Deck 63: Nursing Management: Musculoskeletal Trauma and Orthopedic Surgery

Question 1

A patient hospitalized with multiple fractures has a long-arm plaster cast applied for immobilization of a fractured left radius. Until the cast has completely dried, the nurse should

A) keep the left arm in a dependent position.
B) handle the cast with the palms of the hands.
C) place gauze around the cast edge to pad any roughness.
D) cover the cast with a small blanket to absorb the dampness.

Answer 1

handle the cast with the palms of the hands.

Question 2

A patient is seen at the urgent care center after falling on the right arm and shoulder. It will be most important for the nurse to determine

A) whether there is bruising at the shoulder area.
B) whether the right arm is shorter than the left.
C) the amount of pain the patient is experiencing.
D) how much range of motion (ROM) is present.

Answer 2

whether the right arm is shorter than the left.

Question 3

A 22-year-old patient started an exercise regimen 2 months ago that includes running 3 to 4 miles a day. The patient tells the nurse, "I enjoy my daily runs, but now I have shin splints." Which response by the nurse is appropriate?

A) "You may be increasing your running time too quickly and need to cut back a little bit."
B) "You need to have x-rays of your lower legs to be sure you do not have stress fractures."
C) "You should expect some leg pain while running."
D) "You should try speed-walking rather than running."

Answer 3

"You may be increasing your running time too quickly and need to cut back a little bit."

Question 4

A patient with a fractured radius asks when the cast can be removed. The nurse will instruct the patient that the cast can be removed only after the bone

A) is strong enough to stand mild stress.
B) union is complete on the x-ray.
C) fragments are fully fused.
D) healing has started.

Question 5

When evaluating the crutch-walking technique of a patient with a right-leg long-leg cast and no weight bearing on the right leg, the nurse determines that the patient is prepared to ambulate independently with the crutches on observing that the patient

A) uses the bedside chair to assist in balance as needed when ambulating in the room.
B) keeps the padded area of the crutch firmly in the axillary area when ambulating.
C) advances the right leg and both crutches together and then advances the left leg.
D) moves the left crutch with the left leg and then the right crutch with the right leg.

Question 6

Following the application of a hip spica cast for a patient with a fracture of the proximal third of the left femur, an appropriate nursing intervention is to

A) use the cast support bar to reposition the patient every 2 to 3 hours.
B) ask the patient about any abdominal discomfort or nausea.
C) discuss the reasons for remaining on bed rest for several weeks.
D) promote drying of the cast by placing the patient in a prone position every 4 hours.

Question 7

A patient with a comminuted fracture of the right femur has Buck's traction in place while waiting for surgery. To assess for pressure areas on the patient's back and sacral area and to provide skin care, the nurse should

A) have the patient lift the buttocks by bending and pushing with the left leg.
B) turn the patient partially to each side with the assistance of another nurse.
C) place a pillow between the patient's legs and turn gently to each side.
D) loosen the traction and have the patient turn onto the unaffected side.

Question 8

A checkout clerk in a grocery store has muscle and tendon tears that have become inflamed, causing pain and weakness in the left hand and elbow. The nurse identifies these symptoms as related to

A) muscle spasms.
B) meniscus injury.
C) repetitive strain injury.
D) carpal tunnel syndrome.

Question 9

A patient with comminuted fractures of the tibia and fibula is treated with open reduction and application of an external fixator. The next day, the patient complains of severe pain in the leg, which is unrelieved by ordered analgesics. The patient's toes are pink, but the patient complains of numbness and tingling. The most appropriate action by the nurse is to

A) notify the patient's health care provider.
B) check the patient's blood pressure.
C) assess the external fixator pins for redness or drainage.
D) elevate the extremity and apply ice over the wound site.

Question 10

When counseling an older patient about ways to prevent fractures, which information will the nurse include?

A) Tacking down scatter rugs in the home is recommended.
B) Occasional weight-bearing exercise will improve muscle and bone strength.
C) Most falls happen outside the home.
D) Buying shoes that provide good support and are comfortable to wear is recommended.

Question 11

Following a motor-vehicle accident, a patient arrives in the emergency department with massive right lower-leg swelling. Which action will the nurse take first?

A) Elevate the leg on pillows.
B) Apply a compression bandage.
C) Place ice packs on the lower leg.
D) Check leg pulses and sensation.

Question 12

A patient arrives in the emergency department with ankle swelling and severe pain after twisting the ankle playing soccer. All of the following orders are written by the health care provider. Which one will the nurse act on first?

A) Administer naproxen (Naprosyn) 500 mg PO.
B) Wrap the ankle and apply an ice pack.
C) Give acetaminophen with codeine (Tylenol #3).
D) Take the patient to the radiology department for x-rays.

Question 13

When working with a patient whose job involves many hours of word processing, the nurse will teach the patient about the need to

A) do stretching and warm-up exercises before starting work.
B) wrap the wrists with a compression bandage every morning.
C) use acetaminophen (Tylenol) instead of NSAIDs for wrist pain.
D) obtain a keyboard pad to support the wrist while word processing.

Question 14

A patient has a short-arm plaster cast applied at the outpatient center for a wrist fracture. An understanding of discharge teaching is apparent when the patient says,

A) "I can get the cast wet as long as I dry it right away with a hair dryer."
B) "I should avoid moving my fingers and elbow until the cast is removed."
C) "I will apply an ice pack to the cast over the fracture site for the next 24 hours."
D) "I can rub lotion on any itching areas under the cast with a cotton-tipped applicator."

Question 15

A patient is admitted to the emergency department with possible fractures of the bones of the left lower extremity. The initial action by the nurse should be to

A) splint the lower leg.
B) elevate the left leg.
C) check the popliteal, dorsalis pedis, and posterior tibial pulses.
D) obtain information about the patient's tetanus immunization status.

Question 16

A 20-year-old baseball pitcher has an arthroscopic repair of a rotator cuff injury performed in same-day surgery. When the nurse plans postoperative teaching for the patient, which information will be included?

A) "You have an appointment with a physical therapist for tomorrow."
B) "Leave the shoulder immobilizer on for the first few days to minimize pain."
C) "The doctor will use the drop-arm test to determine the success of the procedure."
D) "You should try to find a different position to play on the baseball team."

Question 17

A patient with a fractured pelvis is initially treated with bed rest with no turning from side to side permitted. The second day after admission, the patient develops chest pain, tachypnea, and tachycardia. The nurse determines that the patient's symptoms are most likely related to fat embolism when assessment of the patient reveals

A) a blood pressure of 100/65 mm Hg.
B) anxiety, restlessness, and confusion.
C) warm, reddened areas in the calf.
D) pinpoint red areas on the upper chest.

Question 18

A patient in the emergency department is diagnosed with a patellar dislocation. The initial patient teaching by the nurse will focus on the need for

A) conscious sedation.
B) a knee immobilizer.
C) gentle knee flexion.
D) cast application.

Question 19

Following x-rays of an injured wrist, the patient is informed that it is badly sprained. In teaching the patient to care for the injury, the nurse tells the patient to

A) apply a heating pad to reduce muscle spasms.
B) wear an elastic compression bandage continuously.
C) use pillows to keep the arm elevated above the heart.
D) gently exercise the joint to prevent muscle shortening.

Question 20

In developing a care plan for a patient with an open reduction and internal fixation (ORIF) of an open, displaced fracture of the tibia, the priority nursing diagnosis is

A) risk for constipation related to prolonged bed rest.
B) activity intolerance related to deconditioning.
C) risk for infection related to disruption of skin integrity.
D) risk for impaired skin integrity related to immobility.

Question 21

The health care provider initially orders bed rest for a patient with an open-book pelvic fracture. Which assessment data obtained by the nurse are most important to report to the health care provider?

A) The bowel tones are absent.
B) There is an unusual amount of pelvic movement.
C) The patient complains of level 4 abdominal pain on a 10-point pain scale.
D) There is bruising of the abdomen.

Question 22

A patient with severe ulnar drift caused by rheumatoid arthritis (RA) is scheduled for an arthroplasty of the right hand and fingers. The nurse determines that the patient has realistic expectations of the outcome of surgery when the patient says,

A) "I will be able to use my fingers to grasp objects better."
B) "My fingers will appear normal in size and shape after this surgery."
C) "This procedure will prevent further deformity in my hands and fingers."
D) "I will not have to do as many hand exercises after the surgery."

Question 23

When getting a patient from the bed into the chair for the first time since having an ORIF of a hip fracture, the nurse should

A) use a mechanical lift to transfer the patient from the bed to the chair.
B) assist the patient to use a walker with partial weight bearing to assist in transfer to the chair.
C) have the patient use crutches with a swing-through gait to transfer.
D) ask a nursing assistant to help the patient to stand at the bedside and pivot to the chair.

Question 24

On the first postoperative day, a patient with a below-the-knee amputation complains of pain in the amputated limb. An appropriate action by the nurse is to

A) administer prescribed opioids to relieve the pain.
B) explain the reasons for phantom limb pain.
C) loosen the compression bandage to decrease incisional pressure.
D) remind the patient that this phantom pain will diminish over time.

Question 25

A patient who has severe peripheral arterial disease and ischemic foot ulcers is upset with the health care provider's recommendation to have an above-the-knee amputation. The patient tells the nurse, "If they want to cut off my leg, they should just shoot me instead." The most appropriate response to the patient's statement is,

A) "Let's talk about how you feel this surgery will affect you."
B) "If you do not want the surgery, you do not have to have it."
C) "I understand why you are upset, but there really is no choice because your leg is so badly diseased."
D) "Many people are able to function normally with a prosthesis after amputation, and you can too."

Question 26

A patient undergoes a right below-the-knee amputation with an immediate prosthetic fitting. When the patient is returned to the nursing unit, the nurse should

A) check the surgical site for hemorrhage.
B) take the patient's vital signs frequently.
C) keep the residual leg elevated on a pillow.
D) place the patient in a prone position.

Question 27

A patient with an intracapsular fracture of the left femur is placed in Buck's traction before surgery for a hip replacement. The patient asks why traction is necessary when surgery is planned. The nurse's response to the patient is based on the knowledge that traction

A) will help prevent flexion contractures of the affected hip.
B) is necessary to prevent displacement of the fracture.
C) will decrease the incidence of painful muscle spasms
D) is used to maintain the leg in the external rotation position.

Question 28

The nurse provides discharge instructions to a patient with an above-the-knee amputation who will be fitted with a prosthesis when healing is complete and the residual limb is well molded. The nurse determines that teaching has been effective when the patient says,

A) "I should change the limb sock when it becomes soiled or stretched out."
B) "I should use lotion on the stump to prevent drying and cracking of the skin."
C) "I should elevate my residual limb on a pillow 2 or 3 times a day."
D) "I should lay on my abdomen for 30 minutes 3 or 4 times a day."

Question 29

The nurse observes a patient doing all these activities after having a hip-replacement surgery. Which patient action requires that the nurse intervene immediately?

A) The patient sits straight up on the edge of the bed.
B) The patient leans over to pull shoes and socks on.
C) The patient bends over the sink while brushing the teeth.
D) The patient uses crutches with a swing-to gait.

Question 30

All these medications are ordered at 9:00 AM for a patient who has had a right-hip replacement the previous day and is scheduled to ambulate with the physical therapist for the first time at 9:45. Which medication should be given first?

A) Oxycodone (Roxicodone) 5 mg PO
B) Ceftriaxone (Rocephin) 500 mg IV
C) Enoxaparin (Lovenox) 30 mg SC
D) Psyllium (Metamucil) 1 tsp PO

Question 31

When giving home-care instructions to a patient who has multiple forearm fractures and a long-arm cast on the right arm, which information should the nurse include?

A) Keep the hand immobile to prevent soft tissue swelling.
B) Call the health care provider for increased swelling or numbness.
C) Keep the right shoulder elevated on a pillow or cushion.
D) Avoid the use of NSAIDs for the first 48 hours after the injury.

Question 32

A patient who has been hospitalized for 3 days with a hip fracture and Buck's traction has sudden onset shortness of breath and tachypnea. The patient tells the nurse, "I feel like I am going to die!" Which action should the nurse take first?

A) Stay with the patient and offer reassurance.
B) Administer oxygen at 4 L/min by a nasal cannula.
C) Notify the health care provider about the patient's symptoms.
D) Check the patient's legs for swelling or tenderness.

Question 33

A patient is to be discharged from the hospital 4 days after undergoing a total hip arthroplasty. A statement by the patient that indicates a need for additional discharge instructions is

A) "I should not cross my legs while sitting."
B) "I can sleep in any position that is comfortable for me."
C) "I will use a toilet elevator on the toilet seat."
D) "I will have someone else put on my shoes and socks."

Question 34

A patient with severe osteoarthritis of the left knee has undergone left-knee arthroplasty with replacement of the total knee joint with a plastic prosthesis. Postoperatively, the nurse expects care of the leg to include

A) bed rest for 3 days with the left leg immobilized in an extended position.
B) use of a compression bandage to hold the left knee in a flexed position.
C) progressive leg exercises to obtain 90-degree flexion.
D) early ambulation with full weight bearing on the left leg.

Question 35

A patient is admitted with facial injuries after a bicycle accident and has a repair of a fractured mandible. When doing postoperative teaching, the nurse will include information about

A) the use of sterile technique for dressing changes.
B) the importance of including high-fiber foods in the diet.
C) when the patient may need to cut the immobilizing wires.
D) self-administration of nasogastric tube feedings.

Question 36

A patient with lower-leg fractures has an external fixation device in place and is scheduled for discharge. Which information will the nurse include in the discharge teaching?

A) "You will need to remain on bed rest until bone healing is complete."
B) "The external fixator can be removed during the bath or shower."
C) "Prophylactic antibiotics are needed until the external fixator is removed."
D) "You will need to assess and clean the pin insertion sites daily."

Question 37

A patient who has a proximal humerus fracture that is immobilized with a left-sided long-arm cast, and a sling is admitted to the medical-surgical unit. Which nursing intervention will be included in the plan of care?

A) Use surgical net dressing to hang the arm from an IV pole.
B) Immobilize the fingers on the left hand with gauze dressings.
C) Assess the left axilla and change absorbent dressings as needed.
D) Assist the patient in passive range of motion (ROM) for the right arm.

Question 38

After falling at home, a patient is admitted to the emergency department, where x-rays confirm the presence of an extracapsular fracture of the femur. When assessing the patient, the nurse would expect to find

A) bruising of the left hip and thigh.
B) numbness in the left leg and hip.
C) outward pointing toes on the left leg.
D) weak or nonpalpable left leg pulses.

Question 39

When preparing a patient to ambulate the day after an ORIF for a hip fracture, which action is most important for the nurse to take?

A) Administering the ordered oral opioid pain medication
B) Instructing the patient about the benefits of ambulation
C) Ensuring that the incisional drain has been discontinued
D) Changing the hip dressing and document the appearance of the site