Chapter 69

Import Settings:
Base Settings: Brownstone Default

Information Field: Chapter
Information Field: Client Needs
Information Field: Cognitive Level
Information Field: Difficulty
Information Field: Integrated Process
Information Field: Objective
Information Field: Page and Header
Highest Answer Letter: E
Multiple Keywords in Same Paragraph: No
Chapter: Chapter 69: Management of Patients With Musculoskeletal Trauma
Multiple Choice
1. A patient is arriving to the orthopedic floor from the emergency room. While giving report to
the floor nurse, the emergency room nurse states that the patient has a fracture of the nose that
has resulted in a skin tear and involvement of the mucous membranes of the nasal passages. The
orthopedic nurse is aware that this description likely indicates which type of fracture?
A) Compression
B) Compound
C) Impacted
D) Transverse
Ans: B
Chapter: 69
Client Needs: D-4
Cognitive Level: Analysis
Difficulty: Moderate
Integrated Process: Nursing Process
Objective: 3
Page and Header: 2084, Fractures
Feedback: A compound fracture involves damage to the skin or mucous membranes and is also
called an open fracture. A compression fracture involves compression of bone and is seen in
vertebral fractures. An impacted fracture occurs when a bone fragment is driven into another
bone fragment. A transverse fracture occurs straight across the bone shaft.
2. A patient has sustained a long bone fracture. The nurse is preparing a care plan for this
patient. Which intervention should the nurse include in the care plan to enhance fracture healing?
A) Limit weight-bearing and exercising
B) Monitor color, temperature, and pulses of the affected extremity
C) Avoid immobilization of the fracture fragments
D) Administration of high doses of corticosteroids
Ans: B
Chapter: 69
Client Needs: D-3
Cognitive Level: Application
Difficulty: Difficult
Objective: 6
Page and Header: 2107, Fractures of Specific Sites
Feedback: The nurse should include monitoring for sufficient blood supply by assessing the
color, temperature, and pulses of the affected extremity as adequate blood supply enhances the
healing of a fracture. Factors that inhibit fracture healing include inadequate or lack of
immobilization of the fracture fragments and administration of corticosteroids. Weight-bearing
exercises are encouraged for patients with long bone fractures.
3. The nurse is assessing a patient's right knee. The assessment shows edema, tenderness,
muscle spasms, and ecchymosis. The patient states that 2 days ago he ran 10 miles and now it
hurts to stand up. Based upon these symptoms, the nurse bases her teaching upon the fact that
she anticipates the patient has experienced what?
A) A first-degree strain
B) A second-degree strain
C) A first-degree sprain
D) A second-degree sprain
Ans: B
Chapter: 69
Client Needs: D-4
Objective: 1
Page and Header: 2081, Contusions, Strains, and Sprains
Feedback: A second-degree strain involves tearing of muscle fibers and is manifested by notable
loss of load-bearing strength with accompanying edema, tenderness, muscle spasm, and
ecchymosis. A first-degree strain reflects tearing of a few muscle fibers and is accompanied by
minor edema, tenderness, and mild muscle spasm, without noticeable loss of function. A first-
degree sprain is caused by tearing of a few ligamentous fibers and is manifested by mild edema,
local tenderness, and pain that is elicited when the joint is moved, but there is no joint instability.
A second-degree sprain involves tearing of nerve fibers and results in increased edema,
tenderness, pain with motion, joint instability, and partial loss of normal joint function.
4. The nurse is preparing the patient for discharge from the emergency room to home after
incurring a sprain to the left ankle. While providing discharge teaching, the nurse is correct when
they instruct the patient to what?
A) Apply heat for the first 24 to 48 hours after injury
B) Maintain the ankle in a dependent position
C) Exercise hourly by performing rotation exercises of the ankle
D) Apply an elastic compression bandage to the ankle
Ans: D
Chapter: 69
Client Needs: D-3
Difficulty: Easy
Integrated Process: Teaching/Learning
Objective: 2
Feedback: Treatment of a sprain consists of resting and elevating the affected part, applying
cold, and using a compression bandage. After the acute inflammatory stage (usually 24 to 48
hours after injury), heat may be applied intermittently.
5. The nurse is writing a care plan for a patient admitted to the Emergency Department (ED)
with an open fracture. The nurse will assign priority to what nursing diagnosis for a patient with
an open fracture of the radius?
A) Risk for infection
B) Risk for activity intolerance
C) Risk for imbalanced nutrition: less than body requirements
D) Risk for powerlessness
Ans: A
Chapter: 69
Client Needs: D-3
Objective: 4
Feedback: While all nursing diagnoses may be pertinent to the care of a patient with an open
fracture of the radius, the nursing diagnosis that will receive the highest priority is “Risk for
infection” related to the risks of osteomyelitis and tetanus. The objectives of management are to
prevent infection of the wound, soft tissue, and bone and to promote healing. Another priority
diagnosis for a patient with an open fracture would be “Risk for peripheral neurovascular
dysfunction”.
6. While caring for a patient with a hip fracture, the nurse will instruct the patient to do what to
prevent the most common complication associated with a hip fracture?
A) Take the prescribed stool softener daily.
B) Use the prescribed oxygen with ambulation.
C) Increase fluid intake.
D) Avoid movement of the feet and ankles.
Ans: C
Chapter: 69
Client Needs: D-3
Objective: 8
Feedback: Deep vein thrombosis (DVT) is the most common complication related to a hip
fracture. To prevent DVT, the nurse encourages intake of fluids and ankle and foot exercises.
While respiratory complications commonly include atelectasis and pneumonia, the use of deep-
breathing exercises, changes in position at least every 2 hours, and the use of incentive
spirometry help prevent the respiratory complications. Constipation may also occur after a hip
fracture, but is not the most common complication.
7. A clinic nurse is caring for a patient who has a tibial fracture. The patient has just had a long-
leg walking cast removed and a short leg cast applied. The nurse explains to the patient that the
short leg cast will allow for what?
A) Ankle motion
B) Knee motion
C) Hip motion
D) Toe motion
Ans: B
Chapter: 69
Client Needs: D-1
Objective: 7
Feedback: A short leg cast or brace is placed 3 to 4 weeks after the fracture and will allow for
knee motion that is not allowed by the long leg walking cast.
8. The patient scheduled for a Syme amputation in the morning is concerned about the ability to
stand on the amputated extremity. The patient asks the nurse about his ability to stand after
surgery. What is the nurse's best response to this question?
A) “You will be able to withstand full weight-bearing on this durable extremity after the
amputation.”
B) “You will have minimal weight-bearing on this extremity and will require the use of an
assistive device.”
C) “You will not be able to use this extremity and will receive teaching on use of a wheelchair.”
D) “You will be fitted for a prosthesis and your commitment to rehabilitation will determine
your functional abilities.”
Ans: A
Chapter: 69
Client Needs: D-1
Objective: 9
Page and Header: 2108, Amputation
Feedback: Syme amputation (modified ankle disarticulation amputation) is performed most

frequently for extensive foot trauma and produces a painless, durable extremity end that can
withstand full weight-bearing. Therefore options B, C, and D are incorrect.
9. A patient with a simple fracture is involved in discharge teaching with their nurse. What
would the nurse instruct the patient to do?
A) Elevate the affected extremity to shoulder level.
B) Engage in exercises that strengthen the unaffected muscles.
C) Take corticosteroids as prescribed.
D) Expect to regain full strength and mobility in 2 to 4 weeks.
Ans: B
Chapter: 69
Client Needs: D-3
Difficulty: Easy
Objective: 5
Feedback: The nurse will encourage the patient to engage in exercises that strengthen the
unaffected muscles. Corticosteroids should be avoided, as this classification of drug will inhibit
the healing of the fracture. The nurse should inform the patient that fracture healing and
restoration of full strength may take months. Comfort measures may include analgesics and
elevation of the affected extremity to the heart level.
10. Six weeks after an above the knee (AKA) amputation, a patient returns to the outpatient
office for a routine postoperative check up. During the nurse's assessment, the patient reports
symptoms of phantom pain. What would the nurse correctly tell the patient to do to reduce the
discomfort of the phantom pain?
A) Apply hot compresses to the area of the amputation.
B) Avoid rehabilitation exercises until the pain subsides.
C) Comfortably increase their level of activity.
D) Assess for a pulse in the extremity of the amputation every 4 to 6 hours.
Ans: C
Chapter: 69
Client Needs: D-1
Objective: 9
Feedback: Keeping the patient active helps decrease the occurrence of phantom pain. Early
intensive rehabilitation and stump desensitization with kneading massage brings relief. Hot
compresses should be avoided, as the extreme heat can compromise the tissue integrity of the
area of healing. It is not necessary for the patient to assess a pulse in the affected extremity every
4 to 6 hours if experiencing phantom pain, as the cause of the pain is unknown.
11. The nurse is caring for a patient who had a right extremity below the knee amputation
(BKA). The nurse recognizes the importance of implementing measures that focus on preventing
flexion contracture of the hip and maintaining proper positioning. Which of the following
measures will achieve these goals?
A) Encouraging the patient to turn from side to side and to assume a prone position
B) Initiating ROM exercises of the hip and knee 3 months after the amputation
C) Minimizing movement of the flexor muscles of the hip
D) Encouraging the patient to sit in the chair for at least 8 hours of the day
Ans: A
Chapter: 69
Client Needs: D-3
Objective: 8
Feedback: The nurse encourages the patient to turn from side to side and to assume a prone
position, if possible, to stretch the flexor muscles and to prevent flexion contracture of the hip.
Postoperative ROM exercises are started early, because contracture deformities develop rapidly.
ROM exercises include hip and knee exericises for patients with BKAs. The nurse also
discourages sitting for prolonged periods of time.
12. You are caring for a patient wearing a sling to support her arm after a clavicle fracture. What
would the nurse instructs the patient to do?
A) Elevate the arm above the shoulder 3 or 4 times daily.
B) Avoid moving the elbow, wrist, and fingers for about 2 months.
C) Engage in active range of motion using the affected bone.
D) Use the arm for light activities within the range of motion.
Ans: A
Chapter: 69
Client Needs: D-3
Objective: 4
Feedback: A patient with a clavicle fracture may use a sling to support the arm and relieve the
pain. The patient may be permitted to use the arm for light activities within the range of comfort.
The patient should not elevate the arm above the shoulder level until the ends of the bones have
united at about 6 weeks, but the nurse should encourage the patient to exercise the elbow, wrist,
and fingers. Vigorous activity is limited for 3 months.
13. The orthopedic nurse is precepting a graduate nurse. They are caring for four fracture
patients. The orthopedic nurse asks the graduate nurse which of their patients is at an increased
risk for Volkmann's contracture. What should the graduate nurse respond?
A) Femur
B) Humerus
C) Radial head
D) Clavicle
Ans: B
Chapter: 69
Client Needs: D-3
Cognitive Level: Comprehension
Objective: 6
Feedback: The most serious complication of a supracondular fracture of the humerus is

Volkmann's ischemic contracture, which results from antecubital swelling or damage to the
brachial artery.
14. The nurse at the pediatrian's office is assessing a 17-year-old soccer player who presented to
the clinic stating that he sustained an injury that resulted in the knee being struck medially while
his foot is firmly planted on the ground. The nurse knows that the patient likely has experienced
what?
A) Lateral collateral ligament injury
B) Medial collateral ligament injury
C) Anterior cruciate ligament injury
D) Posterior cruciate ligament injury
Ans: A
Chapter: 69
Client Needs: D-4
Objective: 2
Page and Header: 2082, Injuries to the Tendons, Ligaments, and Menisci
Feedback: When the knee is struck medially, damage may occur to the lateral collateral
ligament. If the knee is struck laterally, damage may occur to the medial collateral ligament.
15. A 16-year-old girl is taken to the emergency department after being kicked in the lower leg
during a volleyball match. The leg area has become swollen and discolored. The triage nurse
recognizes that the patient has likely sustained what?
A) Sprain
B) Strain
C) Contusion
D) Dislocation
Ans: C
Chapter: 69
Client Needs: D-4
Difficulty: Easy
Objective: 1
Feedback: A contusion is a soft-tissue injury that results in bleeding into soft tissues, creating a
hematoma and ecchymosis. A sprain is an injury to ligaments caused by wrenching or twisting. A
strain is a “muscle-pull” from overuse, overstretching, or excessive stress. A dislocation is a
condition in which the articular surfaces of the bones forming a joint are no longer in anatomic
contact.
16. Radiographs were ordered for a 10-year-old boy who had his right upper arm injured. The
radiographs show that the humerus appears to be fractured on one side and slightly bent on the
other. What type of fracture is this an example of?
A) Impacted
B) Compound
C) Compression
D) Greenstick
Ans: D
Chapter: 69
Client Needs: D-4
Objective: 3
Feedback: Greenstick fractures are a result of the bone being broken on one side, while the other
side is bent. Therefore options A, B, and C are incorrect.
17. The nurse is performing a shift assessment on an elderly patient who is recovering after
surgery for a hip fracture. The nurse notes that the patient is complaining of chest pain, has an
increased heart rate and respiratory rate. The nurse further notes that the patient is febrile and
hypoxic, coughing and producing large amounts of thick white sputum. The nurse recognizes
that this is a medical emergency and calls for assistance, as she recognizes that this patient is
likely demonstrating symptoms related to what?
A) Avascular necrosis of bone
B) Compartment syndrome
C) Fat embolism syndrome
D) Complex regional pain syndrome
Ans: C
Chapter: 69
Client Needs: D-4
Objective: 7
Feedback: Fat embolism syndrome occurs most frequently in young adults and elderly patients
who experience fractures of the proximal femur (ie, hip fracture). Presenting features of fat
embolism syndrome include hypoxia, tachypnea, tachycardia, and pyrexia. The respiratory
distress response includes tachypnea, dyspnea, wheezes, precordial chest pain, cough, large
amounts of thick white sputum, and tachycardia. Avascular necrosis (AVN) occurs when the
bone loses its blood supply and dies it does not include coughing and neither does complex
regional pain syndrome.
18. A 28-year-old man with a fractured humerus calls the nurse into his room. Upon assessment,
the nurse finds the patient to be tachycardic, pale, and confused. The nurse suspects the patient
may be experiencing which of the following complications?
A) Disseminated intravascular coagulopathy
B) Compartment syndrome
C) Fat emboli
D) Deep vein thrombosis
Ans: C
Chapter: 69
Client Needs: D-4
Objective: 6
Feedback: Long-bone fractures may develop fat emboli syndrome, which presents with features
including hypoxia, tachypnea, tachycardia, pyrexia, and mental status changes.
19. iWhich of the following is the most appropriate nursing intervention for the nursing
diagnosis of Impaired physical mobility related to fractured hip?
A) Administer analgesics as required.
B) Place pillow between legs when turning.
C) Monitor vital signs.
D) Assess wound appearance.
Ans: B
Chapter: 69
Client Needs: D-1
Integrated Process: Documentation
Objective: 5
Feedback: Placing a pillow between the patient's legs when turning prevents adduction and
supports the patient's legs. Administering analgesics is appropriate for the nursing diagnosis of
pain. Monitoring vital signs is appropriate for the nursing diagnoses related to hyperthermia,
ineffective breathing pattern or impaired cardiac output. Assessing wound appearance would be
appropriate for a nursing diagnosis of Impaired skin integrity.
20. A patient with a fractured left femur is being cared for by an orthopedic nurse. The nurse
would know that what signs indicate potential fat emboli?
A) Increased partial pressure of arterial oxygen (PaO2), reduced sensation in left leg or foot
B) Left leg pain, dyspnea
C) Bradycardia, skin bruises
D) Cyanosis, decreased PaO2
Ans: D
Chapter: 69
Client Needs: D-4
Objective: 6
Feedback: Fat emboli may occur with fractures of the long bones and pelvis and may be fatal.
Clinical manifestations include cyanosis, dyspnea, tachycardia, chest pain, tachypnea,
apprehension, restlessness, confusion, petechiae, and decreased PaO2. Increased PaO2 reduced
sensation in left leg or foot, pain in the affected extremity, skin bruises, and bradycardia aren't
associated with fat emboli.
21. A 55-year-old male is brought to the emergency department by ambulance after stepping in a
hole and falling. While assessing him the nurse notes that his right leg is shorter than his left leg;
his right hip is deformed and he is in acute pain. What would the nurse suspect has happened to
this patient?
A) Subluxated right hip
B) Fractured right hip
C) Right pelvic fracture
D) Traumatic dislocation of right hip
Ans: D
Chapter: 69
Client Needs: D-4
Objective: 1
Page and Header: 2081, Joint Dislocations
Feedback: Signs and symptoms of a traumatic dislocation include acute pain, change in
positioning of the joint, shortening of the extremity, deformity, and decreased mobility. A
subluxation is a partial dislocation and does not cause as much deformity as a complete
dislocation. A fracture does not necessarily cause a deformity. A pelvic fracture would not cause
a deformity of the right hip.
22. The nursing instructor is discussing dislocations and subluxations with the beginning nursing
students. Why would the instructor tell the students that dislocation and subluxations are medical
emergencies and need to be reduced immediately?
A) The longer the joint is misplaced, the harder it is to get it back in place
B) Because the pain is so bad
C) The longer the joint is misplaced, the more difficult it is to apply splints to immobilize the
extremity
D) Avascular necrosis may develop
Ans: D
Chapter: 69
Client Needs: A-1
Difficulty: Easy
Objective: 1
Page and Header: 2081, Joint Dislocations
Feedback: If a dislocation or subluxation is not reduced immediately, avascular necrosis (AVN)

may develop.
Multiple Selection
23. According to the U.S. Department of Labor, occupation-related musculoskeletal disorders

are illnesses or injuries of what? (Mark all that apply.)
A) Nerves
B) Cartilage
C) Tendons
D) Arteries
E) Veins
Ans: A, B, C
Chapter: 69
Client Needs: A-1
Cognitive Level: Knowledge
Difficulty: Easy
Objective: 2
Page and Header: 2108, Occupation-Related Injuries
Feedback: According to the U.S. Department of Labor, occupation-related musculoskeletal
disorders are injuries or illnesses of the muscles, nerves, tendons, joints, cartilage, and bones that
occur because of exposure to work-related risks. Veins and arteries are not included in
musculoskeletal disorders.
Multiple Choice
24. A hockey player is brought to the emergency department after a game because of an injury.
He is complaining of not being able to move his left arm, and his left arm appears longer than his
right arm. The triage nurse suspects the hockey player has what?
A) Dislocated left shoulder
B) Fractured left clavicle
C) Dislocated left elbow
D) Fractured left humerus
Ans: A
Chapter: 69
Client Needs: D-4
Objective: 2
Page and Header: 2108, Sports-Related Injuries
Feedback: Symptoms of a dislocated shoulder: pain. lack of motion, may feel empty shoulder
socket, uneven posture in comparison to other shoulder, affected arm appears longer, abduction
limited.
25. A patient has presented to the emergency department with an injury to the wrist. The patient
is diagnosed with a third-degree strain. Why would the physician order an x-ray of the wrist?
A) Nerve damage is associated with third-degree strains.
B) Compartment syndrome is associated with third-degree strains.
C) Avulsion fractures are associated with third-degree strains.
D) Greenstick fractures are associated with third-degree strains.
Ans: C
Chapter: 69
Client Needs: D-3
Objective: 3
Feedback: An x-ray should be obtained to rule out bone injury, because an avulsion fracture (in
which a bone fragment is pulled away from the bone by a tendon) may be associated with a
third-degree strain. Nerve damage, compartment syndrome, and greenstick fractures are not
associated with third-degree strains.
26. A 12-year-old boy is brought in by ambulance to the emergency department after being
involved in an accident while participating in a BMX race. The boy has an open fracture of his
tibia. The wound is highly contaminated and there is extensive soft tissue damage. What grade
fracture would this be considered?
A) Grade I
B) Grade II
C) Grade III
D) Grade IV
Ans: D
Chapter: 69
Client Needs: A-1
Objective: 3
Feedback: Open fractures are graded according to the following criteria. Grade I is a clean
wound less than 1 cm long. Grade II is a larger wound without extensive soft tissue damage.
Grade III is highly contaminated, has extensive soft tissue damage, and is the most severe. There
is no grade IV fracture.
27. A 25-year-old male is involved in a motorcycle accident and injures his arm. The physician
diagnoses the man with an intra-articular fracture and splints the injury. When the man comes
back for his 6-week checkup the nurse implements the teaching plan she has developed for this
patient. What sequelae of intra-articular fractures would the nurse be sure to inform the patient
about?
A) Post-traumatic arthritis
B) Post-traumatic nerve damage
C) Post-traumatic stress syndrome
D) Post-traumatic compartment syndrome
Ans: A
Chapter: 69
Client Needs: A-1
Objective: 4
Feedback: Intra-articular fractures often lead to post-traumatic arthritis. Research does not
indicate a correlation between intra-articular fractures and nerve damage, PTSD, or compartment
syndrome.
28. A 65-year-old female patient has fallen and injured her ankle. Radiographs show that the
woman has a trimalleolar fracture. The physician informs the woman that she needs surgery to
repair her ankle. What type of internal fixation device would be used to hold the malleolus of the
tibia in place?
A) Plate
B) Wire
C) Screw
D) Rod
Ans: C
Chapter: 69
Client Needs: D-4
Objective: 4
Feedback: Through a surgical approach, the fracture fragments are anatomically aligned.
Internal fixation devices (metallic pins, wires, screws, plates, nails, or rods) may be used to hold
the bone fragments in position until solid bone healing occurs. Screws are used to hold the small
malleolus in anatomical place after it has broken off the tibia.
Multiple Selection
29. A 29-year-old male is admitted to the orthopedic unit with a fractured femur after running
his motorcycle into a bridge abutment. The patient has been placed in traction until his femur can
be rodded in surgery. What early complications would the nurse have to monitor this patient for?
(Mark all that apply.)
A) Alteration in elimination
B) Alteration in personality
C) Deep vein thrombosis
D) Compartment syndrome
E) Fat embolism
Ans: C, D, E
Chapter: 69
Client Needs: D-3
Objective: 5
Feedback: Early complications include shock, fat embolism, compartment syndrome, and
venous thromboemboli (deep vein thrombosis [DVT], pulmonary embolism [PE]). Alteration in
elimination and Alteration in personality are nursing diagnosis, not complications.
Multiple Choice
30. The patient is 6 weeks post-ORIF of his ankle when he comes to the orthopedic clinic for a
follow-up appointment. The physician informs the patient that the bones in his ankle have not
grown back together. What type of complication is this considered?
A) Late complication
B) Early complication
C) Minor complication
D) Major complication
Ans: A
Chapter: 69
Client Needs: D-3
Difficulty: Easy
Objective: 5
Feedback: Late complications include delayed union, malunion, and nonunion; therefore options
B, C, and D are incorrect.
31. A 77-year-old female has fallen in her home and is brought to the emergency department by
ambulance with a suspected fractured hip. X-rays confirm a fracture of the neck of the left femur.
What complication is common in fractures of the neck of the femur?
A) Osteoporosis
B) Avascular necrosis
C) Nonadherance of bones
D) Septicemia
Ans: B
Chapter: 69
Client Needs: D-3
Objective: 7
Feedback: Fractures of the neck of the femur may damage the vascular system that supplies
blood to the head and the neck of the femur, and the bone may become ischemic. For this reason,
AVN is common in patients with femoral neck fractures. Osteoporosis is not a complication of a
fractured femur neck. Options C and D are also not complications of a fractured femur neck.
32. A 74-year-old male has fallen and broken his hip. What must the nurse be sure to assess the
patient for so that complications can be prevented?
A) Family history
B) AVN
C) Chronic conditions
D) Fat embolism
Ans: C
Chapter: 69
Client Needs: D-3
Objective: 7
Feedback: To prevent complications, the nurse must assess the elderly patient for chronic
conditions that require close monitoring. Family history is assessed but it does not prevent
complications. A fat embolism is an early complication; assessing for it does not prevent
complications. An AVN is the result of certain types of hip fractures; assessing for it does not aid
in preventing fractures.
33. Patients who have had amputations are cared for by a multidisciplinary rehabilitation team.
What does the multidisciplinary team do for patients who are amputees?
A) Ensure top quality health care
B) Provide holistic health care
C) Assist in preventing complications
D) Help achieve the highest possible level of function
Ans: D
Chapter: 69
Client Needs: D-4
Objective: 8
Feedback: The multidisciplinary rehabilitation team (patient, nurse, physician, social worker,
physical therapist, occupational therapist, psychologist, prosthetist, vocational rehabilitation
worker) helps the patient achieve the highest possible level of function and participation in life
activities. Prosthetic clinics and amputee support groups facilitate this rehabilitation process.
34. A rehabilitation nurse is working with a patient who is an amputee. The nurse knows that it
is important for a patient who is an amputee to be an active participant is self-care. What do the
nurse and patient need to maintain during the learning process?
A) Positive attitudes
B) Balanced nutrition
C) Optimal mobility
D) Family support
Ans: A
Chapter: 69
Client Needs: D-4
Objective: 8
Feedback: Amputation of an extremity affects the patient's ability to provide adequate self-care.
The patient is encouraged to be an active participant in self-care. The patient needs time to
accomplish these tasks and must not be rushed. Practicing an activity with consistent, supportive
supervision in a relaxed environment enables the patient to learn self-care skills. The patient and
the nurse need to maintain positive attitudes and to minimize fatigue and frustration during the
learning process. Balanced nutrition, optimal mobility, and family support are important in the
rehabilitation process but they do not have a higher priority in the delivery of care to amputees
than the maintaining of positive attitudes.
35. You are caring for a patient who has had an amputation. What nursing action would you be
least likely to perform with this type of patient?
A) Teaching the patient self-care activities
B) Placing the residual limb on a pillow
C) Promoting mobility
D) Teaching the patient how to wrap the stump
Ans: B
Chapter: 69
Client Needs: D-4
Objective: 9
Feedback: The residual limb should not be placed on a pillow, because a flexion contracture of
the hip may result. This would be the least likely nursing action you would perform.
Short Answer
36. Your patient is returned from the PACU after an AKA of the right leg. You know to monitor
for postoperative bleeding. Put your actions in the correct order that you would perform them if
postoperative bleeding occurs after an amputation.
A. Apply tourniquet that is kept at the bedside to affected limb.
B. Monitor vital signs.
C. Apply a pressure dressing.
D. Call the surgeon.
Ans: A, D, B, C
Chapter: 69
Client Needs: D-3
Objective: 9
Feedback: Immediate postoperative bleeding may develop slowly or may take the form of
massive hemorrhage resulting from a loosened suture. A large tourniquet should be in plain sight
at the patient's bedside, so that if severe bleeding occurs, it can be applied to the residual limb to
control the hemorrhage. The nurse immediately notifies the surgeon in the event of excessive
bleeding. A pressure dressing is only applied at the doctor's order.
Multiple Choice
37. A patient is a BKA amputee who is to be discharged in 48 hours. You are going over
discharge teaching with this patient. You review what factors with this patient?
A) Exercise
B) Nutrition
C) Support groups
D) Mobility aids
Ans: D
Chapter: 69
Client Needs: A-1
Objective: 9
Feedback: The patient receives ongoing instructions and practice sessions to learn to transfer
and to use mobility aids and other assistive devices safely.
38. As an amputee a patient is being assessed prior to being discharged home. What is an
expected patient outcome the nurse would assess for?
A) Patient exhibits healed, nontender, nonadherent scar
B) Patient can stand for at least 2 hours
C) Patient eats three nutritious meals daily
D) Patient exercises 30 minutes weekly
Ans: A
Chapter: 69
Client Needs: D-4
Objective: 8
Feedback: Expected patient outcomes may include the following: achieves wound healing;
controls residual limb edema; exhibits healed, nontender, nonadherent scar; demonstrates
residual limb care.
Multiple Selection
39. An elderly woman with a fractured hip is being cared for on your unit. What are contributory
factors in the incidence of falls and fractured hips? (Mark all that apply.)
A) Living alone
B) TIAs
C) Emboli
D) Decreased hearing
E) General frailty
Ans: B, C, E
Chapter: 69
Client Needs: D-3
Objective: 7
Feedback: Elderly people (particularly women) who have low bone density from osteoporosis
and who tend to fall frequently have a high incidence of hip fracture. Weak quadriceps muscles,
general frailty due to age, and conditions that produce decreased cerebral arterial perfusion
(transient ischemic attacks, anemia, emboli, cardiovascular disease, effects of medications)
contribute to the incidence of falls. Decreased hearing and living alone do not contribute to the
incidence of falls.
Multiple Choice
40. The patient was placed in a long arm cast after fracturing her humerus. Twelve hours after
the application of the cast, the patient tells the nurse that her arm hurts. Analgesics do not relieve
the pain. What would be the most appropriate nursing action?
A) Preparing the patient for cast removal or bivalving of the cast
B) Obtaining an order for a different pain medication
C) Encouraging the patient to wiggle and move the fingers
D) Petaling the edges of his cast
Ans: A
Chapter: 69
Client Needs: D-3
Objective: 5
Feedback: Acute compartment syndrome involves a sudden and severe decrease in blood flow to
the tissues distal to an area of injury that results in ischemic necrosis if prompt, decisive
intervention does not occur. The patient complains of deep, throbbing, unrelenting pain, which
continues to increase despite the administration of opioids and seems out of proportion to the
injury. Removing or bivalving the cast relieves pressure. Ordering different analgesics doesn't
address the underlying problem. Encouraging the patient to move the fingers or perform range-
of-motion exercises won't treat or prevent compartment syndrome. Petaling the edges of a cast
with tape prevents abrasions and skin breakdown, not compartment syndrome.

Chapter 69

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Chapter 69

Uploaded by

Copyright:

Available Formats

Import Settings:

Base Settings: Brownstone Default

Chapter: Chapter 69: Management of Patients With Musculoskeletal Trauma

Feedback: Syme amputation (modified ankle disarticulation amputation) is performed most

Feedback: The most serious complication of a supracondular fracture of the humerus is

Feedback: If a dislocation or subluxation is not reduced immediately, avascular necrosis (AVN)

23. According to the U.S. Department of Labor, occupation-related musculoskeletal disorders

You might also like