Chapter 60Musculoskeletal Trauma: Nursing Management My Nursing Test Banks

Chapter 60Musculoskeletal Trauma: Nursing Management

MULTIPLE CHOICE

1.A client tells the nurse that he has pain, swelling, fatigue, and numbness of his hands. The nurse should assess the client for which of the following occupations?

1.

Retail store clerk

2.

Lifeguard

3.

Computer keyboard operator

4.

Bus driver

ANS: 3

Some occupations, sports, and tasks can create repetitive motion injuries or cumulative trauma. A computer keyboard operator is an occupation with a high incidence of overuse syndrome.

PTS:1DIF:Apply

REF: Box 60-2 Occupations and Sports with High Incidence of Overuse Syndrome

2.A client who plays baseball on the weekends is experiencing an arm injury. The nurse realizes this client needs to be evaluated for:

1.

a rotator cuff tear.

2.

lateral epicondylitis.

3.

dislocation of the shoulder.

4.

patellar tendinopathy.

ANS: 1

A rotator cuff tear can be caused by extensive overhead movements found in sports and activities such baseball, softball, tennis, swimming, and volleyball. A dislocation of the shoulder is most commonly caused by a fall on an outstretched hand and arm. Lateral epicondylitis, or tennis elbow, is an overuse injury that involves the extensor/supinator muscles that attach to the distal humerus. Patellar tendinopathy, also known as jumpers knee, is seen in athletes who participate in activities that require a lot of jumping such as basketball.

PTS: 1 DIF: Analyze REF: Rotator Cuff Tears: Etiology

3.A client, diagnosed with an ankle sprain, is prescribed ibuprofen to control pain and inflammation. What instruction should the client receive concerning this medication?

1.

Bleeding is not a problem with this medication.

2.

Take on an empty stomach to maximize its effect.

3.

Take with food to minimize gastrointestinal irritation.

4.

Wear sunscreen if outside to prevent a burn.

ANS: 3

Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID). NSAIDs should be taken with food to minimize gastrointestinal irritation. Ibuprofen does not increase photosensitivity; however, bleeding can be a problem when taking ibuprofen.

PTS: 1 DIF: Apply REF: Ankle Sprain: Pharmacology

4.A client, experiencing a fractured arm, asks the nurse why the splint is being applied. Which of the following should the nurse respond to this client?

1.

It reduces the need for a cast.

2.

It reduces bleeding, swelling and pain.

3.

It prevents the need for surgery.

4.

It immobilizes the muscles and joints.

ANS: 2

Splinting of a fractured extremity minimizes bleeding, edema, and pain. Splinting does not reduce the need for a cast nor prevent the need for surgery. A cast immobilizes the muscles and joints.

PTS: 1 DIF: Apply REF: Fractures: Planning and Implementation

5.A client has had a cast applied to immobilize a right ulnar fracture. Which of the following nursing interventions is most important?

1.

Calling physical therapy for a sling

2.

Checking capillary refill time

3.

Giving pain medication

4.

Starting discharge teaching

ANS: 2

Checking the capillary refill time determines that circulation is not compromised. The other options can be completed after ensuring that circulation to the site is still adequate.

PTS: 1 DIF: Apply REF: Fractures: Planning and Implementation

6.A client with a right arm cast is experiencing signs of a serious complication. Which of the following would cause the nurse the most concern?

1.

Capillary refill time less than 3 seconds

2.

Finger movement

3.

Itching under the cast

4.

Severe pain to the right arm continues after receiving pain medication

ANS: 4

Severe pain that continues after receiving pain medication would be considered as being disproportionate to the injury, can be a sign of compartment syndrome, and should be immediately reported. The other options are expected assessment findings for a client with a cast.

PTS:1DIF:Analyze

REF: Fractures; Compartment Syndrome: Assessment with Clinical Manifestations

7.A client is unable to pass the chair raise test. The nurse realizes this client is experiencing:

1.

carpal tunnel syndrome.

2.

rotator cuff tear.

3.

fractured arm.

4.

lateral epicondylitis.

ANS: 4

The chair raise test examines the clients ability to grip and lift. The client stands behind a chair and places the hands on the chair back. The client then attempts to raise the chair. If pain is experienced over the lateral elbows, lateral epicondylitis may be present. The chair raise test is not used to diagnose carpal tunnel syndrome, rotator cuff tear, or a fractured arm.

PTS:1DIF:Analyze

REF:Lateral Epicondylitis: Assessment with Clinical Manifestations

8.A client has been wearing a splint for carpal tunnel syndrome for 7 weeks. The nurse realizes that which of the following would be the next course of treatment for this client?

1.

Surgery

2.

Exercises

3.

Corticosteroid injection

4.

Casting

ANS: 3

If after 2 to 7 weeks of conservative treatment the carpal tunnel syndrome symptoms do not improve, corticosteroid injection is recommended. Surgery is not recommended until after corticosteroid injections have been tried. Exercises are implemented with the use of the splint. Casting is not a treatment for carpal tunnel syndrome.

PTS:1DIF:Analyze

REF: Carpal Tunnel Syndrome: Planning and Implementation

9.The nurse is planning care for a client recovering from a meniscal injury. Which of the following should be included as strategies to avoid future injuries?

1.

Avoid hamstring muscle exercises.

2.

Stretch before and after exercise.

3.

Wear similar shoes for all activities.

4.

Avoid skiing.

ANS: 2

Strategies to prevent future meniscal injuries include having strong thigh and hamstring muscles; stretching before and after exercise; wearing shoes that fit and are appropriate for the activity; and when skiing, having bindings that release the skis with a fall.

PTS: 1 DIF: Apply REF: Meniscal Injuries: Planning and Implementation

10.A client with an ankle sprain is instructed to follow RICE. Which of the following should the nurse instruct the client regarding this process?

1.

Maintain your normal level of activity.

2.

Apply ice to the ankle once a day.

3.

Apply an elastic bandage to the site.

4.

Elevate the extremity every day for 20 to 30 minutes.

ANS: 3

The nurse should instruct the client to use crutches to allow for the rest of the ankle joint and relieve pain; apply ice for 20 to 30 minutes 3 to 4 times a day; apply an elastic bandage to the site; and elevate the ankle for the first 48 hours after the injury.

PTS: 1 DIF: Apply REF: Ankle Sprain: Planning and Implementation

11.The nurse is evaluating the effectiveness of care for a client recovering from an injured Achilles tendon. Which of the following would indicate that care has been effective?

1.

Client states steroid injections will be helpful to reduce the amount of pain.

2.

Client plans to participate in rehabilitation for 5 to 6 months after the injury.

3.

Client resumes sports activities as soon as possible.

4.

Client uses heat to decrease the inflammation and swelling from the injury.

ANS: 2

Evidence that care has been effective for a client recovering from an injured Achilles tendon would be that the client plans to participate in rehabilitation for 5 to 6 months after the injury. Steroid injections are not used for this type of injury. Sports activities should be avoided until the injury has healed and rehabilitation is completed. Cryotherapy, not heat, is used to decrease the inflammation and swelling from the injury.

PTS:1DIF:Analyze

REF: Achilles Tendon Injuries: Planning and Implementation

12.The nurse is instructing a client on ways to prevent the onset of stress fractures. Which of the following should be included in these instructions?

1.

Avoid overtraining

2.

Increase intensity of training 10% each day

3.

Limit warm up exercises

4.

Avoid shock absorbing footwear

ANS: 1

Interventions to prevent the onset of stress fractures include: avoid overtraining; gradually increase the intensity of workouts by 10% each week; perform adequate warm up exercises; and use shock absorbing footwear and insoles.

PTS: 1 DIF: Apply REF: Box 60-4 Prevention of Stress Fractures

13.The nurse suspects a client, recovering from hip replacement surgery, is experiencing an infection when which of the following is assessed?

1.

Client using crutches to ambulate

2.

Blood pressure 110/68 mmHg

3.

Pain with movement

4.

Foot intact to sensation and motion

ANS: 3

Evidence of an infection in the joint of a client recovering from hip replacement surgery includes erythema, edema, drainage, and tenderness over the joint; persistent pain in the joint with movement; and narrowing of the joint space upon x-ray. Using crutches to ambulate would not indicate an infection in the operative site. A blood pressure of 110/68 mmHg is within normal limits. The foot being intact to sensation and motion would indicate the limb is receiving sufficient blood and oxygenation.

PTS: 1 DIF: Analyze REF: Hip Fractures: Complications

MULTIPLE RESPONSE

1.The nurse is concerned that a client is demonstrating signs of compartment syndrome. Which of the following is considered a classical symptom of this disorder? (Select all that apply.)

1.

Pain

2.

Paraplegia

3.

Paresthesia

4.

Pink

5.

Pressure

6.

Pulselessness

ANS: 1, 3, 5, 6

The classical symptoms of the six Ps of compartment syndrome are pain, paresthesia, paresis, pressure, pallor, and pulselessness. The pink color and paraplegia are not part of the classic Ps.

PTS:1DIF:Apply

REF: Compartment Syndrome: Assessment with Clinical Manifestations

2.A client is diagnosed with a pathological fracture. For which of the following disease processes should the nurse assess the client? (Select all that apply.)

1.

Cushings syndrome

2.

Osteomalacia

3.

Pagets disease

4.

Heart failure

5.

Diabetes mellitus

6.

Chronic obstructive pulmonary disease

ANS: 1, 2, 3

Causes of pathological fractures include Cushings syndrome, osteomalacia, and Pagets disease. Pathological fractures are not associated with heart failure, diabetes mellitus, or chronic obstructive pulmonary disease.

PTS: 1 DIF: Apply REF: Box 60-5 Causes of Pathological Fractures

3.A client, recovering from a fractured pelvis, begins to have dyspnea and restlessness. The nurse is concerned that the client is experiencing a fat emboli when which of the following are assessed? (Select all that apply.)

1.

Upper body petechiae

2.

Cough

3.

Protein in the urine

4.

Seizures

5.

Temperature 102F

6.

Elevated blood glucose level

ANS: 1, 4, 5

Symptoms of fat emboli include hypoxemia, mental status changes, petechiae, seizures, and a body temperature greater than 101.3F. Cough, protein in the urine, and elevated blood glucose level are not symptoms of fat emboli.

PTS:1DIF:Analyze

REF: Fat Embolism Syndrome: Assessment with Clinical Manifestations

4.The nurse is assessing a client recovering from abdominal surgery for the development of a deep vein thrombosis. Which of the following would indicate that the client is experiencing this disorder? (Select all that apply.)

1.

Pain and tenderness of the lower extremity

2.

Red area on a limb that is warm to the touch

3.

Unexplained dyspnea

4.

Chest pain

5.

Hemoptysis

6.

Drop in blood pressure

ANS: 1, 2, 3, 4, 5

The client may describe limb pain as aching, cramping, sharp, dull, severe, or mild. Tenderness and pain of the lower extremity and a red area that is warm to touch are also indications that the disorder is present. Other signs and symptoms include unexplained dyspnea, chest pain, and hemoptysis. A drop in blood pressure is not an indication for a deep vein thrombosis.

PTS:1DIF:Apply

REF: Venous Thromboembolism: Assessment with Clinical Manifestations

5.The nurse is planning care for a client recovering from an amputation. Which of the following should be included in this plan of care? (Select all that apply.)

1.

Provide pain medication 30 minutes before stump care.

2.

Wash the stump daily with mild soap and warm water.

3.

Allow the stump to dry open to the air for 10 minutes after washing.

4.

Avoid massaging the stump.

5.

Elevate the stump on a pillow.

6.

Lie prone 10 to 20 minutes every day.

ANS: 1, 2, 3, 6

Care of the client recovering from an amputation includes providing pain medication 30 minutes before stump care; washing the stump daily with mild soap and warm water; allowing the stump to dry open to the air for 10 minutes after washing; massaging the stump daily; avoiding elevating the stump on a pillow to prevent contractures; and lying prone for 10 to 20 minutes every day to prevent contractures.

PTS: 1 DIF: Apply REF: Amputation: Planning and Implementation

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