prepU ch 42 Management of Patients With Musculoskeletal Trauma
A client is treated in the emergency department for acute muscle strain in the left leg caused by trying a new exercise. During discharge preparation, the nurse should provide which instruction?
"Apply ice packs for the first 24 to 48 hours, then apply heat packs."
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 has sustained a right tibial fracture and has just had a cast applied. Which instruction should the nurse provide in client cast care?
"Keep your right leg elevated above heart level."
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?
Contusion
Which nursing intervention is appropriate for a client with a closed-reduction extremity fracture?
Encourage participation in ADLs
Which nursing diagnosis takes highest priority for a client with a compound fracture?
Infection related to effects of trauma
Elderly clients who fall are most at risk for which injuries?
Pelvic fractures
Which of the following musculoskeletal injuries is manifested by acromioclavicular joint pain?
Rotator cuff tears
Colles fracture occurs in which area?
distal radius
A fracture is considered pathologic when it
occurs through an area of diseased bone.
A client has been diagnosed with a muscle strain. What does the physician mean with the term "strain"?
stretched or pulled beyond its capacity
The nurse is caring for a patient after arthroscopic surgery for a rotator cuff tear. The nurse informs the patient that full activity can usually resume after what period of time?
6 to 12 months
When is it advisable for the nurse to apply heat to a sprain or a contusion?
After 2 days
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?
All options are correct.
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
An x-ray demonstrates a fracture in which a bone has splintered into several pieces. Which type of fracture is this?
Comminuted
A client sustains a fractured right humerus in an automobile accident. The arm is edematous, the client states not being able to move or feel the fingers, and the nurse does not feel a pulse. What condition should the nurse be concerned about that requires emergency measures?
Compartment syndrome
In a client with a dislocation, the nurse should initially perform neurovascular assessments a minimum of every 15 minutes until stable. Which complication does the assessments help the nurse to monitor in the client?
Compartment syndrome
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 comes to the emergency department complaining of localized pain and swelling of the lower leg. Ecchymotic areas are noted. History reveals that the client got hit in the leg with a baseball bat. Which of the following would the nurse suspect as most likely?
Contusion
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?
Difficulty lying on affected side
Which of the following disorders results in widespread hemorrhage and microthrombosis with ischemia?
Disseminated intravascular coagulation (DIC)
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.
Which general nursing measure is used for a client with a fracture reduction?
Encourage participation in ADLs
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?
Fat emboli
The nurse is monitoring a patient who sustained a fracture of the left hip. The nurse should be aware that which kind of shock can be a complication of this type of injury?
Hypovolemic
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
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 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?
Prevent internal rotation of the affected leg.
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 sustains an injury to the ligaments surrounding a joint. What will the nurse identify this injury as?
Sprain
Which type of fracture is one in which the skin or mucous membrane wound extends to the fractured bone?
complete
A client is brought to the emergency department after being struck with a baseball bat on the upper arm while diving for a pitched ball. Diagnostic tests reveal that the humerus is not broken but that the client has suffered another type of injury. What type of injury would the physician likely diagnose?
contusion
The type of fracture described as having one side of the bone broken and the other side bent would be:
greenstick
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 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
An important nursing assessment, post fracture, is to evaluate neurovascular status. Therefore, the nurse should check for:
Capillary refill.
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
The primary nursing intervention that will control swelling while treating a musculoskeletal injury is:
Elevate the affected area.
A client with arterial insufficiency undergoes below-knee amputation of the right leg. Which action should the nurse include in the postoperative care plan?
Elevating the stump for the first 24 hours
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
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
