Deck 27: Management of Clients with Musculoskeletal Trauma or Overuse

Question 1

The nursing intervention that would be most appropriate for a client who has entered the emergency department with a severe strain to the knee is

A) apply a heat pack to reduce swelling.
B) elevate the leg and apply ice.
C) manipulate the knee in the full range of motion.
D) teach the client exercises to speed healing.

Answer 1

elevate the leg and apply ice.

Question 2

The assessment that would alert the nurse to the possibility of cast syndrome in a client with a spica cast is

A) abdominal distention.
B) diminished pulses in the foot.
C) "hot spot" felt on cast.
D) musty, unpleasant odor to cast.

Answer 2

abdominal distention.

Question 3

The nurse explains that the rationale for LMW (low-molecular-weight) heparin therapy after open reduction of a fractured femur is to

A) decrease hematoma at the fracture site.
B) decreases the threat of thrombus.
C) increase blood supply at the fracture site.
D) increase platelet formation.

Answer 3

decreases the threat of thrombus.

Question 4

In caring for a client in skeletal traction with a nursing diagnosis of Risk for Injury related to traction, the nurse should take special care to

A) carefully inspect pin sites every other day to assess for pin site infection.
B) encourage the client to assume a position of comfort to reduce the risk of pressure ulcers.
C) knot ropes between the client and pulley to prevent weights from touching the floor.
D) position weight ropes to ensure that the weights hang freely from pulleys.

Question 5

The nurse informs a client that her plaster cast is dry because the nurse has assessed that the cast is

A) cold to the touch.
B) dull on percussion.
C) gray in color.
D) odorless.

Question 6

After the cast on a client's fractured ulna has been changed to a bivalve cast, the nurse will alter the approach to care by

A) omitting vascular checks to the extremity.
B) preventing pinching the extremity between the two halves.
C) taking off both halves of the cast when x-ray films are ordered.
D) taping the halves together with paper tape.

Question 7

The nurse assesses an 85-year-old client who has fallen and finds crepitus and swelling below the right elbow. The nurse interprets these findings as

A) a closed fracture.
B) a dislocation.
C) manifestations of degenerative joint disease.
D) normal variations related to age.

Question 8

The initial process of bone healing occurring at the fracture site in the first 72 hours is

A) formation of a hematoma.
B) formation of a provisional callus.
C) proliferation of osteoblasts.
D) reabsorption of the clot.

Question 9

An elderly client is in the emergency department after suffering a fracture. The daughter is distraught and says "This will never heal in my mother; she's so old!" The most appropriate response by the nurse is

A) "Actually fractures in infants take the longest to heal."
B) "Do you think your mother has a bone disease, like osteoporosis?"
C) "Unless there are other problems, elderly bones heal as quickly as in adults."
D) "You're right; fractures take longer to heal in the elderly."

Question 10

The nurse explains to the client that in addition to approximating the bone fragments, traction also

A) increases blood supply to the fracture site.
B) increases speed of bone healing.
C) reduces muscle spasm.
D) reduces neuromuscular dysfunction.

Question 11

When a 68-year-old client with a new full-leg cast exhibits bilateral pedal edema, the nurse would assess for

A) compartment syndrome.
B) cardiovascular disease.
C) local leg trauma.
D) thrombophlebitis.

Question 12

A client is admitted to the emergency department with a complete fracture of the left radius. The nurse understands that with this type of fracture, the bone is

A) displaced with fragments out of normal position.
B) fractured only through one cortex of bone.
C) fractured through the entire bone.
D) fragmented with multiple pieces of bone.

Question 13

A client is considering running as an exercise. The nurse counsels that to prevent injuries, it is important before running to

A) consume a large amount of carbohydrates, such as cereal or pasta.
B) do 30 minutes of isometric leg exercises using weights.
C) engage in a series of stretching and relaxing movements.
D) perform static stretching exercises for 10 minutes.

Question 14

After application of a synthetic cast, the client asks the nurse how long he must wait until the cast is completely dry and he can tolerate weight-bearing. The nurse's most appropriate response is

A) 10 minutes.
B) 20 minutes.
C) 30 minutes.
D) 60 minutes.

Question 15

A client with long-standing dementia is sent to the emergency department from the nursing home in which the client resides. The report from the nursing staff states that the client is complaining of vague pain in the buttocks but seems to be ambulating without problems. The family requested the transfer. The emergency department nurse would suspect

A) an overprotective family.
B) arthritis pain the client cannot articulate.
C) possible hip fracture.
D) worsening dementia.

Question 16

Two days after an accident in which a client sustained multiple injuries, including fractures, the client becomes confused and dyspneic and has a fever of 103.4° F. The nurse assesses that the client has developed

A) a fat embolism.
B) a pulmonary embolism.
C) compartment syndrome.
D) wound infection.

Question 17

A client with a left lower leg fracture in a cast for 3 days complains to the nurse that the pain medication does not relieve the pain any more. The priority action by the nurse would be to

A) administer more analgesics.
B) do a neurovascular assessment.
C) elevate the cast on pillows.
D) notify the physician.

Question 18

In the emergent care of a client with a pelvic fracture, the nurse must be especially alert for indications of the complication of

A) deep vein thrombosis.
B) hyperthermia.
C) hypovolemic shock.
D) infection.

Question 19

The nurse explains to a client with delayed union of a fractured femur that treatment for this complication is based on

A) finding and correcting the cause.
B) physical therapy using deep-heat modalities.
C) realigning the fracture with traction.
D) stabilizing the fracture with a metal plate.

Question 20

In the application of a plaster cast, the most appropriate nursing intervention is to

A) allow excess casting material to dry on the skin before removal.
B) carefully cut the stockinette to the exact length of the cast.
C) gently support the extremity from underneath.
D) flush plaster-laden water down the toilet rather than the sink.

Question 21

A nurse is teaching a community group about bone health. Which of the following does the nurse recommend? (Select all that apply.)

A) Engage in regular weight-bearing exercise.
B) Get plenty of calcium and vitamin D in the diet.
C) If diagnosed with osteoporosis, take medications as prescribed.
D) Stop, or do not start, smoking.
E) Swim or cycle to get aerobic activity without stressing joints.

Question 22

When delegating the application of heat or cold therapies to an unlicensed assistive personnel (UAP), the nurse should (Select all that apply)

A) allow the UAP to document the treatment and the client's response.
B) clarify the order to ensure the task can be delegated.
C) inspect the client's skin before the treatment.
D) instruct the UAP to wrap the heat or cold in a protective cover.
E) reassess the client's skin after the treatment is done.

Question 23

A victim of a motorcycle accident has an open fracture of the left femur with an associated wound of 8 cm. The nurse's assessment records this injury as grade

A) I.
B) II.
C) III.
D) IV.

Question 24

A client who has undergone repair of the anterior cruciate ligament complains that the use of the continuous passive motion (CPM) machine causes pain and asks how long he is expected to use the machine. The nurse's most appropriate response would be

A) "I will give you pain medication to make you comfortable, since you should use the machine at least 8 hours out of 24."
B) "Try using the machine for 1 hour of every 4 hours, and see if that schedule reduces your discomfort."
C) "You do not have to use the machine for the next few days. You can resume after the pain subsides."
D) "You should use the machine continuously. I will ask the physician to increase your dose of analgesics."

Question 25

A nurse planning discharge teaching and counseling for the client being dismissed with multiple fractures plans support services knowing that fractures can disrupt quality of life by causing (Select all that apply)

A) activity restrictions.
B) disability.
C) economic loss.
D) pain and suffering.

Question 26

The nurse notices a stain on a newly dried plaster cast over a client's fracture site. The most appropriate method to assess this finding is to

A) assess for a "hot spot" over the stain.
B) bivalve the cast and inspect the site.
C) draw around the circumference with a pen and record.
D) dry the stained area of the cast with a hair dryer.

Question 27

The complaint of proximal thigh pain in an older client who has fallen leads the nurse to suspect a hip fracture and that the location of the fracture is

A) intracapsular.
B) intratrochanteric.
C) subtrochanteric.
D) the femoral neck.

Question 28

A client who will not regain mobility has a case manager. What important topics does the nurse need to address in the client's long-term plan of care? (Select all that apply.)

A) Informal caregivers
B) Sexuality
C) Recreation
D) Vocational adjustments

Question 29

Important self-care measures the nurse should teach to the client who is expected to be immobile in a wheelchair for a lengthy period of time include

A) learning how to inspect all skin surfaces for friction or pressure.
B) massaging bony prominences four times a day.
C) sitting upright in a chair or wheelchair on the sacrum.
D) using a gel wheelchair cushion to prevent pressure ulcers.

Question 30

The principal concept that a nurse would include in a teaching plan regarding partial weight-bearing is that the client should

A) bear as much weight as can be tolerated 30% to 50% of the time.
B) prevent the affected limb from touching the floor; bear weight on the unaffected limb.
C) rest the affected foot on the floor and place weight on it 30% to 50% of the time.
D) use a walker or crutches and bear 30% to 50% of weight on the affected limb.

Question 31

The nurse assesses a client in the emergency department who complains of shoulder pain and is unable to abduct or externally rotate the right arm. From these observations the nurse suspects injury to the

A) anterior cruciate ligament.
B) meniscus.
C) tendonitis.
D) rotator cuff.

Question 32

The nurse in the emergency department caring for a client with an anterior dislocation of the knee should have as a priority the assessment of

A) capillary refill of the toes.
B) degree of misalignment in the limb.
C) degree of pain in the joint.
D) mobility in the affected limb.