Musculoskeletal System Supplementary Materials

Term 8 / 20 Which statement from the client regarding cast care requires additional teaching by the nurse? A. "I can use plastic shields around the cast while showering or bathing." B. "If the edges become rough and irritating, I can remove the rough edges." C. "I can apply ice to the cast and elevate my arm to prevent swelling." D. "I should never place objects in the cast to relieve itching." Term 7/20 A client sustained a radial fracture and a cast was just applied. The client states that there is unrelieved pain and numbness in the fingers on the affected side. Which intervention should be a priority? A. Notifying the healthcare provider for cast removal B. Elevating the extremity C. Preparing for fasciotomy D. Performing frequent neurovascular checks Term 2 / 20 Which statement by the nurse describes a comminuted fracture to the client? A. The ends of the broken bones are forced together." B. The bone is breaking through the skin." C. The bone is broken into many pieces." D. A fragment of the bone is separated from the rest of the bone." Which client should the nurse identify to be at a greater risk of fractures while reviewing their health records? (Select all that apply.) A. The client with leukemia B. The client with bone neoplasms C. The client who is malnourished D. The client with osteoporosis E. The client with hypercalcemia Term 6 / 20 The nurse is providing discharge teaching to the family of an older adult client who was treated for a fracture after a fall. Which recommendation should the nurse include in the teaching? A. Always wear socks when ambulating. B. Use a step stool when possible. C. Start a mild exercise program. D. Remove the rubber mat from tub. 9. Your patient is 2 hours post-op from a cast placement on the right leg. The patient has family in the room. Which action by the significant other requires you to re-educate the patient and family about cast care? • A. Gently moving the cast with the fingertips of the hands every 2 hours to help with drying. • B. Elevating the cast above heart level with pillows. • C. Checking the color and temperature of the right foot. • D. Using a hair dryer on the cool setting to help with drying. x The answer is A. The cast should always be moved with the palms of the hands (NOT finger tips) during the drying period to prevent dent formation because this can cause the development of ulcers under the skin where the dents develop. 10. A patient sustained a fracture to the femur. The patient has suddenly become confused, restless, and has a respiratory rate of 30 breaths per minute. Based on the location of fracture and the presenting symptoms, this patient may be experiencing what type of complication? • A. Compartment Syndrome • B. Osteomyelitis X • C. Fat embolism • D. Hypovolemia The answer is C. Patients who experience a fracture of the long bones (such as the femur) are at risk for a fat embolism. The patient will become confused and restless along with an abnormal respiratory status. 11. Which assessment finding found while assessing a patient with a fracture who has traction requires immediate intervention? • A. The weights are freely hanging on the floor. • B. Pin sites are free from drainage. C. Patient uses the overhead trapeze bar to move around in the bed. X • D. Patient's extremities have a capillary refill of less than 2 seconds. The answer is A. Weights used for traction should freely hang but NOT on the floor. All the other options are expected findings. 5. A 85 year old patient has an accidental fall while going to the bathroom without assistance. It appears the patient has sustained a bone fracture to the left leg. The leg's shape is deformed and the patient is unable to move it. The patient is alert and oriented but in pain. What will you do FIRST after confirming the patient is safe and stable? • A. Apply an ice pack covered with a towel to the site. • B. Immobilize the fracture with a splint. • C. Administer pain medication. D. Elevate the extremity above heart level. The answer is B. After confirming the patient is safe and stable, the nurse would immobilize the fracture with a splinting device. This will prevent the accidental movement of the extremity by the patient. Immobilization is important because it prevents further pain or bleeding along with more damage that can occur to the surrounding tissues. In addition, if a bone is not immobilized but moved after it has been fractured this can affect the healing process. 6. Which statement by a patient, who just received a cast on the right arm for a fracture, requires you to notify the physician immediately? A. "It is really itchy inside my cast!" B. "My pain is so severe that it hurts to stretch or elevate my arm." C"I can feel my fingers and move them." • D. "I've been using ice packs to reduce swelling The answer is B. This statement is very concerning and may represent a condition called compartment syndrome. Compartment syndrome is where the nerves and blood vessels are becoming compromised due to Increasing pressure in the compartments within the fascia (remember fascia doesn't expand, so if there is building pressure within the compartments of muscle from bleeding etc. it will compromise circulation and nerve function). Remember to monitor the 6 P's. (pain, pallor, paralysis. paresthesia, pulselessness (late sign), poikilothermia) 7. What is a late sign of compartment syndrome? • A. Paralysis x • B. Pain C. Parethesia • D. Pulselessness The answer is D. Pulselessness is a late sign of compartment syndrome.