Deck 51: Care of Patients with Musculoskeletal Trauma

Question 1

A nurse plans care for a client who is recovering from a below-the-knee amputation of the left leg.Which intervention should the nurse include in this client's plan of care?

A) Place pillows between the client's knees.
B) Encourage range-of-motion exercises.
C) Administer prophylactic antibiotics.
D) Implement strict bedrest in a supine position.

Answer 1

Encourage range-of-motion exercises.

Question 2

A trauma nurse cares for several clients with fractures.Which client should the nurse identify as at highest risk for developing deep vein thrombosis?

A) An 18-year-old male athlete with a fractured clavicle
B) A 36-year old female with type 2 diabetes and fractured ribs
C) A 55-year-old woman prescribed aspirin for rheumatoid arthritis
D) A 74-year-old man who smokes and has a fractured pelvis

Answer 2

A 74-year-old man who smokes and has a fractured pelvis

Question 3

A nurse assesses a client with a rotator cuff injury.Which finding should the nurse expect to assess?

A) Inability to maintain adduction of the affected arm for more than 30 seconds
B) Shoulder pain that is relieved with overhead stretches and at night
C) Inability to initiate or maintain abduction of the affected arm at the shoulder
D) Referred pain to the shoulder and arm opposite the affected shoulder

Answer 3

Inability to initiate or maintain abduction of the affected arm at the shoulder

Question 4

A nurse cares for a client who had a wrist cast applied 3 days ago.The client states,"The cast is loose enough to slide off." How should the nurse respond?

A) "Keep your arm above the level of your heart."
B) "As your muscles atrophy, the cast is expected to loosen."
C) "I will wrap a bandage around the cast to prevent it from slipping."
D) "You need a new cast now that the swelling is decreased."

Question 5

A nurse reviews prescriptions for an 82-year-old client with a fractured left hip.Which prescription should alert the nurse to contact the provider and express concerns for client safety?

A) Meperidine (Demerol) 50 mg IV every 4 hours
B) Patient-controlled analgesia (PCA) with morphine sulfate
C) Percocet 2 tablets orally every 6 hours PRN for pain
D) Ibuprofen elixir every 8 hours for first 2 days

Question 6

An emergency department nurse triages a client with diabetes mellitus who has fractured her arm.Which action should the nurse take first?

A) Remove the medical alert bracelet from the fractured arm.
B) Immobilize the arm by splinting the fractured site.
C) Place the client in a supine position with a warm blanket.
D) Cover any open areas with a sterile dressing.

Question 7

A nurse notes crepitation when performing range-of-motion exercises on a client with a fractured left humerus.Which action should the nurse take next?

A) Immobilize the left arm.
B) Assess the client's distal pulse.
C) Monitor for signs of infection.
D) Administer prescribed steroids.

Question 8

An emergency department nurse cares for a client who sustained a crush injury to the right lower leg.The client reports numbness and tingling in the affected leg.Which action should the nurse take first?

A) Assess the pedal pulses.
B) Apply oxygen by nasal cannula.
C) Increase the IV flow rate.
D) Loosen the traction.

Question 9

A nurse cares for a client placed in skeletal traction.The client asks,"What is the primary purpose of this type of traction?" How should the nurse respond?

A) "Skeletal traction will assist in realigning your fractured bone."
B) "This treatment will prevent future complications and back pain."
C) "Traction decreases muscle spasms that occur with a fracture."
D) "This type of traction minimizes damage as a result of fracture treatment."

Question 10

A nurse assesses a client with a pelvic fracture.Which assessment finding should the nurse identify as a complication of this injury?

A) Hypertension
B) Constipation
C) Infection
D) Hematuria

Question 11

A nurse obtains the health history of a client with a fractured femur.Which factor identified in the client's history should the nurse recognize as an aspect that may impede healing of the fracture?

A) Sedentary lifestyle
B) A 30-pack-year smoking history
C) Prescribed oral contraceptives
D) Paget's disease

Question 12

A nurse delegates care of a client in traction to an unlicensed assistive personnel (UAP).Which statement should the nurse include when delegating hygiene care for this client?

A) "Remove the traction when re-positioning the client."
B) "Inspect the client's skin when performing a bed bath."
C) "Provide pin care by using alcohol wipes to clean the sites."
D) "Ensure that the weights remain freely hanging at all times."

Question 13

A nurse cares for a client with a fractured fibula.Which assessment should alert the nurse to take immediate action?

A) Pain of 4 on a scale of 0 to 10
B) Numbness in the extremity
C) Swollen extremity at the injury site
D) Feeling cold while lying in bed

Question 14

A nurse assesses a client with a fracture who is being treated with skeletal traction.Which assessment should alert the nurse to urgently contact the health provider?

A) Blood pressure increases to 130/86 mm Hg
B) Traction weights are resting on the floor
C) Oozing of clear fluid is noted at the pin site
D) Capillary refill is less than 3 seconds

Question 15

A nurse assesses an older adult client who was admitted 2 days ago with a fractured hip.The nurse notes that the client is confused and restless.The client's vital signs are heart rate 98 beats/min,respiratory rate 32 breaths/min,blood pressure 132/78 mm Hg,and SpO₂ 88%.Which action should the nurse take first?

A) Administer oxygen via nasal cannula.
B) Re-position to a high-Fowler's position.
C) Increase the intravenous flow rate.
D) Assess response to pain medications.

Question 16

A nurse coordinates care for a client with a wet plaster cast.Which statement should the nurse include when delegating care for this client to an unlicensed assistive personnel (UAP)?

A) "Assess distal pulses for potential compartment syndrome."
B) "Turn the client every 3 to 4 hours to promote cast drying."
C) "Use a cloth-covered pillow to elevate the client's leg."
D) "Handle the cast with your fingertips to prevent indentations."

Question 17

A nurse is caring for a client who is recovering from an above-the-knee amputation.The client reports pain in the limb that was removed.How should the nurse respond?

A) "The pain you are feeling does not actually exist."
B) "This type of pain is common and will eventually go away."
C) "Would you like to learn how to use imagery to minimize your pain?"
D) "How would you describe the pain that you are feeling?"

Question 18

A home health nurse assesses a client with diabetes who has a new cast on the arm.The nurse notes the client's fingers are pale,cool,and slightly swollen.Which action should the nurse take first?

A) Raise the arm above the level of the heart.
B) Encourage range of motion.
C) Apply heat to the affected hand.
D) Bivalve the cast to decrease pressure.

Question 19

A nurse cares for a client recovering from an above-the-knee amputation of the right leg.The client reports pain in the right foot.Which prescribed medication should the nurse administer first?

A) Intravenous morphine
B) Oral acetaminophen
C) Intravenous calcitonin
D) Oral ibuprofen

Question 20

A nurse cares for a client in skeletal traction.The nurse notes that the skin around the client's pin sites is swollen,red,and crusty with dried drainage.Which action should the nurse take next?

A) Request a prescription to decrease the traction weight.
B) Apply an antibiotic ointment and a clean dressing.
C) Cleanse the area, scrubbing off the crusty areas.
D) Obtain a prescription to culture the drainage.

Question 21

An emergency nurse assesses a client who is admitted with a pelvic fracture.Which assessments should the nurse monitor to prevent a complication of this injury? (Select all that apply.)

A) Temperature
B) Urinary output
C) Blood pressure
D) Pupil reaction
E) Skin color

Question 22

After teaching a client who is recovering from a vertebroplasty,the nurse assesses the client's understanding.Which statement by the client indicates a need for additional teaching?

A) "I can drive myself home after the procedure."
B) "I will monitor the puncture site for signs of infection."
C) "I can start walking tomorrow and increase my activity slowly."
D) "I will remove the dressing the day after discharge."

Question 23

A nurse cares for an older adult client who is recovering from a leg amputation surgery.The client states,"I don't want to live with only one leg.I should have died during the surgery." How should the nurse respond?

A) "Your vital signs are good, and you are doing just fine right now."
B) "Your children are waiting outside.Do you want them to grow up without a father?"
C) "This is a big change for you.What support system do you have to help you cope?"
D) "You will be able to do some of the same things as before you became disabled."

Question 24

A nurse cares for a client who had a long-leg cast applied last week.The client states,"I cannot seem to catch my breath and I feel a bit light-headed." Which action should the nurse take next?

A) Auscultate the client's lung fields anteriorly and posteriorly.
B) Administer oxygen to keep saturations greater than 92%.
C) Check the client's blood glucose level.
D) Ask the client to take deep breaths.

Question 25

A nurse teaches a client with a fractured tibia about external fixation.Which advantages of external fixation for the immobilization of fractures should the nurse share with the client? (Select all that apply.)

A) It leads to minimal blood loss.
B) It allows for early ambulation.
C) It decreases the risk of infection.
D) It increases blood supply to tissues.
E) It promotes healing.

Question 26

A nurse plans care for a client who is prescribed skeletal traction.Which intervention should the nurse include in this plan of care to decrease the client's risk for infection?

A) Wash the traction lines and sockets once a day.
B) Release traction tension for 30 minutes twice a day.
C) Do not place the traction weights on the floor.
D) Schedule for pin care to be provided every shift.

Question 27

A nurse assesses a client with a cast for potential compartment syndrome.Which clinical manifestations are correctly paired with the physiologic changes of compartment syndrome? (Select all that apply.)

A) Edema - Increased capillary permeability
B) Pallor - Increased blood blow to the area
C) Unequal pulses - Increased production of lactic acid
D) Cyanosis - Anaerobic metabolism
E) Tingling - A release of histamine

Question 28

A nurse plans care for a client who is recovering from open reduction and internal fixation (ORIF)surgery for a right hip fracture.Which interventions should the nurse include in this client's plan of care? (Select all that apply.)

A) Elevate heels off the bed with a pillow.
B) Ambulate the client on the first postoperative day.
C) Push the client's patient-controlled analgesia button.
D) Re-position the client every 2 hours.
E) Use pillows to encourage subluxation of the hip.

Question 29

A nurse teaches a client who is at risk for carpal tunnel syndrome.Which health promotion activities should the nurse include in this client's teaching? (Select all that apply.)

A) Frequently assess the ergonomics of the equipment being used.
B) Take breaks to stretch fingers and wrists during working hours.
C) Do not participate in activities that require repetitive actions.
D) Take ibuprofen (Motrin) to decrease pain and swelling in wrists.
E) Adjust chair height to allow for good posture.

Question 30

A nurse teaches a client about prosthesis care after amputation.Which statements should the nurse include in this client's teaching? (Select all that apply.)

A) "The device has been custom made specifically for you."
B) "Your prosthetic is good for work but not for exercising."
C) "A prosthetist will clean your inserts for you each month."
D) "Make sure that you wear the correct liners with your prosthetic."
E) "I have scheduled a follow-up appointment for you."

Question 31

A phone triage nurse speaks with a client who has an arm cast.The client states,"My arm feels really tight and puffy." How should the nurse respond?

A) "Elevate your arm on two pillows and get ice to apply to the cast."
B) "Continue to take ibuprofen (Motrin) until the swelling subsides."
C) "This is normal.A new cast will often feel a little tight for the first few days."
D) "Please come to the clinic today to have your arm checked by the provider."

Question 32

A nurse cares for an older adult client with multiple fractures.Which action should the nurse take to manage this client's pain?

A) Meperidine (Demerol) injections every 4 hours around the clock
B) Patient-controlled analgesia (PCA) pump with morphine
C) Ibuprofen (Motrin) 600 mg orally every 4 hours PRN for pain
D) Morphine 4 mg intravenous push every 2 hours PRN for pain

Question 33

A nurse cares for a client with a fracture injury.Twenty minutes after an opioid pain medication is administered,the client reports pain in the site of the fracture.Which actions should the nurse take? (Select all that apply.)

A) Administer additional opioids as prescribed.
B) Elevate the extremity on pillows.
C) Apply ice to the fracture site.
D) Place a heating pad at the site of the injury.
E) Keep the extremity in a dependent position.

Question 34

After teaching a client with a fractured humerus,the nurse assesses the client's understanding.Which dietary choice demonstrates that the client correctly understands the nutrition needed to assist in healing the fracture?

A) Baked fish with orange juice and a vitamin D supplement
B) Bacon, lettuce, and tomato sandwich with a vitamin B supplement
C) Vegetable lasagna with a green salad and a vitamin A supplement
D) Roast beef with low-fat milk and a vitamin C supplement