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Chapter 42: Management of Patients With Musculoskeletal Trauma A nurse admits a patient who has a fracture of the nose that has resulted in a skin tearof the mucous membranes of the nasal passages. The orthopedic nurse is aware that this des and involvementcription likely indicates which type of fra...

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TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

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Chapter42:ManagementofPatientsWithMusculoskeletalTrauma  1.

Anurseadmitsapatientwhohasafractureofthenosethathasresultedinaskintearandinvolvement ofthemucousmembranesofthenasalpassages.Theorthopedicnurseisawarethatthisdescription likelyindicateswhichtypeoffracture?

A)

Compression

B)

Compound

C)

Impacted

D)

Transverse

Ans:

B Feedback: Acompoundfractureinvolvesdamagetotheskinormucousmembranesandisalsocalledanopen fracture.Acompressionfractureinvolvescompressionofboneandisseeninvertebralfractures.An impactedfractureoccurswhenabonefragmentisdrivenintoanotherbonefragment.Atransverse fractureoccursstraightacrosstheboneshaft.

2.

Apatienthassustainedalongbonefractureandthenurseispreparingthepatientscareplan.Whichof thefollowingshouldthenurseincludeinthecareplan?

A)

AdministervitaminDandcalciumsupplementsasordered.

B)

Monitortemperatureandpulsesoftheaffectedextremity.

C)

Performpassiverangeofmotionexercisesastolerated.

D)

Administercorticosteroidsasordered.

Ans:

B Feedback: Thenurseshouldincludemonitoringforsufficientbloodsupplybyassessingthecolor,temperature,and pulsesoftheaffectedextremity.Weight-bearingexercisesareencouraged,butpassiveROMexercises havethepotentialtocausepainandinhibithealing.Corticosteroids,vitaminD,andcalciumarenot normallyadministered.

3.

Anursesassessmentofapatientskneerevealsedema,tenderness,musclespasms,andecchymosis.The

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

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patientstatesthat2daysagoheran10milesandnowitreallyhurtstostandup.Thenurseshouldplan carebasedonthebeliefthatthepatienthasexperiencedwhat? A)

Afirst-degreestrain

B)

Asecond-degreestrain

C)

Afirst-degreesprain

D)

Asecond-degreesprain

Ans:

B Feedback: Asecond-degreestraininvolvestearingofmusclefibersandismanifestedbynotablelossofloadbearingstrengthwithaccompanyingedema,tenderness,musclespasm,andecchymosis.Afirst-degree strainreflectstearingofafewmusclefibersandisaccompaniedbyminoredema,tenderness,andmild musclespasm,withoutnoticeablelossoffunction.However,thispatientstatesalossoffunction.A sprainnormallyinvolvestwisting,whichisinconsistentwiththepatientsoveruseinjury.

4.

Anurseispreparingtodischargeapatientfromtheemergencydepartmentafterreceivingtreatmentfor ananklesprain.Whileprovidingdischargeeducation,thenurseshouldencouragewhichofthe following?

A)

Applyheatforthefirst24to48hoursaftertheinjury.

B)

Maintaintheankleinadependentposition.

C)

Exercisehourlybyperformingrotationexercisesoftheankle.

D) Ans:

Keepanelasticcompressionbandageontheankle.

D Feedback: Treatmentofasprainconsistsofrestingandelevatingtheaffectedpart,applyingcold,andusinga compressionbandage.Aftertheacuteinflammatorystage(usually24to48hoursafterinjury),heatmay beappliedintermittently.Rotationexerciseswouldlikelybepainful.

5.

A)

Anurseiswritingacareplanforapatientadmittedtotheemergencydepartment(ED)withanopen fracture.Thenursewillassignprioritytowhatnursingdiagnosisforapatientwithanopenfractureof theradius? RiskforInfection

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B) C) D) Ans:

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RiskforIneffectiveRolePerformance RiskforPerioperativePositioningInjury RiskforPowerlessness

A Feedback: Thepatienthasasignificantriskforosteomyelitisandtetanusduetothefactthatthefractureisopen. Powerlessnessandineffectiveroleperformancearepsychosocialdiagnosesthatmayormaynotapply, andwhichwouldbesupersededbyimmediatephysiologicthreatssuchasinfection.Surgicalpositioning injuryisnotplausible,sincesurgeryisnotlikelyindicated.

6.

Anurseiscaringforapatientwhohassufferedahipfractureandwhowillrequireanextendedhospital stay.Thenurseshouldensurethatthepatientdoeswhichofthefollowinginordertopreventcommon complicationsassociatedwithahipfracture?

A)

Avoidrequestinganalgesiaunlesspainbecomesunbearable.

B)

Usesupplementaryoxygenwhentransferringormobilizing.

C)

Increasefluidintakeandperformprescribedfootexercises.

D)

Remainonbedrestfor14daysoruntilinstructedbytheorthopedicsurgeon.

Ans:

C Feedback: Deepveinthrombosis(DVT)isamongthemostcommoncomplicationsrelatedtoahipfracture.To preventDVT,thenurseencouragesintakeoffluidsandankleandfootexercises.Thepatientshouldnot betoldtoendurepain;aproactiveapproachtopaincontrolshouldbeadopted.Whilerespiratory complicationscommonlyincludeatelectasisandpneumonia,theuseofdeep-breathingexercises, changesinpositionatleastevery2hours,andtheuseofincentivespirometryhelppreventthe respiratorycomplicationsmorethanusingsupplementaryoxygen.Bedrestmaybeindicatedintheshort term,butisnotnormallyrequiredfor14days.

7.

Anurseiscaringforapatientwhohassufferedanunstablethoracolumbarfracture.Whichofthe followingisthepriorityduringnursingcare?

A)

Preventinginfection

B)

Maintainingspinalalignment

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C)

Maximizingfunction

D)

Preventingincreasedintracranialpressure

Ans:

B

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Feedback: Patientswithanunstablefracturemusthavetheirspineinalignmentatalltimesinordertoprevent neurologicdamage.Thisisagreaterthreat,andhigherpriority,thanpromotingfunctionandpreventing infection,eventhoughthesearebothvalidconsiderations.IncreasedICPisnotahighrisk. 8.

A)

ThepatientscheduledforaSymeamputationisconcernedabouttheabilitytoeventuallystandonthe amputatedextremity.Howshouldthenursebestrespondtothepatientsconcern? Youwilleventuallybeabletowithstandfullweight-bearingaftertheamputation.

B)

Youwillhaveminimalweight-bearingonthisextremitybutyoullbetaughthowtouseanassistive device.

C)

Youlikelywillnotbeabletousethisextremitybutyouwillreceiveteachingonuseofa wheelchair.

D)

Youwillbefittedforaprosthesiswhichmayormaynotallowyoutowalk.

Ans:

A Feedback: Symeamputation(modifiedankledisarticulationamputation)isperformedmostfrequentlyforextensive foottraumaandproducesapainless,durableextremityendthatcanwithstandfullweight-bearing. Therefore,eachoftheotherteachingstatementsisincorrect.

9.

Apatientwithasimplearmfractureisreceivingdischargeeducationfromthenurse.Whatwouldthe nurseinstructthepatienttodo?

A)

Elevatetheaffectedextremitytoshoulderlevelwhenatrest.

B)

Engageinexercisesthatstrengthentheunaffectedmuscles.

C)

Applytopicalanestheticstoaccessibleskinsurfacesasneeded.

D)

Avoidusinganalgesicssothatfurtherdamageisnotmasked.

Ans:

B

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Feedback: Thenursewillencouragethepatienttoengageinexercisesthatstrengthentheunaffectedmuscles. Comfortmeasuresmayincludeappropriateuseofanalgesicsandelevationoftheaffectedextremityto theheartlevel.Topicalanestheticsarenottypicallyused. 10. Sixweeksafteranabove-the-kneeamputation(AKA),apatientreturnstotheoutpatientofficefora routinepostoperativecheckup.Duringthenursesassessment,thepatientreportssymptomsofphantom pain.Whatshouldthenursetellthepatienttodotoreducethediscomfortofthephantompain? A)

Applyintermittenthotcompressestotheareaoftheamputation.

B)

Avoidactivityuntilthepainsubsides.

C)

Takeopioidanalgesicsasordered.

D)

Elevatetheleveloftheamputationsite.

Ans:

C Feedback: Opioidanalgesicsmaybeeffectiveinrelievingphantompain.Heat,immobility,andelevationarenot notedtorelievethisformofpain.

Anurseiscaringforapatientwhohadarightbelow-the-kneeamputation(BKA).Thenurserecognizes 11. theimportanceofimplementingmeasuresthatfocusonpreventingflexioncontractureofthehipand maintainingproperpositioning.Whichofthefollowingmeasureswillbestachievethesegoals? A)

Encouragingthepatienttoturnfromsidetosideandtoassumeaproneposition

B)

InitiatingROMexercisesofthehipandknee10to12weeksaftertheamputation

C)

Minimizingmovementoftheflexormusclesofthehip

D)

Encouragingthepatienttositinachairforatleast8hoursaday

Ans:

A Feedback: Thenurseencouragesthepatienttoturnfromsidetosideandtoassumeaproneposition,ifpossible,to stretchtheflexormusclesandtopreventflexioncontractureofthehip.PostoperativeROMexercisesare startedearly,becausecontracturedeformitiesdeveloprapidly.ROMexercisesincludehipandknee exercisesforpatientswithBKAs.Thenursealsodiscouragessittingforprolongedperiodsoftime.

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12. Anurseispreparingtodischargeanemergencydepartmentpatientwhohasbeenfittedwithaslingto supportherarmafteraclaviclefracture.Whatshouldthenurseinstructthepatienttodo? A)

Elevatethearmabovetheshoulder3to4timesdaily.

B)

Avoidmovingtheelbow,wrist,andfingersuntilboneremodelingiscomplete.

C)

Engageinactiverangeofmotionusingtheaffectedarm.

D)

Usethearmforlightactivitieswithintherangeofmotion.

Ans:

D Feedback: Apatientwithaclaviclefracturemayuseaslingtosupportthearmandrelievethepain.Thepatient maybepermittedtousethearmforlightactivitieswithintherangeofcomfort.Thepatientshouldnot elevatethearmabovetheshoulderleveluntiltheendsoftheboneshaveunited,butthenurseshould encouragethepatienttoexercisetheelbow,wrist,andfingers.

13. TheorthopedicnurseshouldassessforsignsandsymptomsofVolkmannscontractureifapatienthas fracturedwhichofthefollowingbones? A)

Femur

B)

Humerus

C)

Radialhead

D)

Clavicle

Ans:

B Feedback: ThemostseriouscomplicationofasupracondylarfractureofthehumerusisVolkmannsischemic contracture,whichresultsfromantecubitalswellingordamagetothebrachialartery.Thiscomplication isspecifictohumeralfractures.

Anemergencydepartmentnurseisassessinga17-year-oldsoccerplayerwhopresentedwithaknee 14. injury.Thepatientsdescriptionoftheinjuryindicatesthathiskneewasstruckmediallywhilehisfoot wasontheground.Thenurseknowsthatthepatientlikelyhasexperiencedwhatinjury? A)

Lateralcollateralligamentinjury

B)

Medialcollateralligamentinjury

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C)

Anteriorcruciateligamentinjury

D)

Posteriorcruciateligamentinjury

Ans:

A

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Feedback: Whenthekneeisstruckmedially,damagemayoccurtothelateralcollateralligament.Ifthekneeis strucklaterally,damagemayoccurtothemedialcollateralligament.TheACLandPCLarenottypically injuredinthisway. 15. Aschoolnurseisassessingastudentwhowaskickedintheshinduringasoccergame.Theareaofthe injuryhasbecomeswollenanddiscolored.Thetriagenurserecognizesthatthepatienthaslikely sustainedwhat? A)

Sprain

B)

Strain

C)

Contusion

D)

Dislocation

Ans:

C Feedback: Acontusionisasoft-tissueinjurythatresultsinbleedingintosofttissues,creatingahematomaand ecchymosis.Asprainisaninjurytoligamentscausedbywrenchingortwisting.Astrainisamusclepull fromoveruse,overstretching,orexcessivestress.Adislocationisaconditioninwhichthearticular surfacesofthebonesformingajointarenolongerinanatomiccontact.Becausetheinjuryisnotatthe siteofajoint,thepatienthasnotexperiencedasprain,strain,ordislocation.

16. Radiographsofaboysupperarmshowthatthehumerusappearstobefracturedononesideandslightly bentontheother.Thisdiagnosticresultsuggestswhattypeoffracture? A)

Impacted

B)

Compound

C)

Compression

D)

Greenstick

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

Ans:

808

D Feedback: Greenstickfracturesareanincompletefracturethatresultsinthebonebeingbrokenononeside,while theothersideisbent.Thisisnotcharacteristicofanimpacted,compound,orcompressionfracture.

17. Anurseisperformingashiftassessmentonanelderlypatientwhoisrecoveringaftersurgeryforahip fracture.Thenursenotesthatthepatientiscomplainingofchestpain,hasanincreasedheartrate,and increasedrespiratoryrate.Thenursefurthernotesthatthepatientisfebrileandhypoxic,coughing,and producinglargeamountsofthick,whitesputum.Thenurserecognizesthatthisisamedicalemergency andcallsforassistance,recognizingthatthispatientislikelydemonstratingsymptomsofwhat complication? A)

Avascularnecrosisofbone

B)

Compartmentsyndrome

C)

Fatembolismsyndrome

D)

Complexregionalpainsyndrome

Ans:

C Feedback: Fatembolismsyndromeoccursmostfrequentlyinyoungadultsandelderlypatientswhoexperience fracturesoftheproximalfemur(i.e.,hipfracture).Presentingfeaturesoffatembolismsyndromeinclude hypoxia,tachypnea,tachycardia,andpyrexia.Therespiratorydistressresponseincludestachypnea, dyspnea,wheezes,precordialchestpain,cough,largeamountsofthick,whitesputum,andtachycardia. Avascularnecrosis(AVN)occurswhenthebonelosesitsbloodsupplyanddies.Thisdoesnotcause coughing.Complexregionalpainsyndromedoesnothavecardiopulmonaryinvolvement.

18. Ayoungpatientisbeingtreatedforafemoralfracturesufferedinasnowboardingaccident.Thenurses mostrecentassessmentrevealsthatthepatientisuncharacteristicallyconfused.Whatdiagnostictest shouldbeperformedonthispatient? A)

Electrolyteassessment

B)

Electrocardiogram

C)

Arterialbloodgases

D)

Abdominalultrasound

Ans:

C

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

809

Feedback: Subtlepersonalitychanges,restlessness,irritability,orconfusioninapatientwhohassustaineda fractureareindicationsforimmediatearterialbloodgasstudiesduetothepossibilityoffatembolism syndrome.Thisassessmentfindingdoesnotindicateanimmediateneedforelectrolytelevels,anECG, orabdominalultrasound. 19. Whichofthefollowingisthemostappropriatenursinginterventiontofacilitatehealinginapatientwho hassufferedahipfracture? A)

Administeranalgesicsasrequired.

B)

Placeapillowbetweenthepatientslegswhenturning.

C)

Maintainpronepositioningatalltimes.

D)

Encourageinternalandexternalrotationoftheaffectedleg.

Ans:

B Feedback: Placingapillowbetweenthepatientslegswhenturningpreventsadductionandsupportsthepatients legs.Administeringanalgesicsaddressespainbutdoesnotdirectlyprotectboneremodelingand promotehealing.Rotationoftheaffectedlegcancausedislocationandmustbeavoided.Prone positioningdoesnotneedtobemaintainedatalltimes.

20. Anurseisplanningthecareofanolderadultpatientwhowillsoonbedischargedhomeaftertreatment forafracturedhip.Inanefforttopreventfuturefractures,thenurseshouldencouragewhichofthe following?Selectallthatapply. A)

Regularbonedensitytesting

B)

Ahigh-calciumdiet

C)

Useoffallspreventionprecautions

D)

Useofcorticosteroidsasordered

E)

Weight-bearingexercise

Ans:

A,B,C,E Feedback:

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

810

Healthpromotionmeasuresafteranolderadultshipfractureincludeweight-bearingexercise,promotion ofahealthydiet,fallsprevention,andbonedensitytesting.Corticosteroidshavethepotentialtoreduce bonedensityandincreasetheriskforfractures. 21. Apatientisbroughttotheemergencydepartmentbyambulanceaftersteppinginaholeandfalling. Whileassessinghimthenursenotesthathisrightlegisshorterthanhisleftleg;hisrighthipis noticeablydeformedandheisinacutepain.Imagingdoesnotrevealafracture.Whichofthefollowing isthemostplausibleexplanationforthispatientssignsandsymptoms? A)

Subluxatedrighthip

B)

Righthipcontusion

C)

Hipstrain

D)

Traumatichipdislocation

Ans:

D Feedback: Signsandsymptomsofatraumaticdislocationincludeacutepain,changeinpositioningofthejoint, shorteningoftheextremity,deformity,anddecreasedmobility.Asubluxationwouldcausemoderate deformity,orpossiblynodeformity.Acontusionorstrainwouldnotcauseobviousdeformities.

22. Anemergencydepartmentpatientisdiagnosedwithahipdislocation.Thepatientsfamilyisrelieved thatthepatienthasnotsufferedahipfracture,butthenurseexplainsthatthisisstillconsideredtobea medicalemer...