Musculoskeletal TB & WB
The nurse is caring for a patient with osteomyelitis. Which lab results are of primary concern for this disorder?
White blood cell count and erythrocyte sedimentation rate
A man who severed a finger while working on his car comes into the emergency department. The bleeding from the site is well controlled, and the patient is alert and stable. What does the nurse do with the severed finger?
Wrap it in dry gauze, place it in a water proof bag, and put the bag in ice water
A nurse cares for a client who had a wrist cast applied 3 days ago. The client states, The cast is loose enough to slide off. How should the nurse respond?
You need a new cast now that the swelling has decreased.
A patient with a leg cast denies pain; toes are pink, capillary refill is brisk and toes move freely, and the leg is elevated with an ice pack. Six hours later, the patient reports worsening pain unrelieved by medication. The patients toes are cool and pulse is difficult to detect. What does the nurse suspect is occurring?
Acute compartment syndrome
A patient with chronic osteomyelitis is being discharged from the hospital. What information is important for the nurse to teach this client and family?
Adherence to the antibiotic regimen. Eating high protein and high carbohydrate foods. Proper use of the intravenous equipment.
A nurse cares for a client with a fracture injury. Twenty minutes after an opioid pain medication is administer, the client reports pain in the site of the fracture. Which actions should the nurse take?
Administer additional opioids and prescribed. Elevate the extremity on pillows. Apply ice to the fracture site.
A nurse assesses an older client who was admitted 2 days ago with a fractured hip. The nurse notes that the client is confused and restless. The clients vital signs are heart rate 98 beats/min, respiratory rate 32 breaths/min, blood pressure 132/78 mm Hg, and SpO2 88%. Which action should the nurse take first?
Administer oxygen via nasal cannula.
An older adult has been admitted with a hip fracture. Approximately 20 hours after injury the patient develops a sign that the nurse recognizes as an early indicator of fat embolism syndrome. What is the sign?
Change in mental status
A patient who has sustained a traumatic amputation of the left leg expresses grief and loss. What resources could the nurse recommend to help the patient adjust to his lost limb?
Chaplain Psychiatric social worker National Amputation foundation Other spiritual leaders
Which syndrome is described as a dysfunction of the central and peripheral nervous systems, leading to severe chronic pain?
Complex regional pain syndrome (CRPS)
The nurse is reviewing the laboratory results of a patient who may have fat embolism syndrome. Which adnormal laboratory finding accompany this condition?
Decreased Pao2 level (often below 60) Increased ESR Decreased serum calcium Decreased RBC and platelet counts Increased serum level of lipids
When assessing the child with ostogenesis imperfecta, the nurse should expect to make which observation?
Discolored Teeth
The nurse is assessing a client for chronic osteomyelitis. Which features distinguish this from the acute form of the disease? SATA
Draining sinus tracts. Presence of foot ulcers. Acute would be high fever, swelling, redness. Pain and tenderness can be in either.
The nurse is caring for a patient with complex regional pain syndrome (CRPS). Which clinical sign of CRPS is a manifestation of autonomic nervous system dysfunction seen in this complication?
Edema
A nurse assesses a client with a cast for potential compartment syndrome. Which clinical manifestations are correctly paired with the physiologic changes of compartment syndrome?
Edema increased capillary permeability. Unequal pulses increased production of lactic acid. Cyanosis Anaerobic metabolism
The nurse must adjust a pair of crutches to properly fit a patient. Which description illustrates correct crutch adjustment?
Elbow is flexed no more than 30 degrees when the palm is on the handle
A nurse plans care for a client who is recovering from a below the knee amputation of the left leg. Which intervention should the nurse include in this clients plan of care?
Encourage range of motion. This prevents flexion contractions and prepares for a prosthesis.
A young high school athlete had a great toe amputated because of severe injury. The patient is depressed and withdrawn after the health care provider tells him that the amputation will affect balance and gait. What should the nurse do first?
Encourage verbalization of feelings and thoughts related to the situation.
A 30 year old patient who is hospitalized for repair of a fractured tibia and fibula reports shortness of breath. Which complication related to the injury might the patient be experiencing?
Fat embolism
Compared to acute osteomyelitis which characteristic is more associated with chronic osteomyelitis?
Sinus tract formation
The nurse is providing teaching for a patient with a forearm cast. What information does the nurse give to the patient?
Sling should distribute weight over a large area of the shoulders and trunk.
A patient in a cast reports a painful "hot spot" underneath the cast, and the nurse notices an unpleasant odor. Which intervention is the nurse most likely to perform first?
Take the patients temperature and other vital signs
A 40 year old patient is admitted for acute osteomyelitis of the left lower leg. What does the nurse expect to find documented in the patients admitting assessment?
Temperature greater than 101, swelling, tenderness, erythema, and warmth of area
Which is a realistic outcome for a child with osteogenesis imperfecta?
The child will have a decreased number of fractures.
A nurse is caring for a client who is recovering from an above the knee amputation. the client reports pain in the limb that was removed. How should the nurse respond?
How would you describe the pain that you are feeling?
A nurse notes crepitation when performing rang of motion exercises on a client with a fractured left humerus. Which action should the nurse take next?
Immobilize the left arm.
A patient comes to the emergency department after slipping on some chalk in her classroom. She "did not have a hard all" and was able to walk with the assistance of one of her students. What type of fracture does the patient most likely have?
Incomplete = able to walk with assistance
Which clinical sign of complex regional pain syndrome (CRPS) does the nurse know to be a manifestation of the sensory perception abnormalities seen in this syndrome?
Intense burning pain
Which factor is important to include in the teaching plan for the parents of a child with legg-calve-Perthes disease?
Legg-Calve-Perthese disease is a self limiting disease that affects the blood supply to the femoral epiphysis.
The nurse cares for several patients on an orthopedic trauma unit. Which conditions pose a high risk for development of acute compartment syndrome?
Lower legs caught between the bumpers of two cars. Massive infiltration of IV fluid into forearm. Multiple insect bites to lower legs. Severe burns o the upper extremities.
A patient reports dramatic changes in color and temperature of the skin over the left foot with intense burning pain, sensitive skin, excessive sweating, and edema. The health care provider makes a preliminary diagnosis of complex regional pain syndrome. Which is the priority for nursing care?
Management of pain
A nurse reviews prescriptions for an 82 year old client with a fractured left hip. Which prescription should alert the nurse to contact the provider and express concern for his safety?
Meperidine (Demerol) 50mg IV every 4 hours
A nurse cares for a client with a fractured fibula. Which assessment should alert the nurse to take immediate action?
Numbness in the extremity. Numbness or tingling can be a sign of acute compartment syndrome.
A nurse cares for a client in skeletal traction. The nurse notes that the skin around the clients pin sites is swollen, red, and crusty with dried drainage. Which action should the nurse take first?
Obtain a prescription to culture the drainage. This could be a sign of possible infection that can lead to osteomyelitis.
An older patients family is trying to find an appropriate cane for the patient to use because of chronic pain in the right ankle. The nurse instructs the family to purchase what type of cane?
One with a top that is parallel to greater trochanter of the femur
A patient comes into the emergency department after falling off his four wheeler. Assessment of his lower leg reveals bleeding and bone fragments protruding from the skin. What type of fracture does this patient most likely have?
Open is protruding
Which motor clinical manifestation may be seen in a patient with complex regional pain syndrome (CRPS)?
Paresis
A female patient with osteoporosis comes to the emergency department after falling suddenly while opening her car door. She said she felt as though her "leg gave way" and caused her to fall. What type of fracture is this most likely?
Pathologic = caused by disease
A nurse cares for an adult client with multiple fractures. Which action should the nurse take to manage the client pain?
Patient controlled analgesia pump with morphine
The patient is admitted for acute osteomyelitis of the right lower leg with severe vascular compromise. Upon assessment the patient denies pain or discomfort in the leg. Based on the concept of perfusion, how does the nurse interpret the patients response?
Patient has sustained extensive nerve damage because of inadequate perfusion.
A patient has a fracture of the right wrist. What is an early sign that indicates this patient may be having a complication?
Patient reports a subjective numbness and tingling.
Which signs/symptoms represent the priority concepts for musculoskeletal trauma?
Patient reports decreased range of motion and pain in leg that is unrelieved by medication. Indicated compartment syndrome.
A chemical sympathetic nerve block may be used to manage complex regional pain syndrome (CRPS). Which drug, administered intravenously, is used to block sympathetic nerve receptors?
Phentolamine
The nurse is supervising a nursing student who is caring for a patient with a cast to the lower leg who reports pain that is worsening despite medication, with decreased movement and skin sensation. The nurse would intervene if the student performed which action?
Places an extra pillow underneath the cast
A phone triage nurse speaks with a client who has an arm cast. The client states, my arm feels really tight and puffy. How should you respond?
Please come to the clinic today to have your arm checked by the provider. Could indicate compartment syndrome.
A home health nurse assesses a client with diabetes who has a new cast on the arm. The nurse notes the clients fingers are cool and slightly swollen. Which action should the nurse take first?
Raise the arm above the level of the heart.
After teaching a client with a fractured humerus, the nurse assesses the clients understanding. Which dietary choice demonstrates that the client correctly understands the nutrition needed to assist in healing the fracture?
Roast beef with low fat milk and vitamin C supplement
The UAP is assisting the orthopedic cast technician to cut a window in the patients cast. What does the nurse instruct the UAP to do?
Save the cutout cast pieces so it can be taped in place.
A trauma nurse cares for several clients with fractures. Which client should the nurse identify as at the highest risk for developing deep vein thrombosis?
A 74 year old man who smokes and has a fractured pelvis.
The nurse's neighbor comes running over because her husband "cut his finger off with a power saw." What is the priority nursing action?
Assess for airway and breathing problems.
An emergency department nurse cares for a client who sustained a crush injury to the right lower leg. The client reports numbness and tingling in the affected leg. Which action should the nurse take first?
Assess the pedal pulses. These symptoms represent early warning signs of acute compartment syndrome. Would need to notify doctor if decrease in pulses.
A nurse assesses a client with a pelvic fracture. Which assessment finding should the nurse identify as a complication of this injury?
Hematuria
When teaching the parents of a child with osteogenesis imperfecta about nutrition, the nurse should emphasize a diet that is:
High in calcium
A nurse teaches a client about prosthesis care after amputation. Which statements should the nurse include in this clients teaching?
The device has been custom made for you. Make sure that you wear the correct liners with your prosthetic. I have scheduled a follow up appointment for you.
The major concern guiding treatment for the child with legg-calve-Perthes disease is to:
The priority concern for treatment is to prevent deformity through decreased activity.
A nurse coordinates care for a client with a wet plaster cast. Which statement should the nurse include when delegating care for this client to an unlicensed assistive personnel?
Use a cloth-covered pillow to elevate the clients leg.
The nurse is caring for a patient with an open fracture. Which intervention does the nurse perform to prevent infection of the fracture?
Use aseptic technique for dressing changes and wound irrigations.
