PrepU - Ch. 37: Management of Patients with MSK Trauma

Which actions by the nurse demonstrate an understanding of caring for a client in traction? Select all that apply. - Removing skeletal traction to turn and reposition the client - Ensuring that the weights are hanging freely - Placing a trapeze on the bed - Frequently assessing pain level - Assessing the client's alignment in the bed

- Ensuring that the weights are hanging freely - Placing a trapeze on the bed - Frequently assessing pain level - Assessing the client's alignment in the bed (The weights must hang freely, with the client in good alignment in the center of the bed. The nurse should frequently monitor pain, as uncontrolled pain may be a sign of a complication. The client will be able to assist with alignment and bed mobility if a trapeze is placed on the bed. Skeletal traction should never be interrupted.)

The nurse teaches the client which intervention to avoid hip dislocation after replacement surgery? A) Never cross the affected leg when seated B) Bend forward only when seated in a chair C) Avoid placing a pillow between the legs when sleeping D) Keep the knees together at all times

A) Never cross the affected leg when seated (Crossing the affected leg may result in dislocation of the hip joint after total hip replacement. The client should be taught to keep the knees apart at all times, to put a pillow between the legs when sleeping, and to avoid bending forward when seated in a chair.)

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. What is the priority action of the nurse? A) Notify the health care provider. B) Apply Buck's traction. C) Externally rotate the extremity. D) Bend the knee and rotate the knee internally.

A) Notify the health care provider. (If any clinical manifestations of dislocation of the prosthesis occur, including acute groin pain in the affected hip or shortening of the affected extremity, the nurse (or the client, if at home) must immediately notify the surgeon, because the hip must be reduced and stabilized promptly so that the leg does not sustain circulatory and nerve damage. After closed reduction, the hip may be stabilized with Buck's traction or a brace to prevent recurrent dislocation. As the muscles and joint capsule heal, the chance of dislocation diminishes. Stresses to the new hip joint should be avoided for the first 8 to 12 weeks, when the risk of dislocation is greatest.)

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

A) The hip may be flexed to put on clothing such as pants, stockings, socks, or shoes. (Guidelines for avoiding hip dislocation after replacement surgery specify that the hip should not be flexed to put on clothing such as pants, stockings, socks, or shoes. Clients should keep the knees apart at all times, put a pillow between the legs when sleeping, and never cross the legs when seated.)

A nurse is reviewing a client's activities of daily living prior to discharge from total hip replacement. The nurse should identify what activity as posing a potential risk for hip dislocation? A) Lifting items above shoulder level B) Transferring from a sitting to standing position C) Bending down to put on socks D) Straining during a bowel movement

C) Bending down to put on socks (Bending to put on socks or shoes can cause hip dislocation. None of the other listed actions poses a serious threat to the integrity of the new hip.)

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

A) "I don't know if I'll be able to get off that low toilet seat at home by myself." (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.)

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

B) "Keep your right leg elevated above heart level." (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.)

The health care provider is preparing to bivalve the client's cast. Which supplies should the nurse assemble? A) Stockinette and cotton padding B) Sterile saline and basin C) Gauze bandages and tape D) Elastic compression bandages

D) Elastic compression bandages (Bivalving of a cast involves splitting the cast longitudinally and spreading the cast apart to relieve pressure. The fractured extremity is immobilized by securing the two parts of the cast together with an elastic compression bandage.)

The orthopedic surgeon has prescribed balanced skeletal traction for a client. What advantage is conferred by balanced traction? A) Balanced traction is portable and may accompany the client's movements. B) Balanced traction allows for greater client movement and independence than other forms of traction. C) Balanced traction can be applied at night and removed during the day. D) Balanced traction facilitates bone remodeling in as little as 6 days.

B) Balanced traction allows for greater client movement and independence than other forms of traction. (Often, skeletal traction is balanced traction, which supports the affected extremity, allows for some client movement, and facilitates client independence and nursing care while maintaining effective traction. It is not portable, however, and it cannot be removed. Bone remodeling takes longer than 6 days.)

A patient in pelvic traction needs circulatory status assessed. How should the nurse assess for a positive Homans' sign? A) Have the patient squeeze the nurse's hands with his or her hands to evaluate any difference in strength. B) Have the patient extend each leg and dorsiflex each foot to determine if pain or tenderness is present in the lower leg. C) Have the patient plantar flex both feet while the nurse performs the blanch test on all of the patient's toes. D) Have the patient extend both hands while the nurse compares the volume of both radial pulses.

B) Have the patient extend each leg and dorsiflex each foot to determine if pain or tenderness is present in the lower leg. (The nurse should assess for pain on passive flexion of each foot, which could indicate deep vein thrombosis.)

A nurse is providing discharge education to a client who is going home with a cast on his leg. What topic should the nurse emphasize in the teaching session? A) Removing the cast correctly at the end of the treatment period B) Reporting signs of impaired circulation C) Using crutches efficiently D) Exercising joints above and below the cast, as prescribed

B) Reporting signs of impaired circulation (Reporting signs of impaired circulation is critical; signs of impaired circulation must be reported to the physician immediately to prevent permanent damage. For this reason, this education is a priority over exercise and crutch use. The client does not independently remove the cast.)

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

C) Apply antiembolism stockings (Applying antiembolism stockings helps prevent deep vein thrombosis (DVT) in a client who is immobilized due to orthopedic surgery. Regular administration of analgesics controls and prevents escalation of pain, while ROM exercises help maintain muscle strength and tone and prevent contractions. On the other hand, cold packs are applied to help reduce swelling; cold does not prevent deep vein thrombosis.)

A nurse is caring for a client with a cast on the left arm after sustaining a fracture. Which assessment finding is most significant for this client? A) Presence of a normal popliteal pulse B) Cast edges are rough, with skin irritation present C) Fingers on the left hand are swollen and cool D) Minimal pain in the left arm

C) Fingers on the left hand are swollen and cool (Swollen and cool fingers on the left hand are the most significant assessment findings. They represent altered circulation to the hand caused by the cast. A normal radial, not popliteal, pulse should be present in the left arm; the popliteal pulse is found on the leg. Skin irritation is an abnormal assessment finding but it isn't as significant as altered circulation. Minimal pain in the left arm is expected.)

A nurse is caring for a client who is recovering in the hospital following orthopedic surgery. The nurse is performing frequent assessments for signs and symptoms of infection in the knowledge that the client faces a high risk of what infectious complication? A) Sepsis B) Septic arthritis C) Osteomyelitis D) Cellulitis

C) Osteomyelitis (Infection is a risk after any surgery, but it is of particular concern for the postoperative orthopedic client because of the risk of osteomyelitis. Orthopedic clients do not have an exaggerated risk of cellulitis, sepsis, or septic arthritis when compared to other surgical clients.)

An elite high school football player has been diagnosed and treated for a shoulder dislocation. What should the nurse emphasize during health education to facilitate the player's rejoining the team? A) The need to take analgesia regardless of the short-term absence of pain B) The fact that he has a permanently increased risk of future shoulder dislocations C) The importance of adhering to the prescribed treatment and rehabilitation regimen D) The importance of monitoring for intracapsular bleeding once he resumes playing

C) The importance of adhering to the prescribed treatment and rehabilitation regimen (Clients who have experienced sports-related injuries are often highly motivated to return to their previous level of activity. Adherence to restriction of activities and gradual resumption of activities need to be reinforced. Appropriate analgesia use must be encouraged, but analgesia does not necessarily have to be taken in the absence of pain. If healing is complete, the client does not likely have a greatly increased risk of reinjury. Dislocations rarely cause bleeding after the healing process.)

The nurse in an orthopedic clinic is caring for a new client. What sign or symptom 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

D) Difficulty lying on affected side (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.)

A client with a fracture develops compartment syndrome that requires surgical intervention. What treatment will the nurse would most likely prepare the client for? A) Amputation B) Bone graft C) Joint replacement D) Fasciotomy

D) Fasciotomy (Surgical treatment of compartment syndrome is achieved with a fasciotomy, a surgical incision of the fascia and separation of the muscle to relieve pressure and restore tissue perfusion. Bone graft, joint replacement or amputation may be done for a client who experiences avascular necrosis.)

The femur fracture that commonly leads to avascular necrosis or nonunion because of an abundant supply of blood vessels in the area is a fracture of the: A) Condylar area. B) Trochanteric region. C) Shaft of the femur. D) Femoral neck.

D) Femoral neck. (A fracture of the neck of the femur may damage the vascular system and the bone will become ischemic. Therefore, a vascular necrosis is common.)

Which of the following musculoskeletal injuries is manifested by acromioclavicular joint pain? A) Epicondylitis B) Acute compartment syndrome C) Heterotopic ossification D) Rotator cuff tears

D) Rotator cuff tears (Key assessment findings related to rotator cuff tears include acromioclavicular joint pain, limited range of motion, and muscle weakness. Epicondylitis (tennis elbow) is manifested by pain that usually radiates down the extensor surface of the forearm and generally is relieved with rest and avoidance of the aggravating activity. Heterotopic ossification is the abnormal formation of bone, near bones or in muscle, in response to soft tissue trauma after blunt trauma, fracture, or total joint replacement. Acute compartment syndrome involves a sudden and severe decrease in blood flow to the tissues distal to an area of injury that results in ischemic necrosis if prompt, decisive intervention does not occur.)

A client comes to the emergency department and it is found that the client's radial head is partially dislocated. What is this partially dislocated radial head documented as? A) Volkmann's contracture B) Compartment syndrome C) Sprain D) Subluxation

D) Subluxation (A partial dislocation is referred to as a subluxation. A Volkmann's contracture is a claw like deformity that results from compartment syndrome or obstructed arterial blood flow to the forearm and hand. Compartment syndrome is a condition in which a structure such as a tendon or nerve is constricted in a confined space and affects nerve innervation, leading to subsequent palsy. A sprain is injury to the ligaments surrounding the joint.)