Deck 65: Nursing Management: Musculoskeletal Trauma and Orthopedic Surgery

Question 1

A woman is seen at the urgent care centre after falling on her right arm and shoulder.What is an assessment finding noted by the nurse that would indicate the patient has a dislocated shoulder?

A) Bruising at the shoulder area
B) The right arm being shorter than the left arm
C) Decreased range of motion of the right shoulder
D) Increased pain caused by flexing and extending the elbow

Answer 1

The right arm being shorter than the left arm

Question 2

A patient has a short arm plaster cast applied at the outpatient centre for a stable wrist fracture.An understanding of discharge teaching is apparent when the patient gives which of the following responses?

A) "I can get the cast wet if 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) "If I have itching under the cast,I can apply lotion to the area with a cotton-tipped applicator."

Answer 2

"I will apply an ice pack to the cast over the fracture site for the next 24 hours."

Question 3

A patient with a fractured right tibia has a long leg cast applied and has been taught crutch walking with no weight bearing on his affected leg.The nurse determines that the patient is prepared to ambulate independently with the crutches on observing the patient do which of the following actions?

A) Advancing the crutches together and swinging the body past the crutches
B) Advancing the right leg and both crutches together and then advancing the left leg
C) Advancing the left crutch with the right leg and then the right crutch with the left leg
D) Advancing the left crutch,then the left leg,and then the right crutch followed by the right leg

Answer 3

Advancing the right leg and both crutches together and then advancing the left leg

Question 4

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

A) Risk for constipation related to immobilization
B) Activity intolerance related to prolonged immobility
C) Risk for impaired skin integrity related to immobility
D) Risk for infection related to disruption of skin integrity

Question 5

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.Which of the following nursing assessments helps determine that the patient's symptoms are most likely related to fat embolism?

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 6

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

A) "You have an appointment with a physiotherapist 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 7

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 8

A 73-year-old woman tells the nurse that she is "slowing down" and does not try to push herself to do much these days because of her age.She spends most of the day and evening watching television and has hired someone to do most of her home maintenance chores.Recognizing that the woman is at risk for musculoskeletal problems,what is the best response to her comment?

A) "To improve your condition,you should join an exercise program,perhaps one at your local senior centre."
B) "Mild,regular exercise will increase your strength and coordination and help increase your sense of well-being."
C) "Many older people benefit from occasional exercise,which helps prevent muscle wasting and fatigue common in old age."
D) "Many musculoskeletal changes occur with age that may limit physical activities.This is normal and to be expected."

Question 9

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

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 10

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 completes which process?

A) Ossification
B) Remodelling
C) Consolidation
D) Callus formation

Question 11

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

A) Keep the extremity in a dependent position.
B) Handle the cast with the palms of the hands.
C) Position the cast on a pillow to prevent abnormal shaping.
D) Cover the cast with a small blanket to absorb the dampness.

Question 12

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

A) Reposition the patient,using the support bar at the thighs.
B) Assess the patient for abdominal pain,and nausea and vomiting.
C) Psychologically prepare the patient for a long period of bed rest without ambulation.
D) Turn the patient to the prone position every 4 hours to promote drying of the posterior part of the cast.

Question 13

While working in an urgent care centre,the nurse sees many patients with sports-related injuries.In teaching these patients about health promotion during physical activity,what should the nurse emphasize?

A) Stretching and warm-up exercises are an important part of the exercise routine.
B) All joints at risk for injury should be wrapped with adhesive tape before exercising.
C) Low-impact activities should be substituted for strenuous,physically stressful exercise.
D) All strenuous exercise should be followed with a period of complete physical relaxation.

Question 14

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 physician.Which one will the nurse act on first?

A) Administer naproxen (Naprosyn)500 mg orally.
B) Wrap the ankle,and apply an ice pack.
C) Give acetaminophen with codeine (Tylenol No.3).
D) Take the patient to the radiology department for X-ray films.

Question 15

A patient is admitted to the emergency department with possible fractures of the bones of the left lower extremity.Before initiating treatment for the patient,what is it most important for the nurse to do?

A) Splint the lower leg.
B) Elevate the injured limb.
C) Check neurovascular status distal to the injury.
D) Assess the patient's tetanus immunization status.

Question 16

A cashier in a grocery store has muscle and tendon tears that have become inflamed,causing pain and weakness in her left hand and elbow.What should the nurse identify these symptoms as being related to?

A) Bursitis
B) Meniscus injury
C) Repetitive strain injury (RSI)
D) Carpal tunnel syndrome

Question 17

A patient in the emergency department is diagnosed with a patellar dislocation.What will the nurse's initial patient teaching focus on?

A) Conscious sedation
B) A knee immobilizer
C) Gentle knee flexion
D) Cast application

Question 18

A 24-year-old man recently started an exercise regimen that includes running 5 to 7 km a day.He tells the nurse he has developed shin splints so severe that they limit his ability to run.What is an appropriate response?

A) "You may be increasing your running time too quickly and need to cut back a little bit."
B) "You need to have X-ray films made 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."

Question 19

Following X-ray films of an injured wrist,the patient is informed that it is just badly sprained.In teaching the patient to care for the injury,what should the nurse teach the patient to do?

A) Apply a heating pad to reduce muscle spasms.
B) Wear an elastic compression bandage continuously.
C) Gently exercise the joint to prevent muscle shortening.
D) Keep the arm elevated above the heart,even during sleep.

Question 20

A patient with open,comminuted fractures of the tibia and fibula is treated with open reduction and application of an external fixator.The day following surgery,the patient complains of severe pain in her affected leg,which is unrelieved by ordered analgesics.The patient's toes are pink,but she says they are numb and tingling.What is the most appropriate nursing action?

A) Notify the patient's physician.
B) Check the patient's temperature.
C) Loosen the screws on the pins of the external fixator.
D) Elevate the extremity,and apply ice at the wound site.

Question 21

Which of the following describes a complication of fracture healing known as malunion?

A) Fracture healing progresses more slowly than expected.
B) Fracture fails to heal properly despite treatment.
C) Fracture heals in the expected time but in an unsatisfactory position.
D) Fracture heals in an abnormal position in relation to midline of structure.

Question 22

When performing preoperative teaching for a patient who is scheduled for an ORIF of a left intertrochanteric hip fracture,what should the nurse inform the patient about regarding the expected outcome of this surgery?

A) Restriction of activity to bed rest and sitting in a chair
B) Confinement in bed with skeletal traction applied to the distal part of her femur
C) Early ambulation with the use of an assistive device,such as a walker or crutches
D) The ability to ambulate several days after surgery with full weight bearing on the affected limb

Question 23

Which one of the following workers would be most at risk for an RSI?

A) Butcher
B) Car sales person
C) Long-haul truck driver
D) Nurse

Question 24

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 moulded.The nurse determines that teaching has been effective when the patient gives which of the following responses?

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

Question 25

The physician initially orders bed rest for a patient with a fractured pelvis.During assessment of the patient,which of the following findings would alert the nurse to a complication of the fracture?

A) Absence of bowel sounds
B) Unusual pelvic movement
C) Lower abdominal tenderness
D) Ecchymosis of the lower abdomen

Question 26

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 which of the following?

A) The use of sterile technique for dressing changes
B) The importance of including high-fibre foods in the diet
C) When the patient may have to cut the immobilizing wires
D) Self-administration of nasogastric tube feedings

Question 27

On the first postoperative day,a patient with a below-the-knee amputation complains of pain in the amputated limb.What is an appropriate nursing action?

A) Administer prescribed opioids to relieve the pain.
B) Ask the patient to ignore the pain because it is not real.
C) Loosen the compression bandage to prevent pressure on the surgical incision.
D) Tell the patient that this phantom pain will diminish over time with increasing awareness of the absence of the limb.

Question 28

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 what knowledge about 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 29

The nurse observes a patient doing all of these activities after having 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

For which one of the following injuries would the nurse anticipate treatment with rest,ice,and nonsteroidal anti-inflammatory drugs (NSAIDs)?

A) Ligament injury
B) Impingement syndrome
C) Rotator cuff tear
D) Tendinoligamentous injury

Question 31

A patient with severe ulnar drift caused by rheumatoid arthritis 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 gives which of the following responses?

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 perform exercises of my hands as frequently as I did before the surgery."

Question 32

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

A) "Let's talk about how you feel this surgery will affect you."
B) "I will stay with you because I know this is a difficult decision for you to make."
C) "I'm so sorry,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 33

The nurse identifies a nursing diagnosis of impaired physical mobility related to decreased muscle strength for a 75-year-old patient recovering from a right total hip arthroplasty.What is an appropriate nursing intervention for the patient?

A) Promote vitamin D and calcium intake in the diet.
B) Encourage quadriceps-setting exercises at least four times daily.
C) Provide passive range of motion to all of the joints four times daily.
D) Keep the right leg in extension and abduction to prevent contractures.

Question 34

A patient has been diagnosed with a Greenstick fracture.Which of the following describes what type of fracture this is?

A) The line of the fracture extends across the bone shaft at a right angle to the longitudinal axis.
B) The line of the fracture extends in a spiral direction along the shaft of the bone.
C) An incomplete fracture with more than two fragments.
D) The line of the fracture extends in an oblique direction.

Question 35

After falling at home,an 81-year-old man was admitted to the emergency department,where X-ray films confirmed the presence of an extracapsular fracture of the femur.When assessing the patient,what would the nurse 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 36

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 intravenous 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 for the right arm.

Question 37

Which diagnosis does the nurse anticipate when a patient has a positive McMurray's test?

A) Torn knee meniscus
B) Tear in the rotator cuff
C) Carpal tunnel syndrome
D) RSI

Question 38

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,what should the nurse expect care of the leg to include?

A) Progressive leg exercises to obtain 90-degree flexion
B) Early ambulation with full weight bearing on the left leg
C) Bed rest for 3 days with the left leg immobilized in extension
D) Immobilization of the left knee in 30-degree flexion for 6 weeks to prevent dislocation