N321: Final Exam - Musculoskeletal
A nurse is preparing a list of cast care instructions for a client who just had a plaster cast applied to his right forearm. Include what instructions for patient?
1) Keep cast and extremity elevated 2) The cast needs to be kept clean and dry allow the wet cast 24 hours to 72 hours to dry
A client with a hip fracture asks the nurse why Buck's extension traction is being applied before surgery. The nurse's response is based on the understanding that Buck's extension traction primarily:
1) Provides comfort by reducing muscle spasms 2) Provides fracture immobilization
A client is complaining of pain underneath a cast in the area of a bony prominence. The nurse interprets that this client may need to have what?
A window cut in the cast. A window may be cut in a dried cast to relieve pressure, monitor pulses, relieve discomfort, or remove drains
A nurse is checking the casted extremity of a client. The nurse would check for which of the following signs and symptoms indicative of infection A. edema B. no distal pulses C. hot spot on the cast
C. hot spot on the cast
A client has had skeletal traction applied to the right leg and has an overhead trapeze available for use. The nurse should monitor which the following as a high-risk area for pressure and breakdown?
Elbows if they are used for repositioning instead of trapeze, heel of good leg when used as a brace when pushing up in bed. ischial tuberosity, popliteal space, and achilles tendon
A nurse is assigned to care for a client with multiple trauma who is admitted to the hospital. The client has a leg fracture, and a plaster cast had been applied. In positioning the casted leg , the nurse should do what?
Elevate the leg on pillow continuously for 24-48 hours
A nurse is caring for a client with fresh application of a plaster leg cast. The nurse plans to prevent the development of compartment syndrome by doing what?
Elevating the limb and applying ice to the affected leg. Compartment syndrome is prevented by controlling edema. This is acheived most optimally with elevation and application of ice
If a nonplaster (fiberglass) gets wet, the client can dry it how?
If the cast gets wet, it can be dried with a hair dryer set to a COOL setting to prevent skin breakdown.
For the patient in Buck's extension traction which is applied to a leg, the nurse can provide counteraction by:
Slightly elevating the foot of the bed
A client has a fiberglass (nonplaster) cast applied to the lower leg. The client asks the nurse when he will be able to walk on the cast. The nurse replies that the client will be able to bear weight on the cast when?
The client can bear weight within 20 to 30 minutes of application
A nurse is planning to teach the client with a left arm cast about measures to keep the left shoulder from becoming stiff. Which suggestion would the nurse include in the teaching plan?
The shoulder of a casted arm should be lifted over the head perodically as a prevenetive measure.
All these medications are ordered at 9:00 AM for a patient who has had a right-hip replacement the previous day and is scheduled to ambulate with the physical therapist for the first time at 9:45. Which medication should be given first? a. Oxycodone (Roxicodone) 5 mg PO b. Ceftriaxone (Rocephin) 500 mg IV c. Enoxaparin (Lovenox) 30 mg SC d. Psyllium (Metamucil) 1 tsp PO
a. Oxycodone (Roxicodone) 5 mg PO R: The pain medication should be given so that it has time to take effect before the patient is ambulated. The other medications will not affect whether the patient can ambulate or not, although the antibiotic and anticoagulant medications should be given as soon as possible in order to maintain therapeutic blood levels.
A patient with a comminuted fracture of the right femur has Buck's traction in place while waiting for surgery. To assess for pressure areas on the patient's back and sacral area and to provide skin care, the nurse should a. have the patient lift the buttocks by bending and pushing with the left leg. b.turn the patient partially to each side with the assistance of another nurse. c. place a pillow between the patient's legs and turn gently to each side. d. loosen the traction and have the patient turn onto the unaffected side.
a. have the patient lift the buttocks by bending and pushing with the left leg. R: The patient can lift the buttocks off the bed by using the left leg without changing the right-leg alignment. Turning the patient will tend to move the leg out of alignment. Disconnecting the traction will interrupt the weight needed to immobilize and align the fracture.
A patient with a fractured radius asks when the cast can be removed. The nurse will instruct the patient that the cast can be removed only after the bone a. is strong enough to stand mild stress. b. union is complete on the x-ray. c. fragments are fully fused. d. healing has started.
a. is strong enough to stand mild stress. R: The cast may be removed when callus ossification has occurred. It is not necessary to wait until radiologic union or complete bone fusion occurs. Bone healing starts immediately after the injury, but the cast will need to be worn at least 3 weeks.
A patient who has been hospitalized for 3 days with a hip fracture and Buck's traction has sudden onset shortness of breath and tachypnea. The patient tells the nurse, "I feel like I am going to die!" Which action should the nurse take first? a. Stay with the patient and offer reassurance. b. Administer oxygen at 4 L/min by a nasal cannula. c. Notify the health care provider about the patient's symptoms. d. Check the patient's legs for swelling or tenderness.
b. Administer oxygen at 4 L/min by a nasal cannula. R: The patient's clinical manifestations and history are consistent with a pulmonary embolus, and the nurse's first action should be to ensure adequate oxygenation. The nurse should offer reassurance to the patient, but meeting the physiologic need for oxygen is a higher priority. The health care provider should be notified after the oxygen is started and pulse oximetry and assessment for deep vein thrombosis (DVT) are obtained.
When giving home-care instructions to a patient who has multiple forearm fractures and a long-arm cast on the right arm, which information should the nurse include? a. Keep the hand immobile to prevent soft tissue swelling. b. Call the health care provider for increased swelling or numbness. c. Keep the right shoulder elevated on a pillow or cushion. d. Avoid the use of NSAIDs for the first 48 hours after the injury.
b. Call the health care provider for increased swelling or numbness. R: Increased swelling or numbness may indicate increased pressure at the injury, and the health care provider should be notified immediately to avoid damage to nerves and other tissues. The patient should be encouraged to move the joints above and below the cast to avoid stiffness. There is no need to elevate the shoulder, although the forearm should be elevated to reduce swelling. NSAIDs are appropriate to treat pain after a fracture.
The nurse observes a patient doing all these activities after having a hip-replacement surgery. Which patient action requires that the nurse intervene immediately? a. The patient sits straight up on the edge of the bed. b. The patient leans over to pull shoes and socks on. c. The patient bends over the sink while brushing the teeth. d. The patient uses crutches with a swing-to gait.
b. The patient leans over to pull shoes and socks on. R: Leaning over would flex the hip at greater than 90 degrees and predispose the patient to hip dislocation. The other patient actions are appropriate and do not require any immediate action by the nurse to protect the patient.
A patient hospitalized with multiple fractures has a long-arm plaster cast applied for immobilization of a fractured left radius. Until the cast has completely dried, the nurse should a. keep the left arm in a dependent position. b. handle the cast with the palms of the hands. c. place gauze around the cast edge to pad any roughness. d. cover the cast with a small blanket to absorb the dampness.
b. handle the cast with the palms of the hands. R: Until a plaster cast has dried, placing pressure on the cast should be avoided to prevent creating areas inside the cast that could place pressure on the arm. The left arm should be elevated to prevent swelling. The edges of the cast may be petaled once the cast is dry, but padding the edges before that may cause the cast to be misshapen. The cast should not be covered until it is dry because heat builds up during drying.
A patient is to be discharged from the hospital 4 days after undergoing a total hip arthroplasty. A statement by the patient that indicates a need for additional discharge instructions is a."I should not cross my legs while sitting." b."I can sleep in any position that is comfortable for me." c."I will use a toilet elevator on the toilet seat." d."I will have someone else put on my shoes and socks."
b."I can sleep in any position that is comfortable for me." R: The patient needs to sleep in a position that allows excessive internal rotation or flexion of the hip. The other patient statements indicate that the patient has understood the teaching.
A patient has a short-arm plaster cast applied at the outpatient center for a wrist fracture. An understanding of discharge teaching is apparent when the patient says, a. "I can get the cast wet as long as I dry it right away with a hair dryer." b. "I should avoid moving my fingers and elbow until the cast is removed." c. "I will apply an ice pack to the cast over the fracture site for the next 24 hours." d. "I can rub lotion on any itching areas under the cast with a cotton-tipped applicator."
c. "I will apply an ice pack to the cast over the fracture site for the next 24 hours." R: Ice application for the first 24 hours after a fracture will help to reduce swelling and can be placed over the cast. Plaster casts should not get wet. The patient should be encouraged to move the joints above and below the cast. Patients should not insert objects inside the cast.
A patient who has a proximal humerus fracture that is immobilized with a left-sided long-arm cast, and a sling is admitted to the medical-surgical unit. Which nursing intervention will be included in the plan of care? a. Use surgical net dressing to hang the arm from an IV pole. b. Immobilize the fingers on the left hand with gauze dressings. c. Assess the left axilla and change absorbent dressings as needed. d. Assist the patient in passive range of motion (ROM) for the right arm.
c. Assess the left axilla and change absorbent dressings as needed. R: The axilla can become excoriated when a sling is used to support the arm, and the nurse should check the axilla and apply absorbent dressings to prevent this. A patient with a sling would not have traction applied by hanging. The patient will be encouraged to move the fingers on the injured arm to maintain function and to help decrease swelling. The patient will do active ROM on the uninjured side.
A patient with an intracapsular fracture of the left femur is placed in Buck's traction before surgery for a hip replacement. The patient asks why traction is necessary when surgery is planned. The nurse's response to the patient is based on the knowledge that traction a. will help prevent flexion contractures of the affected hip. b. is necessary to prevent displacement of the fracture. c. will decrease the incidence of painful muscle spasms d. is used to maintain the leg in the external rotation position.
c. will decrease the incidence of painful muscle spasms R: Buck's traction keeps the leg immobilized and reduces muscle spasm. Flexion contractures are not likely to occur during the short time before surgery. Displacement of the hip is prevented by keeping the patient on bed rest before surgery. The leg is externally rotated because of the hip fracture, not because of traction.