NCLEX Secrets: Musculoskeletal Injuries (51-55) NCLEX Secrets about Musculoskeletal Injuries

51. A client has a fiberglass (nonplaster) cast applied to the lower leg. The client asks the nurse when the client will be able to walk using the casted leg. The nurse replies that the client will be able to bear weight on the casted leg:

a) in 48 hours b) in 24 hours c) in about hours d) within 20 to 30 minutes of application

52. A nurse has given a client with a leg cast instructions on cast care at home. The nurse would evaluate that the client needs further instruction if the client makes which of the following statements?

a) I should avoid walking on wet, slippery floors b) I'm not supposed to scratch the skin underneath the cast c) it's okay to wipe dirt off the top of the cast with a damp cloth d) if the cast gets wet, I can dry it with a hair dryer turned to the warmest setting

53. A client with a hip fracture asks the nurse why Buck's extension traction is being applied before surgery. The nurse's response is based on the understanding that Buck's extension traction primarily:

a) allows bony healing to begin before surgery b) provides rigid immobilization of the fracture site

c) lengthens the fractured leg to prevent severing of blood vessels d) provides comfort by reducing muscle spasms and provides fracture immobilization

54. A client returns to the nursing unit following the application of skeletal leg traction. Upon assessment, the nurse notes a small amount of bleeding around the pin insertion sites. The nurse should take which action?

a) notify the surgeon b) recheck the site in 1 hour c) check the client's vital signs d) place a small pressure dressing at the bleeding site

55. A nurse is evaluating the pin sites of a client in skeletal traction. The nurse would be least concerned with which of the following findings?

a) inflammation b) serous drainage c) pain at a pin site d) purulent drainage

NCLEX SECRETS ABOUT MUSCULOSKELETAL INJURIES: ANSWERS AND RATIONALE

51) D - A fiberglass cast is made of water-activated polyurethane materials that are dry to the touch within minutes and reach full rigid strength in about 20 minutes. Because of this, the client can bear weight on the cast within 20 to 30 minutes.

52) D - Client instructions should include avoiding walking on wet slippery floors to prevent falls. Surface soil on a cast can be removed with a damp cloth. If the cast gets wet, it can be dried with a hair dryer set to a cool setting to prevent skin breakdown. If the skin under the cast itches, cool air from a hair dryer may be used to relieve it. The client should never scratch under a cast because of the risk of skin breakdown and ulcer formation.

53) D - Bucks extension traction is a type of skin traction often applied after hip fracture before the fracture is reduced in surgery. Traction reduces muscle spasms and helps immobilize the fracture. Traction does not lengthen the leg for the purpose of preventing blood vessel severance. Traction also does not allow for bony healing to begin.

54) D - Following pin insertion for skeletal traction, a small amount of bleeding is expected. This can be controlled with small pressure dressings; however, bleeding that continues for more than 24 hours should be brought to the surgeon's attention. It is not necessary to notify the surgeon immediately. Rechecking the site in 1 hour delays necessary intervention. Although vital signs may be checked in the immediate post-operative period, this action is unrelated to the small amount of bleeding.

55) B

- A small amount of serous oozing is expected at pin insertion sites. Signs of infection such as inflammation, purulent drainage, and pain at the pin site are not expected findings and should be reported to the physician.