musculoskeletal Saunders (Answered)
2022/2023
Which cast care instructions should the nurse provide to a client who just had a
plaster cast applied to the right forearm? Select all that apply.
-Keep the cast clean and dry.
- Allow the cast 24 to 72 hours to dry.
- Keep the cast and extremity elevated
plaster cast teaching
- A cool setting on the hair dryer can be used to dry a plaster cast (heat cannot be used
on a plaster cast because the cast heats up and burns the skin).
- not to stick anything under the cast because of the risk of breaking skin integrity.
- The client is instructed to monitor the extremity for circulatory impairment, such as
pain, swelling, discoloration, tingling, numbness, coolness, or diminished pulse.
A client is being discharged to home after application of a plaster leg cast. Which
statement indicates that the client understands proper care of the cast?
I need to avoid getting the cast wet."
The nurse is assessing the casted extremity of a client. Which sign is indicative
of infection?
Presence of a "hot spot" on the cast
fracture pain
Most pain associated with fractures can be minimized with rest, elevation, application of
cold, and administration of analgesics. Pain that is not relieved by these measures
should be reported to the health care provider because pain unrelieved by medications
and other measures may indicate neurovascular compromise.
A client has sustained a closed fracture and has just had a cast applied to the
affected arm. The client is complaining of intense pain. The nurse elevates the
limb, applies an ice bag, and administers an analgesic, with little relief. Which
problem may be causing this pain?
Impaired tissue perfusion
The nurse is admitting a client with multiple trauma injuries to the nursing unit.
The client has a leg fracture and had a plaster cast applied. Which position would
be best for the casted leg?
Elevated on pillows continuously for 24 to 48 hours
A client being measured for crutches asks the nurse why the crutches cannot
rest up underneath the arm for extra support. The nurse responds knowing that
which would most likely result from this improper crutch measurement?
Injury to the brachial plexus nerves
crutch measurement
Crutches are measured so that the tops are 2 to 3 fingerwidths from the axillae. This
ensures that the client's axillae are not resting on the crutch or bearing the weight of the
crutch, which could result in injury to the nerves of the brachial plexus.
The nurse has given the client instructions about crutch safety. Which statement
indicates that the client understands the instructions? Select all that apply.
,- I should not use someone else's crutches."
- "I need to remove any scatter rugs at home."
- "I need to have spare crutches and tips available."
The nurse is caring for a client being treated for fat embolus after multiple
fractures. Which data would the nurse evaluate as the most favorable indication
of resolution of the fat embolus?
Clear mentation
sign fat embolus is resolving
An altered mental state is an early indication of fat emboli; therefore, clear mentation is
a good indicator that a fat embolus is resolving.
The nurse has conducted teaching with a client in an arm cast about the signs
and symptoms of compartment syndrome. The nurse determines that the client
understands the information if the client states that he or she should report which
early symptom of compartment syndrome?
Numbness and tingling in the fingers
The earliest symptom of compartment syndrome is paresthesia (numbness and
tingling in the fingers). Other symptoms include pain unrelieved by opioids, pain
that increases with limb elevation, and pallor and coolness to the distal limb.
Cyanosis is a late sign. Pain that is out of proportion to the severity of the
fracture,
The earliest symptom of compartment syndrome is paresthesia (numbness and tingling
in the fingers). Other symptoms include pain unrelieved by opioids, pain that increases
with limb elevation, and pallor and coolness to the distal limb. Cyanosis is a late sign.
Pain that is out of proportion to the severity of the fracture,
compartment syndrome 5 P's
unrelieved pain, paresthesia, pallor, paralysis, pulselessness (fasciotomy)
A client with diabetes mellitus has had a right below-knee amputation. Given the
client's history of diabetes mellitus, which complication is the client at most risk
for after surgery?
Separation of the wound edges
A client is complaining of low back pain that radiates down the left posterior
thigh. The nurse should ask the client if the pain is worsened or aggravated by
which factor?
Bending or lifting
The nurse is caring for a client with a diagnosis of gout. Which laboratory value
would the nurse expect to note in the client?
Uric acid level of 9.0 mg/dL (0.54 mmol/L
In addition to the presence of clinical manifestations, gout is diagnosed by the presence
of persistent hyperuricemia, with a uric acid level higher than 8 mg/dL
A client with a hip fracture asks the nurse about Buck's (extension) traction that
is being applied before surgery and what is involved. The nurse should provide
which information to the client?
Provides comfort by reducing muscle spasms, provides fracture immobilization, and
involves pulleys and wheels
how many types of traction are there
2 types skeletal and skin (buck's traction)
, The nurse is assigned to care for a client in traction. The nurse creates a plan of
care for the client and should include which action in the plan?
Check the weights to ensure that they are off of the floor.
Buck's Traction (skin traction)
To achieve proper traction, weights need to be free-hanging, with knots kept away from
the pulleys. Weights should not be kept resting on a firm surface. The head of the bed is
usually kept low to provide countertraction
The nurse is caring for an older adult who has been placed in Buck's extension
traction after a hip fracture. On assessment of the client, the nurse notes that the
client is disoriented. What is the best nursing action based on this information?
Place a clock and calendar in the client's room.
The nurse is creating a plan of care for a client in skin traction. The nurse should
monitor for which priority finding in this client?
Signs of skin breakdown
Skin traction (Buck's traction)
Skin traction is achieved by Ace wraps, boots, or slings that apply a direct force on the
client's skin. Traction is maintained with 5 to 8 lb (2.3 to 3.6 kg) of weight, and this type
of traction can cause skin breakdown.
The nurse develops a plan of care for a client with a spica cast that covers a
lower extremity and documents that the client is at risk for constipation. When
planning for bowel elimination needs, the nurse should include which in the plan
of care?
Use a fracture pan for bowel elimination.
The nurse is preparing to teach a client how to safely use crutches. Before
initiating the teaching, the nurse performs an assessment on the client. The
priority nursing assessment should include which information?
The client's vital signs, muscle strength, and previous activity level
The nurse is providing instructions to a client regarding ambulation after the
application of a fiberglass cast to the lower leg. The nurse determines that the
client understands the instructions if the client states that weight bearing on the
casted leg can begin at which time period?
Within 20 to 30 minutes of application
The nurse is caring for a client in skeletal leg traction with an overbed frame.
Which nursing intervention will best assist the client with self-positioning in bed?
Place a trapeze on the bed frame to provide a means for the client to lift the hips off the
bed.
The nurse is caring for the client who has skeletal traction applied to the left leg.
The client complains of severe left leg pain. The nurse checks the client's
alignment in bed and notes that proper alignment is maintained. Which is the
priority nursing action?
Call the health care provider.
Severe pain in a client in skeletal traction may indicate a need for realignment, or the
traction weights applied to the limb may be too heavy.
2022/2023
Which cast care instructions should the nurse provide to a client who just had a
plaster cast applied to the right forearm? Select all that apply.
-Keep the cast clean and dry.
- Allow the cast 24 to 72 hours to dry.
- Keep the cast and extremity elevated
plaster cast teaching
- A cool setting on the hair dryer can be used to dry a plaster cast (heat cannot be used
on a plaster cast because the cast heats up and burns the skin).
- not to stick anything under the cast because of the risk of breaking skin integrity.
- The client is instructed to monitor the extremity for circulatory impairment, such as
pain, swelling, discoloration, tingling, numbness, coolness, or diminished pulse.
A client is being discharged to home after application of a plaster leg cast. Which
statement indicates that the client understands proper care of the cast?
I need to avoid getting the cast wet."
The nurse is assessing the casted extremity of a client. Which sign is indicative
of infection?
Presence of a "hot spot" on the cast
fracture pain
Most pain associated with fractures can be minimized with rest, elevation, application of
cold, and administration of analgesics. Pain that is not relieved by these measures
should be reported to the health care provider because pain unrelieved by medications
and other measures may indicate neurovascular compromise.
A client has sustained a closed fracture and has just had a cast applied to the
affected arm. The client is complaining of intense pain. The nurse elevates the
limb, applies an ice bag, and administers an analgesic, with little relief. Which
problem may be causing this pain?
Impaired tissue perfusion
The nurse is admitting a client with multiple trauma injuries to the nursing unit.
The client has a leg fracture and had a plaster cast applied. Which position would
be best for the casted leg?
Elevated on pillows continuously for 24 to 48 hours
A client being measured for crutches asks the nurse why the crutches cannot
rest up underneath the arm for extra support. The nurse responds knowing that
which would most likely result from this improper crutch measurement?
Injury to the brachial plexus nerves
crutch measurement
Crutches are measured so that the tops are 2 to 3 fingerwidths from the axillae. This
ensures that the client's axillae are not resting on the crutch or bearing the weight of the
crutch, which could result in injury to the nerves of the brachial plexus.
The nurse has given the client instructions about crutch safety. Which statement
indicates that the client understands the instructions? Select all that apply.
,- I should not use someone else's crutches."
- "I need to remove any scatter rugs at home."
- "I need to have spare crutches and tips available."
The nurse is caring for a client being treated for fat embolus after multiple
fractures. Which data would the nurse evaluate as the most favorable indication
of resolution of the fat embolus?
Clear mentation
sign fat embolus is resolving
An altered mental state is an early indication of fat emboli; therefore, clear mentation is
a good indicator that a fat embolus is resolving.
The nurse has conducted teaching with a client in an arm cast about the signs
and symptoms of compartment syndrome. The nurse determines that the client
understands the information if the client states that he or she should report which
early symptom of compartment syndrome?
Numbness and tingling in the fingers
The earliest symptom of compartment syndrome is paresthesia (numbness and
tingling in the fingers). Other symptoms include pain unrelieved by opioids, pain
that increases with limb elevation, and pallor and coolness to the distal limb.
Cyanosis is a late sign. Pain that is out of proportion to the severity of the
fracture,
The earliest symptom of compartment syndrome is paresthesia (numbness and tingling
in the fingers). Other symptoms include pain unrelieved by opioids, pain that increases
with limb elevation, and pallor and coolness to the distal limb. Cyanosis is a late sign.
Pain that is out of proportion to the severity of the fracture,
compartment syndrome 5 P's
unrelieved pain, paresthesia, pallor, paralysis, pulselessness (fasciotomy)
A client with diabetes mellitus has had a right below-knee amputation. Given the
client's history of diabetes mellitus, which complication is the client at most risk
for after surgery?
Separation of the wound edges
A client is complaining of low back pain that radiates down the left posterior
thigh. The nurse should ask the client if the pain is worsened or aggravated by
which factor?
Bending or lifting
The nurse is caring for a client with a diagnosis of gout. Which laboratory value
would the nurse expect to note in the client?
Uric acid level of 9.0 mg/dL (0.54 mmol/L
In addition to the presence of clinical manifestations, gout is diagnosed by the presence
of persistent hyperuricemia, with a uric acid level higher than 8 mg/dL
A client with a hip fracture asks the nurse about Buck's (extension) traction that
is being applied before surgery and what is involved. The nurse should provide
which information to the client?
Provides comfort by reducing muscle spasms, provides fracture immobilization, and
involves pulleys and wheels
how many types of traction are there
2 types skeletal and skin (buck's traction)
, The nurse is assigned to care for a client in traction. The nurse creates a plan of
care for the client and should include which action in the plan?
Check the weights to ensure that they are off of the floor.
Buck's Traction (skin traction)
To achieve proper traction, weights need to be free-hanging, with knots kept away from
the pulleys. Weights should not be kept resting on a firm surface. The head of the bed is
usually kept low to provide countertraction
The nurse is caring for an older adult who has been placed in Buck's extension
traction after a hip fracture. On assessment of the client, the nurse notes that the
client is disoriented. What is the best nursing action based on this information?
Place a clock and calendar in the client's room.
The nurse is creating a plan of care for a client in skin traction. The nurse should
monitor for which priority finding in this client?
Signs of skin breakdown
Skin traction (Buck's traction)
Skin traction is achieved by Ace wraps, boots, or slings that apply a direct force on the
client's skin. Traction is maintained with 5 to 8 lb (2.3 to 3.6 kg) of weight, and this type
of traction can cause skin breakdown.
The nurse develops a plan of care for a client with a spica cast that covers a
lower extremity and documents that the client is at risk for constipation. When
planning for bowel elimination needs, the nurse should include which in the plan
of care?
Use a fracture pan for bowel elimination.
The nurse is preparing to teach a client how to safely use crutches. Before
initiating the teaching, the nurse performs an assessment on the client. The
priority nursing assessment should include which information?
The client's vital signs, muscle strength, and previous activity level
The nurse is providing instructions to a client regarding ambulation after the
application of a fiberglass cast to the lower leg. The nurse determines that the
client understands the instructions if the client states that weight bearing on the
casted leg can begin at which time period?
Within 20 to 30 minutes of application
The nurse is caring for a client in skeletal leg traction with an overbed frame.
Which nursing intervention will best assist the client with self-positioning in bed?
Place a trapeze on the bed frame to provide a means for the client to lift the hips off the
bed.
The nurse is caring for the client who has skeletal traction applied to the left leg.
The client complains of severe left leg pain. The nurse checks the client's
alignment in bed and notes that proper alignment is maintained. Which is the
priority nursing action?
Call the health care provider.
Severe pain in a client in skeletal traction may indicate a need for realignment, or the
traction weights applied to the limb may be too heavy.
