LeMone & Burke's Medical-Surgical Nursing, 7e (Bauldoff/Gubrud/Carno)

Chapter 39 Nursing Care of Patients with Musculoskeletal Trauma

1) The nurse instructs an adolescent patient on the care of a sprain at home. Which patient statement indicates the need for further instruction?

1. "I should put a heating pad on my leg as soon as I get home."

2. "I should avoid weight bearing on this leg for a couple of days."

3. "I should make sure to keep the ace bandage on my leg."

4. "I should prop this leg up when I'm sitting in a chair."

Page Ref: 1412

Cognitive Level: Analyzing

Client Need & Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: VII.5. Use evidence-based practices to guide health teaching, health counseling, screening, outreach, disease and outbreak investigation, referral and follow-up throughout the lifespan | NLN Competencies: Context and Environment; Relationship-Centered Care; Practice-Know-How; Communicate information effectively | Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 39.1 Describe the pathophysiology and manifestations of traumatic injuries of the muscles, ligaments, and tendons, and outline the interprofessional care and nursing care of patients with these injuries.

MNL Learning Outcome: 4. Determine appropriate nursing interventions for patients with musculoskeletal trauma.

2) A patient with a long leg cast is exhibiting signs of compartment syndrome. What should the nurse prepare to aid in the treatment of the patient?

1. Extra pillows to elevate the casted extremity above the heart

2. Doppler to assess the strength of peripheral pulses

3. Straps to wrap around the bivalved cast

4. Percussion hammer to assess reflexes for damage

Page Ref: 1431

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 39.2 Describe the pathophysiology and manifestations of traumatic injuries of bones, and outline the interprofessional care and nursing care of patients with these injuries.

MNL Learning Outcome: 2. Consider intraprofessional care for patients with musculoskeletal trauma.

3) A patient is placed in Buck's traction after a hip fracture. What should be included in this patient's plan of care?

1. Providing pin site care every shift as prescribed

2. Placing an abduction pillow between the legs for alignment

3. Having another person hold the weights when pulling the patient up in bed

4. Turning the patient to the unaffected side every 2 hours

Page Ref: 1428

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 39.2 Describe the pathophysiology and manifestations of traumatic injuries of bones, and outline the interprofessional care and nursing care of patients with these injuries.

MNL Learning Outcome: 3. Analyze assessment data to determine a plan of care for patients with musculoskeletal trauma.

4) The nurse is planning care for a patient recovering from an above-the-knee amputation. Which position should the nurse include in this patient's plan of care?

1. Sims' position as tolerated

2. Prone for 1 hour, several times a day

3. High Fowler's position

4. Sitting in a chair while awake

Page Ref: 1443

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 39.2 Describe the pathophysiology and manifestations of traumatic injuries of bones, and outline the interprofessional care and nursing care of patients with these injuries.

MNL Learning Outcome: 4. Determine appropriate nursing interventions for patients with musculoskeletal trauma.

5) The nurse is concerned that a patient is at risk for developing carpal tunnel syndrome. Which occupation would increase this patient's risk? Select all that apply.

1. Farmer

2. Police officer

3. Barber

4. Computer technician

5. Carpet installer

Page Ref: 1416

Cognitive Level: Analyzing

Client Need & Sub: Health Promotion and Maintenance: Lifestyle Choices

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 39.1 Describe the pathophysiology and manifestations of traumatic injuries of the muscles, ligaments, and tendons, and outline the interprofessional care and nursing care of patients with these injuries.

MNL Learning Outcome: 1. Examine the pathophysiology, incidence, risk factors, and clinical manifestations for patients with musculoskeletal trauma.

6) A patient is diagnosed with an open compound fracture and is scheduled for immediate surgery. On which problem should the nurse focus during the patient's immediate postoperative period?

1. Difficulty with mobility

2. Anxiety related to the surgical procedure

3. Potential for infection

4. Possibility of falling

Page Ref: 1418

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 39.2 Describe the pathophysiology and manifestations of traumatic injuries of bones, and outline the interprofessional care and nursing care of patients with these injuries.

MNL Learning Outcome: 4. Determine appropriate nursing interventions for patients with musculoskeletal trauma.

7) The nurse is caring for a patient with a long leg cast. What should the nurse include when assessing this patient for indications of compromised circulation? Select all that apply.

1. Swelling of the toes

2. Drainage on the cast

3. Increased temperature

4. Foul odor

5. A tight cast

Page Ref: 1431

Cognitive Level: Analyzing

Client Need & Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 39.2 Describe the pathophysiology and manifestations of traumatic injuries of bones, and outline the interprofessional care and nursing care of patients with these injuries.

MNL Learning Outcome: 3. Analyze assessment data to determine a plan of care for patients with musculoskeletal trauma.

8) A patient is diagnosed with a humeral fracture. What should the nurse identify as a priority treatment goal for the patient?

1. Immediate surgical correction

2. Immobilizing the fractured bone in normal anatomic position

3. Applying ice and compression to the injured arm

4. Applying elastic bandage wrap and elevating the arm

Page Ref: 1422

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 39.2 Describe the pathophysiology and manifestations of traumatic injuries of bones, and outline the interprofessional care and nursing care of patients with these injuries.

MNL Learning Outcome: 3. Analyze assessment data to determine a plan of care for patients with musculoskeletal trauma.

9) A patient with facial and chest injuries from a motor vehicle accident has rhonchi in the upper airways. For which problem should the nurse plan care?

1. Inability to clear the airway

2. Problem with swallowing

3. Changes in oral mucous membrane integrity

4. Potential for additional injury

Page Ref: 1422

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management, and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 39.2 Describe the pathophysiology and manifestations of traumatic injuries of bones, and outline the interprofessional care and nursing care of patients with these injuries.

MNL Learning Outcome: 3. Analyze assessment data to determine a plan of care for patients with musculoskeletal trauma.

10) An older patient lives at home alone. Which assessment data would indicate modifiable risk factors for a hip fracture? Select all that apply.

1. Complaints of lower extremity weakness

2. Problems with balance

3. Medications: atenolol 50 mg daily, lisinopril 10 mg daily, Xanax 0.25 mg daily, Seroquel 50 mg daily

4. Report of sleeping with two pillows

5. Complaints of nonproductive dry cough

Page Ref: 1423

Cognitive Level: Analyzing

Client Need & Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 39.2 Describe the pathophysiology and manifestations of traumatic injuries of bones, and outline the interprofessional care and nursing care of patients with these injuries.

MNL Learning Outcome: 1. Examine the pathophysiology, incidence, risk factors, and clinical manifestations for patients with musculoskeletal trauma.

11) A patient is diagnosed with a sprained right ankle. Which treatment should the nurse instruct the patient for the sprain?

1. Applying of a long leg cast

2. Pain medication

3. Heat, rest, compression, and elevation

4. Protection, rest, ice, compression, and elevation

Page Ref: 1412

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Communicate information effectively | Nursing/Integrated Concepts: Nursing Process: Implementation/Teaching/Learning

Learning Outcome: 39.1 Describe the pathophysiology and manifestations of traumatic injuries of the muscles, ligaments, and tendons, and outline the interprofessional care and nursing care of patients with these injuries.

MNL Learning Outcome: 4. Determine appropriate nursing interventions for patients with musculoskeletal trauma.

12) A patient is recovering from endoscopic carpal tunnel surgery. Which statement indicates that the surgery has been effective?

1. "I only feel numbness when I've been on the computer for more than 15 minutes."

2. "I guess in a couple of months the numbness will go away."

3. "I will always have some tingling in my fingers after I've been on the computer."

4. "I'm not feeling tingling or numbness in my thumb or index finger any longer."

Page Ref: 1416-1417

Cognitive Level: Analyzing

Client Need & Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.9. Monitor client outcomes to evaluate the effectiveness of psychobiological interventions | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 39.1 Describe the pathophysiology and manifestations of traumatic injuries of the muscles, ligaments, and tendons, and outline the interprofessional care and nursing care of patients with these injuries.

MNL Learning Outcome: 2. Consider intraprofessional care for patients with musculoskeletal trauma.

13) A patient is diagnosed with epicondylitis. Which treatment may be indicated for this patient? Select all that apply.

1. Ibuprofen 600 mg twice daily

2. Morphine sulfate 4 mg IV

3. Arm splint to be used while awake

4. Ice followed by heat

5. Surgical repair

Page Ref: 1416

Cognitive Level: Analyzing

Client Need & Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 39.1 Describe the pathophysiology and manifestations of traumatic injuries of the muscles, ligaments, and tendons, and outline the interprofessional care and nursing care of patients with these injuries.

MNL Learning Outcome: 2. Consider intraprofessional care for patients with musculoskeletal trauma.

14) A patient diagnosed with bursitis asks, "Why do you keep asking what my pain level is? Don't you believe me?" How should the nurse respond?

1. "It is important to know your pain level so that we can provide you with the best medication."

2. "If you don't want the medication, you don't have to take it."

3. "I can't give you the medication unless I know what your pain level is."

4. "I don't understand why you are concerned about my questions. Would you clarify?"

Page Ref: 1417

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Basic Care and Comfort

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.4. Communicate effectively with all members of the healthcare team, including the patient and the patient's support network | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Communicate information effectively | Nursing/Integrated Concepts: Nursing Process: Implementation/Communication and Documentation

Learning Outcome: 39.1 Describe the pathophysiology and manifestations of traumatic injuries of the muscles, ligaments, and tendons, and outline the interprofessional care and nursing care of patients with these injuries.

MNL Learning Outcome: 3. Analyze assessment data to determine a plan of care for patients with musculoskeletal trauma.

15) A patient is diagnosed with an oblique fracture of the left femur. In which order should the nurse explain the steps of healing? Place in the correct order the steps of the process.

Choice 1. Bony callus formation

Choice 2. Fibrocartilaginous callus formation

Choice 3. Hematoma formation

Choice 4. Remodeling

Page Ref: 1418

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Physiological Adaptation

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Communicate information effectively | Nursing/Integrated Concepts: Nursing Process: Implementation/Teaching/Learning

Learning Outcome: 39.2 Describe the pathophysiology and manifestations of traumatic injuries of bones, and outline the interprofessional care and nursing care of patients with these injuries.

MNL Learning Outcome: 1. Examine the pathophysiology, incidence, risk factors, and clinical manifestations for patients with musculoskeletal trauma.

16) An older patient with a history of diabetes is experiencing poor healing of a fractured ankle. Which factor should the nurse consider that contributes to this patient's delay in bone healing? Select all that apply.

1. Immobilization

2. Advanced age

3. Diabetes

4. Moderate activity level prior to injury

5. Presence of foreign body at the fracture site

Page Ref: 1422

Cognitive Level: Analyzing

Client Need & Sub: Physiological Integrity: Physiological Adaptation

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 39.2 Describe the pathophysiology and manifestations of traumatic injuries of bones, and outline the interprofessional care and nursing care of patients with these injuries.

MNL Learning Outcome: 1. Examine the pathophysiology, incidence, risk factors, and clinical manifestations for patients with musculoskeletal trauma.

17) After sustaining a fracture, a patient was treated by applying ice and a cast. After several weeks, the cast is removed and the patient is able to ambulate without difficulty. Which positive local factor influenced this patient's bone healing? Select all that apply.

1. Immobilization

2. Timely correction of displacement

3. Application of ice

4. Delay in correction of displacement

5. Malnutrition

Page Ref: 1422

Cognitive Level: Analyzing

Client Need & Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 39.2 Describe the pathophysiology and manifestations of traumatic injuries of bones, and outline the interprofessional care and nursing care of patients with these injuries.

MNL Learning Outcome: 2. Consider intraprofessional care for patients with musculoskeletal trauma.

18) Nonunion of a fractured tibia is seen in a patient after 8 weeks in a long leg cast. Which intervention may be necessary to encourage bone healing?

1. Removing the old cast and reapplying another

2. Placing the patient in Buck's traction

3. Surgical intervention with open reduction and internal fixation

4. Bone debridement

Page Ref: 1437

Cognitive Level: Analyzing

Client Need & Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 39.2 Describe the pathophysiology and manifestations of traumatic injuries of bones, and outline the interprofessional care and nursing care of patients with these injuries.

MNL Learning Outcome: 2. Consider intraprofessional care for patients with musculoskeletal trauma.

19) A patient diagnosed with a fractured left femur complains of chest pain, shortness of breath, and a rash on the chest. What complication should the nurse suspect?

1. Fat embolism syndrome

2. Deep vein thrombosis

3. Compartment syndrome

4. Disseminated intravascular coagulation (DIC)

Page Ref: 1436

Cognitive Level: Analyzing

Client Need & Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 39.2 Describe the pathophysiology and manifestations of traumatic injuries of bones, and outline the interprofessional care and nursing care of patients with these injuries.

MNL Learning Outcome: 3. Analyze assessment data to determine a plan of care for patients with musculoskeletal trauma.

20) The nurse suspects that a patient is experiencing fat embolism syndrome (FES). Which assessment data supports the nurse's clinical decision? Select all that apply.

1. Pulse oximetry 88%

2. Petechiae observed on the chest and upper arms

3. Complaints of shortness of breath

4. Respiratory rate 32 breaths/min

5. Skin warm and dry

Page Ref: 1437

Cognitive Level: Analyzing

Client Need & Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 39.2 Describe the pathophysiology and manifestations of traumatic injuries of bones, and outline the interprofessional care and nursing care of patients with these injuries.

MNL Learning Outcome: 3. Analyze assessment data to determine a plan of care for patients with musculoskeletal trauma.

21) A patient recovering from a fractured hip is at risk for developing deep vein thrombosis (DVT). Which treatment would be indicated for the patient at this time?

1. Heparin

2. Prevention

3. Vena cava filter

4. Massaging the affected extremity

Page Ref: 1437

Cognitive Level: Analyzing

Client Need & Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 39.2 Describe the pathophysiology and manifestations of traumatic injuries of bones, and outline the interprofessional care and nursing care of patients with these injuries.

MNL Learning Outcome: 4. Determine appropriate nursing interventions for patients with musculoskeletal trauma.

22) A patient with an open fracture of the left femur that punctured the skin waited 2 hours before getting to the hospital. What would be the priority problem to address when caring for this patient?

1. Insufficient nutrition

2. High potential for infection

3. Low body temperature

4. Fear and anxiety

Page Ref: 1437

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 39.2 Describe the pathophysiology and manifestations of traumatic injuries of bones, and outline the interprofessional care and nursing care of patients with these injuries.

MNL Learning Outcome: 3. Analyze assessment data to determine a plan of care for patients with musculoskeletal trauma.

23) The nurse is explaining to a patient the procedure to alleviate pressure on a casted extremity. How should the nurse explain the procedure?

1. "This procedure is called bivalving. The doctor will use a cast saw to split the cast down both sides to relieve pressure on your leg."

2. "This procedure is called an external fixation and will help the bone heal."

3. "This procedure is called an open reduction with internal fixation to help the bone fuse together."

4. "This procedure will help heal your leg faster so that the cast can come off sooner."

Page Ref: 1431

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Communicate information effectively | Nursing/Integrated Concepts: Nursing Process: Implementation/Teaching/Learning

Learning Outcome: 39.2 Describe the pathophysiology and manifestations of traumatic injuries of bones, and outline the interprofessional care and nursing care of patients with these injuries.

MNL Learning Outcome: 2. Consider intraprofessional care for patients with musculoskeletal trauma.

24) The nurse has identified that a patient recovering from an above-the-knee amputation has a problem with pain control. Which nursing intervention would be beneficial for this patient? Select all that apply.

1. Administering analgesics before pain reaches a higher level

2. Splinting and supporting the injured area

3. Elevating the stump on three pillows

4. Encouraging deep breathing and relaxation exercises

5. Repositioning the patient every 8 hours

Page Ref: 1442

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 39.2 Describe the pathophysiology and manifestations of traumatic injuries of bones, and outline the interprofessional care and nursing care of patients with these injuries.

MNL Learning Outcome: 4. Determine appropriate nursing interventions for patients with musculoskeletal trauma.

25) A patient is recovering from a below-the-knee amputation. For which complication should the nurse assess this patient? Select all that apply.

1. Diabetes mellitus

2. Phantom pain

3. Infection

4. Chronic stump pain

5. Contractures

Page Ref: 1446

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 39.2 Describe the pathophysiology and manifestations of traumatic injuries of bones, and outline the interprofessional care and nursing care of patients with these injuries.

MNL Learning Outcome: 3. Analyze assessment data to determine a plan of care for patients with musculoskeletal trauma.

26) The nurse is teaching older adults about lowering the risk for musculoskeletal trauma. Which strategy should the nurse include?

1. Avoid falls at home by not using throw rugs.

2. Avoid injury in motor vehicle accidents by not driving.

3. Avoid fire by not cooking in the kitchen when alone.

4. Avoid injury by not using assistive devices at home.

Page Ref: 1438

Cognitive Level: Applying

Client Need & Sub: Safe and Effective Care Environment: Safety and Infection Control

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Communicate information effectively | Nursing/Integrated Concepts: Nursing Process: Implementation/Teaching/Learning

Learning Outcome: 39.2 Describe the pathophysiology and manifestations of traumatic injuries of bones, and outline the interprofessional care and nursing care of patients with these injuries.

MNL Learning Outcome: 4. Determine appropriate nursing interventions for patients with musculoskeletal trauma.

27) The nurse is concerned that patients on an orthopedic care area are at risk for compartment syndrome. In which circumstance should the nurse assess for manifestations of compartment syndrome? Select all that apply.

1. Fasciotomy

2. Cast applied to a limb

3. Crush injury to a limb

4. Fat embolism

5. Total hip replacement surgery

Page Ref: 1436

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 39.2 Describe the pathophysiology and manifestations of traumatic injuries of bones, and outline the interprofessional care and nursing care of patients with these injuries.

MNL Learning Outcome: 3. Analyze assessment data to determine a plan of care for patients with musculoskeletal trauma.

28) The nurse is caring for a patient receiving care on the orthopedic unit. Which assessment finding indicates that the patient is developing complex regional pain syndrome?

1. Complains of persistent pain, swelling, and decreased motion

2. Bone has not healed within the expected time period

3. Complains of leg swelling, pain, tenderness, and cramping

4. Complains of numbness beyond a cast, and toes are pale, with delayed capillary refill

Page Ref: 1437

Cognitive Level: Analyzing

Client Need & Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 39.2 Describe the pathophysiology and manifestations of traumatic injuries of bones, and outline the interprofessional care and nursing care of patients with these injuries.

MNL Learning Outcome: 3. Analyze assessment data to determine a plan of care for patients with musculoskeletal trauma.

29) Following the application of a cast to a patient's right lower leg, the nurse is monitoring for complications. Which assessment data leads the nurse to be concerned about a serious complication?

1. The toes on the right foot are pink and warm, and sensation is intact.

2. The patient complains of numbness in the right foot and toes.

3. The patient reports itching under the cast.

4. The patient complains of general discomfort in the lower-right leg.

Page Ref: 1436

Cognitive Level: Analyzing

Client Need & Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 39.2 Describe the pathophysiology and manifestations of traumatic injuries of bones, and outline the interprofessional care and nursing care of patients with these injuries.

MNL Learning Outcome: 3. Analyze assessment data to determine a plan of care for patients with musculoskeletal trauma.

30) A patient is scheduled to have skeletal traction. What should the nurse recognize about this type of traction?

1. Weighted skin traction will be applied.

2. A surgical pin will be inserted into a bone and the traction will be applied to the pin.

3. A cast will be applied to the area and a traction device will be connected to the cast.

4. Manual traction will be applied.

Page Ref: 1427-1428

Cognitive Level: Analyzing

Client Need & Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 39.2 Describe the pathophysiology and manifestations of traumatic injuries of bones, and outline the interprofessional care and nursing care of patients with these injuries.

MNL Learning Outcome: 2. Consider intraprofessional care for patients with musculoskeletal trauma.

31) The nurse is caring for a patient with an external fixator device. What care should the nurse provide to this patient?

1. Cleansing pin sites per orders to reduce the chance of infection

2. Adjusting the tension on the pins whenever the patient experiences pain

3. Explaining that bathing in a tub can be resumed after 3 days

4. Encouraging the patient to keep the limb with the external fixator very still

Page Ref: 1429

Cognitive Level: Applying

Client Need & Sub: Safe and Effective Care Environment: Safety and Infection Control

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 39.2 Describe the pathophysiology and manifestations of traumatic injuries of bones, and outline the interprofessional care and nursing care of patients with these injuries.

MNL Learning Outcome: 4. Determine appropriate nursing interventions for patients with musculoskeletal trauma.

32) A patient whose recovery from a fracture has been very slow is prescribed a treatment that will increase the migration of osteoblasts and osteoclasts to the fracture site. For which treatment should the nurse instruct this patient?

1. Open reduction and manipulation

2. Open visualization and debridement

3. Electrical bone stimulation

4. Fracture assimilation

Page Ref: 1428-1429

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Communicate information effectively | Nursing/Integrated Concepts: Nursing Process: Implementation/Teaching/Learning

Learning Outcome: 39.2 Describe the pathophysiology and manifestations of traumatic injuries of bones, and outline the interprofessional care and nursing care of patients with these injuries.

MNL Learning Outcome: 2. Consider intraprofessional care for patients with musculoskeletal trauma.

33) A patient with facial fractures has a pulse of 108 bpm, respiratory rate of 24 breaths/min, and obvious deformities to the right side of the face. What should the nurse identify as the priority of care for this patient?

1. Frequently assessing the blood pressure for signs of shock and initiating IV fluids

2. Monitoring the elevated respiratory rate and maintaining the airway

3. Monitoring the elevated pulse rate and looking for signs of pallor

4. Frequently assessing for facial pain and administering pain medication p.r.n.

Page Ref: 1422

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 39.2 Describe the pathophysiology and manifestations of traumatic injuries of bones, and outline the interprofessional care and nursing care of patients with these injuries.

MNL Learning Outcome: 3. Analyze assessment data to determine a plan of care for patients with musculoskeletal trauma.

34) A patient is prescribed PRICE therapy. How should the nurse describe the components of this therapy?

1. Protection, rest, ice, compression, and elevation

2. Protection, rest, ice, CT scan, and elimination of pain

3. Protection, rest, immobilization, CT scan, and elimination of pain

4. Protection, rest, immobilization, compression, and elevation

Page Ref: 1412

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Communicate information effectively | Nursing/Integrated Concepts: Nursing Process: Implementation/Teaching/Learning

Learning Outcome: 39.1 Describe the pathophysiology and manifestations of traumatic injuries of the muscles, ligaments, and tendons, and outline the interprofessional care and nursing care of patients with these injuries.

MNL Learning Outcome: 4. Determine appropriate nursing interventions for patients with musculoskeletal trauma.

35) A patient recovering from an amputation refuses to look at the stump or participate in care. For what problem should the nurse plan interventions to help this patient?

1. Infection

2. Insufficient nutrition

3. Problems with body image

4. Risk for chronic pain

Page Ref: 1443

Cognitive Level: Applying

Client Need & Sub: Psychosocial Integrity: Coping Mechanisms

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 39.2 Describe the pathophysiology and manifestations of traumatic injuries of bones, and outline the interprofessional care and nursing care of patients with these injuries.

MNL Learning Outcome: 3. Analyze assessment data to determine a plan of care for patients with musculoskeletal trauma.

36) The nurse needs to reposition a patient with a fractured leg. Which action should the nurse take when moving this patient?

1. Making sure the extremity is supported distal to the fracture

2. Disconnecting the weights from the balanced traction setup

3. Supporting the extremity above and below the fracture

4. Supporting the leg directly under the fracture

Page Ref: 1430

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 39.2 Describe the pathophysiology and manifestations of traumatic injuries of bones, and outline the interprofessional care and nursing care of patients with these injuries.

MNL Learning Outcome: 4. Determine appropriate nursing interventions for patients with musculoskeletal trauma.

37) A patient is diagnosed with a rotator cuff tear. Which intervention should the nurse expect to be prescribed for this patient? Select all that apply.

1. Joint rest

2. NSAIDs

3. Moist heat

4. Physical therapy

5. Immediate surgery

Page Ref: 1414

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 39.1 Describe the pathophysiology and manifestations of traumatic injuries of the muscles, ligaments, and tendons, and outline the interprofessional care and nursing care of patients with these injuries.

MNL Learning Outcome: 2. Consider intraprofessional care for patients with musculoskeletal trauma.

38) The healthcare provider is pleased that an adolescent's broken arm has healed within 4 weeks. What factor in the patient's health history facilitated the healing of this fracture? Select all that apply.

1. The patient is 17 years old.

2. There are no active disease processes in the health history.

3. The patient waited 4 hours to get the fracture treated.

4. The patient bicycles and plays tennis nearly every day.

5. The patient drinks four 8-ounce glasses of milk a day.

Page Ref: 1422

Cognitive Level: Analyzing

Client Need & Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.9. Monitor client outcomes to evaluate the effectiveness of psychobiological interventions | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 39.2 Describe the pathophysiology and manifestations of traumatic injuries of bones, and outline the interprofessional care and nursing care of patients with these injuries.

MNL Learning Outcome: 4. Determine appropriate nursing interventions for patients with musculoskeletal trauma.

39) The nurse is evaluating the effectiveness of instruction provided to a patient with a newly applied arm cast. Which statement indicates that additional teaching is required? Select all that apply.

1. "I can wrap the cast in plastic wrap to protect it."

2. "I can use a blow dryer to make the cast dry faster."

3. "I will call the doctor if the arm starts to hurt more."

4. "I can use a sling to distribute the weight of the cast."

5. "I can use a coat hanger to scratch itchy skin under the cast."

Page Ref: 1428

Cognitive Level: Analyzing

Client Need & Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.9. Monitor client outcomes to evaluate the effectiveness of psychobiological interventions | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Communicate information effectively | Nursing/Integrated Concepts: Nursing Process: Evaluation/Teaching/Learning

Learning Outcome: 39.2 Describe the pathophysiology and manifestations of traumatic injuries of bones, and outline the interprofessional care and nursing care of patients with these injuries.

MNL Learning Outcome: 4. Determine appropriate nursing interventions for patients with musculoskeletal trauma.

40) The nurse is concerned that a patient with a below-the-knee amputation is at risk for delayed healing. What information from the patient's medical history led the nurse to make this clinical decision? Select all that apply.

1. Body mass index 15

2. History of hypokalemia

3. Smokes 2 ppd of cigarettes

4. Takes vitamin supplements

5. Treated for right heart failure

Page Ref: 1440

Cognitive Level: Analyzing

Client Need & Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches | NLN Competencies: Context and Environment; Knowledge; transcultural approaches to health | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 39.2 Describe the pathophysiology and manifestations of traumatic injuries of bones, and outline the interprofessional care and nursing care of patients with these injuries.

MNL Learning Outcome: 1. Examine the pathophysiology, incidence, risk factors, and clinical manifestations for patients with musculoskeletal trauma.

41) The nurse is providing discharge instructions to a patient recovering from an above-the-knee amputation. What should the nurse include in this teaching? Select all that apply.

1. Techniques for wrapping the stump

2. Installation of grab bars in the bathroom

3. Type and frequency of stump exercises

4. The importance of resting with the stump elevated on pillows

5. Resuming activities of daily living as soon as possible

Page Ref: 1445

Cognitive Level: Applying

Client Need & Sub: Physiological Integrity: Reduction of Risk Potential

Standards: QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient-centered care | AACN Essentials Competencies: IX.7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care | NLN Competencies: Relationship-Centered Care; Practice-Know-How; Communicate information effectively | Nursing/Integrated Concepts: Nursing Process: Implementation/Teaching/Learning

Learning Outcome: 39.2 Describe the pathophysiology and manifestations of traumatic injuries of bones, and outline the interprofessional care and nursing care of patients with these injuries.

MNL Learning Outcome: 4. Determine appropriate nursing interventions for patients with musculoskeletal trauma.