Chapter 37: Musculoskeletal Trauma Flashcards
A nurse is caring for a client who has had a plaster arm cast applied. Immediately after application, the nurse should provide what teaching to the client?
A. The cast will feel cool to touch for the first 30 minutes.
B. The cast should be wrapped snuggly with a towel until the client gets home.
C. The cast should be supported on a board while drying.
D. The cast will only have full strength when dry.
ANS: D
Rationale: A cast requires approximately 24 to 72 hours to dry, and until dry, it does not have full strength. While drying, the cast should not be placed on a hard surface. The cast will exude heat while it dries and should not be wrapped.
A client is admitted to the orthopedic unit in skeletal traction for a fractured proximal femur. Which explanation should the nurse give the client about skeletal traction?
A. “Skeletal traction temporarily stabilizes the fracture before surgery.”
B. “Weights are attached to the leg using a boot.”
C. “Traction involves passing a pin through the bone.”
D. “Light weights must be used with skeletal traction.”
ANS: C
Rationale: In skeletal traction, a metal pin or wire is passed through the bone and traction is then applied using ropes and weights attached to the pins. Skin traction, not skeletal traction, stabilizes the fracture until surgery is performed and uses a boot or Velcro to attach the ropes and weights to the leg. Skeletal traction is used when greater weight (11 to 18 kg [25 to 40 lb]) is needed to achieve the therapeutic effect.
A nurse is caring for a client who is postoperative day 1 following a total arthroplasty of the right hip. How should the nurse position the client?
A. Place a pillow between the legs.
B. Turn the client on the surgical side.
C. Avoid flexion of the right hip.
D. Keep the right hip adducted at all times.
ANS: A
Rationale: The hips should be kept in abduction by a pillow placed between the legs. When positioning the client in bed, the nurse should avoid placing the client on the operated hip. The right hip should not be flexed more than 90 degrees to avoid dislocation. The right hip should be maintained in an abducted position.
A client was brought to the emergency department after a fall. The client is taken to the operating room to receive a right hip prosthesis. In the immediate postoperative period, what health education should the nurse emphasize?
A. “Make sure you don’t bring your knees close together.”
B. “Try to lie as still as possible for the first few days.”
C. “Try to avoid bending your knees until next week.”
D. “Keep your legs higher than your chest whenever you can.”
ANS: A
Rationale: After receiving a hip prosthesis, the affected leg should be kept abducted. Mobility should be encouraged within safe limits. There is no need to avoid knee flexion and the client’s legs do not need to be higher than the level of the chest.
A client with a total hip replacement has developed decreased breath sounds What is the nurse’s best action?
A. Place the client on bed rest.
B. Request an antitussive medication from the health care provider.
C. Encourage use of the incentive spirometer.
D. Assess for signs and symptoms of systemic infection.
ANS: C
Rationale: Atelectasis may occur in the client after surgery and can be prevented with the use of an incentive spirometer. Since bedrest increases the risk for atelectasis and pneumonia after surgery, the client should be encouraged to ambulate and sit up in a chair rather than lie in bed. Since the client should be encouraged to deep breath and cough, requesting an antitussive medication for the client would not be appropriate. Atelectasis is not a clinical manifestation of infection.
A nurse is caring for a client who has a leg cast. The nurse observes the client using a pencil to scratch the skin under the edge of the cast. How should the nurse respond to this observation?
A. Allow the client to gently scratch inside the cast with a pencil.
B. Give the client a sterile tongue depressor to use for scratching instead of the pencil.
C. Provide a fan to blow cool air into the cast to relieve itching,
D. Obtain a prescription for a sedative, such as lorazepam, to prevent the client from scratching.
ANS: C
Rationale: The client may receive relief from itching by using a fan or hair dryer to blow cool air into the cast. Scratching should be discouraged using a pencil or a sterile tongue depressor because of the risk for skin breakdown or damage to the cast. Benzodiazepines would not be given for this purpose.
The nurse educator on an orthopedic trauma unit is reviewing the safe and effective use of traction with some recent nursing graduates. What principle should the educator promote?
A. Knots in the rope should not be resting against pulleys.
B. Weights should rest against the bed rails.
C. The end of the limb in traction should be braced by the footboard of the bed.
D. Skeletal traction may be removed for brief periods to facilitate the client’s independence.
ANS: A
Rationale: Knots in the rope should not rest against pulleys because this interferes with traction. Weights are used to apply the vector of force necessary to achieve effective traction and should hang freely at all times. To avoid interrupting traction, the limb in traction should not rest against anything. Skeletal traction is never interrupted.
The nursing care plan for a client in traction specifies regular assessments for venous thromboembolism (VTE). When assessing a client’s lower limbs, what sign or symptom is suggestive of deep vein thrombosis (DVT)?
A. Increased warmth of the calf
B. Decreased circumference of the calf
C. Loss of sensation to the calf
D. Pale-appearing calf
ANS: A
Rationale: Signs of DVT include increased warmth, redness, swelling, and calf tenderness. These findings are promptly reported to the health care provider for definitive evaluation and therapy. Signs and symptoms of a DVT do not include a decreased circumference of the calf, a loss of sensation in the calf, or a pale-appearing calf.
A client with a right tibial fracture is being discharged home after having a cast applied. What instruction should the nurse provide in relationship to the client’s cast care?
A. “Cover the cast with a blanket until the cast dries.”
B. “Keep your right leg elevated above heart level.”
C. “Use a clean object to scratch itches inside the cast.”
D. “A foul smell from the cast is normal after the first few days.”
ANS: B
Rationale: The leg should be elevated to promote venous return and prevent edema. The cast shouldn’t be covered while drying because this will cause heat buildup and prevent air circulation. No foreign object should be inserted inside 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.
A nurse is caring for a client who has had a total hip replacement. The nurse is reviewing health education prior to discharge. Which of the client’s statements would indicate to the nurse that the client requires further teaching?
A. “I’ll need to keep several pillows between my legs at night.”
B. “I need to remember not to cross my legs. It’s such a habit.”
C. “The occupational therapist is showing me how to use a ‘sock puller’ to help me get dressed.”
D. “I will need my husband to assist me in getting off the low toilet seat at home.”
ANS: D
Rationale: To prevent hip dislocation after a total hip replacement, the client must avoid bending the hips beyond 90 degrees. Assistive devices, such as a raised toilet seat, should be used 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. Likewise, 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 suffered a muscle strain and is reporting pain at 6 on a 10-point scale. The nurse should recommend what action?
A. Taking an opioid analgesic as prescribed
B. Applying a cold pack to the injured site
C. Performing passive ROM exercises
D. Applying a heating pad to the affected muscle
ANS: B
Rationale: Most pain can be relieved by elevating the involved part, applying cold packs, and administering analgesics as prescribed. Heat may exacerbate the pain by increasing blood circulation, and ROM exercises would likely be painful. Analgesia is likely necessary, but NSAIDs would be more appropriate than opioids.
A nurse is assessing the neurovascular status of a client who has had a leg cast recently applied. The nurse is unable to palpate the client’s dorsalis pedis or posterior tibial pulse and the client’s foot is pale. What is the nurse’s most appropriate action?
A. Warm the client’s foot and determine whether circulation improves.
B. Reposition the client with the affected foot dependent.
C. Reassess the client’s neurovascular status in 15 minutes.
D. Promptly inform the primary care provider.
ANS: D
Rationale: Signs of neurovascular dysfunction warrant immediate medical follow-up. It would be unsafe to delay. Warming the foot or repositioning the client may be of some benefit, but the care provider should be informed first.
A client has just begun been receiving skeletal traction and the nurse is aware that muscles in the client’s affected limb are spastic. How does this change in muscle tone affect the client’s traction prescription?
A. Traction must temporarily be aligned in a slightly different direction.
B. Extra weight is needed initially to keep the limb in proper alignment.
C. A lighter weight should be initially used.
D. Weight will temporarily alternate between heavier and lighter weights.
ANS: B
Rationale: The traction weights applied initially must overcome the shortening spasms of the affected muscles. As the muscles relax, the traction weight is reduced to prevent fracture dislocation and to promote healing. Weights never alternate between heavy and light.
A nurse is caring for a client receiving skeletal traction. Due to the client’s severe limits on mobility, the nurse has identified a risk for atelectasis or pneumonia. What intervention should the nurse provide in order to prevent these complications?
A. Perform chest physiotherapy once per shift and as needed.
B. Teach the client to perform deep breathing and coughing exercises.
C. Administer prophylactic antibiotics as prescribed.
D. Administer nebulized bronchodilators and corticosteroids as prescribed.
ANS: B
Rationale: To prevent these complications, the nurse should educate the client about performing deep-breathing and coughing exercises to aid in fully expanding the lungs and clearing pulmonary secretions. Antibiotics, bronchodilators, and steroids are not used on a preventative basis, and chest physiotherapy is unnecessary and implausible for a client in traction.
A client who had a total hip replacement two days ago reports new onset calf tenderness to the nurse. Which action should the nurse take?
A. Administer pain medication.
B. Massage the client’s calf.
C. Apply antiembolic stockings.
D. Notify the health care provider.
ANS: D
Rationale: Since calf tenderness may be a sign of deep vein thrombosis (DVT), the nurse should notify the health care provider about this finding. The nurse should not administer pain medication since it is prescribed for surgical pain and this tenderness in the calf should not be masked until it is evaluated. The nurse should not massage the client’s calf as this may dislodge a thrombus. Antiembolic stockings should be worn prophylactically to prevent DVT but are not applied to treat DVT.
A nurse is assessing a client who is receiving traction. The nurse’s assessment confirms that the client is able to perform plantar flexion. What conclusion can the nurse draw from this finding?
A. The leg that was assessed is free from DVT.
B. The client’s tibial nerve is functional.
C. Circulation to the distal extremity is adequate.
D. The client does not have peripheral neurovascular dysfunction.
ANS: B
Rationale: Plantar flexion demonstrates function of the tibial nerve. It does not demonstrate the absence of DVT and does not allow the nurse to ascertain adequate circulation. The nurse must perform more assessments on more sites in order to determine an absence of peripheral neurovascular dysfunction.
