Musculoskeletal Nursing Orthopedic Surgery Exam 144 Questions with Verified Answers
Emergency medical technicians transport a client to the emergency
... [Show More] department and inform the nurse that the client fell from a two-story building. The comatose client has a large contusion on the left side of the chest, a hematoma in the left parietal area, and a compound fracture of the left femur. The client was intubated and is maintaining an arterial oxygen saturation of 92% by pulse oximeter with a manual-resuscitation bag. Which intervention by the nurse has the highest priority? - CORRECT ANSWER assessing the left leg
Lifestyle risk factors for osteoporosis include - CORRECT ANSWER lack of exposure to sunshine
The nurse assesses subtle personality changes, restlessness, irritability, and confusion in a client who has sustained a fracture. The nurse suspects which complication? - CORRECT ANSWER fat embolism syndrome
Which is one of the most common causes of death in clients diagnosed with fat emboli syndrome? - CORRECT ANSWER acute respiratory distress syndrome
The health care provider is preparing to bivalve the client's cast. Which supplies should the nurse assemble? - CORRECT ANSWER elastic compression bandages
The nurse is providing instructions to the client following application of a fiberglass cast. Which statement by the client indicates further education is needed? - CORRECT ANSWER "Under no circumstances should I get my cast wet."
The client is admitted to the hospital with a diagnosis of left femoral neck fracture. Which treatment modality would the nurse expect the health care provider to order? - CORRECT ANSWER Buck's traction
A client has a cast that extends from below the elbow to the palmar crease and is secured around the base of the thumb. The thumb is also casted. The nurse identifies this as which type of cast?` - CORRECT ANSWER Gauntlet cast
Which intervention would the nurse implement with the client in skeletal traction? - CORRECT ANSWER ensure the pins or wires are covered with caps, position trapeze within the client's reach, instruct the client on isometric exercises for immobilized extremity
The nurse is caring for the client with chronic osteomyelitis of the jaw with a draining wound. Which client goal is a priority for the client? - CORRECT ANSWER The client will experience a tolerable level of pain.
The client will demonstrate wound care.
The client will maintain adequate nutritional intake.
A client who has fractured the radial head asks the nurse about factors that will promote bone healing. Which statement should the nurse include when responding to the client? - CORRECT ANSWER "Immobilization of the fracture will promote healing by maximizing contact of bone fragments."
"Fractured bones require a good blood supply and adequate nutrition for healing."
"Weight bearing stimulates healing of the long bones of the leg, if the fracture is stabilized."
A client with a fractured femur is admitted to the nursing unit. Which assessment finding requires follow up by the nurse? - CORRECT ANSWER "I cannot seem to catch my breath."
"I have a pins-and-needles sensation in my toes."
Dorsoplantar weak and unequal bilaterally
T 101.2 degrees F; HR 110; RR 28; pulse oximetry 90%
Which of the following describes failure of the ends of a fractured bone to unite in normal alignment? - CORRECT ANSWER Nonunion
Which of the following are associated with compartment syndrome? - CORRECT ANSWER Trauma from accidents
Surgery
Casts
Tight bandages
Crushing injuries
Which assessment findings would the nurse expect to find in the client with osteomyelitis? - CORRECT ANSWER Column B
What areas of the body may be examined when bone densitometry is done? - CORRECT ANSWER hip, spine, wrist
A client who was injured while playing basketball reports an extremely painful elbow, which is very edematous. What type of injury has the client experienced? - CORRECT ANSWER sprain
A client has undergone a leg amputation. What teachings should the nurse offer such a client to prevent abduction deformity? - CORRECT ANSWER Advise the client to use a trochanter roll.
Advise the client to adduct the stump so it presses against the other leg when the client is lying on the stomach.
Which statements describe open reduction of a fracture? - CORRECT ANSWER It is performed in the operating room.
The bone is surgically exposed and realigned.
The client usually receives general or spinal anesthetic.
A client is having traction applied to a fractured left lower extremity prior to surgery. What outcomes does the nurse expect from the application of the traction for the client? - CORRECT ANSWER Muscle spasms will be relieved.
The bones of the left leg will be aligned.
Immobilization of the left leg will be maintained
A client comes to the clinic 2 days after sustaining a sprain to the left ankle. What intervention can the nurse encourage the client to perform that will help improve circulation? - CORRECT ANSWER applying heat
A client arrives in the emergency room complaining of severe pain in her left hip after falling out of the bed. What indication upon assessment does the nurse recognize as a dislocated left hip? - CORRECT ANSWER The left leg is shorter than the right.
Limited range of motion of the left hip.
The skin of the lower left leg is pale.
A client diagnosed with osteoporosis is being discharged home. Which priority education should the nurse should provide? - CORRECT ANSWER Remove all small rugs from the home
What assessment findings of the leg are consistent with a fracture of the femoral neck? - CORRECT ANSWER Shortened, adducted, and externally rotated
A 75-year-old client had surgery for a left hip fracture yesterday. When completing the plan of care, the nurse should include assessment for which complications? - CORRECT ANSWER Pneumonia, skin breakdown, sepsis, delirium
A client with a short arm cast is suspected to have compartment syndrome. What actions should the nurse include in the plan of care? - CORRECT ANSWER Prepare to remove the cast.
Provide support to the injured extremity.
A client with a tibia fracture was placed in an external fixator 24 hours ago. The nurse is completing pin care and notices redness at the pin site and a small amount of serous drainage. What action by the nurse is appropriate? - CORRECT ANSWER document the findings
A client is admitted to the orthopedic unit with a fractured femur after a motorcycle accident. The client has been placed in traction until the femur can be rodded in surgery. For what early complication(s) should the nurse monitor this client? - CORRECT ANSWER Deep vein thrombosis
Compartment syndrome
Fat embolism
An older adult client has fallen in the home and is brought to the emergency department by ambulance with a suspected fractured hip. X-rays confirm a fracture of the left femoral neck. When planning assessments during the client's presurgical care, the nurse should be aware of the client's heightened risk of what complication? - CORRECT ANSWER avascular necrosis
The nurse is providing care for a client who has had a below-the-knee amputation. The nurse enters the client's room and finds the client resting in bed with the residual limb supported on a pillow. What is the nurse's most appropriate action? - CORRECT ANSWER Explain the risks of flexion contracture to the client
A client has suffered a muscle strain and is reporting pain at 6 on a 10-point scale. The nurse should recommend what action? - CORRECT ANSWER Applying a cold pack to the injured site
A client has had a brace prescribed to facilitate recovery from a knee injury. What are the potential therapeutic benefits of a brace? - CORRECT ANSWER Preventing additional injury
Providing support
Controlling movement
A physician writes a prescription to discontinue skeletal traction on an orthopedic client. The nurse should anticipate what subsequent intervention? - CORRECT ANSWER application of a cast
A client has just begun been receiving skeletal traction and the nurse is aware that muscles in the client's affected limb are spastic. How does this change in muscle tone affect the client's traction prescription? - CORRECT ANSWER Extra weight is needed initially to keep the limb in proper alignment.
A client is scheduled for a total hip replacement and the surgeon has explained the risks of blood loss associated with orthopedic surgery. The risk of blood loss is the indication for which of the following actions? - CORRECT ANSWER Autologous blood donation
A nurse is caring for an older adult client who is preparing for discharge following recovery from a total hip replacement. What outcome must be met prior to discharge? - CORRECT ANSWER client is able to perform transfers safely
A nurse is caring for a client who is being assessed following reports of severe and persistent low back pain. The client is scheduled for diagnostic testing in the morning. Which of the following are appropriate diagnostic tests for assessing low back pain? - CORRECT ANSWER CT, Magnetic resonance imaging, Ultrasound, X-ray
A client with an arm cast reports pain. What nursing interventions should the nurse provide in order to reduce the incidence of complications? - CORRECT ANSWER Assess the fingers for color and temp, assess for a pressure sore, determine the exact site of the pain
A client has low back pain and the healthcare provider needs to rule out the presence of a tumor. Which diagnostic procedure would the nurse anticipate to be ordered for the client? - CORRECT ANSWER bone scan
A provider asks the nurse to teach a client with low back pain how to sit in order to minimize pressure on the spine. Which teaching points would the nurse include? - CORRECT ANSWER Avoid hip extension.
Place feet flat on the floor.
Sit with the buttocks "tucked under."
Sit in a straight-backed chair with arm rests
A nurse is caring for a client after stabilization of a radial fracture. Which actions by the nurse would be appropriate for the client following arm casting? - CORRECT ANSWER Handle the cast with the palms of hands
Circulate room air with a portable fan
Petal and smooth the edges of the cast
The nurse provides care for a client in balanced suspension traction. The client reports pain in the affected extremity, and the nurse administers medication. One hour later the client states, "I don't know why, but the pain isn't getting any better." Which action does the nurse take first? - CORRECT ANSWER perform a neuromuscular assessment
The nurse provides care for an older adult client eight days after an open reduction and internal fixation of the right hip. The nurse intervenes if which observation is made? - CORRECT ANSWER the client is not wearing elastic stockings
The nurse prepares a client for a total hip replacement. What information will likely postpone the surgery? - CORRECT ANSWER the client reports burning on urination
The nurse teaches a client with a BKA to care for the residual limb at home. The nurse advises the client to take which action? - CORRECT ANSWER expose the residual limb to air
The nurse teaches a client diagnosed with a fractured left demur that is in a cast. The client asks how to keep the muscles if the legs strong during the time the cast os on the left leg. Which response by the nurse is best? - CORRECT ANSWER "I'll teach you how to do isometric exercises with your left leg"
The nurse provides care for a client with DJD (osteoarthritis). The client receives a new prescription for celecoxib. The nurse is most concerned if the client makes which statement? - CORRECT ANSWER "I am allergic to aspirin"
An older adult client is diagnosed with a fractured femur. The nurse recognizes which observation is an early sign of fat embolism? - CORRECT ANSWER Altered mental status
The nurse provides care for a client with a newly applied plaster cast to the lower extremity. The nurse takes which action? - CORRECT ANSWER Elevates the leg on pillows and leaves the cast open to air
A client asks the nurse, "What is the difference between RA and osteoarthritis?" Which response by the nurse is best? - CORRECT ANSWER "Rheumatoid arthritis is a systemic disease and osteoarthritis is not."
The nurse assesses a client diagnosed with osteoarthritis. The nurse expects to observe which signs/ symptoms? - CORRECT ANSWER Pain usually provoked by activity, and stiffness of the joints after periods of rest
The clinic nurse counsels a client reporting low back pain. Which client statement requires a follow-up by the nurse? - CORRECT ANSWER "I work full-time as a package handler at Amazon"
The nurse evaluates care given to a client after a left BKA. The nurse intervenes if which observation is made? - CORRECT ANSWER The dressing to the surgical site is dated two days prior
A client diagnosed with Type 1 Diabetes is scheduled for a right BKA due to a gangrenous toe. The client asks the nurse why the amputation is so extensive. The nurse's response is based on which understanding? - CORRECT ANSWER A below the skeeter's amputation results in better circulation and healing
The nurse provides care for an older adult client after a total hip replacement due to degenerative joint disease. The nurse intervenes if which observation is made? - CORRECT ANSWER The client is sitting on a chair with no arms
Prednisone 2 mg daily is prescribed for a client with RA. Which important point does the nurse include when teaching the client about this medication? - CORRECT ANSWER The dosage of prednisone must be increased and decreased gradually
The home care nurse makes a home visit to a client diagnosed with osteoarthritis. The nurse asks the client's spouse if the client is having any problems. The nurse further assesses if the spouse makes which statement? - CORRECT ANSWER "My spouse has not been participating in regular activities."
The nurse provides care for a client immediately following a right BKA. The nurse is most concerned if which observation is made? - CORRECT ANSWER The client reports persistent pain at the operative site
The nurse provides care for a client in Buck traction. Which is the most important nursing action to maintain effective traction? - CORRECT ANSWER Allow weights to hang freely at all times
An older adult client has an open reduction and internal fixation of the left femoral head after a fracture. Which action by the nurse is best? - CORRECT ANSWER Encourage the client to cough and deep breathe every 2 hours
The nurse provides care for a client after an amputation with an immediate prosthetic fitting. The nurse includes which activity in the client's plan of care? - CORRECT ANSWER Provide cast care on the affected extremity
A client experiences an acute bout of gouty arthritis. The nurse expects the client's affected foot to have which appearance? - CORRECT ANSWER Red
Three hours after arriving in the orthopedic unit, a client reports a hot feeling under the cast. Which action does the nurse take first? - CORRECT ANSWER Assesses the circulation in the casted extremity and changes the client's position
Total hip arthroplasty is scheduled for a client with DJD of the left femoral head. Following surgery, it is most important for the nurse to place the client's left leg in which position? - CORRECT ANSWER Abducted with toes pointing upward
Aspirin is prescribed for a client. The nurse administers this medication with which liquid? - CORRECT ANSWER A glass of milk
The nurse witnesses a car hit a pedestrian in the parking lot. As the nurse approaches the pedestrian, the pedestrian cries out, "I think my leg is broken!" Which action does the nurse take first? - CORRECT ANSWER Inspects the affected leg for evidence of bleeding
The nurse provides care for an older adult client reporting a new onset of bone pain, rapidly increasing in intensity, as well as fatigue and difficulty walking. The client reports a decrease in height and the labs show a high alkaline phosphatase level. The nurse prepares to teach the client about which disease process? - CORRECT ANSWER Paget disease
The nurse provides care for a client with RA. Which finding assumes the highest priority for the nurse when assessing and planning the client's care? - CORRECT ANSWER Slight contracture of the right wrist
Which nursing intervention is most appropriate for a client diagnosed with RA and reporting generalized pain? - CORRECT ANSWER Assist the client with heat application and ROM exercises
The nurse makes a home health care visit to a client with a fractured right femur. The nurse assesses the client's ability to safely use crutches. The nurse intervenes if which observation is made? - CORRECT ANSWER Before the client sits in a chair, the client stands on the unaffected leg and transfers both crutches to the hand on the affected side of the body
The nurse is in the outpatient clinic instructs a client receiving probenecid. It is most important for the nurse to make which statement? - CORRECT ANSWER Drink 6-8 glasses of water a day
________ permits visualization of the segments of the spinal cord; used when MRIs are not clear or patient cannot tolerate laying flat or has claustrophobia; bed rest for 2 hours afterwards, hydrate heavily afterwards to remove dye - CORRECT ANSWER Myelogram
_______ is the same as a myelogram but allows you to see the intervertebral discs of the spinal cord; usually done in OR after someone has an epidural - CORRECT ANSWER Discogram
____ is performed when patient has joint pain; checks progression of diseases; contrast involved - CORRECT ANSWER Arthrogram
_________ is carried out to obtain synovial fluid for purposes of examination or to relieve pain due to effusion. Helpful in the diagnosis of septic arthritis and other inflammatory arthropathies. Normally, synovial fluid is clear, pale, straw-colored and scanty in volume - CORRECT ANSWER Arthrocentesis
_________ allows direct visualization of a joint through the use of a fiberoptic endoscope; useful to adjunct diagnosing of joint disorders. Biopsy and treatment of tears, defects, and disease processes may be performed through this procedure. - CORRECT ANSWER Arthroscopy
_________-evaluates bone mineral density; by x-ray or ultrasounds; DEXA scan - CORRECT ANSWER Bone densitometry
______ or an EMG; pins and needles inserted into your muscles and nerves to check electrical potential to rule out muscle damage - CORRECT ANSWER Electromyography
Which baseline labs should be gathered before Heparin administration? - CORRECT ANSWER PTT, CBC w/ diff, Hgb/Hct, RBC
What would be given if the patient started bleeding uncontrollably? - CORRECT ANSWER protamine sulfate
What oral medication will your patient likely be on when Heparin therapy is stopped? - CORRECT ANSWER Warfarin
What is the reversal agent for Warfarin? - CORRECT ANSWER Vitamin K
_______ is an enzyme produced by an osteoblast, needed for mineralization of the bone. If it is elevated, healing fractures, bone cancers, osteoporosis, vitamin D deficiencies may be the cause. - CORRECT ANSWER Alkaline Phosphatase
______ is a study in which they watch red blood cells fall and count the rate in which they become sediment. If elevated, RA, osteomyelitis, inflammation may be present. - CORRECT ANSWER ESR/ Sed Rate
What does a CBC include? - CORRECT ANSWER WBC, RBC, Hgb, Hct, Platelet count
_____ is the bending of a joint, like flexing a muscle - CORRECT ANSWER Flexion
_____ is stretching something out, like straightening a joint - CORRECT ANSWER Extension
______ is moving away from the body - CORRECT ANSWER Abduction
____ is bringing closer to the body - CORRECT ANSWER Adduction
_____ is rotating a joint, like your head - CORRECT ANSWER Rotation
______ is rotating a joint all the way around, 360 degrees - CORRECT ANSWER Circumduction
_____ is turning upward, like lying supine, or palms facing upward - CORRECT ANSWER Supination
_____ is the opposite of supination, like palms facing down - CORRECT ANSWER Pronation
_____ is turning in of a body part, like inverting something - CORRECT ANSWER Inversion
_____ is turning out, like ballerina feet - CORRECT ANSWER Eversion
____ is pushing forward, like bench press - CORRECT ANSWER Protraction
____ is pulling back - CORRECT ANSWER Retraction
____ is an injury of the ligaments around a joint caused by twisting or wrenching a motion beyond its ROM. Blood vessels are torn which causes swelling and pain - CORRECT ANSWER Sprain
______ is an injury to a muscle due to overuse, over stretching, or excessive stress; painful with no swelling - CORRECT ANSWER Strain
When should intermittent heat be used for care of a soft tissue injury? - CORRECT ANSWER after the acute inflammatory phase
_____ is a Fracture that is completely in two different pieces, completely separated - CORRECT ANSWER Complete
______ is a fracture in which a Fragment remains attached, and only a portion of the bone is broken - CORRECT ANSWER Incomplete
_____ is a fracture in which bones are broken and no longer in anatomical position; something will have to be manipulated before casting for it to grow back correctly - CORRECT ANSWER Displaced
____ is a fracture that remains in good anatomical position - CORRECT ANSWER Non-displaced
_____ is a fracture that is Crossways at right angles to long axis of bone, straight across - CORRECT ANSWER Transverse
_____ is a fracture that is a slanting break - CORRECT ANSWER Oblique
______ is a fracture that is Twisted around the shaft of the bone (usually child abuse injuries will be this type) - CORRECT ANSWER Spiral
_______ is a fracture in which One side is broken, the other is just bent; occurs in young children with soft bones - CORRECT ANSWER Greenstick
_____ is a fracture Resulting from strong pulling effect of tendon or ligaments at the bone attachment - CORRECT ANSWER Avulsion
_____ is a fracture broken into multiple small pieces, may happen in jam or crush injury - CORRECT ANSWER Comminuted
_____ is a fracture in which fragments are driven into each other; legs on dash when in car wreck, or fall and land on legs - CORRECT ANSWER Impacted
_____ is a fracture in which the line extends through the articular surface of the bone - CORRECT ANSWER Intra-articular
_____ is a fracture across long axis of the bone - CORRECT ANSWER Longitudinal
______ is a fracture that is Spontaneous at site of bone disease (tumor or osteomyelitis) - CORRECT ANSWER Pathologic
_____ is a fracture that occurs as a result of repeated stress to the bones; overtraining in runner or severe bone disease - CORRECT ANSWER Stress
What are the 5 P's? - CORRECT ANSWER pain, pallor, paresthesias, paralysis, pulselessness
_____ is the restoring of a bone to proper anatomical alignment - CORRECT ANSWER Reduction
______ is done after a fracture is reduced to maintain proper position and alignment until union occurs - CORRECT ANSWER Immobilization
______ is the application of a pulling force to an injured or diseased body part - CORRECT ANSWER Traction
______ is the shrinkage-like decrease in the size of the muscle - CORRECT ANSWER Atrophy
____ is a fluid-filled sac found in connective tissue - CORRECT ANSWER Bursa
_____ is the rhythmic contraction of muscle - CORRECT ANSWER Clonus
______ is a grating or crackling sound or sensation - CORRECT ANSWER Crepitus
Which types of bone cells function to build bone? - CORRECT ANSWER Osteoblasts
Which type of bone cells, that are located in the lacunae, are mature cells that function in bone maintenance? - CORRECT ANSWER Osteocytes
Which type of bone cells, that are located in Howship's lacunae are multinuclear cells that function in destroying, resorbing, and remodeling bone? - CORRECT ANSWER Osteoclasts
____ is the process of formation of the bone matrix and deposition of minerals - CORRECT ANSWER Ossification
What are the functions of the musculoskeletal system? - CORRECT ANSWER protection of vital organs, mobility and movement, facilitation of return of blood to the heart, production of blood cells, reservoir for immature blood cells, and reservoir for vital minerals
What is the production of blood cells called? - CORRECT ANSWER hematopoiesis
Where do immature blood cells live? - CORRECT ANSWER the musculoskeletal system (bones)
Muscles are attaches to bones and other structures by ______. - CORRECT ANSWER tendons
What is the fibrous tissue that encases muscles called? - CORRECT ANSWER Fascia
_______ is the contractile unit of skeletal muscle that contains actin and myosin - CORRECT ANSWER Sarcomere
Amputations - CORRECT ANSWER Indications:
-ciculatory impairment
-tramatic and thermal injuries
-malignant tumors
-uncontrolled infection
-congenital disorder
Two major groups:
-surgical, due to effects of peripheral vascular disease and diabetes
-tramatic, due to accidents/injuries
Nurses Role in Prevention - CORRECT ANSWER Surgical: skin inspections, no extreme temperatures, manage glucose, wear shoes
Traumatic: avoid risks/increase safety
Amputations
Goals of Surgery - CORRECT ANSWER -removing infected, damaged, or ischemic tissue while preserving extremity function
-amputation below the knee & elbow joints allow for better prosthetic devices as well as improved function
-AKA: above the knee amputation
-BKA: below the knee amputation
Pre-Op Teaching Plan - CORRECT ANSWER Patient aware of what is going to happen, what will happen after surgery/plan for post-op, where will patient be discharged and where, prosthetic devices, phantom pain (still medicate like regular pain but gradually diminish over time), general post-op nursing care, mobility issues, risk for infection, wound care, risk for depression or impaired body image
Grieving Process - CORRECT ANSWER -depression & inability to look at extremity is normal & expected after the initial surgery
-the patient needs to be supported during the grieving process
-nurse's role: provide support, help identify support systems for the patient
Amputation
Managment - CORRECT ANSWER Post operative: prevention of complications
-short term: hemorrhage (decreased blood pressure increased heart rate and check dressings)
-long term: contracture (need to stretch muscles)
-Body image disturbance r/t amputation
-Impaired skin integrity r/t immobility and improperly fitted prosthesis
-Pain related to phantom limb sensation
-Impaired physical mobility r/t amputation of lower limb
Prevent long term complications - CORRECT ANSWER Flexion contracture a can easily occur and delay rehab. Place client in prone position with hip & leg in extension for 30 minutes 3-4 times per day
Shape residual limb to prepare for prosthesis
-compression bandage
-Shrinker stockings
Pain Management - CORRECT ANSWER Phantom pain:
-patient feels as if amputated limb is still present
-the pain is a real sensation and should be medicated with prescribed analgesic
Total Joint Replacement - CORRECT ANSWER Preformed to relieve pain, improve ROM, and correct deformities, instability
Replacement arthroplasty is available for elbow, shoulder, fingers, hip, knee, ankle, and foot
Two primary types of implants:
-cemented is recommended for older adults
-cementless is recommended for adults with life expectancy of 25 years or more, bone grows on to prosthetic to provide more security
Total Joint Replacement
Nursing Mangement - CORRECT ANSWER Preoperative:
-stop anticoagulants & antiplatelets
-patient must be free of infection and acute joking inflammation (due to high risk of post-op infection)
-education (during hospital stay & home management) positioning, risk for infection, rehab
Postoperative:
-internal rotation, adduction, & 90 degree flexion of hip must be avoided for 4-6 weeks to prevent dislocation (adduction pillows & use raised toilet seats, no driving or tub baths, avoid bending over & never cross legs)
-knee may have compression immobilizer (use of CPM, continuous passive motion, machine)
-elbows & shoulder rehab may be harder and longer
-verbally need Coumadin or Lovenox (high risk for DVT) for a month
-NSAIDs for inflammation
-narcotic analgesics for pain management
-IV & PO antibiotics (risk for infection)
-teach use of walker & cane (remember positioning restrictions)
-neuro vascular checks are essential
-TC&BD or use of incentive spirometer
Total Joint Replacement
Nursing Diagnosis - CORRECT ANSWER -impaired physical immobility r/t pain & surgical procedure
-pain r/t surgical procedure
-self care deficit r/t physical restrictions
-risk for infection r/t surgical procedure
-ineffective management r/t lack of knowledge of follow-up care [Show Less]