Preview Extract
Chapter 56
1. The nurse is aware that which of the following personal characteristic increases a client’s
risk for musculoskeletal injuries?
Select all that apply.
1. Belongs to a weekend softball team
2. Has begun an exercise program to lose weight
3. Avoids dairy products since being diagnosed as lactose intolerant
4. Requires insulin to manage type 2 diabetes mellitus
5. Is allergic to cat dander
Answer: 1. Belongs to a weekend softball team
2. Has begun an exercise program to lose weight
3. Avoids dairy products since being diagnosed as lactose intolerant
Rationale:
Belongs to a weekend softball team. Engaging in sports activities increases one’s risk for
musculoskeletal injuries. Has begun an exercise program to lose weight. Engaging in exercise
routines increases one’s risk for musculoskeletal injuries. Avoids dairy products since being
diagnosed as lactose intolerant. Calcium deficiencies pose a risk for bone injury and impaired
bone healing. Requires insulin to manage type 2 diabetes mellitus. Insulin use would not pose
an increased risk. Is allergic to cat dander. An allergy to cat dander would not pose an
increased risk.
2. The nurse is discussing ways to reduce the risks for musculoskeletal trauma with a group
of older adults. The nurse includes:
Select all that apply.
1. Avoiding the use of throw rugs.
2. Wearing nonskid shoes.
3. Using nightlights to illuminate paths to the bathroom and kitchen.
4. Installing handrails for assistance in entering and exiting bathtub.
5. Wearing an emergency alert device.
Answer: 1. Avoiding the use of throw rugs.
2. Wearing nonskid shoes.
3. Using nightlights to illuminate paths to the bathroom and kitchen.
4. Installing handrails for assistance in entering and exiting bathtub.
Rationale:
Avoiding the use of throw rugs. Throw rugs, cords, and other objects that impinge on traffic
areas increase the risk of falls at home for older adults. Wearing nonskid shoes. Improper
footwear increases the risk of falls at home for older adults. Using nightlights to illuminate
paths to the bathroom and kitchen. Risk of falling can be decreased by the use of appropriate
lighting. Installing handrails for assistance in entering and exiting bathtub. Risk of falling can
be decreased by the availability of handrails for both steps and in the bathroom. Wearing an
emergency alert device. Wearing an emergency alert device is effective in securing help if a
fall injury occurs, but does not reduce the risk of actually falling.
3. The nurse is aware that the older adult is at increased risk for musculoskeletal injuries as a
result of musculoskeletal changes associated with aging such as:
Select all that apply.
1. Decreased bone mass.
2. Chronic illness and impaired healing.
3. Decreased range of motion.
4. Increased calcium reabsorption.
5. Vertebrae elongation.
Answer: 1. Decreased bone mass.
2. Chronic illness and impaired healing.
3. Decreased range of motion.
Rationale:
Decreased bone mass. With aging, decreased bone mass and calcium absorption contribute to
bones that are thinner and weaker (osteoporosis). Chronic illness and impaired healing. The
nurse should be aware of specific gerontological considerations such as chronic illness and
impaired healing. Decreased range of motion. Range of motion declines with age, resulting in
a risk for injury and falls. Muscle fibers atrophy, leading to loss of muscle mass, strength, and
agility. Increased calcium reabsorption. Increased calcium absorption and is not normally
seen in the older client. Vertebrae elongation. Vertebrae elongation is not normally seen in the
older client.
4. A client who has been casted for a fracture of the left ulna bone asks the nurse when the
cast will come off. The nurse’s response is based on the knowledge that this will occur when:
1. The x-ray of the fractured bone shows that the ends are well joined.
2. A cartilage collar can be clearly felt at the site of the original break.
3. A predetermined amount of time has passed; the time is determined by the severity of the
break.
4. The remodeling phase of the bone healing process has been completed, allowing for
application of mechanical stress.
Answer: The x-ray of the fractured bone shows that the ends are well joined.
Rationale:
Ossification is the final laying down of bone after the fracture has been bridged and the
fragments are united. Mature bone replaces the callus, and the fracture site feels firm and
appears united on radiograph. It is at this point that a cast may be removed. During cellular
proliferation and callus formation, a cartilage “collar” is evident around the fracture site, but
this does not signify that the bone has healed sufficiently to remove the cast. While the
amount of time a fracture requires casting varies, the severity of the fracture is only one
factor that is considered. Remodeling of the bone occurs after the cast is removed.
5. A client has dislocated his hip as a result of a fall. The nurse recognizes that the primary
need to quickly and effectively return the femoral head to its normal position is to:
1. Preserve blood flow to the head of the femur.
2. Eliminate the severe pain the client is experiencing.
3. Minimize the damage being caused to affected ligaments.
4. Avoid damage to nerves located in the affected area.
Answer: Preserve blood flow to the head of the femur.
Rationale:
A dislocation is a displacement of a bone from its normal position in a joint. While the
dislocation requires reduction as soon as possible to reduce pain and avoid ligament, vascular,
and/or nerve damage, the primary concern is interference with blood supply to the femoral
head. This can lead to severe complications such as avascular necrosis (AVN), in which the
bone tissue dies due to a temporary or permanent loss of blood supply to the bone. While
important, the other manifestations of the dislocation do not have priority over interrupted
blood flow.
6. The nurse explains to a client who is having a cast removed that the remodeling phase of
fracture healing involves the:
Select all that apply.
1. Strengthening of the new bone at the site of the fracture.
2. Reabsorption of excess new bone at the site of the callus.
3. Prudent application of stress and weight to the affected bone.
4. Creation of the cartilage collar at the fracture sight.
5. Granulation of new bone tissue to form the connective bridge.
Answer: 1. Strengthening of the new bone at the site of the fracture.
2. Reabsorption of excess new bone at the site of the callus.
3. Prudent application of stress and weight to the affected bone.
Rationale:
Strengthening of the new bone at the site of the fracture. The remodeling process involves
reabsorption of the excess callus in the marrow space and the external aspect of the fracture.
The process is directed by mechanical stress and weight bearing, causing the bone to become
stronger in relation to its function. Reabsorption of excess new bone at the site of the callus.
The remodeling process involves reabsorption of the excess callus in the marrow space and
the external aspect of the fracture. Prudent application of stress and weight to the affected
bone. The remodeling process is directed by mechanical stress and weight bearing, causing
the bone to become stronger in relation to its function. Creation of the cartilage collar at the
fracture sight. A cartilage collar does form, but this does not occur in the remodeling phase.
Granulation of new bone tissue to form the connective bridge. Granulation is responsible for
the formation of a connective bridge, but this does not occur in the remodeling phase.
7. The nurse caring for a client who has experienced an open fracture of the humerus that is
classified as a Grade II is aware that the client:
Select all that apply.
1. Will be scheduled for an inspection and debridement (I&D) procedure.
2. Has a moderately high risk for developing an infection.
3. Experienced some crushing of the bone.
4. Will require major vascular reconstruction.
5. Has an “inside-out” fracture.
Answer: 1. Will be scheduled for an inspection and debridement (I&D) procedure.
2. Has a moderately high risk for developing an infection.
3. Experienced some crushing of the bone.
Rationale:
Will be scheduled for an inspection and debridement (I&D) procedure. The wound requires a
procedure to wash out the contamination; this is commonly referred to as an inspection and
debridement (I&D). Has a moderately high risk for developing an infection. An important
concept is that all open fractures have the potential to be contaminated. thus increasing the
risk of infection. Experienced some crushing of the bone. A Grade II open fracture has a
moderately contaminated wound bed and contains a moderate amount of comminution (bone
fragments). Will require major vascular reconstruction. Major vascular reconstruction is not
typically needed for this injury. Has an “inside-out” fracture. A Grade I open fracture is
sometimes referred to as an “inside-out” fracture, while major vascular injury is classified a
Grade IIIC.
8. An elderly client is admitted with a diagnosis of a fractured right hip resulting from a fall
in her home. The nurse is preparing to initiate the order for the application of Buck’s traction
to the affected leg. Put the following actions in the proper order to accomplish the
intervention:
1. Assemble the traction device and attach to the foot of the bed.
2. Carefully attach the weight to hang freely at the foot of the bed.
3. Have an assistant stand at the foot of the bed holding traction in a straight line.
4. Secure the Buck’s boot to the skin on the leg.
5. Place the Buck’s boot around the lower leg.
• 1, 3, 5, 4, 2
• 3, 1, 2, 4, 5
• 1, 5, 4, 3, 2
• 2, 1, 5, 3, 4
Answer: 1, 3, 5, 4, 2
Rationale:
Application or adjusting Buck’s traction is a two-person procedure that must be planned stepby-step in order to prevent further injury and minimize client discomfort. First, set up the
traction at the foot of the bed. Then, have an assistant stand at the foot of the bed holding
traction in a straight line. The third step is to place the Buck’s boot around the lower leg.
Then, secure the Buck’s boot to the skin on the leg. The final step is to carefully attach the
weight to hang at the foot of the bed while the assistant holds straight traction.
9. The nurse caring for a client whose fractured left femur was surgically managed with an
intramedullary (I-M) rodding shares with the client’s family that the benefit of this type of
fixation is that it:
Select all that apply.
1. Allows for early weight bearing.
2. Results in only minimal skin scarring.
3. Does not interfere with range of motion.
4. Facilitates direct visualization of the fracture.
5. Reduces the risk of a postsurgical fat embolus.
Answer: 1. Allows for early weight bearing.
2. Results in only minimal skin scarring.
3. Does not interfere with range of motion.
Rationale:
Allows for early weight bearing. Intramedullary (I-M) rodding refers to a method of fracture
fixation that entails sliding a metal rod down the medullary canal of a long bone. This form of
fixation allows for early weight bearing because it shares the load and leaves joints free to
move. Results in only minimal skin scarring. The benefits of this fixation method include
small surgical scars in less obvious places than with other methods. Does not interfere with
range of motion. The benefits of this fixation method include less interference with range of
motion. Facilitates direct visualization of the fracture. Open reduction methods allow for
direct visualization of the actual fracture. Reduces the risk of a postsurgical fat embolus.
There is a slight increased risk of fat embolism with this method.
10. An elderly woman admitted to the orthopedic unit following a fall that resulted in a
fractured left hip is placed in Buck’s traction. The nurse includes which of the following
interventions in the client’s preoperative plan of care?
1. Having someone hold the weights when moving the client up in bed
2. Providing pin site care every shift
3. Placing an abduction pillow between the client’s legs
4. Turning the client to the unaffected side every 2 hours
Answer: Having someone hold the weights when moving the client up in bed
Rationale:
Buck’s traction is used preoperatively to control muscle spasms, immobilize a fractured hip,
and maintain alignment of an extremity. Often, clients will “scoot” down toward the end of
the bed, and the weights will rest on the floor. To avoid injury and added pain, one person
holds the weights while the others use a lift sheet to reposition the client. Buck’s traction is
skin traction; no skeletal pins are used. An abduction pillow is used postoperatively. A client
cannot be turned with this type of injury.
11. The nurse cannot palpate a client’s pedal pulse following an open reduction internal
fixation (ORIF) procedure for a fractured tibia. Which action is the priority intervention?
1. Use a Doppler to find the pedal pulse.
2. Notify the surgeon of the problem.
3. Check the lower extremity for pallor.
4. Assess the client’s pain rating.
Answer: Use a Doppler to find the pedal pulse.
Rationale:
To assess if circulation is present when the pulse is not palpable, the nurse should use a
Doppler. Notifying the surgeon should occur once all assessment data are collected; this
would include the presence of pallor and pain.
12. The nurse is caring for a client who recently experienced a traumatic amputation of the
left leg just below the knee due to a crushing injury at work while he was taking a smoke
break. The nurse shows an understanding of this client’s condition when acknowledging that:
Select all that apply.
1. The client’s report of pain in the area of the amputated foot is real.
2. Nerve regeneration to a reattached lower limb usually results in poor function.
3. Smoking is a significant risk factor for reattachment of limbs.
4. The recovery period for a limb reattachment would be similar to one for a surgical
amputation.
5. Crushing injuries are usually suitable for reattachment of the limb.
Answer: 1. The client’s report of pain in the area of the amputated foot is real.
2. Nerve regeneration to a reattached lower limb usually results in poor function.
3. Smoking is a significant risk factor for reattachment of limbs.
Rationale:
The client’s report of pain in the area of the amputated foot is real. The patient may have
bizarre sensations, such as feeling like the absent foot is cold or itchy. These are called
phantom limb sensations. Nerve regeneration to a reattached lower limb usually results in
poor function. Surgical reattachment of a severed limb is done only under certain
circumstances because the surgery is difficult. For adults, it is nearly impossible for nerves to
regenerate in the lower extremity, and the reattached limb may be painful and dysfunctional.
Smoking is a significant risk factor for reattachment of limbs. Only cleanly separated
traumatic amputations in patients without significant risk factors for impaired healing such as
smoking are considered for reattachment. The recovery period for a limb reattachment would
be similar to one for a surgical amputation. Complete amputation and prosthesis could allow
a patient to return to normal activities in days to weeks, whereas reconstruction of mangled
limbs can span over years, with a huge psychological strain and impact on function and
occupation. Crushing injuries are usually suitable for reattachment of the limb. Reattachment
in crush-type amputations is not attempted due to the poor outcome.
13. There is concern that a client wearing a long leg cast is at risk for developing
compartment syndrome due to swelling. The nurse caring for the client shows the best
understanding of the complication and its specific treatment by gathering the following
equipment:
1. Ace bandages, to wrap around the bi-valved cast.
2. Extra pillows, to elevate the casted extremity above the heart.
3. A Doppler, to aid in assessing the strength of peripheral pulses.
4. A percussion hammer, to physically assess reflexes for damage.
Answer: Ace bandages, to wrap around the bi-valved cast.
Rationale:
Compartment syndrome occurs when excess pressure in a limited space constricts the
structures within a compartment, reducing circulation to muscles and nerves. With increased
edema, this event threatens the viability of the client’s limb and increases the risk of sepsis.
Treatment can include removing the cast entirely or bi-valving it (splitting it apart with a cast
cutter) and securing the two sides with ace wraps, tape, or Velcro straps. If the pressure is
internal, a fasciotomy might be necessary. Elevating the leg above the heart would
compromise circulation. A Doppler could be used to assess pulses, and a percussion hammer
to check reflexes, but these are not therapeutic treatments specific for compartment
syndrome.
14. The day after surgery to replace a hip joint, the client states he is not ready to ambulate,
and will consider it tomorrow. The nurse’s initial action is to:
1. Explain the benefits of ambulation at this time to the client.
2. Ask the client why he is resistant to ambulating at this time.
3. Notify the surgeon of the client’s noncompliance.
4. Document the client’s refusal.
Answer: Explain the benefits of ambulation at this time to the client.
Rationale:
Educating the client about the rationale for ambulation at this time is the initial intervention.
It is premature to contact the health care provider. If the client continues to refuse to
ambulate, his reasons for doing so should be discussed. Documentation of the exchange is
needed, but should be done once the reason for the refusal is known.
15. An otherwise healthy client is scheduled to undergo a hip replacement to manage
osteoarthritis. When providing education concerning the procedure, the client asks if she
should be concerned about complications. The nurse best responds by replying:
1. “Complications may occur with any surgical procedure, so let’s discuss the common ones.”
2. “Complications are variable, so it’s difficult to predict.”
3. “Your health care provider will be in to discuss complications with you just before the
surgery.”
4. “You are healthy and should have an uneventful recovery.”
Answer: “Complications may occur with any surgical procedure, so let’s discuss the common
ones.”
Rationale:
Complications can result from any surgery. The client should be aware of the most common
problems. Advising the client that complications are “variable” does not meet the question
posed to the nurse. Waiting until just before the surgery is too late to begin discussing
complications. The client’s overall health does impact the incidence of complications, but it
does not negate their occurrence.
16. A group of nurses whose practice focuses of the care of clients with musculoskeletal
injuries is attempting to decide on a research topic that will have impact on the care of their
particular clients. The group decides to address the issue of:
1. The use of alternative methods to manage pain on the orthopedic unit.
2. The effectiveness of Buck’s traction for the stabilization of closed tibia fractures.
3. The effects of casting versus splinting on the development of compartment syndrome.
4. The relationship between rhabdomyolysis and renal failure.
Answer: Use of alternative methods to manage pain on the orthopedic unit.
Rationale:
The need for additional research on the use of alternative methods of pain management for
musculoskeletal injuries has been identified as a need related to the nursing care of these
clients; the topic is also one that directly addresses a nursing responsibility. The remaining
topics are all medical in nature and not directly connected to nursing responsibilities.
17. A client with musculoskeletal pain from a leg injury asks the nurse what chiropractic
techniques are successful for his type of problem. The nurse responds:
1. “There is currently very little research published on cases like yours.”
2. “I had some clients who are very happy with the chiropractic care they’ve received.”
3. “I believe that traditional medicinal therapies have better results than chiropractic
therapies.”
4. “When the problem is pain, I’m not sure that chiropractic techniques are research-based.”
Answer: “There is currently very little research published on cases like yours.”
Rationale:
In chiropractic studies, there is a scarcity of higher-level research designs such as randomized
controlled trials. One study focused on patients with chronic musculoskeletal pain, and
compared the clinical outcomes of two chiropractic approaches for these patients. More
research is needed to arrive at definitive recommendations. Basing the response on the reports
of a few clients is not appropriate. The statements regarding traditional medicine and pain are
based on personal opinion, not research.
18. A committee of musculoskeletal care nurses has been meeting to formulate policy
changes regarding the proper method for providing pin site care to best minimize the client’s
risk for infection. Based on the current research findings, the nurses come to the conclusion
that:
1. Chlorhexidine 2 mg/mL solution is the cleanser of choice.
2. The critical period for infection control measures is up to 48 hours out from pin insertion.
3. Pins located in areas of considerable soft tissue are at least risk for infection.
4. Hydrogen peroxide is an acceptable choice of skin cleanser.
Answer: Chlorhexidine 2 mg/mL solution is the cleanser of choice.
Rationale:
Research supports that chlorhexidine 2 mg/mL solution appears be the most effective
cleansing solution for pin site care. Currently, the use of hydrogen peroxide is discouraged
because it may cause damage to the healthy tissue surrounding the pin; it has also been
associated with increased infection rates and the disruption of the skin’s normal flora. The
critical period for infection control is after the first 48 to 72 hours when drainage may be
heavy; pin site care should be done daily. Pins located in areas with considerable soft tissue
should be considered at greater risk for infection.
Test Bank for Timby's Introductory Medical-Surgical Nursing
Loretta A Donnelly-Moreno, Brigitte Moseley
9781975172237, 9781975172268
