PrepU Ch 42: Musculoskeletal Trauma

Which of the following disorders results in widespread hemorrhage andmicrothrombosis with ischemia? a. Fat embolism syndrome (FES) b. Avascular necrosis (AVN) c. Disseminated intravascular coagulation (DIC) d. Complex regional pain syndrome (CRPS)

c. Disseminated intravascular coagulation (DIC) Rationale: DIC is a systemic disorder that results in widespread hemorrhage and microthrombosis with ischemia. AVN of the bone occurs when the bone loses its blood supply and dies. CRPS is a painful sympathetic nervous system problem. FES occurs when the fat globules released when the bone is fractured occludes the small blood vessels that supply the lungs, brain, kidneys, and other organs.

With fractures of the femoral neck, the leg is a. adducted and internally rotated. b. shortened, adducted, and externally rotated. c. abducted and externally rotated. d. shortened, abducted, and internally rotated.

b. shortened, adducted, and externally rotated. Rationale: With fractures of the femoral neck, the leg is shortened, adducted, and externally rotated.

A client with a recent left above-the-knee amputation states, "I can feel pain in my left toes." Which is the best response by the nurse? a. "Describe the pain and rate it on the pain scale." b. "Pain medication usually does not help this type of pain." c. "Your left toes have been amputated." d. "The pain is really from the nerves in the upper leg."

a. "Describe the pain and rate it on the pain scale." Rationale: The nurse should recognize phantom pain as real and complete a pain assessment as if the limb were attached. The client's pain should be address and treated appropriately. By telling the client that the toes have been amputated or the pain is really from the nerves in the upper leg, the nurse is negating the client's pain. Opioid pain medication can be effective with phantom pain.

A client is experiencing pain, joint instability, and difficulty walking due to an injury to the knee ligaments. The injury was judged not to require surgery. Which intervention would not be included in this client's care? a. traction b. joint immobilization c. ice and NSAIDs d. limited weight bearing

a. traction Rationale: Joint immobilization, limited weight bearing, ice, and NSAIDs would be included in the initial treatment. Traction is not required because there is no break, and surgery is not required.

When caring for a client with a fracture, what assessment would take priority? a. Hormonal imbalances b. Altered kidney function c. Neurovascular compromise d. Cardiac problems

c. Neurovascular compromise Rationale: When caring for a client with a fracture, the nurse assesses for the neurovascular compromise. A fracture or a treatment for fracture is not known to lead to hormonal imbalances, cardiac problems, or an altered kidney function.

A 14-year-old client is treated in the emergency room for an acute knee sprain sustained during a soccer game. The nurse reviews discharge instructions with the client's parent. The nurse instructs the parent that the acute inflammatory stage will last how long? a. 3 to 4 days b. 4 to 5 days c. At least 7 days d. 24 to 48 hours

d. 24 to 48 hours Rationale: Rest and ice applications during the first 24 to 48 hours produce vasoconstriction while decreasing bleeding and edema. After this time, the acute inflammatory stage decreases.

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? a. Subluxation b. Strain c. Dislocation d. Sprain

d. Sprain Rationale: A sprain is an injury to the ligaments and tendons surrounding a joint, usually caused by a wrenching or twisting motion. Dislocation refers to the separation of joint surfaces. Subluxation refers to partial separation or dislocation of joint surfaces. Strain refers to a muscle pull or tear.

Which term refers to an injury to ligaments and other soft tissues surrounding a joint? a. Strain b. Dislocation c. Subluxation d. Sprain

d. Sprain Rationale: A sprain is caused by a wrenching or twisting motion. Dislocation refers to the separation of joint surfaces. Subluxation refers to partial separation or dislocation of joint surfaces. Strain refers to a muscle pull or tear.

Which may occur if a client experiences compartment syndrome in an upper extremity? a. Callus b. Subluxation c. Whiplash injury d. Volkmann's contracture

d. Volkmann's contracture Rationale: If compartment syndrome occurs in an upper extremity, it may lead to Volkmann's contracture, a claw-like deformity of the hand resulting from obstructed arterial blood flow to the forearm and hand. A whiplash injury is a cervical spine sprain. Callus refers to the healing mass that occurs with true bone formation after a fracture. Subluxation refers to a partial dislocation.

After surgery to treat a hip fracture, a client returns from the postanesthesia care unit to the medical-surgical unit. Postoperatively, how should the nurse position the client? a. With the affected hip rotated externally b. With the leg on the affected side adducted c. With the affected hip flexed acutely d. With the leg on the affected side abducted

d. With the leg on the affected side abducted Rationale: The nurse must keep the leg on the affected side abducted at all times after hip surgery to prevent accidental dislodgment of the affected hip joint. Placing a pillow or an A-frame between the legs helps maintain abduction and reminds the client not to cross the legs. The nurse should avoid acutely flexing the client's affected hip (for example, by elevating the head of the bed excessively), adducting the leg on the affected side (such as by moving it toward the midline), or externally rotating the affected hip (such as by removing support along the outer side of the leg) because these positions may cause dislocation of the injured hip joint.

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? a. Do not flex the hip more than 60 degrees. b. Do not flex the hip more than 90 degrees. c. Do not flex the hip more than 30 degrees. d. Do not flex the hip more than 120 degrees.

b. Do not flex the hip more than 90 degrees. Rationale: Proper alignment and supported abduction are encouraged for hip repairs. Flexion of the hip more than 90 degrees can cause damage to the a repaired hip fracture.

Which term refers to a break in the continuity of a bone? a. Subluxation b. Malunion c. Fracture d. Dislocation

c. Fracture Rationale: A fracture is a break in the continuity of the bone. A malunion occurs when a fractured bone heals in a misaligned position. Dislocation is a separation of joint surfaces. A subluxation is a partial separation or dislocation of joint surfaces.

An important nursing assessment, post fracture, is to evaluate neurovascular status. Therefore, the nurse should check for: a. Swelling and discoloration. b. Capillary refill. c. Shortening and deformity. d. Crepitus.

b. Capillary refill. Rationale: Assessment for neurovascular impairment includes checking for weak pulses or delayed capillary refill (normal is <2 seconds).

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? a. Infection b. Fat embolism c. Compartment syndrome d. Volkmann's ischemic contracture

b. Fat embolism Rationale: Fat embolism is a relatively rare but life-threatening complication of pelvis and long-bone fractures, arising 24 to 48 hours after the injury. It occurs when fat droplets released at the fracture site enter the circulation, become lodged in pulmonary capillaries, and break down into fatty acids. Because these acids are toxic to the lung parenchyma, capillary endothelium, and surfactant, the client may develop pulmonary hypertension. Signs and symptoms of fat embolism include an altered mental status, fever, tachypnea, tachycardia, hypoxemia, and petechiae. Compartment syndrome and infection may complicate any fracture and aren't specific to a pelvis fracture. Volkmann's ischemic contracture is a potential complication of a hand or forearm fracture.

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? a. Maintaining the client in semi-Fowler's position b. Keeping a pillow between the client's legs at all times c. Performing passive range-of-motion (ROM) exercises on the client's legs once each shift d. Turning the client from side to side every 2 hours

b. Keeping a pillow between the client's legs at all times Rationale: After open reduction with internal fixation, the client must keep the affected leg abducted at all times; placing a pillow between the legs reminds the client not to cross the legs and to keep the leg abducted. Passive or active ROM exercises shouldn't be performed on the affected leg during the postoperative period, because this could damage the operative site and cause hip dislocation. Most clients should be turned to the unaffected side, not from side to side. After open reduction with internal fixation, the client must avoid acute flexion of the affected hip to prevent possible hip dislocation; therefore, semi-Fowler's position should be avoided.

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? a. Fat embolism syndrome b. Carpal tunnel syndrome c. Compartment syndrome d. Disseminated intravascular coagulation

c. Compartment syndrome Rationale: The nurse should initially perform neurovascular assessments a minimum of every 15 minutes until stable in a client with a dislocation to assess for compartment syndrome. It is a complication associated with dislocation. A client with a dislocation does not experience an increased risk of complications such as disseminated intravascular coagulation, carpal tunnel syndrome, or fat embolism syndrome.

A professional tennis player comes to the orthopedic clinic and informs the nurse that he is having pain that radiates down the forearm and is unable to grasp the racket firmly. What does the nurse suspect is occurring with the client? a. Ganglion cyst b. Shoulder dislocation c. Carpal tunnel syndrome d. Epicondylitis

d. Epicondylitis Rationale: Epicondylitis (tennis elbow) is a painful inflammation of the elbow that is caused by injury following excessive pronation and supination of the forearm, such as that which occurs when playing tennis, pitching a ball, or rowing. Client reports pain radiating down the dorsal surface of the forearm and a weak grasp. Carpal tunnel syndrome is compression of the median nerve and affects the hand with burning. Pain is more prominent in the early morning or at night. The pain of a ganglion cyst is more localized in the area of the cyst. The symptoms the client describes do not correlate with a diagnosis of shoulder rotation.

Pulselessness, a very late sign of compartment syndrome, may signify a. Lack of distal tissue perfusion b. Diminished arterial perfusion c. Nerve involvement d. Venous congestion

a. Lack of distal tissue perfusion Rationale: Pulselessness is a very late sign that may signify lack of distal tissue perfusion. The other answers do not apply.

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? a. sprain b. contusion c. subluxation d. strain

b. contusion Rationale: A contusion is a soft tissue injury resulting from a blow or blunt trauma. Sprains are injuries to the ligaments surrounding a joint. A strain is an injury to a muscle when it is stretched or pulled beyond its capacity. A subluxation is a partial dislocation.

Which is not one of the general nursing measures employed when caring for the client with a fracture? a. cranial nerve assessment b. assisting with ADLs c. administering analgesics d. providing comfort measures

a. cranial nerve assessment Rationale: Cranial nerve assessment would only be carried out for head-related injuries or diseases. General nursing measures include administering analgesics, providing comfort measures, assisting with ADLs, preventing constipation, promoting physical mobility, preventing infection, maintaining skin integrity, and preparing client for self-care.

A client asks the nurse why his residual limb cannot be elevated on a pillow. What is the best response by the nurse? a. "You need to turn yourself side to side. If your leg is on a pillow, you would not be able to do that." b. "Elevating the leg might lead to a flexion contracture." c. "I am sorry. We ran out of pillows. I can elevate it on a few blankets." d. "Elevating the extremity may increase your chances of compartment syndrome."

b. "Elevating the leg might lead to a flexion contracture." Rationale: Elevating the residual limb on a pillow may lead to a flexion contracture; this could jeopardize the client's ability to use a prosthesis. The client does need to turn to both sides but might still be able to do it with the extremity elevated. Elevating the extremity would not increase the risk for compartment syndrome. The limb should not be elevated on pillows or blankets.

Which nursing intervention is appropriate for a client with a closed-reduction extremity fracture? a. Promote intake of omega-3 fatty acids b. Administer prescribed enema to prevent constipation c. Use frequent dependent positioning to prevent edema d. Encourage participation in ADLs

d. Encourage participation in ADLs Rationale: General nursing measures for a client with a fracture reduction include administering analgesics, providing comfort measures, encouraging participation with ADLs, promoting physical mobility, preventing infection, maintaining skin integrity, and preparing the client for self-care. Omega-3 fatty acids have no implications on the diet of a client with a fracture reduction. Dependent positioning may increase edema because the extremity is below the level of the heart. While some pain medications may contribute to constipation, this intervention would be reserved for a client experiencing constipation and not as a preventative measure.

A patient sustains an open fracture with extensive soft tissue damage. The nurse determines that this fracture would be classified as what grade? a. III b. IV c. I d. II

a. III Rationale: Open fractures are graded according to the following criteria (Schaller, 2012): Grade I is a clean wound less than 1 cm long. Grade II is a larger wound without extensive soft tissue damage or avulsions. Grade III is highly contaminated and has extensive soft tissue damage. It may be accompanied by traumatic amputation and is the most severe.

A nurse is caring for a construction worker who fell from the second story of a building site and fractured the femoral neck. Which nursing diagnosis is a priority for the client? Select all that apply. a. Risk for injury b. Risk for infection c. Impaired physical mobility d. Disturbed body image e. Urinary incontinence

a. Risk for injury b. Risk for infection c. Impaired physical mobility Rationale: The usual surgical management for a femoral neck fracture is an open reduction and internal fixation with nails or screws, placing the client at risk for infection from a surgical incision. The client's physical mobility is impaired, increasing the risk for injury. Disturbed body image and urinary incontinence are not expected problems for the client with a femoral neck fracture.

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? a. Neurogenic b. Hypovolemic c. Cardiogenic d. Septic

b. Hypovolemic Rationale: In a client with a pelvic fracture, the nurse should be aware of the potential for hypovolemic shock resulting from hemorrhage. Cardiogenic shock, in which the heart cannot pump enough blood to meet the body's needs, often arises from severe myocardial infarction. Neurogenic shock is often a consequence of spinal cord injury and resulting loss of sympathetic nervous system function. Septic shock results from body-wide infection.

A client has been diagnosed with a muscle strain. What does the physician mean with the term "strain"? a. injury resulting from a blow or blunt trauma b. stretched or pulled beyond its capacity c. subluxation of a joint d. injuries to ligaments surrounding a joint

b. stretched or pulled beyond its capacity Rationale: A strain is an injury to a muscle when it is stretched or pulled beyond its capacity.

Which of the following musculoskeletal injuries is manifested by acromioclavicular joint pain? a Heterotopic ossification b. Acute compartment syndrome c. Epicondylitis d. Rotator cuff tears

d. Rotator cuff tears Rationale: 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.

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. Femoral neck. b. Shaft of the femur. c. Condylar area. d. Trochanteric region.

a. Femoral neck. Rationale: 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.

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? a. Strain b. Sprain c. Contusion d. Fracture

c. Contusion Rationale: The client's description of blunt trauma by a baseball bat and localized pain in conjunction with swelling and ecchymosis would most likely suggest a contusion. A fracture would be manifested by pain, loss of function, deformity, swelling, and spasm. A sprain would be manifested by pain and swelling; ecchymosis may appear later. A strain is characterized by inflammation, local tenderness, and muscle spasms.

Which of the following would lead a nurse to suspect that a client has a rotator cuff tear? a. Increased 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 Rationale: 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 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? a. heat and immobilization b. analgesia and immobilization c. joint manipulation and immobilization d. ice and immobilization

c. joint manipulation and immobilization Rationale: The physician manipulates the joint or reduces the displaced parts until they return to normal position, then immobilizes the joint with an elastic bandage, cast, or splint for several weeks.

An x-ray demonstrates a fracture in which a bone has splintered into several pieces. Which type of fracture is this? a. Compound b. Comminuted c. Depressed d. Impacted

b. Comminuted Rationale: A comminuted fracture may require open reduction and internal fixation. A compound fracture is one in which damage also involves the skin or mucous membranes. A depressed fracture is one in which fragments are driven inward. An impacted fracture is one in which a bone fragment is driven into another bone fragment.

A client sustains a fractured right humerus in an automobile accident. The arm is edematous, the client states that he cannot feel or move his fingers, and the nurse does not feel a pulse. What condition should the nurse be concerned about that requires emergency measures? a. Compartment syndrome b. Subluxation c. Dislocation d. Muscle spasms

a. Compartment syndrome Rationale: Separation of adjacent bones from their articulating joint interferes with normal use and produces a distorted appearance. The injury may disrupt local blood supply to structures such as the joint cartilage, causing degeneration, chronic pain, and restricted movement. Compartment syndrome is a condition in which a structure such as a tendon or nerve is constricted in a confined space. The fractured humerus may also be dislocated but is not the result of the impaired circulatory status. Muscle spasms may occur around the fracture site but are not the cause of circulatory impairment. Subluxation is a partial dislocation.

The client with a fractured left humerus reports dyspnea and chest pain. Pulse oximetry is 88%. Temperature is 100.2 degrees Fahrenheit (38.5 degrees Centigrade); heart rate is 110 beats per minute; respiratory rate is 32 breaths per minute. The nurse suspects the client is experiencing: a. Fat embolism syndrome b. Delayed union c. Compartment syndrome d. Complex regional pain syndrome

a. Fat embolism syndrome Rationale: The clinical manifestations described in the scenario are characteristic of fat embolism syndrome.

Which term refers to the failure of fragments of a fractured bone to heal together? a. Subluxation b. Dislocation c. Nonunion d. Malunion

c. Nonunion Rationale: When nonunion occurs, the client reports persistent discomfort and movement at the fracture site. Dislocation refers to the separation of joint surfaces. Subluxation refers to partial separation or dislocation of joint surfaces. Malunion refers to growth of the fragments of a fractured bone in a faulty position, forming an imperfect union.

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? a. Chest strapping b. Thoracentesis c. Mechanical ventilation d. Coughing and deep breathing with pillow splinting

d. Coughing and deep breathing with pillow splinting Rationale: Because these fractures cause pain with respiratory effort, the client tends to decrease respiratory excursions and refrains from coughing. As a result, tracheobronchial secretions are not mobilized, aeration of the lung is diminished, and a predisposition to atelectasis and pneumonia results. To help the client cough and take deep breaths and use an incentive spirometer, the nurse may splint the chest with his or her hands, or may educate the client on using a pillow to temporarily splint the affected site.

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? a. "I'll make sure to keep my ankle elevated as much as possible." b. "I'll start with ice for the first couple of hours and then apply heat." c. "I'll get the prescription filled for the narcotic pain reliever." d. "I need to stay off my ankle for at least the next 3 to 4 weeks."

a. "I'll make sure to keep my ankle elevated as much as possible." Rationale: Treatment consists of applying ice or a chemical cold pack to the area to reduce swelling and relieve pain for the first 24 to 48 hours. Elevation of the part and compression with an elastic bandage also may be recommended. After 2 days, when swelling no longer is likely to increase, applying heat reduces pain and relieves local edema by improving circulation. Full use of the injured joint is discouraged temporarily, not necessarily three to four weeks. Nonsteroidal anti-inflammatory drugs (NSAIDs) are typically recommended; narcotic analgesics typically are not prescribed.

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.) a. Encouraging family and friends to refrain from visiting temporarily because this may increase the client's embarrassment b. Encouraging the client to care for the residual limb c. Introducing the client to local amputee support groups d. Encouraging the client to have family and friends view the residual limb to decrease self-consciousness e. Allowing the client to express grief

b. Encouraging the client to care for the residual limb c. Introducing the client to local amputee support groups e. Allowing the client to express grief Rationale: The nurse helps the client set realistic rehabilitation goals and encourages the client to be an active participant in self-care. The nurse creates an accepting and supportive atmosphere in which the patient and family are encouraged to express and share their feelings and work through the grieving process; support from family and friends promotes the patient's acceptance of the loss. Mental health and support group referrals may be appropriate. Although the nurse supports the client in coming to terms with the appearance and function of the residual limb, and in sharing feelings about the amputation with family and friends, viewing of the residual limb by family and friends is not a priority and may not be helpful for the client's well-being.

A client is to have an amputation. The client is acutely ill and diagnosed with a gangrenous limb and related fever, disorientation, and electrolyte imbalances. Which of the following would be most important for the nurse to monitor in this client? a. Reduced urine output b. Signs of sepsis c. Occurrence of allergic reactions d. Signs of nausea and vomiting

b. Signs of sepsis Rationale: If the client is acutely ill with a gangrenous limb, related fever, disorientation, and electrolyte imbalances, the nurse should monitor for signs of sepsis and circulation in the limb for any changes such as severe pain, color changes, and lack of peripheral pulses. It is crucial for the nurse to inform the physician about the problems as they occur or else the surgery may become an emergency. Monitoring for signs of nausea and vomiting, occurrence of allergic reactions, and reduced urine output, although necessary, is not as crucial for the client.

A patient sustains a fracture of the arm. When does the nurse anticipate pendulum exercise should begin? a. In 2 to 3 weeks, when callus ossification prevents easy movements of bony fragments b. In about 4 to 5 weeks, after new bone is well established c. As soon as tolerated, after a reasonable period of immobilization d. In 2 to 3 months, after normal activities are resumed

c. As soon as tolerated, after a reasonable period of immobilization Rationale: Many impacted fractures of the surgical neck of the humerus are not displaced and do not require reduction. The arm is supported and immobilized by a sling and swathe that secure the supported arm to the trunk (Fig. 43-10). Limitation of motion and stiffness of the shoulder occur with disuse. Therefore, pendulum exercises begin as soon as tolerated by the patient. In pendulum or circumduction exercises, the physical therapist instructs the patient to lean forward and allow the affected arm to hang in abduction and rotate. These fractures require approximately 4 to 10 weeks to heal, and the patient should avoid vigorous arm activity for an additional 4 weeks. Residual stiffness, aching, and some limitation of ROM may persist for 6 months or longer (NAON, 2007).

A client has delayed bone healing in a fractured right humerus. What should the nurse prepare the client for that promotes bone growth? a. Administration of low-dose heparin b. Joint fusion c. Electrical stimulation d. Administration of antibiotics

c. Electrical stimulation Rationale: Delayed union may require surgical interventions to promote bone growth and correct the incorrect union. If necessary, prepare the client for use of electrical stimulation measures that promote bone growth, or for a bone graft. Administration of low-dose heparin would be used to prevent pulmonary embolism. Joint fusion may be used in the case of avascular necrosis. Administration of antibiotics would be used for the potential of infection or to treat an actual infection.

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? a. Keep the hip flexed by placing pillows under the client's knee. b. Keep the affected leg in a position of adduction. c. Prevent internal rotation of the affected leg. d. Use measures other than turning to prevent pressure ulcers.

c. Prevent internal rotation of the affected leg. Rationale: The nurse and other caregivers should prevent internal rotation of the affected leg. However, external rotation and abduction of the hip will help prevent dislocation of a new hip joint. Postoperative total hip replacement clients may be turned onto the unaffected side. The hip may be flexed slightly, but it shouldn't exceed 90 degrees. Maintenance of flexion isn't necessary.

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? a. "Apply ice packs for the first 24 to 48 hours, then apply heat packs." b. "Apply heat packs for the first 24 hours, then apply ice packs for the next 48 hours." c. "Apply ice packs for the first 12 to 18 hours." d. "Apply heat packs for the first 24 to 48 hours."

a. "Apply ice packs for the first 24 to 48 hours, then apply heat packs." Rationale: The nurse should instruct the client to apply ice packs to the injured area for the first 24 to 48 hours to reduce swelling and then apply heat to increase comfort, promote reabsorption of blood and fluid, and speed healing. Applying ice for only 12 to 18 hours may not keep swelling from recurring. Applying heat for the first 24 to 48 hours would worsen, not ease, swelling. Applying ice 48 hours after the injury would be less effective because swelling already has occurred by that time.

Two days after surgery to amputate the left lower leg, a client reports pain in the missing extremity. Which action by the nurse is most appropriate? a. Administer medication, as ordered, for the reported discomfort. b. Contact the health care provider. c. Initiate a consult with a psychologist. d. Do nothing because it isn't possible to have pain in a missing limb.

a. Administer medication, as ordered, for the reported discomfort. Rationale: The sensation of pain and discomfort in an amputated extremity is known as phantom pain. Phantom pain is a normal occurrence after an amputation. It should be treated with medication. The nurse doesn't need to contact the health care provider at this time. Consultation with the psychologist isn't indicated, and the nurse shouldn't take this action without consulting the health care provider.

The primary nursing intervention that will control swelling while treating a musculoskeletal injury is: a. Elevate the affected area. b. Apply cold (moist or dry). c. Apply an elastic compression bandage. d. Immobilize the injured area.

a. Elevate the affected area. Rationale: Elevation is used to control swelling. It is facilitated by cold, immobilization, and compression. Refer to Box 42-1 in the text.

Which nursing diagnosis is the most appropriate for a client with a strained ankle? a. Impaired physical mobility b. Impaired skin integrity c. Risk for deficient fluid volume d. Disturbed body image

a. Impaired physical mobility Rationale: Ankle strains result in pain and damage to the ligaments as well as Impaired physical mobility. Although the traumatic event that caused the strain may disrupt the skin, the manifestations of a strain don't warrant a nursing diagnosis of Impaired skin integrity. Risk for deficient fluid volume is an appropriate nursing diagnosis for a process that results in the loss of a large volume of fluid or blood; it isn't appropriate for a client with a strained ankle. Disturbed body image would be appropriate if the client's livelihood alters because of the strain.

A client who was in a motor vehicle crash is diagnosed with a stable T7 spinal fracture with no neurologic deficits. Which nursing intervention should the nurse implement? a. Maintain bed rest with the head of the bed at 20 degrees. b. Withhold opioid pain medication to prevent ileus. c. Sit the client upright in a padded chair for meals. d. Maintain NPO (nothing by mouth) status for surgical repair.

a. Maintain bed rest with the head of the bed at 20 degrees. Rationale: The client should maintain limited bed rest with the head of the bed lower than 30 degrees. If the client's pain is not controlled with a lower form of pain medication, then an opioid may be used to treat the pain. The nurse should monitor for an ileus. Stable spinal fractures are treated conservatively and not with surgical repair. The client should avoid sitting until the pain eases.

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? a. Provide feedback on the client's strengths and available resources. b. Encourage the client to perform range-of-motion (ROM) exercises to the right leg. c. Request a referral to occupational therapy. d. Provide wound care without discussing the amputation.

a. Provide feedback on the client's strengths and available resources. Rationale: The nurse should encourage the client to look at, and assist with, care of the residual limb. Providing feedback on the client's strengths and resources may allow the client to start to adapt to the body image and lifestyle change. The nurse should also allow time for the client to discuss their feelings related to the amputation. Requesting a referral to occupational therapy and encouraging the client to perform ROM exercises are appropriate but do not address the emotional aspect of losing an extremity.

Which nursing intervention is essential in caring for a client with compartment syndrome? a. Removing all external sources of pressure, such as clothing and jewelry b. Wrapping the affected extremity with a compression dressing to help decrease the swelling c. Starting an I.V. line in the affected extremity in anticipation of venogram studies d. Keeping the affected extremity below the level of the heart

a. Removing all external sources of pressure, such as clothing and jewelry Rationale: Nursing measures should include removing all clothing, jewelry, and external forms of pressure (such as dressings or casts) to prevent constriction and additional tissue compromise. The extremity should be maintained at heart level (further elevation may increase circulatory compromise, whereas a dependent position may increase edema). A compression wrap, which increases tissue pressure, could further damage the affected extremity. There is no indication that diagnostic studies would require I.V. access in the affected extremity.

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.) a. Splinting the injured limb b. Covering the area with a clean dressing if the fracture is open c. Wrapping the arm in an ace bandage d. Immobilizing the affected site e. Asking the patient if he or she is able to move the arm

a. Splinting the injured limb b. Covering the area with a clean dressing if the fracture is open d. Immobilizing the affected site Rationale: Immediately after injury, if a fracture is suspected, the body part must be immobilized before the patient is moved. Adequate splinting is essential. Joints proximal and distal to the fracture also must be immobilized to prevent movement of fracture fragments. In an upper extremity injury, the arm may be bandaged to the chest, or an injured forearm may be placed in a sling. The neurovascular status distal to the injury should be assessed both before and after splinting to determine the adequacy of peripheral tissue perfusion and nerve function. With an open fracture, the wound is covered with a sterile dressing to prevent contamination of deeper tissues.

A patient falls while skiing and sustains a supracondylar fracture. What does the nurse know is the most serious complication of a supracondylar fracture of the humerus? a. Volkmann's ischemic contracture b. Malunion c. Paresthesia d. Hemarthrosis

a. Volkmann's ischemic contracture Rationale: The most serious complication of a supracondylar fracture of the humerus is Volkmann contracture (an acute compartment syndrome), which results from antecubital swelling or damage to the brachial artery.

A client is hospitalized for open reduction of a fractured femur. During the postoperative assessment, the nurse notes that the client is restless and observes petechiae on the client's chest. Which nursing action is indicated first? a. Elevate the affected extremity. b. Administer oxygen. c. Contact the nursing supervisor. d. Contact the health care provider.

b. Administer oxygen. Rationale: The client is demonstrating clinical manifestations consistent with a fatty embolus. Administering oxygen is the top priority. Elevating the extremity won't alter the client's condition. Notifying the nursing supervisor may be indicated by facility policy after other immediate actions have been taken. The nurse should contact the health care provider after administering oxygen.

When is it advisable for the nurse to apply heat to a sprain or a contusion? a. Only after a week b. After 2 days c. Do not apply at all d. Immediately

b. After 2 days Rationale: It is advisable to apply heat on a sprain or a contusion 2 days after a sprain or a contusion has occurred. This is because after 2 days swelling is not likely to increase and as a result heat application reduces pain and relieves local edema by improving circulation. Delaying the application of heat prolongs the pain and increased the risk of local edema.

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? a. Greenstick b. Impacted c. Comminuted d. Compression

b. Impacted Rationale: An impacted fracture is one in which a bone fragment is driven into another bone fragment. A comminuted fracture is one in which the bone has splintered into several fragments. A compression fracture is one in which bone has been compressed. A greenstick fracture is one in which one side of the bone is broken, and the other side is bent.

A nurse is caring for a client who has sustained ligament and a meniscal injury to the knee. Which action would be most appropriate to allow the client to progress without causing further injury? a. Administer nonsteroidal anti-inflammatory drugs (NSAIDs) regularly. b. Apply a cold pack to the affected area every night. c. Assist with a gradual introduction of activity. d. Apply heat to the affected area every night.

c. Assist with a gradual introduction of activity. Rationale: A gradual introduction of activity assists the client with a knee injury to ambulate without causing any further injury. Using NSAIDs or applying ice during the first 48 hours helps ease the pain and the inflammation. The application of heat at a later stage improves the blood circulation. However, the regular use of NSAIDs, cold packs, or heat does not help the client progress without causing any further injury.

Which type of fracture is one in which the skin or mucous membrane wound extends to the fractured bone? a. Complete b. Simple c. Compound d. Incomplete

c. Compound Rationale: A compound fracture is one in which the skin or mucous membrane wound extends to the fractured bone. A complete fracture involves a break across the entire cross section of the bone and is frequently displaced. An incomplete fracture involves a break through only part of the cross section of the bone. A simple fracture is one that does not cause a break in the skin.

Which type of fracture involves a break through only part of the cross-section of the bone? a. Open b. Oblique c. Comminuted d. Incomplete

d. Incomplete Rationale: An incomplete fracture involves a break through only part of the cross-section of the bone. A comminuted fracture is one that produces several bone fragments. An open fracture is one in which the skin or mucous membrane wound extends to the fractured bone. An oblique fracture runs across the bone at a diagonal angle of 45 to 60 degrees.