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.

Accepted Answer

Acute sprains require RICE: rest, ice, compression, and elevation for the first 24-48 hours to reduce swelling. Heat may be used after that if desired. During healing, which takes 4-6 weeks, movement of the injured part should be minimized.

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.

Accepted Answer

Abdominal distention and persistent vomiting result when the duodenum is compressed between major vessels and vertebral bodies because of constriction on the spica cast.

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.

Accepted Answer

Prevention of DVT is a primary goal for the client after ORIF. Pharmacologic agents such as LMW heparin or warfarin are used to prevent DVT.

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.

Accepted Answer

The weights must hang freely to ensure traction. Knotting the ropes between the client and the pulley causes distraction. The client must be kept in anatomic alignment to prevent poor union. Pin sites should be checked more often than every other day.

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.

Accepted Answer

A dry plaster cast is odorless, resonant, white, and feels close to room temperature.

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.

Accepted Answer

The bivalve cast allows for removal of the top half for wound care or x-ray films and for ease in assessing tissue perfusion or pressure areas. When the top half is reapplied, the nurse must take precaution not to pinch the client's extremity between the two halves as they are secured together with an Ace wrap.

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.

Accepted Answer

Crepitus and swelling are caused by motion in the middle of a bone or by bone fragments rubbing together.

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.

Accepted Answer

Immediate formation of a hematoma at a fracture site occurs in 1 to 3 days.

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."

Accepted Answer

A fracture in an infant may heal in only 4-6 weeks, but the time increases somewhat with age. However, fractures in the elderly heal at the same speed as in other adults, unless a disease like osteoporosis is present. Other favorable and unfavorable factors that affect bone healing are summarized in Box 27-1.

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.

Accepted Answer

The purpose of traction is to realign the fracture and decrease muscle spasm. It does not increase blood supply, speed healing, or reduce 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.

Accepted Answer

Swelling after traumatic injury and reduction should peak within 24-48 hours, but mild swelling afterwards is expected. Moderate or severe swelling and discoloration are abnormal. With abnormal unilateral pedal edema, the nurse should consider whether it is caused by further trauma, by compartment syndrome, or by thrombophlebitis. With bilateral pedal edema, the nurse should consider a cardiovascular origin.

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.

Accepted Answer

In a complete fracture, the fracture line extends across the entire bone. Option a is a displaced fracture; option b is an incomplete fracture; and option d is a burst fracture.

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.

Accepted Answer

Static stretching involves holding muscles in a stretched position for a few moments rather than repeatedly stretching and relaxing them. This is important to do before exercise requiring joint flexibility in order to prevent injury.

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.

Accepted Answer

Synthetic casts are dry to the touch in a few minutes but require about 30 minutes to set and allow weight-bearing.

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.

Accepted Answer

Some clients with hip fractures have normal ambulation and complain only of vague pain in their buttocks, knees, thighs, groin, or back, especially if they also have dementia. Since hip fractures are one of the leading causes of morbidity and mortality in the elderly, the nurse must maintain a high index of suspicion for fractures, especially in a client who has 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.

Accepted Answer

Manifestations of confusion, hypoxia, and fever may indicate a fat embolism in a client with multiple fractures.

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.

Accepted Answer

Unrelieved pain is a manifestation of compartment syndrome, which is a serious complication of fractures. Other manifestations include pain out of proportion to the injury and escalating pain. If unrecognized or untreated, the client can lose nerve and muscle function. Amputation may be necessary. The nurse should perform a complete neurovascular assessment and 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.

Accepted Answer

Pelvic fractures can result in hemorrhage into the pelvic cavity. The pelvic cavity can hold as much as 4 liters of blood.

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.

Accepted Answer

If the cause of the delayed union can be identified and corrected, the fracture usually heals.

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.

Accepted Answer

The nurse assisting during a cast application should support the extremity from underneath using only the palms of the hands to avoid applying pressure to any one area. The nurse should ensure he/she does not press fingertips into the cast or allow it to rest on a hard surface because this can lead to indentations in the cast that can ultimately cause pressure and injury to the client. The stockinette is cut several inches longer than the anticipated cast. As soon as the cast is applied, excess plaster needs to be removed from the client's skin. The water used to wet the plaster should be dumped down a sink with a plaster trap. If no such sink is available, the water should be allowed to sit until the plaster settles at the bottom of the bucket; then the water can be drained off the top and the plaster scooped out into a trash bag.

Quiz 27: Management of Clients with Musculoskeletal Trauma or Overuse

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

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

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

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

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

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

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

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

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

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

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

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

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

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 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

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

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

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