Deck 54: Care of Patients With Musculoskeletal Trauma

Question 1

A client has been diagnosed with carpal tunnel syndrome.Which intervention does the nurse question in the treatment of this injury?

A) Ibuprofen 600 mg three times a day with meals
B) Weekly injections of a corticosteroid by the physician
C) Morphine 30 mg to be taken orally every 4 hours
D) Use of a hand brace or splint during the day

Answer 1

Morphine 30 mg to be taken orally every 4 hours

Question 2

The nurse assesses a client with a below-knee amputation.Which assessment of the skin flap requires immediate action?

A) Pink and warm to the touch
B) Pale and cool to the touch
C) Dark pink and dry to the touch
D) Pink and slightly moist to the touch

Answer 2

Pale and cool to the touch

Question 3

A client who has sustained a crush injury to the right lower leg reports numbness and tingling of the affected extremity.The skin of the right leg appears pale.Which is the nurse's first intervention?

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

Answer 3

Assess pedal pulses.

Question 4

The nurse is caring for a client with a fractured femur.Which factor in the client's history may impede healing of the fracture?

A) A sedentary lifestyle
B) A history of smoking
C) Oral contraceptive use
D) Paget's disease

Question 5

The nurse is rounding on assigned orthopedic clients.The client with which type of fracture requires immediate interventions to prevent infection?

A) Fractured clavicle
B) Open fracture of the tibia
C) Simple fracture of the wrist
D) Compression fracture of a vertebra

Question 6

The nurse is caring for a client with a pelvic fracture.Which is the nurse's priority action to prevent complications?

A) Monitor temperature daily.
B) Insert a urethral catheter.
C) Monitor blood pressure frequently.
D) Turn the client every 2 hours.

Question 7

The nurse is assessing a client with a body cast.Which assessment finding indicates a complication that must be reported to the health care provider?

A) Blood pressure, 130/85 mm Hg
B) Urinary output, 40 mL/hr
C) Redness around the edges of the cast
D) Vomiting after meals

Question 8

The nurse notes that the skin around the client's skeletal traction pin site is swollen,red,and crusty,with dried drainage.Which is the nurse's priority intervention?

A) Decrease the traction weight.
B) Apply a new dressing.
C) Cleanse the area, scrubbing off the crusty areas.
D) Culture the drainage.

Question 9

A client who has had an above-knee amputation of the right leg reports pain in the right foot.Which priority medication does the nurse administer?

A) IV morphine
B) 650 mg of acetaminophen
C) IV calcitonin
D) 600 mg of ibuprofen

Question 10

A client for whom skeletal traction is planned asks for an explanation regarding the purpose of this type of traction.Which is the nurse's best response?

A) "It aids in realigning the bone."
B) "It prevents low back pain."
C) "It decreases muscle spasms that occur with a fracture."
D) "It prevents injury to the skin as a result of the fracture."

Question 11

The nurse is caring for a client with an external fixator in place on the leg.What does the nurse assess for first?

A) Alteration in skin integrity
B) Impaired motor action
C) Acute pain
D) Signs of infection

Question 12

A client who had a plaster cast applied to the right arm 3 weeks ago presents to the clinic with an erythrocyte sedimentation rate (ESR)that has increased from 15 to 25 mm/hr.Which is the nurse's best action?

A) Repeat this laboratory assessment in 4 hours.
B) Have the cast reapplied.
C) Evaluate temperature and vital signs.
D) Obtain blood for a platelet count.

Question 13

While assessing an older adult client admitted 2 days ago with a fractured hip,the nurse notes that the client is confused,tachypneic,and restless.Which is the nurse's first action?

A) Administer oxygen via nasal cannula.
B) Apply restraints and ask for a sitter.
C) Slow the IV flow rate.
D) Discontinue the pain medication.

Question 14

A client who had a wrist cast applied 3 days ago calls from home,reporting that the cast is loose enough to slide off.How does 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) "Wrap an elastic bandage around the cast to prevent it from slipping."
D) "You need a new cast now that the swelling is decreased."

Question 15

The nurse is caring for several clients with fractures.Which client does the nurse consider at highest risk for developing deep vein thrombosis?

A) Middle-aged woman with a fractured ankle taking aspirin for rheumatoid arthritis
B) Young adult male athlete with a fractured clavicle
C) Female with type 2 diabetes with fractured ribs
D) Older man who smokes and has a fractured pelvis

Question 16

The nurse is performing an assessment on a client admitted with a fractured left humerus.When the client moves the extremity,the nurse notes the presence of a grating sound.Which is the nurse's best intervention?

A) Immobilize the arm.
B) Perform range of motion.
C) Monitor for other signs of infection.
D) Administer steroids.

Question 17

The nurse is teaching a client who has left leg weakness to walk with a cane.Which gait training technique is correct?

A) Place the cane in the client's left hand and move the cane forward, followed by moving the left leg one step forward.
B) Place the cane in the client's left hand and move the cane forward, followed by moving the right leg one step forward.
C) Place the cane in the client's right hand and move the cane forward, followed by moving the left leg one step forward.
D) Place the cane in the client's right hand and move the cane forward, followed by moving the right leg one step forward.

Question 18

A client has a fracture and is being treated with skeletal traction.Which assessment causes the nurse to take immediate action?

A) The client's blood pressure is 130/86 mm Hg.
B) The traction weights are resting on the floor.
C) Slight oozing of clear fluid is noted at the pin site.
D) Capillary refill of the extremity is less than 3 seconds.

Question 19

A client asks why a plaster cast is not applied to the fractured clavicle.Which is the nurse's best response?

A) "Plaster will make the area too heavy for movement."
B) "A splint or a bandage is sufficient to keep the bones in alignment."
C) "Cloth braces are less likely to disrupt circulation."
D) "Fractures to the upper body always heal more quickly."

Question 20

The home care nurse is visiting a client with diabetes who has a new cast on the arm.On assessment,the nurse finds the client's fingers to be pale,cool,and slightly swollen.Which is the nurse's first intervention?

A) Elevate the arm above the level of the heart.
B) Encourage active and passive range of motion.
C) Apply heat to the affected hand.
D) Place a window or bivalve the cast.

Question 21

A client has left-sided weakness.Which action by the client indicates that additional teaching about proper cane use is needed?

A) Holding the cane in the right hand
B) Advancing the cane while the right leg moves forward
C) Stepping forward first with the right leg when ambulating
D) Flexing the elbow 15 to 20 degrees when holding the cane

Question 22

The nurse is caring for an older adult client with multiple fractures.How does the nurse manage pain in this client?

A) Meperidine (Demerol) injections every 4 hours rather than PRN
B) Patient-controlled analgesia (PCA) pump with morphine
C) Ibuprofen (Motrin) 600 mg every 4 hours
D) IV morphine PRN

Question 23

The nurse is caring for a client with a fractured fibula.Which assessment prompts immediate action by the nurse?

A) Reported pain of 4 on a scale of 0 to 10
B) Numbness and tingling in the extremity
C) Swollen extremity where the injury occurred
D) Reports of being cold in bed

Question 24

The client is being assessed for rotator cuff injury.Which physical assessment finding is consistent with this type of injury?

A) The client is unable to maintain adduction of the affected arm at the shoulder for longer than 30 seconds.
B) The client is able to raise the affected arm to shoulder height but feels pain on doing this maneuver.
C) The client is unable to initiate or maintain abduction of the affected arm at the shoulder.
D) The client has referred pain to the shoulder and arm opposite the affected shoulder.

Question 25

The nurse is caring for an older adult client who had leg amputation surgery the previous day.During the admission assessment,the client tells the nurse,"I don't want to live with only one leg,so I should have died during the surgery." Which is the nurse's best response?

A) "Your vital signs are good, and you are doing just fine right now."
B) "Your children are waiting outside and do not want to lose their parent."
C) "Remember that you are still the same person inside, with a missing body part."
D) "You will be able to do some of the same things as before you became disabled."

Question 26

A client with a new fracture reports pain in the site of the fracture.An opioid pain medication was administered 20 minutes ago.Which is the nurse's best intervention?

A) Administration of additional opioids
B) Elevation of the extremity
C) Application of ice
D) Application of heat
E) Keeping the extremity in a dependent position

Question 27

A client has a fractured humerus.Which dietary choice indicates that the client understands the nutrition needed to assist in healing the fracture?

A) Skim milk, vitamin D supplements, and fish
B) Soy milk, vitamin B supplements, and bacon, lettuce, and tomato sandwich
C) Whole milk, vitamin A supplements, and vegetable lasagna
D) Low-fat milk, vitamin C supplements, and roast beef

Question 28

A client has an arm cast and reports that it feels really tight and the fingers are puffy.What is the nurse's best response?

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

Question 29

A client who had a long-leg cast applied last week reports to the clinic nurse,"I can't seem to catch my breath and I feel a bit lightheaded." Which is the priority action of the nurse?

A) Listen to the client's lungs and check the client's blood glucose level.
B) Give the client 2 L of oxygen via nasal cannula and check vital signs.
C) Check the client's pulse oximetry and arrange emergency transfer to the hospital.
D) Reassure the client that it takes much more effort to move with a long-leg cast.

Question 30

An older woman is admitted after falling down the stairs.Which assessment findings require immediate intervention?

A) Blood pressure, 80/50 mm Hg
B) Potassium, 6.0 mEq/L
C) Dark brown urine
D) Heart rate, 90 beats/min
E) Urine output, 50 mL/hr

Question 31

The nurse is caring for clients with above-knee amputations.Which client does the nurse treat first?

A) Client who reports phantom limb pain
B) Client who reports cramping
C) Client who does not want to move the leg
D) Client with regional pain syndrome

Question 32

A client has a fractured tibia and is asking the nurse about external fixation.What are some advantages for the use of external fixation for the immobilization of fractures?

A) Leads to minimal blood loss
B) Allows for early ambulation
C) Decreases the risk of infection
D) Increases blood supply to tissues
E) Provides visualization of bone ends
F) Promotes healing

Question 33

The nurse is caring for a client 3 days after a below-knee amputation.Which is a priority intervention?

A) Muscle-strengthening exercises
B) Use of a very soft bed mattress
C) Placing a pillow between the client's knees
D) Placing the client in high Fowler's position

Question 34

The nurse is caring for a client after arthroscopy surgery.Which intervention is a postoperative priority for this client?

A) Passive range of motion on the involved knee
B) Active range of motion on the involved knee
C) Straight leg raises with the involved leg
D) Immobilization of the leg