Chapter 63: Nursing Management: Musculoskeletal Trauma and Orthopedic Surgery Flashcards Quizlet PDF

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Chapter 63: Nursing Management: Musculoskeletal Trauma and Orthopedic Surgery Flashcards | Quizlet

11/21/21, 2&14 PM

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Chapter 63: Nursing Management: Musculoskeletal Trauma and Orthopedic Surgery Terms in this set (47) 1. When teaching seniors at a

ANS: C

community recreation center,

Comfortable shoes with good support will help decrease

which information will the nurse

the risk for falls. Scatter rugs should be eliminated, not

include about ways to prevent

just tacked down. Activities of daily living provide range

fractures?

of motion exercise; these do not need to be taught by a

a.

physical therapist. Falls inside the home are responsible

Tack down scatter rugs in the

for many injuries.

home. b.

DIF: Cognitive Level: Apply (application) REF: 1506

Most falls happen outside the

TOP: Nursing Process: Implementation MSC: NCLEX:

home.

Safe and Effective Care Environment

c. Buy shoes that provide good support and are comfortable to

hould pist.

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ANS: D he n to

Treatment for repetitive strain syndrome includes changing the ergonomics of the activity. Elbow injections

teach the patient about

and surgery are not initial options for this type of injury. A

a.

wrist splint might be used for hand or wrist pain.

surgical options. b.

DIF: Cognitive Level: Apply (application) REF: 1509

elbow injections.

TOP: Nursing Process: Planning MSC: NCLEX:

c.

Physiological Integrity

wearing a left wrist splint. d. modifying arm movements.

3. The occupational health nurse

ANS: A

will teach the patient whose job

Repetitive strain injuries caused by prolonged times

involves many hours of typing

working at a keyboard can be prevented by the use of a

about the need to

pad that will keep the wrists in a straight position.

a.

Stretching exercises during the day may be helpful, but

obtain a keyboard pad to support

these would not be needed before starting. Use of a

the wrist.

compression bandage is not needed, although a splint

b.

may be used for carpal tunnel syndrome. NSAIDs are

do stretching exercises before

appropriate to use to decrease swelling.

starting work. c.

DIF: Cognitive Level: Apply (application) REF: 1509

wrap the wrists with compression

TOP: Nursing Process: Implementation MSC: NCLEX:

bandages every morning.

Health Promotion and Maintenance

d. avoid using nonsteroidal antiinflammatory drugs (NSAIDs) for pain.

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4. Which discharge instruction will

ANS: C

the emergency department nurse

Elevation of the leg will reduce the amount of swelling

include for a patient with a

and pain. Compression bandages are used to decrease

sprained ankle?

swelling. For the first 24 to 48 hours, cold packs are used

a.

to reduce swelling. The ankle should be rested and kept

Keep the ankle loosely wrapped

immobile to prevent further swelling or injury.

with gauze. b.

DIF: Cognitive Level: Apply (application) REF: 1508

Apply a heating pad to reduce

TOP: Nursing Process: Implementation MSC: NCLEX:

muscle spasms.

Physiological Integrity

c. Use pillows to elevate the ankle above the heart. d. Gently move the ankle through the range of motion.

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5. A 22-year-old tennis player has

ANS: B

an arthroscopic repair of a rotator

Physical therapy after a rotator cuff repair begins on the

cuff injury performed in same-day

first postoperative day to prevent "frozen shoulder." A

surgery. When the nurse plans

shoulder immobilizer is used immediately after the

postoperative teaching for the

surgery, but leaving the arm immobilized for several days

patient, which information will be

would lead to loss of range of motion (ROM). The drop-

included?

arm test is used to test for rotator cuff injury, but not after

a.

surgery. The patient may be able to return to pitching

"You will not be able to serve a

after rehabilitation.

tennis ball again." b.

DIF: Cognitive Level: Apply (application) REF: 1510

"You will work with a physical

TOP: Nursing Process: Planning MSC: NCLEX:

therapist tomorrow."

Physiological Integrity

c. "The doctor will use the drop-arm test to determine the success of surgery." d. "Leave the shoulder immobilizer on for the first 4 days to minimize pain."

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6. The nurse will instruct the

ANS: B

patient with a fractured left radius

Bone healing starts immediately after the injury, but since

that the cast will need to remain in

ossification does not begin until 3 weeks postinjury, the

place

cast will need to be worn for at least 3 weeks. Complete

a.

union may take up to a year. Resolution of swelling does

for several months.

not indicate bone healing.

b. for at least 3 weeks.

DIF: Cognitive Level: Apply (application) REF: 1513

c.

TOP: Nursing Process: Implementation MSC: NCLEX:

until swelling of the wrist has

Physiological Integrity

resolved. d. until x-rays show complete bony union.

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7. A 48-year-old patient with a

ANS: D

comminuted fracture of the left

The patient can lift the buttocks off the bed by using the

femur has Buck's traction in place

left leg without changing the right-leg alignment. Turning

while waiting for surgery. To assess

the patient will tend to move the leg out of alignment.

for pressure areas on the patient's

Disconnecting the traction will interrupt the weight

back and sacral area and to

needed to immobilize and align the fracture.

provide skin care, the nurse should a.

DIF: Cognitive Level: Apply (application) REF: 1514 | 1520

loosen the traction and help the

TOP: Nursing Process: Assessment MSC: NCLEX: Safe

patient turn onto the unaffected

and Effective Care Environmen

side. b. place a pillow between the patient's legs and turn gently to each side. c. turn the patient partially to each side with the assistance of another nurse. d. have the patient lift the buttocks by bending and pushing with the right leg.

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8. Which nursing intervention will

ANS: B

be included in the plan of care

Assessment of bowel sounds, abdominal pain, and

after a patient with a right femur

nausea and vomiting will detect the development of cast

fracture has a hip spica cast

syndrome. To avoid breakage, the support bar should

applied?

not be used for repositioning. After the cast dries, the

a.

patient can begin ambulating with the assistance of

Avoid placing the patient in prone

physical therapy personnel and may be turned to the

position.

prone position.

b. Ask the patient about abdominal

DIF: Cognitive Level: Apply (application) REF: 1516

discomfort.

TOP: Nursing Process: Planning MSC: NCLEX:

c.

Physiological Integrity

Discuss remaining on bed rest for several weeks. d. Use the cast support bar to reposition the patient.

9. A patient has a long-arm plaster

ANS: B

cast applied for immobilization of

Until a plaster cast has dried, using the palms rather than

a fractured left radius. Until the

the fingertips to handle the cast helps prevent creating

cast has completely dried, the

protrusions inside the cast that could place pressure on

nurse should

the skin. The left arm should be elevated to prevent

a.

swelling. The edges of the cast may be petaled once the

keep the left arm in dependent

cast is dry, but padding the edges before that may cause

position.

the cast to be misshapen. The cast should not be

b.

covered until it is dry because heat builds up during

avoid handling the cast using

drying.

fingertips. c.

DIF: Cognitive Level: Apply (application) REF: 1515

place gauze around the cast edge

TOP: Nursing Process: Implementation MSC: NCLEX:

to pad any roughness.

Physiological Integrity

d. cover the cast with a small blanket to absorb the dampness.

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10. Which statement by the patient

ANS: C

indicates a good understanding of

Ice application for the first 24 hours after a fracture will

the nurse's teaching about a new

help reduce swelling and can be placed over the cast.

short-arm plaster cast?

Plaster casts should not get wet. The patient should be

a.

encouraged to move the joints above and below the

"I can get the cast wet as long as I

cast. Patients should not insert objects inside the cast.

dry it right away with a hair dryer." b.

DIF: Cognitive Level: Apply (application) REF: 1520

"I should avoid moving my fingers

TOP: Nursing Process: Evaluation MSC: NCLEX:

and elbow until the cast is

Physiological Integrity

removed." c. "I will apply an ice pack to the cast over the fracture site off and on for 24 hours." d. "I can use a cotton-tipped applicator to rub lotion on any dry areas under the cast.

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11. A patient who is to have no

ANS: B

weight bearing on the left leg is

Patients are usually taught to move the crutches and the

learning to walk using crutches.

injured leg forward at the same time and then to move

Which observation by the nurse

the unaffected leg. Patients are discouraged from using

indicates that the patient can

furniture to assist with ambulation. The patient is taught

safely ambulate independently?

to place weight on the hands, not in the axilla, to avoid

a.

nerve damage. If the 2- or 4-point gaits are to be used,

The patient moves the right crutch

the crutch and leg on opposite sides move forward, not

with the right leg and then the left

the crutch and same-side leg.

crutch with the left leg. b.

DIF: Cognitive Level: Apply (application) REF: 1521

The patient advances the left leg

TOP: Nursing Process: Evaluation MSC: NCLEX: Safe and

and both crutches together and

Effective Care Environment

then advances the right leg. c. The patient uses the bedside chair to assist in balance as needed when ambulating in the room. d. The patient keeps the padded area of the crutch firmly in the axillary area when ambulating.

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12. A 32-year-old patient who has

ANS: A

had an open reduction and

The patient's clinical manifestations suggest

internal fixation (ORIF) of left

compartment syndrome and delay in diagnosis and

lower leg fractures continues to

treatment may lead to severe functional impairment. The

complain of severe pain in the leg

data do not suggest problems with blood pressure or

15 minutes after receiving the

infection. Elevation of the leg will decrease arterial flow

prescribed IV morphine. Pulses

and further reduce perfusion.

are faintly palpable and the foot is cool. Which action should the

DIF: Cognitive Level: Apply (application) REF: 1522

nurse take next?

TOP: Nursing Process: Implementation MSC: NCLEX:

a.

Physiological Integrity

Notify the health care provider. b. Assess the incision for redness. c. Reposition the left leg on pillows. d. Check the patient's blood pressure.

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13. A patient with a complex pelvic

ANS: B

fracture from a motor vehicle

The abdominal distention and absent bowel sounds may

crash is on bed rest. Which nursing

be due to complications of pelvic fractures such as

assessment finding is important to

paralytic ileus or hemorrhage or trauma to the bladder,

report to the health care

urethra, or colon. Pelvic instability, abdominal pain with

provider?

palpation, and abdominal bruising would be expected

a.

with this type of injury.

The patient states that the pelvis feels unstable.

DIF: Cognitive Level: Apply (application) REF: 1524

b.

TOP: Nursing Process: Assessment MSC: NCLEX:

Abdomen is distended and bowel

Physiological Integrity

sounds are absent. c. There are ecchymoses across the abdomen and hips. d. The patient complains of pelvic pain with palpation.

14. Which action will the nurse take

ANS: B

in order to evaluate the

Buck's traction keeps the leg immobilized and reduces

effectiveness of Buck's traction for

painful muscle spasm. Hip contractures and dislocation

a 62-year-old patient who has an

are unlikely to occur in this situation. The peripheral

intracapsular fracture of the right

pulses will be assessed, but this does not help in

femur?

evaluating the effectiveness of Buck's traction.

a. Check peripheral pulses.

DIF: Cognitive Level: Apply (application) REF: 1525

b.

TOP: Nursing Process: Evaluation MSC: NCLEX:

Ask about hip pain level.

Physiological Integrity

c. Assess for hip contractures. d. Monitor for hip dislocation.

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15. A patient with a right lower leg

ANS: A

fracture will be discharged home

Pin insertion sites should be cleaned daily to decrease

with an external fixation device in

the risk for infection at the site. An external fixator allows

place. Which information will the

the patient to be out of bed and avoid the risks of

nurse teach?

prolonged immobility. The device is surgically placed

a.

and is not removed until the bone is stable. Prophylactic

"You will need to check and clean

antibiotics are not routinely given when an external

the pin insertion sites daily."

fixator is used.

b. "The external fixator can be

DIF: Cognitive Level: Apply (application) REF: 1516

removed for your bath or shower."

TOP: Nursing Process: Implementation MSC: NCLEX:

c.

Physiological Integrity

"You will need to remain on bed rest until bone healing is complete." d. "Prophylac...