Musculoskeletal disorders review

PRACTICE QUESTIONS

A client is treated in a physician’s office for a sprained ankle after a fall. Radiographic examination has ruled out a fracture. Before sending the client home, the nurse plans to teach the client to avoid which of the following in the next 24 hours?
a. Resting the foot
b. Applying a heating pad
c. Applying an elastic compression bandage
d. Elevating the ankle on a pillow while sitting or lying down

ANSWER: B – Soft tissue injuries such as sprains are treated by RICE (rest, ice, compression and elevation) for the first 24 hours after the injury. Heat is not used in the first 24 hours because it could increase venous congestion, which would increase edema and pain.


A nurse is conducting health screening for osteoporosis. Which of the following clients is at greatest risk of developing this disorder?
a. A 25-year-old woman who jogs
b. A 36-year-old man who has asthma
c. A 70-year-old man who consumes alcohol
d. A sedentary 65-year-old woman who smokes cigarette

ANSWER: D – Risk factor for osteoporosis include female gender, postmenopausal, advanced age, low calcium diet, excessive alcohol intake, being sedentary, and smoking cigarettes. Long-term use of corticosteroids, anticonvulsants, and/or Furosemide (Lasix) also increases risk.


A nurse has given instructions to a client returning home after knee arthroscopy. The nurse determines that the client understands the instructions of the client states that he or she will:
a. Resume regular exercise the following day.
b. Stay off the leg entirely for the rest of the day.
c. Report fever or site inflammation to the physician.
d. Refrain from eating food for the remainder of the day.

ANSWER: C – Signs and symptoms of infection should be reported to the physician immediately.


A nurse is caring for a client who is going to have arthrography with a contrast medium. Which assessment by the nurse would be of highest priority?
a. Allergy to Iodine or shellfish
b. Ability of the client to remain still during the procedure
c. Whether the client wishes to void before the procedure
d. Whether the client has any remaining questions about the procedure

ANSWER: A – Because the risk of allergy to contrast dye, the nurse places highest priority on assessing whether the client has an allergy to iodine or shellfish.

A nurse is one of several persons who witness a vehicle hit a pedestrian at fairly low speed on a small street. The person is dazed and tries to get up. The leg appears fractured. The nurse would plan to:
a. Try to reduce the fracture manually
b. Assist the person to get up and walk to the side-walk
c. Leave the person for a few moments to call an ambulance
d. Stay with the person and encourage the person to remain still.

ANSWER: D – With a suspected fracture the client is not moved unless it is dangerous to remain in that spot. The nurse should remain with the client and have someone else call for emergency help.


A client has a fiberglass (nonplaster) cast applied to the lower leg. The client asks the nurse when the client will be able to walk using the casted leg. The nurse replies that the client will be able to bear weight in the casted leg:
a. In 48 hours
b. In 24 hours
c. In about 8 hours
d. Within 20 to 30 minutes of application

ANSWER: D – A fiberglass cast is made of water-activated polyurethane materials that are dry to the touch within minutes and reach full rigid strength in about 20 minutes. Because of this, client can bear weight on the cast within 20 to 30 minutes.


A nurse has given a client with a leg cast instruction care at home. The nurse would evaluate that the client needs further instruction if the client makes which of the statements?
a. “I should avoid walking on wet, slippery floors”
b. “I’m not supposed to scratch the skin underneath the cast”
c. “It’s ok to wipe off the top of the cast with a damp cloth”
d. “If the cast gets wet, I can dry it with a hair dryer turned to the warmest setting”

ANSWER: D – If the cast gets wet, it can be dried with a hair dryer set on a cool setting to prevent skin breakdown. If the skin under the cast itches, cool air from a hair dryer may be used to relieve it. The client should never scratch under a cast because of the risk of skin breakdown and ulcer formation.


A client with a hip fracture asks the nurse why Buck’s extension traction is being applied before surgery. The nurse’s response is based in the understanding that Buck’s extension traction primarily:
a. Allows bony healing to begin before surgery
b. Provides rigid mobilization of the fracture site
c. Lengthens the fractured leg to prevent severing of blood vessels
d. Provides comfort by reducing muscle spasms and provides fracture immobilization.

ANSWER: D – Buck’s extension traction is a type of skin traction often applied after hip fracture before the fracture id reduced in surgery. Traction reduces muscle spasms and helps immobilize the fracture.


A nurse is evaluating the pin sites of a client in skeletal traction. The nurse would be least concerned with which of the following findings?
a. Inflammation
b. Serous drainage
c. Pain at a pin site
d. Purulent drainage

ANSWER: B – A small amount of serous oozing is expected at pin insertion sites. Signs of infection such as inflammation, purulent drainage, and pain at the pin site are not expected findings and should be reported to the physician.

A client has a Buck extension traction applied to the right leg. The nurse would plan which of the following interventions to prevent complications of the device?
a. Give pin care once a shift
b. Massage the skin of the right leg with lotion every 8 hours.
c. Inspect the skin on the right leg at least once every 8 hours.
d. Release the weight on the right leg for daily range of motion exercise.

ANSWER: C – Buck’s extension traction is a type of skin traction. The nurse inspect the skin of the limb in traction at least once every 8 hours for irritation or inflammation.

PRACTICE QUESTIONS

A nurse is assessing a casted extremity of a client. A nurse would assess for which of the following signs and symptoms indicative of infections?
a. Dependent edema
b. Diminished distal pulse
c. Presence of a “hot spot” on the cast
d. Coolness and pallor of the extremity

ANSWER: C – Signs and symptoms of infection under a casted area include odor or purulent drainage from the cast or the presence of “hot spots”, which are areas of the cast that are warmer than others.

A client has sustained a closed fracture and has just had a cast applied to the affected arm. The client is complaining of intense pain. The nurse elevates the limb, applies an ice bag, and administers analgesic, with little relief. The nurse interprets that this pain may be caused by:
a. Infection under the cast
b. The anxiety of the patient
c. Impaired tissue perfusion
d. The recent occurrence of the fracture

ANSWER: C – Most pain associated with fractures can be minimized with rest, elevation, application of cold, and administration of analgesics. Pain that is not relieved by these measures should be reported to the physician because the pain unrelieved by medications and other measures may indicate neurovascular compromise. Because this is a new closed fracture and cast, infection would not have had time to set in.

A nurse is admitting a client with multiple trauma to the nursing unit. The client has a leg fracture and had a plaster cast applied. In positioning the casted leg, the nurse should:
a. Keep the leg in level position
b. Elevate the leg for 3 hours and put it flat for 1 hour
c. Keep the leg level for 3 hours and elevate it for 1 hour
d. Elevate the leg on pillows continuously for 24 to 48 hours.

ANSWER: D – a casted extremity is elevated continuously for the first 24 to 48 hours to minimize swelling and promote venous drainage.

A client is complaining of skin irritation from the edges of a cast applied the previous day. The nurse should take which of the following actions?
a. Petal the cast edges with adhesive tape
b. Massage the skin at the rim of the cast
c. Use a rough file to smooth the cast edges
d. Apply lotion to the skin at the rim of the cast

ANSWER: A – The nurse petals the edges of the cast with tape to minimize skin irritation. If a client has a cast applied and returns home, the client can be taught to do the same.

A client is being discharged to home after application of a plaster leg cast. The nurse determines that the client understands proper care of the cast if the client states that he or she should:
a. Avoid getting the cast wet.
b. Cover the casted leg with warm blankets
c. Use the fingertips to lift and move the leg
d. Use a padded coat hanger end to scratch under the cast

ANSWER: A – A plaster cast must remain dry to keep its strength.

A client being measured for crutches asks the nurse why the crutches cannot rest up underneath the arm for extra support. The nurse’s response is based on the understanding that this could result in:
a. A fall and further injury
b. Injury to the brachial plexus nerves
c. Skin breakdown in the area of the axilla
d. Impaired range of motion while the client ambulates

ANSWER: B – Crutches are measured so that the tops are two to three finger widths from the axilla. This ensures that the client’s axilla are bit resting on the crutch or bearing the weight of the crutch, which could result in injury to the nerves of the brachial plexus.

A nurse has given client instructions about crutch safety. The nurse determines that the client needs reinforcement of information if the client states:
a. That he or she will not use someone else’s crutches
b. That crutch tips will not slip even when wet
c. The need to have spare crutches and tips available
d. That crutch tips should be inspected periodically for wear

ANSWER: B – Crutch tips should remain dry. Water could cause the client to slip by decreasing the surface friction of the rubber tip on the floor. If crutch tips get wet, the client should dry them with a cloth or paper towel.

A nurse is caring for a client being treated for fat embolus after multiple fractures. Which of the following data would the nurse evaluate as the most favorable indication of resolution of fat embolus?
a. Minimal dyspnea
b. Clear chest radiography
c. Oxygen saturation of 85%
d. Arterial oxygen of 78 mm Hg

ANSWER: B – A clear chest radiograph is a good indicator that a fat embolus is resolving. When fat embolism is resolving. When fat embolism occurs, the client radiograph has a “snowstorm” appearance.

A nurse has conducted teaching with a client in an arm cast about signs and symptoms of compartment syndrome. The nurse determines that the client understands the information if the client states that he or she should report which of the following early symptoms of compartment syndrome?
a. Cold, bluish-colored fingers
b. Numbness and tingling in the fingers
c. Pain that increases when the arm is dependent
d. Pain relieved only with oxycodone and aspirin (percodan)

ANSWER: B – The earliest syndrome of compartment syndrome is paresthesias (numbness and tingling in the fingers).

A client with diabetes mellitus has had a right below-knee amputation. The nurse would assess specifically for which of the following sings and symptoms because of the history of diabetes?
a. Hemorrhage
b. Edema of the stump
c. Slight redness of incision
d. Separation of the edges

ANSWER: D – Clients with diabetes mellitus are more prone to wound infections and delayed wound healing because of the disease.