Final Exam: Musculoskeletal Problems

Question 1

Sprain vs Strain?

Answer 1

Sprain: injury to a ligament
Strain: injury to a muscle or tendon

Question 2

A patient is seen at the urgent care center after falling on the right arm and shoulder. It will be most important for the nurse to determine:

Answer 2

Whether the right arm is shorter than the left arm

Question 3

What does an open comminuted fracture mean?

Answer 3

The bone is splintered into several many pieces

Question 4

What assessment should be done if a fracture is suspected in emergency situations? What patient complaint should be reported to HCP immediately?

Answer 4

• Neurovascular status checks distal to the injury should be initiated immediately
• Notify HCP of persistent tingling and numbness with a cast

Question 5

Following a motor vehicle accident, a patient arrives in the ED with a massive right lower-leg swelling. Which action will the nurse take first?

Answer 5

Check leg pulses and sensation as part of the neurovascular checks

Question 6

Closed reduction is? (2)

Answer 6

• non-surgical manual realignment of bone fragments

- traction is applied to restore position, length, alignment

Question 7

Open reduction is? (2)

Answer 7

• correction of bone alignment through a surgical incision

- includes nails and rods

Question 8

What is Bucks’ traction?

Answer 8

Type of skin traction used preoperatively for patient with a hip fracture to reduce muscle spasms

Question 9

What is important to assess for in Bucks’ traction? (2)

Answer 9

• S/S of infection, very high risk in traction because the patient is immobile
• Skin integrity every 2-4 hrs

Question 10

Which assessment should be done frequently for casts?

Answer 10

Neurovascular assessment should be frequent to assess for possible s/s of compartment syndrome

Question 11

What are the main two complications of fractures?

Answer 11

• compartment syndrome

- pulmonary embolism

Question 12

What is compartment syndrome and what are the s/s (6 Ps)? When should the HCP be notified?

Answer 12

• swelling causes increased pressure within limited space
• s/s: pain, pressure, paresthesia, pallor, paralysis, pulselessness
• immediately report to HCP if s/s persist

Question 13

Manifestations of pulmonary embolism? (6) what is the first sign?

Answer 13

• tachypnea
• hypoxia
• dyspnea
• chest petechia
• tachycardia
• changes in LOC (patient appearing confused will be an EARLY sign of PE)

Question 14

What is the key prevention for reducing the risk of pulmonary embolism in fracture?

Answer 14

Early mobilization

Question 15

Clinical manifestation of hip and femur fracture?

Answer 15

external rotation with a clear distinct shortening of the affected extremity with extreme pain

Question 16

What is the normal urine output per hour?

Answer 16

30 CC

Question 17

What assessments should be made after hip and femur fracture surgeries?

Answer 17

cardiac output by monitoring urine output and stable vital signs

Question 18

At-home care for hip and femur fractures consists of avoiding? (3) The patient should ___.

Answer 18

• sitting at low positions (eg: toilet seats)
• 90-degree flexion
• putting on socks and shoes
• patient should keep a pillow between legs while in a supine position

Question 19

When getting a patient from the bed into the chair for the first time since having an ORIF of a hip fracture, the nurse should:

Answer 19

Assist the patient to use a walker with partial weight-bearing to assist in transfer to the chair

Question 20

Local S/S of osteomyelitis include? (3)

Answer 20

• tenderness
• swelling
• warmth at the site

Question 21

Systemic S/S of osteomyelitis include? (3)

Answer 21

• night sweats
• chills
• malaise

Question 22

Risk factors for osteoporosis? (9)

Answer 22

• white and Asian American
• low body weight
• advancing age
• female sex
• sedentary lifestyle
• decreased levels of estrogen
• family hx of osteoporosis
• alcohol intake
• extended use of corticosteroids

Question 23

Nursing management for osteoporosis? (2)

Answer 23

• nutrition focuses on implementing more foods with calcium (eg: yogurts, dark green leafy vegetables)
• weight-bearing exercises (eg: walking, lifting weights) to build bone density and muscle mass

Question 24

The nurse determine that teaching regarding diet for a patient with osteoporosis has been successful when the patient selects which of these meals as having the highest amount of calcium?

Answer 24

Sardine sandwich on whole wheat bread, one cup of fruit yogurt, and one cup of skim milk

Question 25

What is an important assessment to monitor for patients who are from postoperative procedures for internal fixation or open reduction?

Answer 25

Urine output (indicates how well the organs are functioning)

Question 26

How will a nurse expect the extremity with a fracture to look?

Answer 26

Shorter in length

Question 27

Which fracture is the most deadly and at risk for infection?

Answer 27

Open fractures (bone protruding through skin)

Question 28

What are the 6 Ps of the neurovascular assessment?

Answer 28

Pallor, paresthesia, pain, pulselessness, pressure, paralysis