracture line extends through the entire bone substance in a complete fracture. A fracture that results from an underlying bone disorder, such as osteoporosis or a tumor, is a pathologic fracture, which typically occurs with minimal trauma. Bone fragments are separated at the fracture line in a displaced fracture. (Chapter 42: Management of Patients With Musculoskeletal Trauma - Page 1190)

A client asks the nurse why his residual limb cannot be elevated on a pillow. What is the best response by the nurse? a) "Elevating the extremity may increase your chances of compartment syndrome." b) "Elevating the leg might lead to a flexion contracture." c) "I am sorry. We ran out of pillows. I can elevate it on a few blankets." d) "You need to turn yourself side to side. If your leg is on a pillow, you would not be able to do that."

"Elevating the leg might lead to a flexion contracture." Explanation: Elevating the residual limb on a pillow may lead to a flexion contracture; this could jeopardize the client's ability to use a prosthesis. The client does need to turn to both sides but might still be able to do it with the extremity elevated. Elevating the extremity would not increase the risk for compartment syndrome. The limb should not be elevated on pillows or blankets. (Chapter 42: Management of Patients With Musculoskeletal Trauma - Page 1217)

Which of the following are associated with compartment syndrome? Select all that apply. - Trauma from accidents - Surgery - Crushing injuries - Tight bandages - Casts

- Trauma from accidents - Surgery - Crushing injuries - Tight bandages - Casts Explanation: Risk factors for compartment syndrome include trauma from accidents, surgery, casts, tight bandages, and crushing injuries. In addition, it may be caused by any condition that increases the risk of bleeding or edema in a confined space including patients with soft tissue injury, without fractures, who are on anticoagulants or have bleeding dyscrasias. (Chapter 42: Management of Patients With Musculoskeletal Trauma - Page 1194)

A client has had surgical repair of a hip injury after joint manipulation was unsuccessful. After surgery, the nurse implements measures to prevent complications. Which complications is the nurse seeking to prevent? Select all that apply. - diarrhea - skin breakdown - wound infection - pneumonia

- skin breakdown - wound infection - pneumonia Explanation: After surgery, the nurse implements measures to prevent skin breakdown, wound infection, pneumonia, constipation, urinary retention, muscle atrophy, and contractures. (Chapter 42: Management of Patients With Musculoskeletal Trauma - Page 1203)

The nurse advises a 36-year-old patient who suffered a severe wrist sprain subsequent to a fall that she can begin progressive passive and active exercises in: a) 24 to 48 hours. b) 3 to 5 days. c) 1 to 3 weeks. d) 1 month.

1 to 3 weeks. Explanation: Depending on the severity of the injury, exercises can begin from 2 to 5 days (mild) or 1 to 3 weeks (severe). A sprain takes weeks to months to heal because tendons and ligaments are relatively avascular. (Chapter 42: Management of Patients With Musculoskeletal Trauma - Page 1186)

Which is a hallmark sign of compartment syndrome? a) Motor weakness b) Pain c) Edema d) Weeping skin surfaces

Pain Explanation: A hallmark sign of compartment syndrome is pain that occurs or intensifies with passive range of motion. (Chapter 42: Management of Patients With Musculoskeletal Trauma - Page 1194)

Which may occur if a client experiences compartment syndrome in an upper extremity? a) Subluxation b) Callus c) Whiplash injury d) Volkmann's contracture

Volkmann's contracture Explanation: If compartment syndrome occurs in an upper extremity, it may lead to Volkmann's contracture, a claw-like deformity of the hand resulting from obstructed arterial blood flow to the forearm and hand. A whiplash injury is a cervical spine sprain. Callus refers to the healing mass that occurs with true bone formation after a fracture. Subluxation refers to a partial dislocation. (Chapter 42: Management of Patients With Musculoskeletal Trauma - Page 1199)

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? a) strain b) sprain c) dislocation d) fracture

dislocation Explanation: In joint dislocation, radiographic films show intact yet malpositioned bones. Arthrography or arthroscopy may reveal damage to other structures in the joint capsule. A strain is an injury to a muscle when it is stretched or pulled beyond its capacity. Sprains are injuries to the ligaments surrounding a joint. A fracture is a break in the continuity of a bone. (Chapter 42: Management of Patients With Musculoskeletal Trauma - Page 1186)

The type of fracture described as having one side of the bone broken and the other side bent would be: a) oblique. b) spiral. c) greenstick. d) transverse.

greenstick. Explanation: A greenstick fracture is the type of fracture described as having one side of the bone broken and the other side bent. An oblique fracture occurs at an angle across the bone. A spiral fracture is a fracture that twists around the shaft of the bone. A transverse fracture is a fracture that is straight across the bone. (Chapter 42: Management of Patients With Musculoskeletal Trauma - Page 1190)

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? a) "Use a knitting needle to scratch itches inside the cast." b) "A foul smell from the cast is normal." c) "Keep your right leg elevated above heart level." d) "Cover the cast with a blanket until the cast dries."

"Keep your right leg elevated above heart level." Explanation: The nurse should instruct the client to elevate the leg to promote venous return and prevent edema. The cast shouldn't be covered while drying. Covering the cast will cause heat buildup and prevent air circulation. The client should be instructed not to insert foreign objects into the cast because of the risk of cutting the skin and causing an infection. A foul smell from a cast is never normal and may indicate an infection. (Chapter 42: Management of Patients With Musculoskeletal Trauma - Page 1194)

An older adult client slipped on an area rug at home and fractured the left hip. The client is unable to have surgery immediately and is having severe pain. What interventions should the nurse provide for the patient to minimize energy loss in response to pain? a) Avoid administering too much medication because the client is older. b) Administer prescribed analgesics around-the-clock. c) Administer prescribed pain medication only when the client requests it. d) Give pain medication to the client after providing care.

Administer prescribed analgesics around-the-clock. Explanation: Pain associated with hip fracture is severe and must be carefully managed with around-the-clock dosing of pain medication to minimize energy loss in response to pain. The client may not request the medication even if they are in pain, and it should be offered at the prescribed time. Give pain medication prior to providing any type of care involved in moving the client. (Chapter 42: Management of Patients With Musculoskeletal Trauma - Page 1204)

An x-ray demonstrates a fracture in which a bone has splintered into several pieces. Which type of fracture is this? a) Comminuted b) Impacted c) Depressed d) Compound

Comminuted Explanation: A comminuted fracture may require open reduction and internal fixation. A compound fracture is one in which damage also involves the skin or mucous membranes. A depressed fracture is one in which fragments are driven inward. An impacted fracture is one in which a bone fragment is driven into another bone fragment. (Chapter 42: Management of Patients With Musculoskeletal Trauma - Page 1189-1190)

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? a) Oblique b) Spiral c) Compound d) Greenstick

Compound Explanation: A compound fracture is a fracture in which damage also involves the skin or mucous membranes with the risk of infection great. A greenstick fracture is where one side of the bone is broken and the other side is bent; it does not protrude through the skin. An oblique fracture occurs at an angle across the bone but does not protrude through the skin. A spiral fracture twists around the shaft of the bone but does not protrude through the skin. (Chapter 42: Management of Patients With Musculoskeletal Trauma - Page 1189)

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? a) Performing passive range-of-motion (ROM) exercises on the client's legs once each shift b) Maintaining the client in semi-Fowler's position c) Keeping a pillow between the client's legs at all times d) Turning the client from side to side every 2 hours

Keeping a pillow between the client's legs at all times Explanation: After open reduction with internal fixation, the client must keep the affected leg abducted at all times; placing a pillow between the legs reminds the client not to cross the legs and to keep the leg abducted. Passive or active ROM exercises shouldn't be performed on the affected leg during the postoperative period, because this could damage the operative site and cause hip dislocation. Most clients should be turned to the unaffected side, not from side to side. After open reduction with internal fixation, the client must avoid acute flexion of the affected hip to prevent possible hip dislocation; therefore, semi-Fowler's position should be avoided. (Chapter 42: Management of Patients With Musculoskeletal Trauma - Page 1204)

Which nursing intervention is essential in caring for a client with compartment syndrome? a) Starting an I.V. line in the affected extremity in anticipation of venogram studies b) Keeping the affected extremity below the level of the heart c) Wrapping the affected extremity with a compression dressing to help decrease the swelling d) Removing all external sources of pressure, such as clothing and jewelry

Removing all external sources of pressure, such as clothing and jewelry Explanation: Nursing measures should include removing all clothing, jewelry, and external forms of pressure (such as dressings or casts) to prevent constriction and additional tissue compromise. The extremity should be maintained at heart level (further elevation may increase circulatory compromise, whereas a dependent position may increase edema). A compression wrap, which increases tissue pressure, could further damage the affected extremity. There is no indication that diagnostic studies would require I.V. access in the affected extremity. (Chapter 42: Management of Patients With Musculoskeletal Trauma - Page 1194)