Question 1

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

Accepted Answer

The client with carpal tunnel syndrome can be treated nonsurgically by administration of oral NSAIDs and corticosteroid injections.Most clients find relief with taking these medications and the use of a hand brace or splint to immobilize the wrist.The use of opioids such as morphine should not be necessary.NSAIDs and corticosteroids decrease inflammation and pain.

Question 2

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

Accepted Answer

The skin flap should appear pink in a light-skinned person and not discolored in a darker-skinned person.The area should feel warm but not hot.Pale and cool skin could indicate inadequate blood flow to the area.The nurse would notify the provider.

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?

Accepted Answer

The symptoms represent early warning of acute compartment syndrome.In acute compartment syndrome,sensory deficits such as paresthesias precede changes in vascular or motor signs.If the nurse finds a decrease in pedal pulses,the health care provider should be notified as soon as possible.

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?

Accepted Answer

Paget's disease and bone cancer can cause pathologic fractures such as a fractured femur that do not achieve total healing.The other factors do not impede healing but may cause other health risks.

Question 5

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

Accepted Answer

Bone infection or osteomyelitis is most common in clients with an open fracture because skin integrity is lost and organisms gain access easily.The nurse will remind all those who come into contact with the client to use good handwashing and will observe the wound daily for signs of infection.The other clients do not have extra risk factors for infection.

Question 6

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

Accepted Answer

With a pelvic fracture,internal organ damage may result in bleeding and hypovolemic shock.The nurse monitors the client's vital signs,skin color,and level of consciousness frequently to determine whether shock is occurring.The client may need a urethral catheter inserted at some point in time if voiding is a problem.It is important to monitor the urine for blood to assess whether the urinary system has been damaged with the pelvic fracture.The client should not be turned on his or her side unless the fracture is stabilized.

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?

Accepted Answer

The client in a body cast is monitored for cast syndrome,which results in intestinal obstruction.Vomiting after meals may indicate that this is occurring.Bowel sounds might be "normal" with this condition.The rest of the assessments are not related to cast syndrome.

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?

Accepted Answer

These clinical manifestations indicate inflammation and possible infection.Infected pin sites can lead to osteomyelitis and should be treated immediately.The nurse should obtain a culture and assess vital signs.The provider should be notified.By decreasing the traction weight,applying a new dressing,or cleansing the area,the infection cannot be significantly treated.

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?

Accepted Answer

The client is experiencing phantom limb pain.IV infusions of calcitonin during the week after amputation can reduce phantom limb pain.The other medications will not assist in decreasing the client's pain.

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?

Accepted Answer

Skeletal traction pins or screws are surgically inserted into the bone to aid in bone alignment.The other choices are not primary purposes of skeletal traction.

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?

Accepted Answer

As long as the external fixator is in place,a direct connection is present between the external environment and the bone.The risk for infection is high.An expected alteration in skin integrity and a decrease in movement are noted.Acute pain would not be expected,but the client should be medicated for pain if necessary.

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?

Accepted Answer

A rise in the ESR during fracture healing suggests a bone infection or a fat embolism.The nurse should collect all other assessment data that can assist in confirming this diagnosis and then should notify the health care provider.Repeating the laboratory assessment,reapplying the cast,and assessing a platelet count would not be indicated.

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?

Accepted Answer

The client is at high risk for a fat embolism and has some of the clinical manifestations of altered mental status and dyspnea.Although this is a life-threatening emergency,the nurse should take the time to administer oxygen first and then notify the health care provider.Oxygen administration can reduce the risk for cerebral damage from hypoxia.The nurse would not restrain a client who is confused without further assessment and orders.Pain medication most likely would not cause the client to be restless.The IV rate is not related.

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?

Accepted Answer

Often the surrounding soft tissues may be swollen considerably when the cast is initially applied.After the swelling has resolved,if the cast is loose enough to permit two or more fingers between the cast and the client's skin,the cast needs to be replaced.Elevating the arm will not solve the problem,and the client's muscles should not atrophy while in a cast for 6 weeks or less.An elastic bandage will not prevent slippage of the cast.

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?

Accepted Answer

Deep vein thrombosis (DVT)as a complication with bone fractures occurs more often when fractures are sustained in the lower extremities and the client has additional risk factors for thrombus formation.Other risk factors include obesity,smoking,oral contraceptives,previous thrombus events,advanced age,venous stasis,and heart disease.The other clients do not have risk factors for DVT.

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?

Accepted Answer

The grating sound heard when the affected part is moved is known as crepitation.This sound is created by bone fragments.Because bone fragments may be present,the nurse should immobilize the client's arm and tell him or her not to move the arm.The nurse should not move the extremity for range of motion.The grating sound does not indicate infection.Steroids would not be indicated.

Question 17

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

Accepted Answer

Placing the cane in the client's left hand does not provide sufficient stability.After the cane in the right hand (stronger side)is moved ahead,the cane and the stronger leg provide a stable base for movement of the weaker leg.The other techniques are not correct.

Question 18

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

Accepted Answer

The immediate action of the nurse should be to reapply the weights to give traction to the fracture.The health care provider must be notified that the weights were lying on the floor,and the client should be realigned in bed.Slight oozing of clear fluid is normal as is the capillary refill time.The client's blood pressure is slightly elevated; this could be related to pain and muscle spasms resulting from lack of pressure to reduce the fracture.

Question 19

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

Accepted Answer

Because upper extremities do not bear weight,cloth splints are usually sufficient to immobilize the fracture.The other responses are not accurate for this type of fracture.

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?

Accepted Answer

Arm casts can impinge on circulation when the arm is in the dependent position.The nurse should immediately elevate the arm above the level of the heart,ensuring that the hand is above the elbow,and should reassess the extremity in 15 minutes.If the fingers are warmer and less swollen,the cast is not too tight and adjustments do not need to be made,but a sling should be worn when the client is upright.Heat would cause increased edema and should not be used.Encouraging range of motion would not assist the client as much as elevating the arm.If the cast is assessed to be too tight,it could be bivalved.

Quiz 54: Care of Patients With Musculoskeletal Trauma