Management of Patients with Musculoskeletal Trauma
A client undergoes a total hip replacement. Which statement made by the client indicates to the nurse that the client requires further teaching?
"I don't know if I'll be able to get off that low toilet seat at home by myself."
A client is being discharged from the Emergency Department after being diagnosed with a sprained ankle. Which client statement indicates the client understands the discharge teaching?
"I'll make sure to keep my ankle elevated as much as possible."
When is it advisable for the nurse to apply heat to a sprain or a contusion?
After 2 days
When providing discharge teaching to a client with a fractured toe, the nurse should include which instruction?
Apply ice to the fracture site.
An important nursing assessment, post fracture, is to evaluate neurovascular status. Therefore, the nurse should check for:
Capillary refill.
An x-ray demonstrates a fracture in which a bone has splintered into several pieces. Which type of fracture is this?
Comminuted
Which of the following would lead a nurse to suspect that a client has a rotator cuff tear?
Difficulty lying on affected side
Which of the following disorders results in widespread hemorrhage and microthrombosis with ischemia?
Disseminated intravascular coagulation (DIC)
Colles fracture occurs in which area?
Distal radius
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.
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
Which type of fracture involves a break through only part of the cross-section of the bone?
Incomplete
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
Which factor inhibits fracture healing?
Local malignancy
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?
Provide feedback on the client's strengths and available resources.
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
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
A client has been diagnosed with a muscle strain. What does the physician mean with the term "strain"?
stretched or pulled beyond its capacity
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?
Administer prescribed analgesics around-the-clock.
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
A patient sustains an open fracture of the left arm after an accident at the roller skating rink. What does emergency management of this fracture involve? (Select all that apply.)
Covering the area with a clean dressing if the fracture is open Immobilizing the affected site Splinting the injured limb
Which nursing intervention is appropriate for monitoring the client for the development of Volkmann's contracture?
Assess the radial pulse.
Emergency medical technicians transport a client to the emergency department and inform the nurse that the client fell from a two-story building. The comatose client has a large contusion on the left side of the chest, a hematoma in the left parietal area, and a compound fracture of the left femur. The client was intubated and is maintaining an arterial oxygen saturation of 92% by pulse oximeter with a manual-resuscitation bag. Which intervention by the nurse has the highest priority?
Assessing the left leg
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?
Claw-like deformity of the right hand without ability to extend fingers
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?
Compartment 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
Which type of fracture is one in which the skin or mucous membrane wound extends to the fractured bone?
Compound
Which of the following is a term used to describe a soft tissue injury produced by a blunt force?
Contusion
After a car accident, a client is admitted to an acute care facility with multiple traumatic injuries, including a fractured pelvis. For 24 to 48 hours after the accident, the nurse must monitor the client closely for which potential complication of a fractured pelvis?
Fat embolism
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
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 client has a history of dislocations of the same joint. The nurse understands that this is most likely due to an insufficient deposit of collagen during the healing process, leading to:
reduced tensile strength.
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?
6 to 8 weeks
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?
Between 24 and 48 hours
Which nursing intervention is appropriate for a client with a closed-reduction extremity fracture?
Encourage participation in ADLs
A fracture is considered pathologic when it
occurs through an area of diseased bone.
A nurse is caring for a client who has had an amputation. What interventions can the nurse provide to foster a positive self-image? (Select all that apply.)
Encouraging the client to care for the residual limb Allowing the client to express grief Introducing the client to local amputee support groups
A client experienced an open fracture to the left femur during a horse-riding accident. For which complication is this client at highest risk?
Infection
Which is a hallmark sign of compartment syndrome?
Pain
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.
skin breakdown wound infection pneumonia
